Medicine & Health

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  • (2023) Stirling, Robert
    Thesis
    In Australia, there is no standardised approach to measuring performance of alcohol and other drug (AOD) treatment services. Non-government organisations (NGOs) that provide AOD treatment in Australia manage contracts from multiple funding sources, with performance measures varying between funders. They have reported a high reporting burden and inconsistent expectations from different funders to demonstrate accountability. The primary aim of this thesis was to establish a list of performance measures that are acceptable to service users, treatment providers, and funders; explore approaches to improve implementation of performance measures; and make recommendations to funders of non-government AOD treatment. The research approach involved three phases: 1) an assessment by three independent raters of existing measures used in contracts against best practice; 2) focus groups with service users, treatment providers, and funders (n=10 focus groups) to identify the most important performance measures among diverse stakeholders and explore the challenges associated with implementation; 3) a Delphi process with a purposeful sample of service users, treatment providers, and funders to prioritise a core set of performance measures. Phase One found over 500 unique measures used in contracts for AOD treatment services, with most not adhering to best practice. Further, the majority were output and process measures. In Phase Two, focus groups identified that access, outcome, and experience measures were the most important measurement types across all stakeholder groups, with structural measures also important to service users. In Phase Three, 17 performance measures reached consensus. In contrast to Phase One, the final set were mostly outcome, access, and structural measures (n= 11/17) with only one measure each for output and process. Further, key findings from the focus groups highlighted that identification of measures is only part of a robust performance measurement system. Support systems for collecting, analysing, interpreting, and reporting performance data are also needed. At the policy-level, implementation of the final set of measures can improve accountability of public funds, and support the collection of standardised performance-related data to inform funding decisions and treatment planning. At the practice-level, the measures have the potential to reduce reporting burden, improve organisational efficiency, and inform quality improvement initiatives.

  • (2022) Macdonald, Diane
    Thesis
    The agency of women with disability is undermined by long-held ideas of what women with disability can or should be. These narrow, reductive views of their identity are limiting and harmful, and lead to exclusionary practices. My research used a feminist framework to challenge these views. My research addressed the social inclusion of women with physical disability in two stages. First, it investigated identity and inclusion through photographic self-portraits by women with physical disability. Second, my research examined the role of arts-based research in shifting negative community attitudes about disability. In the first stage, six women with physical disability photographed aspects of themselves using the photovoice method to focus on their strengths and issues affecting them. Photos, stories, interviews and discussions were analysed thematically. Findings from the first stage indicate that these six women engage in the ‘work of disability’. They articulated identity through their depictions of gender and disability. They challenged expectations through portraits of strength, sexuality and connection. They illustrated the gendered realities of daily life with disability that explain disability to non-disabled others. This research emphasised the personal capacity of the women to critically challenge how women with disability are portrayed. In the second stage, I explored the extent to which a public exhibition of disability self-portraits could be an effective platform to provoke social change. Audiences responded to open-ended questions about their thoughts and feelings after viewing the exhibition. I employed interpretive thematic analysis through a generic social processes framework to analyse responses. My findings indicate that audiences acknowledged underlying conscious or unconscious biases that contribute to their negative attitudes about disability. Audiences connected with the exhibition in ways that not only explored the women’s stories, but also led to better understandings of their own value sets. Audiences reassessed their assumptions about disability as a direct result of viewing the exhibition. My research findings demonstrate the valuable role of arts-based research. The agency expressed through self-portraits and stories helped shift negative attitudes and perceptions of disability to counter prejudice and promote equality. My research reveals a new pathway for the public to see women as they see themselves through art.