Mridula Bandyopadhyay

Lived experience of gestational diabetes mellitus among immigrant South Asian women in Australia.

Background:  Women from South Asia have a high incidence of gestational diabetes mellitus (GDM) placing them at risk of adverse pregnancy outcomes. Despite the higher rates of GDM in this group, there are no studies of their experiences of living with GDM in Australia or elsewhere.

Perils and possibilities: achieving best evidence from focus groups in public health research

Objective: Focus group research is often seen as a cost‐effective way of gathering evidence from multiple research participants about the diversity of their views, experiences or beliefs. Our objective is to argue that focus group research only fulfils its potential if analysis of individual views is extended to include analysis of interaction between participants, so that we learn more why people hold these views.

Life with a new baby: how do immigrant and Australian-born women's experiences compare?

Objective: Little is known about immigrant mothers’ experiences of life with a new baby, apart from studies on maternal depression. Our objective was to compare the post‐childbirth experiences of Australian‐born and immigrant mothers from non‐English speaking countries.

Day Surgery in Australia Qualitative Research Report

The article explores the experiences of patients undergoing day surgery in an Australian public hospital for women. We draw primarily on interviews with these patients to identify the factors arising from the specific context which compromised their well-being.

Tackling complexities in understanding the social determinants of health: the contribution of ethnographic research

ObjectiveThe complexities inherent in understanding the social determinants of health are often not well-served by quantitative approaches. My aim is to show that well-designed and well-conducted ethnographic studies have an important contribution to make in this regard. Ethnographic research designs are a difficult but rigorous approach to research questions that require us to understand the complexity of people’s social and cultural lives.ApproachI draw on an ethnographic study to describe the complexities of studying maternal health in a rural area in India. I then show how the lessons learnt in that setting and context can be applied to studies done in very different settings.ResultsI show how ethnographic research depends for rigour on a theoretical framework for sample selection; why immersion in the community under study, and rapport building with research participants, is important to ensure rich and meaningful data; and how flexible approaches to data collection lead to the gradual emergence of an analysis based on intense cross-referencing with community views and thus a conclusion that explains the similarities and differences observed.ConclusionWhen using ethnographic research design it can be difficult to specify in advance the exact details of the study design. Researchers can encounter issues in the field that require them to change what they planned on doing. In rigorous ethnographic studies, the researcher in the field is the research instrument and needs to be well trained in the method.ImplicationEthnographic research is challenging, but nevertheless provides a rewarding way of researching complex health problems that require an understanding of the social and cultural determinants of health.

Introduction to COMPASS: navigating complexity in public health research

An increasing emphasis on the social determinants of health, a more complicated technological and global world and an understanding that human societies can be conceived as complex adaptive systems, have led public health scholars to take an interest in the science of complexity. Complexity science has been described as the study of complex adaptive systems to see ‘the patterns of relationships within them, how they are sustained, how they self organise and how outcomes emerge’ ([1], p. 3). National or local communities, community health services, general practices and public hospitals embedded in political, economic and cultural contexts all act as complex adaptive systems and shape the behaviours of health care professionals, citizens and patients in sometimes unpredictable ways. Complex adaptive systems are characterised by ‘non-linearities and discontinuities, aggregate macroscopic patterns rather than causal microscopic events, probabilistic rather than deterministic outcomes and predictions, change rather than stasis’ [2]. The Organisation for Economic Cooperation and Development (OECD) held a global science forum in 2008 that explored the application of complexity science for public policy, drawing an important distinction between complicated systems (such as a car) whose interactions obey precise and knowable rules and for which traditional scientific methods are well suited, and complex systems (e.g. traffic) in which non-linear and collective patterns of behaviour are less predictable [2]. The new interest in complexity science in public health led to an acknowledgement that the more traditional public health methods would need stretching. Better techniques would be needed to explore the adaptability of health care systems and the web of sometimes unpredictable social and economic relations impacting on the resilience or vulnerability of people and communities, and the complex patterns of behaviours that can sustain good health. The COMPASS multi-disciplinary team of public health scholars have expanded their methods and debated the challenges in addressing complexity in the diversity of studies around women’s health presented in this Special Supplement. COMPASS was funded by the Australian National Health and Medical Research Council (NHMRC) public health research capacity building program to build research capacity for addressing complex questions, settings, interventions and population groups for public health benefit. This special COMPASS supplement of BMC Public Health ‘Navigating Complexity in Public Health Research’ charts the lessons the author investigators in the COMPASS group learnt when conducting research in women’s health, particularly the myriad factors affecting maternal health in culturally diverse, contemporary Australian society. Emerging papers were presented at a special forum in Melbourne on 25th November 2010 where invited discussants responded to the issues raised in each paper and contributed their own insights. The papers presented here reflect the outcomes of these fruitful dialogues. The Supplement opens with a short reflective piece addressing the most pressing public health problem in Australia today – that of Aboriginal and Torres Strait Islander health [3]. Beginning at the complex intersection of political history and dispossession with gender and maternal mental health, Tanya Koolmatrie’s methodological reflection discusses the need for treading gently along the research pathway when setting out as both an Insider and Outsider on an Indigenous research journey. Next, as ethics are a foundation for rigorous public health research, Victoria Palmer and colleagues confront conceptual complexity in ethical practice [4]. Their paper debates the inherent methodological paradoxes and ethical tensions in the use of ‘screening’ as a recruitment method for psychosocial intervention studies among vulnerable populations. They discuss how the application of relational ethics to supplement more traditional ethical paradigms sheds light on the dynamics of the inherent social relations between researchers and participants, and contributes to more comprehensive ethical assessment of complex public health studies. Rhonda Small and colleagues problematise the concept of ‘social support’ and elicit the lessons from two pragmatic community trials which aimed to implement and evaluate differing approaches to social support and augmenting community networks for mothers [5]. These social ecological interventions were conducted where the overlapping and competing needs of the health care and community systems shaping the work patterns of health care professionals met with the needs of individual mothers. The paper discusses the challenges of achieving health enhancing social connections and why these two interventions had limited success. The paper by Karalyn McDonald and colleagues focuses debate on the conceptual complexity of ‘risk’ surrounding decision-making when women are pregnant or breastfeeding - ‘the maternal body’ [6]. The authors tease out the tension inherent in public health research between the risks and benefits of medicines from varying stakeholder standpoints and perceptions of the competing needs of the mother, the developing fetus and the baby. Mridula Bandyopadhyay’s paper illustrates the valuable contribution ethnography makes when more structured methods cannot explain unanticipated consequences of health care system reform to reduce maternal mortality in low income countries [7]. She shows how methodological rigour can be retained; and how methods to uncover emergent social and cultural explanations for ‘non-compliant’ behaviours are potentially transferable from the complex low income country context of maternal health care in West Bengal India, to the care of pregnant South Asian women with gestational diabetes in Australia, if sensitivity to context and flexibility in method can be exercised. The complexity of research involving multiple relationships, far-reaching collaborations, divergent expectations and various outcomes is highlighted in the paper by Fiona Bruinsma and colleagues [8]. In a retrospective cohort study undertaken to understand the health and psychosocial effects of treating tall adolescent girls with high doses of synthetic oestrogens, the authors describe the methodological complexity involving the maintenance of multiple relationships and collaborations with clinicians and the women treated as adolescent girls. The paper offers guidance to maintaining rigour in the complex politics of long term follow-up studies in public health. The final paper by Della Forster and colleagues is situated in the complex setting of maternity care [9]. The authors reflect on why a model of midwife-led care provision shown to have positive outcomes in a randomised controlled trial was not retained following the trial, and seek to elucidate reasons for the lack of the model’s sustainability. They contrast this with a more recent trial of a different midwife-led model in the same setting which is continuing after the trial’s cessation. The authors argue that Normalisation Process Theory can inform research evaluation design to take all aspects of the context, including midwives’ working conditions into account during the evaluation of interventions, and that this may help in understanding what will sustain behaviour and organisational change in the complex and dynamic context of hospital-based maternity care. COMPASS brought together a group of early to mid career researchers for five years to work on addressing questions of complexity in their research undertakings. This Special Supplement is one outcome of our collective endeavours. We hope readers will find useful insights which will contribute to a stronger understanding of how public health research can utilise ‘new tools for finding unanticipated consequences and unrealised opportunities’ in increasingly complex global public health systems for the health benefit of populations [1].

Ethical review and the assessment of research proposals using qualitative research methods

AbstractThe role of Human Research Ethics Committees (HRECs) in health research is well established. Ethics committees have the good of research participants in mind but they must also assess scientific merit including the design and conduct of studies. In this article the authors’ focus is on qualitative research method and the challenge that the National Statement on Ethical Conduct in Human Research (2007) poses for ethics committees when they assess proposals using the methods outlined in the National Statement.We set out a process for judging the standard of qualitative research proposals and propose that qualitative health research can be assessed using a hierarchy designed for evaluating interview studies. We contrast well-designed studies with those that have design flaws in order to focus on the hallmarks of research merit in studies that use qualitative research methods. Finally, we show that our proposal is compatible with the National Statement.Ethics review provides an early opportunity to identify and redesign inadequate studies that will not contribute to our knowledge base. The challenge for members of ethics committees with little experience in qualitative studies is to be able to assess research excellence by assessing research merit in proposals, recognising the special design features of qualitative research methods.

An evaluation of dietary intakes of a selected group of South Asian migrant women with gestational diabetes mellitus

BACKGROUND Women of South Asian descent have an increased risk of developing gestational diabetes mellitus (GDM), and type 2 diabetes mellitus compared to Caucasian women. Dietary advice provided by health practitioners to this group has been found to be culturally inappropriate. The aim of this study was to describe the dietary intakes of South Asian women with gestational diabetes and use this information to develop culturally appropriate dietary models for education and support of dietary management. METHOD An in-depth diet and lifestyle survey was administered with 13 eligible women. Dietary histories were collected for pre-pregnancy, during pregnancy and post-GDM diagnosis to evaluate changes in dietary intake, diet and health beliefs and traditional foods consumed during pregnancy. RESULTS The diets of participants did not meet nutrient requirements for pregnancy; specific areas on concern were dietary fibre, calcium, iron, folate and iodine. Vegetarians were particularly at risk with regards to energy and protein intake. Generally dietary intakes of these women with GDM were not consistent with guidelines for management of GDM. Confusion about what they should eat for GDM, health practitioner advice and conflict with cultural expectations about foods to consume during pregnancy was evident. CONCLUSION The dietary information collected from these women was used to model sample menus for GDM that were culturally appropriate and consistent with vegetarian and non-vegetarian eating patterns.

Domestic goddesses: maternity, globalization and middle-class identity in contemporary India

In this book, Henrike Donner critically explores and analyses the lived experiences of everyday lives of middle-class Hindu Bengali women in contemporary Calcutta (Kolkata), India. She examines shifts in women’s experiences of marriage, motherhood, conjugal relationships, family values and kinship in the context of globalisation, India’s liberalisation policies, neo-liberal ideologies and socio-economic change. The manuscript is based on extensive fieldwork conducted over a 10-year period – between 1995 and 2005 – (including a three-year immersion and several short stays) in a central Calcutta neighbourhood and different south Calcutta localities, where she followed her key informants, belonging to different generations, and their families to gain an insider’s perspective on urban, middle-class, women’s everyday lives. The Introduction entices readers with its opening anecdote of the Congress Party’s women’s group meeting in 1995 seamlessly transporting us into the middle-class home and living room of one of Donner’s research subjects, where women have gathered to discuss their ‘case’. We witness women’s concerns, anxiety relating to the ‘case’ and curiosity of finding a white female researcher conducting a ‘survey’ in their midst. Here, Donner demonstrates her critical awareness of her own positioning in the fieldwork process and the relationships between the researcher and research subjects. She relates how women felt uncomfortable when she had brought these ‘Bengali girls’ (23) – local research assistants – with her. Women were comfortable talking to Donner when she visited them on her own, as she had no likely association with their daily lives and community. In this chapter, Donner presents a bird’s eye view of the neighbourhoods where she conducted her fieldwork and presents a brief history of middle-class bhadrolok, the gendered city, liberalisation and rapid urban transition in India and also discusses methodological issues. Chapter 1, ‘Middle-class Domesticities and Maternities’, is devoted to theoretical discussions and debates on motherhood, reproduction, kinship and family values and provides a good synopsis of these discourses. A succinct description is presented about what reproduction meant in the colonial period and new discourses are explored on maternal health, middle-class identity and gender in the context of globalisation. Theoretical discussion on motherhood, an analysis of how motherhood is constructed and understood by Indian middle-class women and how it encompasses their lives makes for an interesting debate. Donner examines how these discourses and practices surrounding motherhood relate to power relations in the wider society and how it reflects socio-economic change in the context of globalisation, liberalisation and the neo-liberal ideologies reproduced in urban middle-class setting. Chapter 2, ‘Of Love, Marriage and Intimacy’, discusses and examines middle-class concerns relating to ‘love’ marriage and arranged marriages and what are suitable spouses.