Voices of the Unheard

Adversity has the effect of eliciting talents, which, in prosperous circumstances, would have lain dormant. Horace - Roman lyric poet and satirist 65BC – 8 BC This quotation from Horace could well be the chorus to a medley of songs sung by people who face extraordinary adversity and have gained emotional resilience through music making. In this chapter we present three composition ventures that are stories or verses in a new song and whose chorus summarises the nature of the resilience factors present in the narratives. We are aware that words on a page like this can have the effect of filtering out the engaging nature of musical experience and reduce music to a critique or an evaluation of its aesthetic value. This disjuncture between language and the ephemeral, embodied experience is a problem for those who use these creative processes in therapeutic and salutogenic ways (Antonovsky, 1996) for public health. The notion of salutogenic health, put simply, delineates it from therapy in that the processes focus upon wellness rather than therapy. Whilst we include evidence from the fields of community music therapy (Pavlicevic, 2004; Leitschuh et al., 1991), neuroscience (Bittman et al., 2001) and community music (Bartleet et al., 2009) the framework for a salutogenic health outcome in community music is one which seeks to employ music practices and the qualities of music making that provide positive health benefit to communities –to enhance health and well being rather than the “treatment” of disorders. It is essentially a holistic and interdisciplinary study. Therapy and salutogenic health are not mutually exclusive as both depend upon the qualities of music experience to affect change. Collecting, analysing and presenting evidence of change in human behaviour that can be directly attributed to creative music making is a problem of evaluation.

Editorial

The goals of this special issue of the Asia-Pacific Journal of Health, Sport and Physical Education were to provide insights into the developing, yet vital, nature of Wellness. The roots of this special issue are firmly set in the 2009 ACHPER National conference held in Brisbane and the realisation that interest in constructs surrounding “quality of life” had grown. At a broader level, Wellness is now seen as central to redefining the National Health agenda. In 2009, the National Health and Hospitals Reform Commission sponsored a report that earmarked a “Wellness focus” as part of an extensive reform in the Australian health system. Globally, the World Health Organisation and the World Economic Forum (2007) have adopted a Wellness outlook for countries and organisations.

The shaping of midlife women's views of health and health behaviors

The menopausal transition is a marker of aging for women and a time when health professionals urge women to prevent disease. In this research we adopted a constructivist, inductive approach in exploring how and why midlife women think about health in general, about being healthy, and about factors that influence engaging in healthy behaviors. The sample constituted 23 women who had participated in a women’s wellness program intervention trial and subsequent interviews. The women described lives of healthy eating and exercise, yet, their perceptions of health and healthy behavior at midlife contradicted that history. Midlife was associated with risk and guilt at not doing enough to be healthy. Health professionals provided a very limited frame within which to judge what is healthy. Mostly this was left up to individual women. Those who were successful framed health as “being able to do what you want to do when you want to do it.” In this article we present study findings of how meanings attached to health and being healthy were constructed through social expectations, family relationships, and life experiences.

Religious information literacy : using information to learn in church community

What informs members of the church community as they learn? Do the ways people engage with information differ according to the circumstances in which they learn? Informed learning, or the ways in which people use information in the learning experience and the degree to which they are aware of that, has become a focus of contemporary information literacy research. This essay explores the nature of informed learning in the context of the church as a learning community. It is anticipated that insights resulting from this exploration may help church organisations, church leaders and lay people to consider how information can be used to grow faith, develop relationships, manage the church and respond to religious knowledge, which support the pursuit of spiritual wellness and the cultivation of lifelong learning. Information professionals within the church community and the broader information profession are encouraged to foster their awareness of the impact that engagement with information has in the learning experience and in the prioritising of lifelong learning in community contexts.

A social marketing approach to value creation in a Well-Women’s health service

Understanding consumer value is imperative in health care as the receipt of value drives the demand for health care services. While there is increasing research into health-care that adopts an economic approach to value, this paper investigates a non-financial exchange context and uses an experiential approach to value, guided by a social marketing approach to behaviour change. An experiential approach is deemed more appropriate for government health-care services that are free and for preventative rather than treatment purposes. Thus instead of using an illness-paradigm to view health services outcomes, we adopt a wellness paradigm. Using qualitative data gathered during 25 depth interviews the authors demonstrate how social marketing thinking has guided the identification of six themes that represent four dimensions of value (functional, emotional, social and altruistic) evident during the health care consumption process of a free government service.

Health promotion

The ‘promotion of health’ has become everybody’s business: from the marketers of ‘healthy’ products and lifestyles, and gym memberships; government media campaigns to ‘Go for 2&5®’ (fruit and vegetables every day), special ‘extra’ benefits for joining a private health insurance fund and workplace ‘wellness’ programs that include yoga and pilates. For consumers, the list is endless. Health professionals need to understand the background to this growth in the promotion of ‘health’ and the place health promotion plays in public health. We begin this chapter with a discussion on health education, we then trace the evolution of health promotion from health education, the strategies and settings for health promotion, and conclude with challenges for health promotion. Case studies, activities and reflections on the material are presented to assist you.

Experiences of a walking intervention in a University community : Qualitative perspectives

Background: This study explored the experiences of university employees that participated in a walking intervention that encouraged individuals to walk more throughout their workday. The 10-week program was comprised of 5 phases (i.e. baseline, anticipating barriers, short planned walks, longer planned walks and maintenance) and utilized a pedometer diary and an online website for logging steps. The pedometer diary included “action plans” for addressing barriers and planning walking and the online dashboard provided graphical outputs that allowed participants to visualize whether they were reaching or exceeding their step targets. Methods: A subsample of 12 academic and administrative employees from the study completed open ended questionnaires at the end of the study. The questions focused on capturing the major themes of benefits/mediators and problems/moderators of the program and were assessed using phenomenological approaches. Results: Participants found a raised consciousness of physical inactivity throughout the work day. They also found it useful to have a graphical display of physical activity patterns, but found time constraints and lack of managerial support to be the primary barriers/moderators of the program. Those most likely to withdraw from the program experienced technical difficulties with objective monitors and the online website. Conclusions: Findings highlight the value in being involved in a group forum and provide insights into the challenges of supporting such programs within the workplace.

A review of the pharmacobiotic regulation of gastrointestinal inflammation by probiotics, commensal bacteria and prebiotics.

The idea that microbes induce disease has steered medical research toward the discovery of antibacterial products for the prevention and treatment of microbial infections. The twentieth century saw increasing dependency on antimicrobials as mainline therapy accentuating the notion that bacterial interactions with humans were to be avoided or desirably controlled. The last two decades, though, have seen a refocusing of thinking and research effort directed towards elucidating the critical inter-relationships between the gut microbiome and its host that control health/wellness or disease. This research has redefined the interactions between gut microbes and vertebrates, now recognizing that the microbial active cohort and its mammalian host have shared co-evolutionary metabolic interactions that span millennia. Microbial interactions in the gastrointestinal tract provide the necessary cues for the development of regulated pro- and anti-inflammatory signals that promotes immunological tolerance, metabolic regulation and other factors which may then control local and extra-intestinal inflammation. Pharmacobiotics, using nutritional and functional food additives to regulate the gut microbiome, will be an exciting growth area of therapeutics, developing alongside an increased scientific understanding of gut-microbiome symbiosis in health and disease.

Diabetes health program development for Aboriginal and Torres Strait Islander women

According to Australian Health (2008), the area of endocrine, nutritional and metabolic disorders (mainly diabetes) yields the highest cause of death for Indigenous Australian women at 10.1%. Indigenous Brisbane North women’s results reiterate this with slightly higher percentages and are a cause for concern and action due to the noted levels of undiagnosed/unaware Indigenous Brisbane North women with abnormal blood glucose levels, whom participated in the research. A sub-sample of the group (N=17) were piloted to test the feasibility of method of eliciting health information on Indigenous Women within this community. This pilot study revealed the following health information regarding this group of women. 41.2% of Indigenous Brisbane North women were found to have blood glucose levels that were outside normal ranges, however only 29.4% had been diagnosed with diabetes and or endocrine abnormalities. These findings highlight that 11.8% of participants have signs indicating that they may have undiagnosed diabetes or/and pre diabetes juxtaposed to unacceptable endocrine levels compatible with health and wellness. The percentages of Indigenous Brisbane North Women whom have indicated that they have a diagnosis of diabetes have been compared to both National Indigenous peoples percentages and the national percentages for the wider Australian community (all Australians). The rate of diabetes within this population is 9 times that of the wider Australian community and 5 times that of the wider Australian Indigenous community. Data was collected from Indigenous participants on arrival and the attendance numbers of 112 women was recorded for comparison with other current health prevention wellness programs being delivered. Data was also collected through the use of specially designed culturally safe questionnaires undertaken in conjunction with health checks and health service information given to participants.

Chaotic soul - messy heart : the phenomenon of experiencing auditory hallucinations

Globally, it is estimated that 24 million people live with schizophrenia (WHO, 2008), while 1.2 million people have been diagnosed with schizophrenia in Indonesia. Auditory hallucinations are a key symptom of schizophrenia according to the DSM IV-TR (Frances, First, & Pincus, 2002). It is estimated that the prevalence of auditory hallucinations in people with schizophrenia range from 64.3% to 83.4% (Thomas et al., 2007). Until recently, the majority of studies were conducted in Western societies the primary focus of which, has been on the causes and treatments of auditory hallucinations (Walton, 1999) and on the biological and cognitive aspects of the phenomenon (Changas, Garcia-Montes, de Lemus & Olivencia, 2003). While a few studies have explored the lived experience of people with schizophrenia, there is little research about the experience of auditory hallucinations. Therefore, the focus of this study was on an exploration of the experience of auditory hallucinations as described by Indonesian people living with schizophrenia. Based on the available literature, there have been no published qualitative studies relating to the lived experience of auditory hallucinations as described by Indonesian people diagnosed with schizophrenia. Husserlian descriptive phenomenological approach was applied in explicating the phenomenon of auditory hallucinations in this study. In-depth audio-taped interviews were conducted with 13 participants. Analysis of participant transcripts was undertaken using Colaizzi.s (1973) approach. Eight major themes were explicated: Feeling more like a robot than a human being - feeling compelled to respond to auditory hallucinations; voices of contradiction - a point of confusion; a frightening experience, the voices emerged at times of loss and grief; disruption to daily living; tattered relationships and family disarray; finding a personal path to living with auditory hallucinations; seeking relief in Allah through prayer and ritual. Experiencing auditory hallucinations for people diagnosed with schizophrenia is a journey of challenges as each individual struggles to understand their now changed life-world, reconstruct a sense of meaning within their illness experience, and to carve out a pathway to wellness. The challenge for practitioners is to learn from those who have experienced auditory hallucinations, to be with them in their journey of recovery and wellness, and to apply a person-centered approach to care within the context of a multidisciplinary team.

Queensland police service : an evaluation of HealthStart 2012

The HS program consists of a voluntary health screening and personalised feedback (via a website) which incorporates physical measurements, psychological stress assessment and blood tests. The following report describes the results of a research project that evaluated the effectiveness of the QPS-HS program and examines the health benefits it offers its participants. This report has three main areas that correspond to the research questions and includes three primary aims: 1.Review the literature pertaining to the health, social and economic value of wellness programs in workplaces. In particular, we reviewed policing worksites and other safety sensitive workplaces, to understand best-practice wellness programming and return on investment, in terms of value to employees, social value to the community, and economic value to employers; 2.Evaluate health outcomes of participants in the HS program, including physical measurements, such as blood tests and psychological well-being. These measures were to form an outcome evaluation and assess the effectiveness of the HS program in positively impacting physical and psychological health of HS participants; and 3.Assess employee awareness and perceptions of the HS program for a process evaluation.

A pilot study exploring Australian general practice nurses roles, responsibilities and professional development needs in well and sick child care

Aim Explore practice nurses' (PNs) role in child health and development, and advising parents about child health issues. Background Introduction of the four-year-old child health check into general practice in 2008 placed additional responsibilities on PNs in child health and wellness. This study explores their readiness to expand their practice into this area. Design Integrated mixed method design, self-report survey. Method A purpose-developed questionnaire explored demographics, child health roles and responsibilities, difficulties encountered, professional development needs, barriers and facilitators, and professional development activities undertaken in the past year. Surveys were posted to 218 PNs in one rural Division of General Practice (DGP) in Queensland, Australia; 29 responded. Results PNs reported a significant role in well and sick child care (93.1%) though few had a paediatric/child health background (14.3%). Roles included immunisations (92.3%), child health checks (65.4%), general child health and development (26.9%), asthma (23.1%), feeding (15.4%), fever (11.5%), settling/sleeping (11.5%). PNs were interested in learning more about (81.5%) and incorporating more child health into their practice (81.5%). Professional development in childhood growth and development (80.0%), health and illness (60.0%) and advising new mothers (20.0%) was needed. Conclusions PNs play a substantial role in child health, are unprepared for the complexities of this role and have preferred methods for undertaking professional development to address knowledge deficits. Implications for practice PNs are unprepared for an advanced role in child health and wellness. Significant gaps in their knowledge to support this role were identified. This ever-expanding role requires close monitoring to ensure knowledge precedes expectations to practice.

Culture makes you stronger : Aboriginal women’s voices from the South Coast of NSW

This paper will describe a community based research project examining the health and wellbeing of a sample of Aboriginal women in Australia, and present preliminary findings of a community needs analysis. The Shoalhaven Koori Women’s Study (SKWS) is being led by an Aboriginal woman based within Waminda, an Aboriginal women’s community controlled service located on the South Coast of NSW. The community needs analysis is the first stage of the SKWS, and aims to explore Aboriginal women’s perceptions and experiences of wellness and wellbeing, including issues related to their personal strengths, health and social priorities, support needs and that of their families. Thirty Aboriginal women were interviewed using a survey that included closed and open ended questions. Methods used to administer the survey included yarning and Dadirri (deep listening), two valid and culturally safe approaches for data collection with Aboriginal people. Adopting these approaches ensured Aboriginal protocols were maintained and upheld throughout the research process. This enabled scientific rigour while also ensuring activities were culturally safe. Key findings of the survey will be presented, and how Waminda is modifying service delivery to better respond to the health and social priorities of Aboriginal women in the Shoalhaven region will be discussed. Community feedback of survey results will occur to validate the analysis from the community perspective.

Promoting law student well-being through the curriculum

The Australian tertiary sector is becoming increasingly concerned about the psychological well-being of its students.Empirical research in Australia indicates that more than one-third of law students suffer from psychological distress, and the competitive, isolated, adversarial learning environment at law school has been suggested as partly responsible (Brain and Mind Research Institute, 2009). This fellowship program has mobilised strategic change to improve the psychological health of law students. It has lead and stimulated advancement in the legal curriculum, its pedagogy, and assessment practice to better engage, motivate and support student learning of law, focussing on the potential of non-adversarial legal practice. A new conceptual framework for legal education has been developed, demonstrating the pursuit of excellence in the teaching of law, and raising the profile of learning and teaching in Australian law schools. In addition the fellowship has created a national community of practice around this issue through the Wellness Network for Law, and made significant contributions to research and scholarship in the field.

Pathways to peace : a phenomenological exploration of the processes of healing and posttraumatic growth following childhood sexual assault

This thesis explored pathways to healing in men and women who experienced traumatic sexual abuse in childhood and considered themselves to be in a place of wellness. The thesis synthesises current knowledge in this area and has produced a number of models with direct implications for clinical practice. This unique work has also contributed to advancing theoretical understanding of healing following sexual assault.