Experiences of primary healthcare professionals and patients from an area of urban disadvantage : a qualitative study

Background: The health disadvantage in socioeconomically marginalised urban settings can be challenging for health professionals, but strong primary health care improves health equity and outcomes. Aim: To understand challenges and identify needs in general practices in a socioeconomically marginalised Australian setting. Design & setting: Qualitative methodology with general practices in a disadvantaged area of western Sydney. Method: Semi-structured interviews with healthcare professionals and their patients were transcribed and analysed thematically under the guidance of a reference group of stakeholder representatives. Results: A total of 57 participants from 17 practices (comprising 16 GPs, five GP registrars [GPRs], 15 practice staff, 10 patients, and 11 allied health professionals [AHPs]), provided a rich description of local communities and patients, and highlighted areas of satisfaction and challenges of providing high quality health care in this setting. Interviewees identified issues with health systems impacting on patients and healthcare professionals, and recommended healthcare reform. Team-based, patient-centred models of primary health care with remuneration for quality of care rather than patient throughput were strongly advocated, along with strategies to improve patient access to specialist care. Conclusion: The needs of healthcare professionals and patients working and living in urban areas of disadvantage are not adequately addressed by the Australian health system. The authors recommend the implementation of local trials aimed at improving primary health care in areas of need, and wider health system reform in order to improve the health of those at socioeconomic and health disadvantage

Resisting the mantle of the monstrous feminine : women's construction and experience of premenstrual embodiment

The female reproductive body is positioned as abject, as other, as site of defciency and disease, the epitome of the ‘monstrous feminine.’ Premenstrual change in emotion, behavior or embodied sensation is positioned as a sign of madness within, necessitating restraint and control on the part of the women experiencing it (Ussher 2006). Breakdown in this control through manifestation of ‘symptoms’ is diagnosed as PMS (Premenstrual Syndrome) or PMDD (Premenstrual Dysphoric Disorder), a pathology deserving of ‘treatment.’ In this chapter, we adopt a feminist material-discursive theoretical framework to examine the role of premenstrual embodiment in relation to women’s adoption of the subject position of monstrous feminine, drawing on interviews we have conducted with women who self-diagnose as ‘PMS sufferers.’ We theorize women’s self-positioning as subjectifcation, wherein women take up cultural discourse associated with idealized femininity and the reproductive body, resulting in self-objectifcation, distress, and self-condemnation. However, women can resist negative cultural constructions of premenstrual embodiment and the subsequent self-policing. We describe the impact of women-centered psychological therapy which increases awareness of embodied change, and leads to greater acceptance of the premenstrual body and greater self-care, which serves to reduce premenstrual distress

Men's constructions and experiences of PMS and their partner's premenstrual changes

This thesis aimed to examine men’s constructions of Premenstrual Syndrome (PMS) and premenstrual women, and to explore how men’s constructions impact upon their responses to their partner premenstrually. This thesis also aimed to determine what impact a man’s involvement in a couple-based PMS intervention would have on such constructions and responses. Two qualitative studies were conducted, in which men’s accounts of PMS and premenstrual changes were examined. In the first study, men’s online posts from the website PMSbuddy.com were collected and analysed using a thematic discourse analysis. Results from this study showed that the majority of men positioned premenstrual change as having a detrimental impact upon themselves, their partner and their intimate relationship. Most men constructed the premenstrual phase and women’s premenstrual changes as confusing, complicated and illogical. To make sense of premenstrual change, men drew upon cultural discourses that positioned premenstrual change as a disorder necessitating treatment and premenstrual women as mad, bad and dangerous. Although some men positioned premenstrual change as a natural experience and acknowledged the importance of being empathetic and supportive to their partner premenstrually, such instances were scarce. In the second study, a Foucauldian discourse analysis was used to analyse in-depth interviews conducted with 12 male partners prior to, and following, their participation in a couple-based psychological intervention for moderate-severe premenstrual distress. Results from this study showed that men took up several subject positions in relation to their premenstrual partners, which included: the ‘Naïve Partner’, the ‘Expert’, the ‘Supportive Partner’, the ‘Critical Partner’, the ‘Victim’ and the ‘Knowledgeable Partner’. The majority of men who struggled to make sense of premenstrual change took up the Naïve Partner position. By contrast, a small number of men positioned themselves as ‘experts’ in relation to PMS, constructing premenstrual change as predictable and measurable. All but one of the men positioned their partner’s premenstrual changes as a source of strain in their lives, with a small number of men taking up the Victim position to emphasise their suffering and their unjust experiences. Most of these men also adopted the Critical Partner position, as they focused on the negative aspects of premenstrual change and positioned their partner’s premenstrual distress as disruptive and illegitimate. Following the men’s participation in the couple intervention, most men reported that the intervention helped them to develop an enriched understanding and awareness of their partner’s premenstrual experiences. Through this enriched understanding, men positively redefined their experiences with premenstrual change and further resisted the Victim and Critical Partner position. This resistance enabled men to adopt supportive practices that they claimed to help their partner better cope with premenstrual distress. These findings strengthen the notion that premenstrual change is experienced and negotiated within a relational context, and suggest a need for further research on the impact of partners’ constructions of PMS on women’s premenstrual distress and coping

It's not all bad : women's construction and lived experience of positive premenstrual change

Although premenstrual change is invariably pathologized and described as PMS or PMDD, there is evidence that many women experience premenstrual changes positively. This suggests that premenstrual change is both a lived experience and social construction, which is not inevitably positioned as debilitating or distressing. However, previous research has provided little insight into how and why women construct premenstrual change as positive. Accordingly, the present study used a critical realist epistemology and a material-discursive-intrapsychic model to explore women's construction and lived experience of positive premenstrual change. Drawing on focus groups with 47 women, explanations for positive premenstrual experiences included: 'positive emotional outcomes', 'releasing tension', 'increased attractiveness', 'legitimacy of self-care' and 'indication of menstruation'. Findings not only reinforce reports from previous research that many women experience positive premenstrual changes, but also challenge bio-medical conceptualizations of premenstrual change as inherently negative, with accounts of relational negotiation emphasizing the context-dependent nature of premenstrual change

The Influence of Ethnic and Mainstream Cultures on African Americans’ Health Behaviors: A Qualitative Study

Background: Culture plays an important role in shaping individuals’ health behaviors. This qualitative research examines the relationship between African Americans’ ethnic and mainstream cultures and their health behaviors (i.e., food intake and physical activity). Methods: This study used in-depth semi-structured interview format with a group of 25 African Americans to examine the influence of ethnic and mainstream culture on African Americans’ food intake and physical activity. Thematic analysis was used to identify common themes and patterns related to African Americans’ health behaviors as well as to report these patterns within data. Results: The present study found that African Americans position both their ethnic and mainstream culture as important influences on their health behaviors pertaining to food intake and physical activity. Most participants reported taking advantage of “the best of both worlds” by engaging in picking and choosing healthy behaviors from both cultures to which they belong, and they perceived preparing healthy makeovers as a way to optimize their health. They also identified a range of practical considerations that can facilitate or hinder engagement in healthy eating and physical activity (e.g., affordability, social support). Participants discussed a number of other positive (e.g., resilience, spirituality) and negative (e.g., experience of discrimination) influences on health behaviors. Conclusions: African Americans consider both their ethnic and mainstream cultures important in shaping their health behaviors. These cultural influences need to be understood in the context of other psycho-socio-environmental factors that affect individuals’ health behaviors. The current study has practical implications for designing health promotion programs for African Americans

Parents\u27 experiences of information-seeking and decision-making regarding complementary medicine for children with autism spectrum disorder: A qualitative study

Background: Complementary and alternative medicine and therapies (CAM) are widely used by parents of children with autism spectrum disorder (ASD). However, there is a gap in our understanding of how and why parents of children with ASD make decisions about CAM treatment, and how “evidence” influences their decision-making. The aim of this study was to explore views and perspectives on CAM decision-making among parents of children with ASD in Australia. Methods: Semi-structured interviews were conducted with parents of children with ASD (18 years and under) who were living in Australia. The interviews were digitally recorded, transcribed and then analysed using thematic analysis. Results: Twenty-one parents were interviewed (20 women and one man). The mean age of participants was 43 years, (SD = 5.12 years), the majority of whom were born in Australia (71%), and almost half (43%) had a bachelor degree or higher. Three main themes were identified in the thematic analysis. First theme was ‘Parents’ experiences of researching CAM treatments, the second theme was, “Navigating CAM information and practices”, which comprises of the subthemes: Assessing information on CAM treatments’ What counts as ‘evidence’? and Assessing the impact of CAM treatments on the child - What counts as effective?, and the final theme was, “Creating a central and trustworthy source about CAM”. Across themes parents’ CAM decision-making was described as pragmatic, influenced by time, cost, and feasibility. Parents also reported that information on CAM was complex and often conflicting, and the creation of a centralised and reliable source of information on CAM was identified as a potential solution to these challenges. Conclusion: The development of evidence-based information resources for parents and supporting CAM health literacy may assist with navigating CAM decision-making for children’s with ASD

Patient perspectives on psychological care after bariatric surgery : a qualitative study

Psychological interventions may be effective in improving adherence after bariatric surgery; however, there is limited research on patients' willingness to engage with psychological aftercare. This study aimed to qualitatively explore patient perspectives on psychological services in the bariatric setting. Participants reported believing that psychological care is essential for treatment success and indicated that they wanted support with adjusting to changes in lifestyle, self-identity, and relationships after surgery. Participants suggested that psychological aftercare should be recommended by their medical team and incorporated into standard management after bariatric surgery. These findings can be used to inform the design of services for bariatric surgery patients

Supporting Primary Health Care Providers in Western Sydney Areas of Socio-Economic Disadvantage

General Practitioners working with socially disadvantaged populations face challenges in trying to solve complex health issues and social problems, often in time pressured visits. Western Sydney includes some of the most disadvantaged postcodes in Australia and has some of the highest rates of disease prevalence as well as lowest GP to population ratios. This project is describing the needs of primary health care providers (PHCPs) in these areas, to develop a support model and to evaluate early implementation of this model in order to inform funding bids for ongoing research and support. The longer term aim is to build sustainability of the primary care workforce in order to improve health outcomes and inform the Australian health reform agenda particularly regarding workforce shortages in outer urban disadvantaged areas. The research agreements were executed in October 2014 and the first project report has been received. A second project report is due in July 2015 with the project ending in March 2016

Representations of PMS and premenstrual women in men's accounts : an analysis of online posts from PMSBuddy.com

Representations of premenstrual syndrome (PMS) in Western scientific and popular discourse construct premenstrual change as a disorder and portray premenstrual women as out-of-control, emotionally unstable, and dangerous. Previous research has suggested that the adoption of such constructions of PMS by male partners can have a deleterious influence on women's experiences of premenstrual distress. However, few studies to date have examined constructions of PMS and the function of such constructions within men's talk. Representations of PMS and premenstrual women in men's accounts in the online discussion forum PMSBuddy.com, which appeared between September 2008 and February 2009, were analyzed through a thematic discourse analysis. The majority of accounts positioned negative premenstrual change as a hormonal disorder, an excuse, or a nuisance. Some men described themselves as victimized by their premenstrual partners, and positioned their experiences as unfair and undeserved. A small portion of men talked positively about premenstrual women and emphasized the importance of providing support. These findings suggest that it is important to recognize that PMS is constructed and experienced in a relational context. Cultural and relational constructions of PMS can influence both men and women's experiences of premenstrual change

Parents' experiences of information-seeking and decision-making regarding complementary medicine for children with autism spectrum disorder : a qualitative study

Complementary and alternative medicine and therapies (CAM) are widely used by parents of children with autism spectrum disorder (ASD). However, there is a gap in our understanding of how and why parents of children with ASD make decisions about CAM treatment, and how “evidence” influences their decision-making. The aim of this study was to explore views and perspectives on CAM decision-making among parents of children with ASD in Australia