Narelle Warren

How feasible are healthy eating and physical activity for young women

OBJECTIVE This study investigated young womens perceptions of the feasibility of physical activity and healthy eating behaviours, and how these vary by socio-economic status, domestic characteristics and weight status. DESIGN This population-based study used a mailed questionnaire to investigate perceptions of the feasibility of commonly recommended healthy eating and physical activity behaviours among a sample of young women. The feasibility of 29 physical activity behaviours (e.g. relating to frequency, intensity, duration, domain/setting) and 15 healthy eating behaviours (e.g. relating to location/setting, fruit and vegetable intake, fat/sugar intake) was assessed. Height, weight and sociodemographic details were also obtained. SETTING Nation-wide community-based survey. SUBJECTS A total of 445 women aged 18-32 years selected randomly from the Australian electoral roll. RESULTS Most women reported that they either were already engaged in many of the healthy eating behaviours or saw these as highly feasible. Many physical activity behaviours, on the other hand, were perceived as less feasible, particularly among women with children and women who were overweight. CONCLUSIONS Health promotion messages and strategies aimed at increasing physical activity and healthy eating are unlikely to succeed unless they take into account perceptions that these behaviours are not feasible. For young women, this may involve promoting more time-effective, flexible ways of achieving recommended physical activity. Messages specifically targeted to women with children, and women who are overweight, are required.

Endurance and contest: Women's narratives of endometriosis

Endometriosis is an often painful medical condition in which, in response to hormones associated with the menstrual cycle, the uterine lining grows in the peritoneum and other organs, bleeding into the surrounding organs and tissues. Diagnosis is not always straightforward, and women and health professionals alike may have difficulties recognizing period pain as a sign of anomaly, considering it instead as an inevitable part of menstruation. This article describes the illness narratives of Australian women with endometriosis, drawing on data collected during a study conducted in Victoria in 2004—5. Thirty women (aged 20—78 years) from various socio-demographic backgrounds participated in in-depth interviews. We explore the influence of socio-demographic background and social and family norms on womens illness narratives of endurance and contest. Narratives of endurance are characterized by the normalization of period pain by young women, their families and health professionals, and, with diagnosis, long-term exposure to biomedical treatments. In contrast, narratives of contest are dominated by how womens subjective experience is challenged by doctors, their requirements for a patient-centered approach, and their desire to have access to complementary treatments.

Constructing Hope : Dis/continuity and the Narrative Construction of Recovery in the Rehabilitation Unit

Hope and recovery are focal narratives within rehabilitation discourse, which is characterized by its goal of returning physical functioning to individuals in a way reminiscent of their pre-impairment ways of life. Rehabilitation is concerned with coming to terms with often devastating bodily disruption and learning strategies to minimize it. Rehabilitation provides individuals with skills and tools designed to enable them to return to their former life. This discourse of “return to normal” is problematic for elderly or seriously ill patients, whose bodily disruption often occurs toward the end of a phase characterized by an extended period of ill-health and/or disease, and whose embodied experiences directly challenge the rehabilitative discourse. For these patients, the projected future is usually short-term and features decreasing levels of function and participation because of their health status. We explore the disjuncture between rehabilitative discourse constructed by and within the multidisciplinary clinical team and lived experiences for elderly people who have undergone amputation.

Circuit Breaking: Pathways of Treatment Seeking for Women With Endometriosis in Australia

Pain resulting from endometriosis is experienced as both a chronic, ongoing condition and an acute episode at time of menstruation, often occurring in association with diarrhea, vomiting, nausea, heavy bleeding, and other reactions. Women expect pain with menstruation, however, and even if they experience major disruptions as a result, they find it difficult to distinguish normal from pathological discomfort. Drawing on qualitative research conducted from 2004 to 2006, we describe the “circuit breakers” that lead Australian women to seek medical advice. These include outside intercession, major disruptions to everyday life, changes in embodied experience, and difficulties in conception and pregnancy. Womens ideas of menstrual pain as “normal” are shared by doctors, resulting in further delays before a definitive diagnosis of endometriosis is made. During this time, women move between doctors and in and out of medical care, which they described through particular narrative styles to highlight the complexity of help seeking. We explore the ways in which ideas of gender, informed by womens embodiment but also the quality of their reporting of symptoms, influence their interactions with health professionals.

The Art of (Re)Learning to Walk: Trust on the Rehabilitation Ward

Although trust has significant implications for health outcomes, the mechanisms by which its presence or absence influences these outcomes require elucidation. Drawing on ethnographic research conducted in southeast Australia, we explore the tasks of rehabilitation for people who lost a limb because of vascular disease, and the importance of trust in the relationships of patients with their health professionals. Trust underpins procedures and practices designed to minimize problems that might delay rehabilitation or result in the continuing need for medical support and surveillance. Patients develop trust in the rehabilitation team based on three factors: competence, agency, and caring. Our findings emphasize how social skills, as well as technical competence, enable health professionals to gain and maintain their patients’ trust.

Taking control: Complementary and alternative medicine in diabetes and cardiovascular disease management.

The chronicity of chronic disease, and its associated uncertainties and fluctuations in health status, pain and/or discomfort, often leaves those so diagnosed feeling that they have lost control. Treatment can exacerbate this sense of loss of control, as people surrender to the expertise of their biomedical providers and interventions. In principle, self-management aims to return control to the individual, but its promotion is as much motivated by cost-containment as patient autonomy, and is advocated in an environment largely shaped by policy makers and biomedical providers. In this article, we examine how Australians with type 2 diabetes and/or cardiovascular disease supplement medical with complementary and alternative medical (CAM) care. Drawing on in-depth interviews with 69 participants collected in 2009–2010, we illustrate how people rely on medical providers and pharmaceuticals to manage their diabetes, but concurrently consulted with CAM practitioners and used non-biomedical therapies to enhance well-being. In explaining this, participants framed CAM use in the context of reclaiming relative personal and bodily control.

More Than SF-36? Using Narratives to Elaborate Health and Well-Being Data in Recent Lower-Limb Amputees

Limited research has been conducted on the health-related quality of life of people who have undergone a major amputation. This paper explores the complexities of this population, through narratives elicited during in-depth interviews to elaborate data collected through administration of the SF-36 on self-reported health and well-being. Sixty inpatients aged 21-89 were recruited following the amputation of one or both lower limbs whilst at four (two rural, two urban) rehabilitation centres in Victoria, Australia. Results indicated a significant decrease in health-related quality of life in relation to the physical components of the SF-36. However, these limitations were viewed as temporary, and people anticipated a return to higher levels of physical functioning post-rehabilitation. No significant difference was found in regard to mental health (amount of time a person experienced feelings of nervousness, anxiety, depression and happiness) or the overall mental component summary scores, but participants scored signifi- cantly lower on three of the four mental components compared with Australian

Recommendations for spinal rehabilitation professionals regarding sexual education needs and preferences of people with spinal cord dysfunction: a mixed-methods study

Study design:Mixed-methods study using comprehensive survey and semi-structured interviews.Objectives:Compare the experiences of sexual education during rehabilitation for people with non-traumatic spinal cord dysfunction (SCDys) and traumatic spinal cord injury (SCI), determine preferences for the delivery of this information and provide recommendations for spinal rehabilitation professionals.Setting:Community, Australia.Methods:Adults completed survey (traumatic SCI n=115; SCDys=39) or were interviewed (SCDys: n=21). Survey included questions regarding sexual education during rehabilitation, participant satisfaction with this and preferred modes for receiving such information. These themes were also explored during interviews.Results:No difference between SCI and SCDys regarding satisfaction or preferred modes of presentation (all P>0.05). People with SCDys were less likely to report receiving sexuality education during rehabilitation (SCDys n=11, 30%; SCI n=61, 53%; P=0.03). Interviews suggested that this may be gendered, as only two women recalled receiving sexual education, whereas men often received this as part of continence management. Overall, only 18% were satisfied or very satisfied with sexual education and information received, and 36% were dissatisfied or very dissatisfied. Preferred modes for receiving sexuality information included sexuality counsellor (n=97), recommended internet sites (n=77), peer support workers (n=76), staff discussion (n=67), written information (n=67) and DVD (n=58). These preferences were confirmed during interviews, although women expressed a strong preference for written information sheets.Conclusion:There was very low satisfaction with sexuality education during rehabilitation. Our findings highlight the scope and directions for improving the sexual education and information given to people with both SCDys and SCI during rehabilitation.

Reframing Disability and Quality of Life: Contextual Nuances

Research conducted with people living with a long-term condition or disability has relied primarily on quantitative instrumentation to determine quality of life. While quantitative instruments allow summary assessments of how health conditions impact upon people’s well-being, physical functioning, mental and emotional health, and social participation, they cannot provide insights into how and why assess their conditions under different personal circumstances and community conditions. Prior to introducing the chapters in this book, we expand on the importance of ethnographic and other qualitative research for a richer understanding of disability and quality of life.

Transferring responsibility and accountability in maternity care: clinicians defining their boundaries of practice in relation to clinical handover

Objective This exploratory study reports on maternity clinicians’ perceptions of transfer of their responsibility and accountability for patients in relation to clinical handover with particular focus transfers of care in birth suite. Design A qualitative study of semistructured interviews and focus groups of maternity clinicians was undertaken in 2007. De-indentified data were transcribed and coded using the constant comparative method. Multiple themes emerged but only those related to responsibility and accountability are reported in this paper. Setting One tertiary Australian maternity hospital. Participants Maternity care midwives, nurses (neonatal, mental health, bed managers) and doctors (obstetric, neontatology, anaesthetics, internal medicine, psychiatry). Primary outcome measures Primary outcome measures were the perceptions of clinicians of maternity clinical handover. Results The majority of participants did not automatically connect maternity handover with the transfer of responsibility and accountability. Once introduced to this concept, they agreed that it was one of the roles of clinical handover. They spoke of complete transfer, shared and ongoing responsibility and accountability. When clinicians had direct involvement or extensive clinical knowledge of the patient, blurring of transition of responsibility and accountability sometimes occurred. A lack of ‘ownership’ of a patient and their problems were seen to result in confusion about who was to address the clinical issues of the patient. Personal choice of ongoing responsibility and accountability past the handover communication were described. This enabled the off-going person to rectify an inadequate handover or assist in an emergency when duty clinicians were unavailable. Conclusions There is a clear lack of consensus about the transition of responsibility and accountability—this should be explicit at the handover. It is important that on each shift and new workplace environment clinicians agree upon primary role definitions, responsibilities and accountabilities for patients. To provide system resilience, secondary responsibilities may be allocated as required.