Lareen Ann Newman

'I could never do that before': effectiveness of a tailored Internet support intervention to increase the social participation of youth with disabilities.

BACKGROUND Youth use the Internet for a variety of purposes including social networking. Youth with disabilities are limited in their social networks and friendships with peers. The aim was to investigate the effectiveness of tailored one-on-one support strategies designed to facilitate social participation of youth with disabilities through the use of the Internet for social networking. METHODS Eighteen youth aged 10-18 years with cerebral palsy, physical disability or acquired brain injury received support, training and assistive technology at their home to learn to use the Internet for building social networks. The Canadian Occupational Performance Measure (COPM) and Goal Attainment Scale (GAS) were used to evaluate objective changes in performance and satisfaction. Interviews with the youth identified subjective changes they experienced through participation in the programme and to determine whether and how the intervention influenced their social participation. RESULTS Youth showed an increase in performance and satisfaction with performance on identified goals concerning social networking on the COPM; Paired T-test showed that these differences were statistically significant at P < 0.001. GAS T-scores demonstrated successful outcomes (>50) for 78% of the youth. Interviews showed that youth were positive about the benefits of hands-on training at home leading to increased use of the Internet for social networking. CONCLUSIONS The Internet could be a viable method to facilitate social participation for youth with disabilities. Youth identified the benefits of one-to-one support at home and training of the family compared with typical group training at school. Despite its success with this group of youth, the time and effort intensive nature of this approach may limit the viability of such programmes. Further longitudinal research should investigate whether Internet use is sustained post intervention, and to identify the factors that best support ongoing successful and safe use.

Digital technology use among disadvantaged Australians: implications for equitable consumer participation in digitally-mediated communication and information exchange with health services

OBJECTIVE To present research findings on access to, and use of, digital information and communication technologies (ICTs) by Australians from lower income and disadvantaged backgrounds to determine implications for equitable consumer access to digitally-mediated health services and information. METHODS Focus groups were held in 2008-09 with 80 residents from lower income and disadvantaged backgrounds in South Australia, predominantly of working- and family-formation age (25 to 55 years). Qualitative analysis was conducted on a-priori and emergent themes to describe dominant categories. RESULTS Access to, and use of, computers, the Internet and mobile phones varied considerably in extent, frequency and quality within and across groups due to differences in abilities, resources and life experience. Barriers and facilitators included English literacy (including for native speakers), technological literacy, education, income, housing situation, social connection, health status, employment status, and trust. Many people gained ICT skills by trial and error or help from friends, and only a few from formal programs, resulting in varied skills. CONCLUSION The considerable variation in ICT access and use within lower income and disadvantaged groups must be acknowledged and accommodated by health initiatives and services when delivering digitally-mediated consumer-provider interaction, online health information, or online self-management of health conditions. If services require consumers to participate in a digitally-mediated communication exchange, then we suggest they might support skills and technology acquisition, or provide non-ICT alternatives, in order to avoid exacerbating health inequities.

“Never mind the logic, give me the numbers”: Former Australian health ministers' perspectives on the social determinants of health

The articulation of strong evidence and moral arguments about the importance of social determinants of health (SDH) and health equity has not led to commensurate action to address them. Policy windows open when, simultaneously, an issue is recognised as a problem, policy formulation and refinement happens and the political will for action is present. We report on qualitative interviews with 20 former Australian Federal, State or Territory health ministers conducted between September 2011 and January 2012 concerning their views about how and why the windows of policy opportunity on the SDH did or did not open during their tenure. Almost all ex-health ministers were aware of the existence of health inequalities and SDH but their complexity meant that this awareness rarely crystalised into a clear problem other than as a focus on high needs groups, especially Aboriginal people. Formulation of policies about SDH was assisted by cross-portfolio structures, policy entrepreneurs, and evidence from reviews and reports. It was hindered by the complexity of SDH policy, the dominance of medical power and paradigms and the weakness of the policy community advocating for SDH. The political stream was enabling when the general ideological climate was supportive of redistributive policies, the health care sector was not perceived to be in crisis, there was support for action from the head of government and cabinet colleagues, and no opposition from powerful lobby groups. There have been instances of Australian health policy which addressed the SDH over the past twenty five years but they are rare and the windows of opportunity that made them possible did not stay open for long.

Vicious cycles: digital technologies and determinants of health in Australia

Digital technologies are increasingly important as ways to gain access to most of the important social determinants of health including employment, housing, education and social networks. However, little is known about the impact of the new technologies on opportunities for health and well-being. This paper reports on a focus group study of the impact of these technologies on people from low socio-economic backgrounds. We use Bourdieus theories of social inequities and the ways in which social, cultural and economic capitals interact to reinforce and reproduce inequities to examine the ways in which digital technologies are contributing to these processes. Six focus group discussions with 55 people were held to examine their access to and views about using digital technologies. These data are analysed in light of Bourdieus theory to determine how peoples existing capitals shape their access to and use of digital technologies and what the implications of exclusion from the technologies are likely to be for the social determinants of health. The paper concludes that some people are being caught in a vicious cycle whereby lack of digital access or the inability to make beneficial use reinforces and amplifies existing disadvantage including low levels of reading and writing literacy. The paper concludes with a consideration of actions health promoters could take to interrupt this cycle and so contribute to reducing health inequities.

How Parenthood Experiences Influence Desire for More Children in Australia: A Qualitative Study

The low-fertility debate in developed countries has focused on the limits to family size posed by the financial costs of raising children, and difficulties combining work and family. Little attention has been given to the physical and socio-psychological experiences of conception, pregnancy, birth and early parenthood, and their potential effect on parity progression. Womens rising education and workforce participation rates are often seen as key factors in fertility decline, offering attractive alternatives to motherhood, but research suggests that they also undermine levels of knowledge, confidence and interest in motherhood. Demographers have made almost no link between people having fewer children than they might otherwise have had and their previous childbearing and childrearing experiences. Interviews conducted in South Australia in 2003–04 with parents of both small and large families show that fertility and family size are influenced both negatively and positively by experiences of having had children. The paper argues that if low fertility rates are to be stabilized or raised in developed countries, then researchers and policymakers must consider the physical and socio-psychological costs of having children for parents, and provide support mechanisms so that experiences of parenthood contribute as little as possible to fertility gaps and delayed fertility.

Digital Technology Access and Use among Socially and Economically Disadvantaged Groups in South Australia

This paper explores digital technology access and use (computers, Internet and mobile phones) among lower income and disadvantaged groups in Australia. It reports focus group research which identified wide differences in frequency and quality of use, and in skills, confidence and trust. It identifies pathways to digital use (or non-use) related to existing socioeconomic inequities which mean that lack of (or limited) digital access or use creates further barriers to improving the underlying determinants of that use. Technological solutions to the digital divide must therefore be accompanied by a broader digital inclusion approach.

Why planned attended homebirth should be more widely supported in Australia

This article argues that the continuing reluctance on the part of professional and bureaucratic bodies in Australia to provide for and support planned attended homebirth for low‐risk women is unfounded according to the research evidence. It also suggests that such lack of support might be encouraging some planned but intentionally unattended homebirths to occur in Australia, particularly as in recent years there appears to have been an increase in popularity in freebirth (or do‐it‐yourself homebirth). The article calls for RANZCOG and Australian state health departments to support planned attended homebirth for low‐risk women in the face of what is now a considerable amount of evidence showing its safety, when compared with unplanned homebirth and hospital birth. The article raises a number of challenging issues for obstetricians, midwives and managers or planners of maternity services.

Childbirth traditions and cultural perceptions of safety in Nepal: Critical spaces to ensure the survival of mothers and newborns in remote mountain villages

OBJECTIVE to uncover local beliefs regarding pregnancy and birth in remote mountainous villages of Nepal in order to understand the factors which impact on womens experiences of pregnancy and childbirth and the related interplay of tradition, spiritual beliefs, risk and safety which impact on those experiences. DESIGN this study used a qualitative methodological approach with in-depth interviews framework within social constructionist and feminist critical theories. SETTING the setting comprised two remote Nepalese mountain villages where women have high rates of illiteracy, poverty, disadvantage, maternal and newborn mortality, and low life expectancy. Interviews were conducted between February and June, 2010. PARTICIPANTS twenty five pregnant/postnatal women, five husbands, five mothers-in-law, one father-in-law, five service providers and five community stakeholders from the local communities were involved. FINDINGS Nepalese women, their families and most of their community strongly value their childbirth traditions and associated spiritual beliefs and they profoundly shape womens views of safety and risk during pregnancy and childbirth, influencing how birth and new motherhood fit into daily life. These intense culturally-based views of childbirth safety and risk conflict starkly with the medical view of childbirth safety and risk. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE if maternity services are to improve maternal and neonatal survival rates in Nepal, maternity care providers must genuinely partner with local women inclusive of their cultural beliefs, and provide locally based primary maternity care. Women will then be more likely to attend maternity care services, and benefit from feeling culturally safe and culturally respected within their spiritual traditions of birth supported by the reduction of risk provided by informed and reverent medicalised care.

Improving access to health information for older migrants by using grounded theory and social network analysis to understand their information behaviour and digital technology use

Migrant well-being can be strongly influenced by the migration experience and subsequent degree of mainstream language acquisition. There is little research on how older Culturally And Linguistically Diverse (CALD) migrants who have ‘aged in place’ find health information, and the role which digital technology plays in this. Although the research for this paper was not focused on cancer, we draw out implications for providing cancer-related information to this group. We interviewed 54 participants (14 men and 40 women) aged 63–94 years, who were born in Italy or Greece, and who migrated to Australia mostly as young adults after World War II. Constructivist grounded theory and social network analysis were used for data analysis. Participants identified doctors, adult children, local television, spouse, local newspaper and radio as the most important information sources. They did not generally use computers, the Internet or mobile phones to access information. Literacy in their birth language, and the degree of proficiency in understanding and using English, influenced the range of information sources accessed and the means used. The ways in which older CALD migrants seek and access information has important implications for how professionals and policymakers deliver relevant information to them about cancer prevention, screening, support and treatment, particularly as information and resources are moved online as part of e-health.

Learning to use the Internet and online social media: What is the effectiveness of home-based intervention for youth with complex communication needs?

Youth with complex communication needs (CCN) face increased barriers to their social participation due to limited communication abilities and opportunities. Youth today use the internet as a social tool and youth with CCN may also benefit from internet use to increase their social participation. Five youth between the ages of 10–18 with CCN who are unable to use speech for everyday communication and require augmentative and alternative communication were provided with assistive technology and a tailored 1:1 intervention at home to learn to use the internet for connecting with others. Pre and post assessments measured changes in performance on internet use goals, social networks, loneliness and self-concept. Multiple measures were used to examine the impact of internet use for social networking on a range of outcomes and to gather emerging evidence in this area. Results showed that the intervention was effective in increasing performance and satisfaction with goals for increasing internet use to connect with others and for increasing the number of online communication partners. There was no significant change in loneliness or self-concept. This study shows that the internet may be a viable tool in increasing the social participation of youth with CCN. However, some youth and their families required intensive support and technical assistance to gain confidence in internet use and in use for social purposes.