Fran Baum

Participatory action research

This glossary aims to clarify some of the key concepts associated with participatory action research.

Researching public health: Behind the qualitative-quantitative methodological debate

Debates about appropriate methodologies for studying public health problems have tended to be polarized. Traditionalists, advocating the use of epidemiology and other methods drawn from a reductionist research tradition have tended to devalue the potential contribution of more interpretive research methods. Those advocating the use of more qualitative methods have often established the legitimacy of these methods by criticising the contribution of quantitative techniques. These debates often mask more fundamental differences in epistemology and approaches to dealing with the issues of power raised by research which aims to be compatible with the philosophy of the new public health. This paper argues that these underlying issues are crucial to contemporary public health debates and the methods are simply tools that are used to further knowledge and have no inherent status as sound or unsound. Public health problems result from complex social, economic, political, biological, genetic and environmental causes. A range of methods are needed to tackle these and public health researchers are most effective when they are eclectic in their choice of methods.

Epidemiology of participation: an Australian community study

STUDY OBJECTIVE To determine the levels of participation in social and civic community life in a metropolitan region, and to assess differential levels of participation according to demographic, socioeonomic and health status. To contribute to policy debates on community participation, social capital and health using these empirical data. DESIGN Cross sectional, postal, self completed survey on health and participation. SETTING Random sample of the population from the western suburbs of Adelaide, the capital city of South Australia, a population of approximately 210 000. PARTICIPANTS 2542 respondents from a sample of 4000 people aged 18 years and over who were registered on the electoral roll. MAIN RESULTS The response rate to the survey was 63.6% (n=2542). Six indices of participation, on range of social and civic activities, with a number of items in each, were created. Levels of participation were highest in the informal social activities index (46.7–83.7% for individual items), and lowest in the index of civic activities of a collective nature (2.4–5.9% for individual items). Low levels of involvement in social and civic activities were reported more frequently by people of low income and low education levels. CONCLUSIONS Levels of participation in social and civic community life in an urban setting are significantly influenced by individual socioeconomic status, health and other demographic characteristics. An understanding of the pattern of participation is important to inform social and health policy making. Increasing levels of participation will reduce social exclusion and is likely to improve the overall quality of community life.

Involvement in civil society groups: Is it good for your health?

Study objective: To determine the involvement in civil society groups (CSGs) and the impact of this on health. Design: Case study, cross sectional, self completion questionnaire, and semi-structured interviews. Setting: Residents in two suburbs in Adelaide, South Australia. Participants: Every household (1038) received a questionnaire asking the adult with the next birthday to complete it. A total of 530 questionnaires were returned. Sixteen questionnaire respondents were also interviewed. Main results: 279 (53%) questionnaire respondents had been involved in a CSG in the past 12 months, 190 (36%) in locally based CSGs, and 188 (35%) in CSGs outside the area. Eleven of the 16 interviewees had been involved in a CSG. A path analysis examined the relation between demographic variables, CSG involvement, and mental and physical health, as measured by the SF-12. Physical health was negatively associated with CSG involvement and older age, and positively associated with working full time or part time and higher education level. Mental health was positively associated with older age, working full time or part time, and higher income but negatively associated with having a child under 18, speaking a language other than English and higher education level. Very few interviewees made a direct link between CSGs and positive individual health outcomes, though some positive community level outcomes were noted. More consistent were reports of the detrimental effects of CSG involvement on mental and physical health. Conclusions: Involvement in CSGs was significant but not always positive for health. It is possible that CSG involvement is good for a community but not necessarily for the individual.

Do perceived neighbourhood cohesion and safety contribute to neighbourhood differences in health

This paper reports on a survey (N=3344) and in-depth interviews (N=80) from four socio-economically contrasting postcode areas in Adelaide. Logistic regression was used to examine locational differences in self-rated health, controlling for demographic, socio-economic factors, health behaviours, individual social capital (social networks, support, reciprocity, trust) and perceived neighbourhood cohesion and safety. Statistically significant locational differences in health emerged. Perceived neighbourhood cohesion and safety accounted for this difference. Interviews explored perceptions of cohesion and safety and found that they were intricately related and varied between the areas. The implications of the findings for understanding locational differences in health are discussed.

Changes Not for the Fainthearted: Reorienting Health Care Systems Toward Health Equity Through Action on the Social Determinants of Health

Entrenched poor health and health inequity are important public health problems. Conventionally, solutions to such problems originate from the health care sector, a conception reinforced by the dominant biomedical imagination of health. By contrast, attention to the social determinants of health has recently been given new force in the fight against health inequity. The health care sector is a vital determinant of health in itself and a key resource in improving health in an equitable manner. Actors in the health care sector must recognize and reverse the sectors propensity to generate health inequity. The sector must also strengthen its role in working with other sectors of government to act collectively on the deep-rooted causes of poor and inequitable health.

Social capital and health in rural and urban communities in South Australia.

Objective : This paper seeks to compare the relationships between social capital and health for rural and urban residents of South Australia.

Sleep difficulties, pain and other correlates.

Abstract. A multiple regression analysis was used with variables relevant to sleeping problems from a large community health survey in South Australia. The variables that were found to be most strongly correlated with sleep problems were, in order of importance, pain, anxiety, age, somatic health and annual household income, all of which accounted for 22% of the variance. Weight problems, depression and sex of the respondent were not so important in this analysis. Arthritis, which often increases with age, appeared to be most strongly associated with pain, explaining in part why sleeping problems increase with age. Anxiety, pain and poor somatic health were most strongly associated with lying awake at night or sleeping badly, and anxiety and pain were most strongly correlated with taking longer to get to sleep. Poor somatic health and anxiety were most strongly associated with waking early, and age and pain were the most important variables in taking tablets to aid sleep.

Challenging the Stigma of Public Housing: Preliminary Findings from a Qualitative Study in South Australia

Many poor suburbs in Australia with higher than average numbers of public housing tenants do not simply suffer material disadvantage but also suffer from poor reputations that are reinforced though stigmatising assumptions that portray their residents negatively. Preliminary findings from qualitative research undertaken in Adelaide, South Australia paint a somewhat different picture of some residents in public housing which counters such stereotypes and assumptions and suggests that the picture is not as bleak as the stigmatised accounts suggest. This article examines the ways in which residents in stigmatised suburbs and housing actively resist and challenge the negative image ascribed to them and concludes by considering the public policy implications that come from the research.

The Devil's Advocate: A Strategy to Avoid Groupthink and Stimulate Discussion in Focus Groups

The focus group is an increasingly popular qualitative research method in health research to gain insight into complex problems. Concerns have been expressed about how best to stimulate free and open discussion; especially on controversial issues and/or when the group comprises people with different power and status. A potential pitfall of the focus group technique is group-think: the impact of censoring and conforming as described by such social psychologists as Irving Janis. The article describes an evaluation of a method to reduce groupthink and stimulate creativity and controversy in focus groups that analyzed consultation between an Australian federal government department and its communities. The article recommends to researchers using focus groups the selective use of devils advocates to reflect different perspectives to groups, to ask questions in a different way, to introduce new questions, and to avoid groups arriving at premature solutions.