Neighbourhood renewal in Victoria, Australia : an effective way to address social inclusion

People who live in disadvantaged communities are at increased risk of social exclusion through diminished access and quality of services, lack of opportunity and feeling powerless over decisions relating to their neighbourhoods. Neighbourhood Renewal (NR) is a Victorian State Government initiative that seeks to address this. This paper presents the findings from two individual project sites, side-by-side. Data were collected in 2004/5 and 2009 using face-to face interviewing with convenience samples of 900 NR residents across the two NR sites at each time period. A comparison group for each NR site consisted of a sample of 150 people living in the same suburb or town but outside the NR site, data were collected by telephone. Data were analysed separately for each NR project site. Findings indicate that neighbourhood renewal strategies can be effective in improving trust in government, perceptions of community participation, influence and control over community decisions and improved services. Community level strategies are valuable in addressing area-level determinants to improve social inclusion. The successes of the NR scheme support the implementation and continuation of area-specific interventions to address disadvantage and social exclusion across Victoria, Australia.

The delivery of a telephone coaching programme to people with type 2 diabetes by practice nurses in Victoria, Australia : a qualitative evaluation

Aim.  To evaluate telephone coaching undertaken by practice nurses in a randomised controlled trial of self-management support for people with type 2 diabetes.

Background.  Qualitative evaluation of the processes that take place in randomised controlled trials has the advantage of providing information on those variables that contribute to the success or failure of the randomised controlled trial. This additional information can be used to improve or modify chronic disease management programme designs.

Methods.  Grounded theory was used to analyse transcriptions of telephone coaching sessions between practice nurses and patient participants in the randomised controlled trial.

Findings.   Analysis of transcriptions found that patient participants had complex multiple medical conditions to manage, as well as maintaining their daily lives. Two approaches to working with this complexity by practice nurses emerged. We characterised one as ‘treat to target’ and the other as ‘personalised care’. While each approach shapes identities available to patients within the relationship with the practice nurse, the impact or effectiveness of these approaches on outcomes has yet to be reported.

Conclusions.  Telephone coaching takes place in complex social contexts as well as complex medical conditions. People with type 2 diabetes must manage their diabetes care and their care of other conditions within their social contexts. This means a constant negotiation of priorities.

Relevance to clinical practice.  Awareness of how health professional support for patients’ self-management becomes a relationship and element of the negotiated identity of patients is important in adapting clinical guideline-based protocols to achieving targets in the management of chronic illness.

An examination of the health and wellbeing of childless women : A cross-sectional exploratory study in Victoria, Australia

Background
Childlessness among Australian women is increasing. Despite this, little is known about the physical and mental health and wellbeing of childless women, particularly during the reproductive years. The aims of this exploratory study were to: 1) describe the physical and mental health and wellbeing and lifestyle behaviours of childless women who are currently within the latter part of their reproductive years (30 – 45 years of age); and 2) compare the physical and mental health and wellbeing and lifestyle behaviours of these childless women to Australian population norms.
Methods
A convenience sample of 50 women aged between 30 and 45 years were recruited to participate in a computer assisted telephone interview. The SF-36 Health Survey v2 and lifestyle indicators were collected in regards to women’s health and wellbeing. Data were analysed using descriptive statistics, t-tests for independent sample means and 95% confidence intervals for the difference between two independent proportions.
Results
Childless women in this study reported statistically significant poorer general health, vitality, social functioning and mental health when compared to the adult female population of Australia. With the exception of vegetable consumption, lifestyle behaviours were similar for the childless sample compared to the adult female population in Australia.
Conclusions
Childless women may be at a greater risk of experiencing poor physical and mental health when compared to the Australian population. A woman’s health and wellbeing during her reproductive years may have longer term health consequences and as such the health and wellbeing of childless women requires further investigation to identify and address implications for the provision of health (and other social) services for this growing population group.

The value of oral history in natural resource management : the Balcombe Estuary Reserve, Mount Martha, Victoria

This study investigates the benefits of using oral history as a tool for the sustainable management of estuaries. Twenty-two semi-structured interviews were conducted to generate oral history records for the Balcombe Estuary Reserve, a small estuary in a periurban zone on the Mornington Peninsula, Victoria. These interviews establish a more complete picture of changes in land use and ecological change to the estuary since European settlement of the area, and document community values. The interviews were followed with a survey to further explore management issues in the area. Use of oral history was found to be an effective approach to assist holistic estuarine management, especially when complemented by other sources of information.

Young mothers’ lived experiences prior to becoming pregnant in rural Victoria : a phenomenological study

Objective: To explore the lived experiences and social context prior to becoming pregnant, of women who became mothers during adolescence in rural Victoria.
Design: Qualitative interpretive phenomenological study using semistructured interviews.
Setting: Rural community in North East Victoria, Australia.
Participants: Four rural women who gave birth to a child between the ages of 15 and 19.
Results: Five themes emerged from the data as being essential to the participants’ experiences prior to pregnancy. These included feeling isolated; life change: transition into adulthood; support and understanding in sexual relationships; feeling dissatisfied; and overcoming adversity. Participants’ provided practical recommendations to improve life for young people in rural areas through reflecting on their own experiences.
Conclusion: These findings highlight the complex nature of rural young women’s experiences leading up to pregnancy and suggest that early motherhood might be largely reflective of the social environment in which one lives prior to pregnancy. Providing somewhere safe to go, organised and appropriate social activities and increasing access to health services were identified as being pertinent to improving experiences for rural young people prior to pregnancy. Health professionals should consider the importance of supporting young women through non-judgemental, approachable and accessible services.

Damming the flow: cultural barriers to perceived ‘procedural justice’ in Wonthaggi, Victoria

 Drier conditions in Australia have compelled governments to implement projects such as the desalination plant in the South Gippsland town of Wonthaggi. The desalination plant is still under construction, but South Gippsland is already host to wind turbines and marine protected areas, reflecting public pressure to develop renewable energy sources and conserve resources. However, all projects have been met with vocal opposition. Using the desalination project as a case study, this paper will address public concerns about a perceived lack of procedural justice in implementing such projects. Drawing on data from a pilot survey of 320 residents, we argue that procedural shortcomings of the project include inattention to past political disputes in the region and to the culturally entrenched sense of division between city and country. Attention to political and cultural histories is vital to the successful and ethical implementation of projects in regional areas.

Integrating agriculture and food policy to achieve sustainable peri-urban fruit and vegetable production in Victoria, Australia

Efforts to increase fruit and vegetable consump­tion are a significant aspect of national approaches to preventive health. However, policy frameworks for increasing fruit and vegetable consumption rarely take an integrated food-systems approach that includes a focus on production. In this policy analysis and commentary we examine fruit and vegetable production in peri-urban areas of Melbourne in Victoria, Australia, and highlight the significance of emerging environmental and eco­nomic pressures on fruit and vegetable production. This examination will be of interest to other locations around the world also experiencing pressure on their peri-urban agriculture. These pressures suggest that the availability and afforda­bility of fruit and vegetable supplies cannot be taken for granted, and that future initiatives to increase fruit and vegetable consumption should include a focus on sustainable production. Threats to production that include environmental pressures, together with the loss and cost of peri-urban agri­cultural land and a cost-price squeeze due to rising input costs and low farm-gate prices, act in combi­nation to threaten the viability of the Victorian fruit and vegetable industries. We pro­pose that policy initiatives to increase fruit and vegetable consumption should include measures to address the pressures facing production, and that the most effective policy responses are likely to be integrated approaches that aim to increase fruit and vegetable availability and affordability through innovative solutions to problems of production and distribu­tion. Some brief examples of potential integrated policy solutions are identified to illu­strate the possibilities and stimulate discussion.