Using narratives to understand progress in youth alcohol and other drug treatment

Purpose – This paper aims to illustrate how narrative research techniques can be employed to promote greater understanding of young people’s experiences of progress in residential alcohol and other drug treatment. Design/methodology/approach – Narrative inquiry is used to explore client understandings of what characterises progress in treatment for young people attending a residential detoxification and a residential rehabilitation service in Perth, Western Australia. This article focuses on stories of progress collected through in-depth qualitative interviews, observation and participation with clients of the two services, over a five-month period. Findings – Analysis of data revealed that young people were able to vividly describe their progress through treatment, and their drug taking trajectories can be conceptualised along five stages. The authors prepared narrative accounts to illustrate the features characteristic of each stage as identified by the young people. These composite narratives, written from the perspectives of young people, are presented in this article. Practical implications – Clients’ own perceptions of their journeys through drug treatment might enable staff of such services to collaborate with the young person, in shaping and positively reinforcing alternative life-stories; from those of exclusion and disconnection, to narratives of opportunity, inclusion and possibility. Originality/value – Harmful adolescent drug and alcohol use is on the rise in Australia and elsewhere. However, our knowledge of how young people experience progress through residential treatment for substance use is limited. This paper highlights how creating narratives from young people’s own stories of progress can broaden our knowledge of “what works” in residential youth alcohol and other drug treatment services

'You get the quickest and the cheapest stuff you can': Food security issues among low-income earners living with diabetes

Background: Diabetes prevalence is increasing in Australia and worldwide. More than 800,000 Australians live with diabetes, and there are stark inequities in prevalence and clinical outcomes among Indigenous people and low socio-economic groups.The ability to maintain a healthy diet – an essential component of diabetes self-management – is compromised by food availability, accessibility and affordability issues. This paper focuses on food security issues experienced by low-income earners living with type 2 diabetes in Perth, Western Australia. The results presented here are part of a broader qualitative study exploring the impact of socio-economic disadvantage on the experience of diabetes. MethodData were collected through focus groups and semi-structured interviews conducted from October 2008 to November 2009. The sample, comprising 38 participants (Indigenous and non-Indigenous), was recruited from areas with high indices of socio-economic disadvantage in the Perth metropolitan area. Deductive data analysis identified categories from an existing conceptual framework for the relationship between socio-economic position and diabetes health outcomes, while an inductive approach was adopted to identify new themes.ResultsDiet was perceived as the main component of diabetes self-management, and there was a common understanding of the dietary requirements for a person with diabetes. However, access to healthy food was not always realised, as many participants depended on others for food provision and meal preparation and had little control over their diets., and Furthermore, the majority struggled to accommodate the price of healthy food within a limited budget.ConclusionIn this study, low-income earners living with diabetes faced food security issues which limited their ability to implement and sustain recommended dietary changes. Participants reported cost barriers, but also physical barriers relating to functional limitations and lack of transport. This study highlights that the socio-economic circumstances in which the experience of disease of vulnerable populations are embedded need to be understood and addressed in order to reduce the inequities surrounding diabetes outcomes

In search of wellness: Allied health professionals\u27 understandings of wellness in childhood disability services

Purpose. Wellness approaches are not routine in childhood disability services, despite theoretical and empirical support and an increasing demand for them from health consumers and disability activists. We aimed to investigate how health professionals define or understand wellness and its practice in the context of childhood disability. Method. A qualitative, interpretive approach was taken. Semi-structured interviews were conducted with 23 health professionals (allied health therapists and managers) providing early intervention and ongoing therapy within four Australian childhood health and disability services. Years of experience providing services to children with disabilities and their families ranged from 6 months to 30 years (M = 9.41, SD = 9.04). Results.  The data revealed a noteworthy impediment to incorporating wellness into practice – the difficulties in the allied health professionals reaching consensus in defining wellness. There appeared to be distinct differences between the four services, while there appeared to be no appreciable difference based on the individual professional\u27s years of experience or allied health discipline. Conclusions.  The effect of organisational culture should be considered in efforts to embed wellness in childhood health and disability services in order to address client well-being, empowerment, choice, independence and rights to meaningful and productive lives

In search of wellness: Allied health professionals\u27 understandings of wellness in childhood disability services

Purpose. Wellness approaches are not routine in childhood disability services, despite theoretical and empirical support and an increasing demand for them from health consumers and disability activists. We aimed to investigate how health professionals define or understand wellness and its practice in the context of childhood disability. Method. A qualitative, interpretive approach was taken. Semi-structured interviews were conducted with 23 health professionals (allied health therapists and managers) providing early intervention and ongoing therapy within four Australian childhood health and disability services. Years of experience providing services to children with disabilities and their families ranged from 6 months to 30 years (M = 9.41, SD = 9.04). Results.  The data revealed a noteworthy impediment to incorporating wellness into practice – the difficulties in the allied health professionals reaching consensus in defining wellness. There appeared to be distinct differences between the four services, while there appeared to be no appreciable difference based on the individual professional\u27s years of experience or allied health discipline. Conclusions.  The effect of organisational culture should be considered in efforts to embed wellness in childhood health and disability services in order to address client well-being, empowerment, choice, independence and rights to meaningful and productive lives

How safe is sex with condoms? An in-depth investigation of the condom use pattern during the last sex act in an urban area of Bangladesh

The policy of condom intervention is based on achieving ejaculation inside a condom, a "mechanical" goal of sexual interaction. However, most research on condom use has focused upon a simplistic reliance on survey results of condom use during the last sex act. Interviews with 20 hotel-based female sex workers and 15 (male) clients were conducted to explore patterns of claimed condom use during the last sex act. The Health Belief Model guided this study and was found deficient in providing an understanding of condom use. The clients' (male) perceptions of sexuality and "the male's right" to engage in sexual intercourse in commercial settings increased condom use. The invisibility of AIDS reduced participants' perceived susceptibility to and severity of suffering from the disease, while using condoms at any time during intercourse was perceived as being beneficial. Condom interventions need to be based on deeper understanding of the complexity of people's lives

Food Security Issues Among Low-Income Earners Living with Diabetes

Background Diabetes prevalence is increasing worldwide. More than 800,000 Australians live with diabetes, and there are stark inequities in prevalence and clinical outcomes among Indigenous people and low socio-economic groups. Aims This paper focuses on food security issues experienced by low-income earners living with type 2 diabetes in Perth, Western Australia. The results presented here are part of a broader qualitative study exploring the impact of socio-economic disadvantage on diabetes. Method   Data was collected through focus groups and semi-structured interviews conducted from October 2008 to November 2009. The sample, comprising 38 participants (Indigenous and non-Indigenous), was recruited from areas with high indices of socio-economic disadvantage in Perth. Deductive data analysis identified categories from an existing conceptual framework for the relationship between socio-economic position and diabetes health outcomes, while an inductive approach was adopted to identify new themes. Results Participants had a good understanding of their dietary requirements. However, access to healthy food was not always realised, as many participants depended on others for food provision and meal preparation and had little control over their diets. Furthermore, the majority struggled to accommodate the price of healthy food within a limited budget. Conclusion In this study, low-income earners living with diabetes faced food security issues. Participants reported cost barriers, but also physical barriers relating to functional limitations and lack of transport. This study highlights that the socio-economic circumstances in which vulnerable populations experience their disease need to be understood and addressed in order to reduce the inequities surrounding diabetes outcomes.