Filters
Availability
Publication Year
Resource Type
Faculty
School/Institute
Publication Search Results
Sort
Results per page
1 - 5 of 5
-
(2023)ThesisIn 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.
-
(2023)ThesisIntroduction The World Health Organization (WHO) estimates 5.4 million snakebites annually. In 2019, WHO released a strategy to halve the burden of snakebite by 2030. This doctoral research aimed to generate practice and policy relevant evidence at three levels: globally, by understanding the prioritisation process in the WHO; nationally, in India, by evaluating the primary health care (PHC) system; and regionally, in South Asia, by fostering research on treatments. Methods To understand the global prioritisation of snakebite, I conducted a policy analysis, using interviews and documents as data sources. To evaluate health systems in India, I analysed secondary data for the first nationwide assessment of structural capacity and continuum of snakebite care. To understand health systems resilience, I used quantitative (analysis of facility-level data) and qualitative (interviews) approaches to understand the effects of COVID-19 and conducted an evidence synthesis on the effect of climate change. Through an overview of systematic reviews of treatments, I identified the need for a core outcome set (COS) on snakebite. I developed a COS for snakebite research in South Asia, by conducting a systematic review of outcomes and a Delphi survey. Results The policy analysis identified factors which enabled prioritisation of snakebite, and identified unaddressed challenges of sustaining legitimacy, and acceptance within the neglected tropical disease community. I identified structural limitations of the PHC system and gaps in referral pathways, in India. Relevant to the context, I report, how COVID-19 accentuated existing barriers, and identified that the choice of provider is a complex process with multiple factors interplaying. Evidence synthesis indicates the need to prepare health systems for possible geographic shifts in snakebite burden due to climate change. The overview of systematic reviews identified gaps in the evidence ecosystem. By developing a COS for future intervention research on snakebite treatments, I addressed the gap of non-standardised measurement of outcomes. Conclusion The findings of the thesis, provides contextually relevant evidence aligned with pillars of the WHO strategy, to practice and policy at global, national, sub-national, and program level. The policy analysis and COS work provides broader methodological insights, beyond snakebite.
-
(2023)ThesisThe development of knowledge and policy for improving health through urban planning involves multiple disciplines and sectors. Achieving effective policymaking and knowledge production requires transdisciplinary collaboration, which necessitates a willingness among participants to collaborate in areas outside their respective fields. To establish such collaborations, it is crucial to identify and acknowledge the ontological perspectives of the actors involved. This thesis aims to identify and articulate diverse ontological perspectives on urban health and their implications for advancing transdisciplinary approaches to urban health. The concept of paradigms is applied to identify four urban health paradigms: the ‘medical-industrial city,’ ‘urban health science,’ ‘healthy built environment,’ and ‘health social movement’ paradigms. A meta-narrative review, guided by a bibliometric co-citation network analysis, identifies five urban health research traditions: sustainable urban development, urban ecosystem services, urban resilience, healthy urban planning, and urban green spaces. The four urban health paradigms and five urban health research traditions are employed to analyse the presentation of urban health policy ideas in the planning of the Western Parkland City in Greater Sydney, Australia. The analysis reveals that the key urban health policy ideas are grounded in different sets of urban health paradigms and are involved with different types of urban health research traditions. This finding highlights the need for transdisciplinary approaches to policymaking and indicates that effective urban health policy solutions require collaboration among actors with diverse perspectives. In conclusion, this thesis emphasises the importance of recognising and reflecting on diverse ontological perspectives on urban health to produce and interpret transdisciplinary knowledge for the goal of improving health by transforming urban systems. Scholars, practitioners, and policymakers must seek coherence by understanding the similarities and differences in their approaches to urban health to create an opportunity for coherence in understanding knowledge generated from different paradigms.
-
(2023)ThesisIn recent times cities have increasingly promoted bicycling as part of their strategy to develop a more sustainable transportation system. To increase the number of bike riders, more bicycling infrastructure should be developed in urban areas. The infrastructure should provide a safe and comfortable environment for bicycling. To this end, bicycling should be prioritised within a city's urban and transportation planning. However, in many cities, bicycling gets little attention in urban plans and strategies. One barrier to enhanced bicycling, in many cities around the world, is the organisational complexity, under several tiers of government, of planning and implementing bicycling infrastructure. Such is the case in Australia, where local and state government departments have often distinct policies and strategies for planning bicycling infrastructure that cause problems in project coordination. In addition, decisions about where to prioritise investment in bicycling infrastructure need to be supported with valid and comprehensive evidence. Planning Support Systems (PSS) are geo-information tools that have been created to provide this evidence and support specific urban planning tasks such as bicycling planning. However, improving city bicycling isn't solely reliant on data-driven techniques and new technologies; it also demands planners' adoption of these methods while working collaboratively with other stakeholders. The emerging field of Planning Support Science highlights the significance of research-practice collaboration to achieve shared goals and provide valuable support to those in the field. Geo-design is an approach that enables such collaboration using geo-information tools to support the planning process in a collaborative environment. The geo-design framework enhances the planning approach by providing key stakeholders with data-driven tools ranging from sketch planning to advanced simulation and impact assessment. With these tools, geo-design can be applied to collaboratively construct and evaluate multiple future bike infrastructure scenarios. Therefore, the overarching research question of this study is: ‘How can a geo-design framework facilitate planning for bicycling, and what data-driven methods and tools effectively support such a framework?’. A geo-design framework was developed and evaluated using an experiential case study approach in the Greater Sydney region, specifically focusing on Penrith City (Western Sydney). The main contributions of this research lie in its investigation of the current state of using data-driven approaches to support bicycle planning, and its development, implementation and iterative testing of geo-design incorporating a data-driven support tool based on Agent-Based Modelling (ABM) techniques. The research involved expert participants (transport planners and engineers, urban designers, and academics) from across Sydney, including people from both State and Local Government Authorities and other key stakeholders in bicycling planning. The findings of this research provide a novel framework for planners that can guide collaborative planning for better bicycling infrastructure. In addition, the application of data-driven tools, such as ABM for simulation of bicyclists behaviours, augments the evidence base and improves decision-making. Overall, this study has shown that the proposed geo-design framework and developed data-driven tools can improve planning for bicycling by facilitating collaboration among decision-makers and stakeholders.
-
(2024)ThesisMale eating disorders are becoming a vital topic of public health concern. Yet despite increasing attention in media, science and policy, including in Australia, eating disorders among men remain little understood. In this dissertation, I take ‘male eating disorders’ as a set of emergent practices that are ‘in-the-making’. Drawing on ideas in Science and Technology Studies (STS), I focus specifically on how male eating disorders come to be enacted in clinical practices, health communication materials and clinical measurement tools. The overarching aim of this thesis is to critically examine how maleness is performed in the context of eating disorders, to generate new insights which can contribute to how care in relation to male eating disorders can be done otherwise. To address my research aim I employed qualitative methods, including: visual analyses of health promotion infographics; qualitative interviews (n=25) with Australian health care professionals involved in clinical care; and reflection on a situated embodied experiment with clinical assessment measures. My analysis is informed by STS and feminist technoscience scholarship on concepts of ‘care’, ‘becoming’, ‘multiplicity’, and ‘event'. These approaches allow me to attend to MEDs as an ‘enactment’ that is ‘in-the-making’, that is, a site of emergent and uncertain knowledge, in which the situated realities of male eating disorders become produced and stabilised in clinical practices. This dissertation demonstrates the limits of predominant biomedical frameworks of care that tend reproduce and stabilise an assumed dichotomy between the ‘female’ and ‘male’ in relation to the problem of eating disorders. Treating MEDs as a matter of ‘becoming’ shows that care around them is locally situated in particular clinical moments. In these moments, bodies, clinicians, and patients become together constituting a material-semiotic network of care. The analysis points to the need to trouble the imagined fixed female/male dichotomy embedded in clinical practices in order to open up a more sensitive and flexible model of care. It is argued that there is a need for a new language, a new set of practices, which hold open the possibility for the field to attend to (male) eating disorders.