Colleen Fisher

Changed and Changing Gender and Family Roles and Domestic Violence in African Refugee Background Communities Post-Settlement in Perth, Australia:

In this study, domestic violence (DV) in five African refugee background communities post-settlement in Perth, Australia, is investigated—specifically, the interrelationship between experiences of DV, and changed and changing gender and family roles and responsibilities. The participatory qualitative design utilized in-depth interviews with 54 members of the Somalian, Sierra Leonean, Ethiopian, Liberian and Sudanese Communities, and focus groups with 24 professionals who support them. Three key dimensions of this interrelationship are discussed: “male loss of the breadwinner role and status,” “financial independence,” and “mismatch between formal response and expectations.” The importance of understanding experiences of DV within the context of cultural transition is highlighted here.

Rediscovering nursing: A study of overseas nurses working in Western Australia

The shortage of nurses worldwide has taken its toll on the Australian healthcare system and, as a result, there is an increased migration of overseas-qualified nurses, some of them with a non-English-speaking background. Despite Australias regulations that assess the eligibility for nursing registration, many migrant nurses who have been successful in gaining their nursing license feel only partially prepared to work. This article presents the findings of a study, based on Husserlian phenomenology, that describes the work experience of 13 female nurses who were working in Western Australia, Australia. The participants, who could recognize the core components of nursing, were taken aback by the way that nursing is practised in Western Australia. The major differences that they encountered were related to clinical skills, holistic care, the work dynamic with doctors and patients, and the overall societal status of the nursing profession. As a result, they had to adjust their practice to conform to the new work environment. In this study, the participants elaborated on some positive and some not-so-positive aspects of their experiences in their endeavor to integrate into the Western Australian metropolitan hospital setting.

Participant experiences of mindfulness-based childbirth education: a qualitative study

BackgroundChildbirth is an important transitional life event, but one in which many women are dissatisfied stemming in part from a sense that labour is something that happens to them rather than with them. Promoting maternal satisfaction with childbirth means equipping women with communication and decision making skills that will enhance their ability to feel involved in their labour. Additionally, traditional antenatal education does not necessarily prepare expectant mothers and their birth support partner adequately for birth. Mindfulness-based interventions appear to hold promise in addressing these issues. Mindfulness-based Child Birth Education (MBCE) was a pilot intervention combining skills-based antenatal education and Mindfulness Based Stress Reduction. Participant experiences of MBCE, both of expectant mothers and their birth support partners are the focus of this article.MethodsA generic qualitative approach was utilised for this study. Pregnant women between 18 and 28 weeks gestation, over 18 years of age, nulliparous with singleton pregnancies and not taking medication for a diagnosed mental illness or taking illicit drugs were eligible to undertake the MBCE program which was run in a metropolitan city in Australia. Focus groups with 12 mothers and seven birth support partners were undertaken approximately four months after the completion of MBCE. Audio recordings of the groups were transcribed verbatim and analysed thematically using the method of constant comparison by all four authors independently and consensus on analysis and interpretation arrived at through team meetings.ResultsA sense of both ‘empowerment’ and ‘community’ were the essences of the experiences of MBCE both for mothers and their birth support partner and permeated the themes of ‘awakening my existing potential’ and ‘being in a community of like-minded parents’. Participants suggested that mindfulness techniques learned during MBCE facilitated their sense of control during birth, and the content and pedagogical approach of MBCE enabled them to be involved in decision making during the birth. The pedagogical approach also fostered a sense of community among participants which extended into the postnatal period.ConclusionsMBCE has the potential to empower women to become active participants in the birthing process, thus addressing common concerns regarding lack of control and satisfaction with labour and facilitate peer support into the postnatal period. Further education of health professionals may be needed to ensure that they respond positively to those women and birth support partners who remain active in decision making during birth.

Psychological and social consequences among mothers suffering from perinatal loss: perspective from a low income country

BackgroundIn developed countries, perinatal death is known to cause major emotional and social effects on mothers. However, little is known about these effects in low income countries which bear the brunt of perinatal mortality burden. This paper reports the impact of perinatal death on psychological status and social consequences among mothers in a rural area of Bangladesh.MethodsA total of 476 women including 122 women with perinatal deaths were assessed with the Edinburgh Postnatal Depression Scale (EPDS-B) at 6 weeks and 6 months postpartum, and followed up for negative social consequences at 6 months postpartum. Trained female interviewers carried out structured interviews at womens home.ResultsOverall 43% (95% CI: 33.7-51.8%) of women with a perinatal loss at 6 weeks postpartum were depressed compared to 17% (95% CI: 13.7-21.9%) with healthy babies (p = < 0.001). Depression status were significantly associated with women reporting negative life changes such as worse relationships with their husband (adjusted OR = 3.89, 95% CI: 1.37-11.04) and feeling guilty (adjusted OR = 2.61, 95% CI: 1.22-5.63) following the results of their last pregnancy outcome after 6 months of childbirth.ConclusionsThis study highlights the greatly increased vulnerability of women with perinatal death to experience negative psychological and social consequences. There is an urgent need to develop appropriate mental health care services for mothers with perinatal deaths in Bangladesh, including interventions to develop positive family support.

A review of the information-gathering process for the provision of medicines for self-medication via community pharmacies in developing countries

BACKGROUND Currently, no review has been completed regarding the information-gathering process for the provision of medicines for self-medication in community pharmacies in developing countries. OBJECTIVE To review the rate of information gathering and the types of information gathered when patients present for self-medication requests. METHODS Six databases were searched for studies that described the rate of information gathering and/or the types of information gathered in the provision of medicines for self-medication in community pharmacies in developing countries. The types of information reported were classified as: signs and symptoms, patient identity, action taken, medications, medical history, and others. RESULTS Twenty-two studies met the inclusion criteria. Variations in the study populations, types of scenarios, research methods, and data reporting were observed. The reported rate of information gathering varied from 18% to 97%, depending on the research methods used. Information on signs and symptoms and patient identity was more frequently reported to be gathered compared with information on action taken, medications, and medical history. CONCLUSION Evidence showed that the information-gathering process for the provision of medicines for self-medication via community pharmacies in developing countries is inconsistent. There is a need to determine the barriers to appropriate information-gathering practice as well as to develop strategies to implement effective information-gathering processes. It is also recommended that international and national pharmacy organizations, including pharmacy academics and pharmacy researchers, develop a consensus on the types of information that should be reported in the original studies. This will facilitate comparison across studies so that areas that need improvement can be identified.

Creating a Village in Modern Suburbia: Parenthood and Social Capital

Local communities with good stocks of social capital nurture and support the families residing within. This qualitative study explored through the perspectives of mothers, how families with children aged 0–5 years build social capital in newer residential areas in Perth, Western Australia. Parenthood generally increased the desire to connect to ones local community, which activated and enhanced social capital. Two themes appear to drive this desire: an increased need for social support and an increased vested interest in the local community. However, newer residential areas commonly have a lag of community infrastructure needed to provide opportunities for families with young children to interact with other families. Urban planning and community sectors need to coordinate to provide infrastructure and opportunities for families with young children to connect and build social capital within their local communities.

Small steps: barriers and facilitators to physical health self-management by people living with mental illness

It has been established that people with mental illness experience mortality and morbidity from all the major health conditions at 2–3 times the rate of those without mental illness. One way to overcome this problem is to encourage consumers of mental health services to self-manage their physical health. The purpose of the study was to investigate the facilitators and barriers to physical health self-management by people living with a mental illness. The study was underpinned by a hermeneutic phenomenological framework and utilised focus groups for data collection. A total of 27 participants, who lived in the community, had a diagnosed mental illness and who also had a co-morbid chronic physical health condition were included in one of three focus groups. The collected data were thematically analysed to identify common experiences and difficulties. It was found that participants were well aware of the need to attend to physical health issues. However, a number of factors at the individual, social and system levels impeded their ability to do so. Barriers to self-management included the debilitating nature of mental illness, poor physical health literacy, stigma from medical staff and social isolation, which resulted in a lack of support. Whereas informal peer networks, group participation and where it was offered, the support and encouragement from healthcare professionals facilitated health self-management.

The essence of being connected: the lived experience of mothers with young children in newer residential areas

Parenthood is a significant life transition and a time of increased social support need. In newer residential areas, a lag in social infrastructure and family relocation can influence potential isolation of families with young children. This qualitative study explored the lived experiences of being connected to local communities for mothers with children aged 0–5 years. Family insights were obtained through in-depth interviews with 12 mothers who were primary caregivers, homeowners and living in newer residential areas in outer suburban Perth, Western Australia. For mothers with young children, being connected to the local community appears to be shaped from their past and present lived experience as well as future aspirations. Connectedness evolves and may develop more slowly in newer communities where social relationships and networks are often recently formed. ‘Interaction’, ‘knowing whats going on’ and ‘help is nearby if you need it’ were identified as the essential themes of connectedness for mothers and families in this study. Belonging was identified as an incidental theme as not all mothers who felt connected felt like they belonged. The findings provide insight for professionals and agencies working with families with young children as well as planners of newer residential areas.

A qualitative evaluation of the implementation of guidelines and a support tool for asthma management in primary care

BackgroundAsthma management in Australia is suboptimal. The “Guidelines for provision of a Pharmacist Only medicine: short acting beta agonists” (SABA guidelines) and a novel West Australian “Asthma Action Plan card” (AAP card) were concurrently developed to improve asthma management. The aim of this qualitative research was to evaluate the collaborative, multidisciplinary and multifaceted implementation of these asthma resources and identify the lessons learnt to inform future initiatives.MethodsFeedback was sought about the implementation of the SABA guidelines and the AAP card using focus groups with key stakeholders including pharmacists (×2), pharmacy assistants, asthma educators, general practitioners, practice nurses and people with asthma (patients). Audio recordings were transcribed verbatim. Data were analysed thematically using constant comparison. The common themes identified from the focus groups were categorised according to a taxonomy of barriers including barriers related to knowledge, attitudes and behaviour.ResultsSeven focus group sessions were held with 57 participants. Knowledge barriers were identified included a lack of awareness and lack of familiarity of the resources. There was a significant lack of awareness of the AAP card where passive implementation methods had been utilised. Pharmacists had good awareness of the SABA guidelines but pharmacy assistants were unaware of the guidelines despite significant involvement in the sale of SABAs. Environmental barriers included time and workflow issues and the role of the pharmacy assistant in the organisation workflows of the pharmacy. The attitudes and behaviours of health professionals and patients with asthma were discordant and this undermined optimal asthma management. Suggestions to improve asthma management included the use of legislation, the use of electronic resources integrated into workflows and training pharmacists or practice nurses to provide patients with written asthma action plans.ConclusionsGreater consideration needs to be given to implementation of resources to improve awareness and overcome barriers to utilisation. Attitudes and behaviours of both health professionals and patients with asthma need to be addressed. Interventions directed toward health professionals should focus on skills needs related to achieving improved communication and patient behaviour change.

It has to be fixed: a qualitative inquiry into perceived ADHD behaviour among affected individuals and parents in Western Australia.

BackgroundThe use of stimulant medication for Attention Deficit Hyperactivity Disorder (ADHD) to improve classroom behaviour and sustained concentration is well known. Achieving a better academic grade has been reported as the prime motivation for stimulant use and is an increasingly discussed topic. The proliferation of stimulant use for ADHD has been a cause for public, medical and policy concern in Australia. This paper explores individuals’ perceptions of ADHD, the meaning that the diagnosis carries for them and their attitudes to stimulant medication treatment.MethodsThis qualitative study was underpinned by a social constructivist approach and involved semi-structured interviews with eight participants. The participants were parents of children with ADHD or were adults who themselves had been diagnosed with ADHD. Interviews were audiotaped, transcribed verbatim and thematically analysed.ResultsThere were three interrelated yet contradictory overarching themes: (i) An impairment to achieving success, which can be a double-edged sword, but has to be fixed; (ii) Diagnosis as a relief that alleviates fault and acknowledges familial inheritance; (iii) Responsibility to be normal and to fit in with societal expectations. Collectively, these perceptions and meanings were powerful drivers of stimulant use.ConclusionsPaying attention to perceptions of ADHD and reasons for seeking or not seeking stimulant treatment is important when planning appropriate interventions for this condition.