Medicine & Health

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  • (2007) Chan, Bibiana Chi Wing
    Report
    Under-utilisation of mental health services is widespread globally and within Australia, especially among culturally and linguistically diverse (CALD) communities. Improving service access is a priority, as is the need to deliver culturally competent services to the CALD communities. Having migrated to Australia in waves for approximately 150 years from China and South East Asia for various social, political and economic reasons, the Chinese population in Sydney is now the fastest growing non-English speaking ethnic group. There is a need to better understand the impact of culture on the emotional experiences of these Chinese in Australia. How do Chinese make sense of their depressive episodes? To address this question, this study explored the ways participants reach out for medical and/or non-medical help. Lay concepts of illness underpin these decisions and were thus unveiled. Mixed-method research design provided the opportunity to bring together multiple vantage points of investigation: population mental health, transcultural psychiatry and medical anthropology. A study combining quantitative survey and qualitative focus groups was undertaken in metropolitan Sydney. Narratives on symptoms, explanatory models and help-seeking strategies were articulated by focus group informants. Surveys covered demographics, symptom-recognition, previous depressive experiences and professional help sought. Depression measurement tools were cross-culturally validated. Self-ratings of ethnic identities and the Suinn-Lew Self-Identity Acculturation Scale were used to quantify Chinese participants’ acculturation level. This allowed comparisons between ‘low-acculturated’ Chinese’, ‘highly-acculturated’ Chinese and Australians. Survey results showed comparable levels of symptom-recognition in all subgroups. Focus group discussions provided rich data on informants’ help-seeking strategies. Highly acculturated Chinese closely resembled the Australians in many study variables, yet qualitative data suggested cultural gaps beyond language barriers in influencing service use. Participants believed that trustful relationships could work as the bridge to link services with those in need. The implications for Australia’s mental health policy include recognising the importance of rapport-building and the existence of cultural gaps. The study indicated professionals can benefit from acquiring information about the mental health beliefs both of individual clients and the wider ethnic communities in which they belong, and respecting the cultural differences between helper and helped as the first step towards cultural competency.

  • (2008) Chan, Bibiana Chi Wing
    Report
    心理衛生服務不被廣泛採用﹐不單是澳洲也是全球性的現象﹐尤其是那些多元文化和語言背景 (Cultural and Linguistically Diverse)的社區。改善接觸服務的各種 門徑自然是當前急務﹐還需要考慮到服務範疇對多元文化的社區是否適切。華裔人士早於一百五十年前從中國及東南亞地區移民到澳洲﹐他們包括來自不同社會﹑政治﹑經濟背景的人士。悉尼的華人人口是澳洲近年增長最迅速的少了民族! 有見及此, 我們需要了解一下文化對情緒表現的影響. 華裔人士怎樣解釋他們的 抑鬱經歷呢? 要回答以上的問題﹐這個研究主要探討參加者怎樣尋求醫療和非醫療的服務。一般華人做這些決定時所持的病理概念就得以揭示出來! 混合式的研究設計 正好提供一個 機會去從一個垮躍多個學術領域 (公共衛生﹑ 跨文化心理學和 醫護人類學)的角度 來進行研究。這個在悉尼市區進行的研究,融合了‘數量’的問卷調查和‘質量’的社區座談會。取得的資料包括 病癥﹑病人的詮釋方法﹐求助途徑等. 問卷搜集到背 景資料, 病癥識辨﹐以往的抑鬱經歷和 曾向那些專業服務求助, 抑鬱症的量表和其 他跨文化的工具都經過嚴格測試覆核﹐其中用來量度華裔參加者的文化適應能力的量表 Suinn-Lew Self-Identity Acculturation Scale, 把參加者客觀地分成較傳統 和較澳洲化兩個組別﹑ 和澳洲人的一組作比較。 問卷調查顯示兩組華人和一組澳洲人對抑鬱症的病癥識辨能力相約﹔社區座談會的討論則引出了有關求助途徑的豐富資料。較澳洲化的華人跟澳洲人組別在很多個研究指標 (或稱變數﹐variables) 上都很接近。不過座談會資料卻指出文化上的差異對選 擇甚麼樣的服務有一定影響,很明顯這是超越語言上的障礙!參加者認為對專業人士或服務機構的信任是連接服務與病者的重要一環。研究結果呼籲澳洲心理衛生的策劃者必須正視‘建立良好關係的重要’。專業人士必需增強了解個別病者和少數民族對精神或心理病的詮釋。尊重求助者和施予援助者之間的文化差異’是踏出推動多元民化心理衛生服務的第一步.

  • (2007) Amoroso, Cheryl; Proudfoot, Judy; Bubner, Tanya; Swan, Edward; Espinel, Paola; Barton, Christopher; Beilby, Justin; Harris, Mark
    Journal Article
    BACKGROUND: Clinical audit is recognised worldwide as a useful tool for quality improvement. METHODS: A feedback report profiling capacity for chronic disease care was sent to 97 general practices. These practices were invited to complete a clinical audit activity based on that feedback. Data were analysed quantitatively and case studies were developed based on the free text responses. RESULTS: Eighty-two (33%) of 247 general practitioners participated in the clinical audit process, representing 57 (59%) of 97 general practices. From the data in their feedback report, 37 (65%) of the 57 practices recognised the area most in need of improvement. This was most likely where the need related to clinical practice or teamwork, and least likely where the need related to linkages with other services, and business and finance. Only 25 practices (46%) developed an action plan related to their recognised area for improvement, and 22 (39%) practices implemented their chosen activity. Participating GPs judged that change activity focused on teamwork was most successful. DISCUSSION: The clinical audit process offered participating GPs and practices an opportunity to reflect on their performance across a number of key areas and to implement change to enhance the practice’s capacity for quality chronic disease care. The relationship between need and action was weak, suggesting a need for greater support to overcome barriers.

  • (2004) Baker, Amanda; Kay-Lambkin, Frances; Bucci, Sandra; Haile, Melanie; Richmond, Robyn; Carr, Vaughan
    Report
    The prevalence of smoking among people with a psychiatric illness, especially schizophrenia, is much higher than in the general population (Goff et al., 1992). Smoking is associated with adverse mental and physical consequences among people with psychotic disorders. In terms of adverse physical consequences, smoking related diseases are the greatest contributor to early mortality among people with a psychotic illness (Lawrence, Holma & Jablensky, 2001). Despite the high prevalence of smoking, smoking cessation programs have not typically been part of treatment regimens available to people with psychiatric illness. This manual describes an intervention delivered over six weekly sessions, followed by two fortnightly booster sessions, and conducted on an individual basis. It includes some of the theoretical and contextual background information relevant to the treatment program, and its evaluation in the randomised controlled trial conducted over 2000-2003. Outcomes for the randomised controlled trial are briefly summarised. Each subsequent section contains a detailed session-by-session guide to the content of the tobacco reduction intervention evaluated in the randomised controlled trial. Many handouts, homework activities and therapist and client resources are additionally provided.

  • (2006) Zwar, N; Harris, Mark; Griffiths, R; Roland, Martin; Dennis, Sarah; Powell Davies, G; Hasan, I
    Report
    This is the final report of a systematic review conducted as part of the Australian Primary Health Care Research Institute (APHCRI) Stream Four funding. The aim of Stream Four was to systematically identify, review, and synthesise knowledge about primary health care organisation, funding, delivery and performance and then consider how this knowledge might be applied in the Australian context. This particular review focussed on the management of chronic diseases in the primary care setting.

  • (2008) Dennis, Sarah
    Report
    Health policy makers in Australia and the United Kingdom have focused on the increasing role of primary health care in the management of people with chronic disease. The approaches taken by the two countries have varied mainly because of the differences in the way primary health care is organised and funded. Many of the Australian policy options arising from the key findings of the chronic disease management review focused on support to improve practice level data and payment systems to facilitate greater multidisciplinary team care to support selfmanagement. This is in contrast to the UK where high quality practice level data are used to monitor and reward chronic disease management through the Quality and Outcomes Framework [1]. In addition to this, the payment system for UK primary health care favours a multi-disciplinary approach to chronic disease management.

  • (2007) Zwar, N; Dennis, Sarah; Griffiths, R; Perkins, D; May, J; Sibbald, B; Caplan, G; Harris, Mark
    Report

  • (2008) Dennis, Sarah
    Report
    Health policy makers in Australia and the United Kingdom have focused on the increasing role of primary health care in the management of people with chronic disease. The approaches taken by the two countries have varied mainly because of the differences in the way primary health care is organised and funded. Many of the Australian policy options arising from the key findings of the chronic disease management review focused on support to improve practice level data and payment systems to facilitate greater multidisciplinary team care to support selfmanagement. This is in contrast to the UK where high quality practice level data are used to monitor and reward chronic disease management through the Quality and Outcomes Framework [1]. In addition to this, the payment system for UK primary health care favours a multi-disciplinary approach to chronic disease management.

  • (2008) Razee, Husna; Ritchie, Jan; Eisenbruch, Maurice
    Conference Paper
    Description of a certain experience as ‘illness’ or distress and the presumed course of treatment developed in one cultural group, may not be applicable to people who share a different set of cultural beliefs about illness and treatment (Kleinman, 1980). Miscommunication occurs in the absence of an understanding of the cultural norms, values and beliefs of the patients (Guindon & Sobhany, 2001) leading to misperceptions and quite possibly to misdiagnosis (Patel, 2001; Wagner et al., 2006). This seminal study provides an empirical understanding of Maldivian women’s mental well-being and contributes a proposed foundation for mental health policy development. Findings of this study may be useful to educate and inform mental health practitioners about culturally congruent and culturally competent approaches to mental health promotion for Maldivian patients and patients who share their cultural concepts such as South Asians.

  • (2002) Hart, Bethne Lynda
    Thesis
    This is a study of the social management of human finitude, through explorations of breast cancer as a life-threatening illness. Three domains of social theory and research form the basis of theoretical analysis: the sociology of dying and death, social studies of women with breast cancer, and the sociology of human mortality. The sociology of dying and death contributes to our understandings of life-threatening illness, but fails to adequately encompass the trajectories of illness and recovery. The absence of feminist perspectives and gendered theorising towards human mortality is also evident. The methodology of this study was informed by a feminist sociological imagination and had two phases. Firstly, longitudinal semi-structured interviews with women with breast cancer (n=20) were conducted over one year. Secondly, health care providers (n=25) representative of the range of services for women with breast cancer were interviewed. Popular representations of women recovering from breast cancer illness present women engaging in heroic adventures and transforming their 'ordinary' lives into the 'extraordinary'. Did confrontation with their own mortality, through life-threatening illness, transform these women's lives? No, they did not pursue new life projects or satisfy long-held aspirations. Instead they appeared to return to 'ordinary' life, but conceived it differently. The illness narratives revealed also that women with breast cancer experienced the fateful moments of human finitude, throughout their illness trajectory. These experiences were commonly suppressed in all areas of social life, not least during the active stage of breast cancer treatment. And what of the health care providers? Some demonstrated awareness in finitude, and awareness to the finitude of others. Others did not, and actively engaged in the suppression of awareness of human mortality. In this study, life-threatening illness brought to consciousness the finiteness of human life. Of most significance is the thesis that life-threatening illness experiences are powerfully shaped and disrupted through the social management of human mortality. However, we can discern also patterns of living and healing that resist these prevailing social processes, and acknowledge the limitations of our lifetimes.