Funded research projects

Building Health Communities RFA Funded Research Projects 2013 – 2015

Building and sustaining healthy communities means all Australians, especially those who are disadvantaged and vulnerable, have the support they need to make decisions that promote their health and wellbeing.

Building Healthy Communities is one of the five Research Focus Areas (RFAs) central to La Trobe University's Future Ready strategy. The Building Healthy Communities RFA fund innovative research projects across the University that are aligned with the University's strategic goals and with the Building Healthy Communities RFA vision of achieving health and wellbeing for communities in Australia and in the Asia Pacific region.

The challenge

As a society we may know many of the answers about what makes us healthier and happier, yet we still face many challenges in translating those research findings into policies and practices that benefit all Australians – especially those traditionally at risk of being ignored or marginalised.

Particular challenges in coming years will be our ageing population, the growing complexity of chronic disease and mental health and the social, emotional and environmental determinants of health.

At La Trobe University we want all Australians, especially those who are disadvantaged and vulnerable, to build health and wellbeing for themselves, and for their communities, supported by access to high quality responsive systems and services.

Global connections now mean that the health and wellbeing of Australians are increasingly influenced by policies, decisions and disasters in the Asia Pacific region, requiring a greater focus on healthy communities further afield.

We know that building and sustaining healthy communities hinges on translating scientific findings into real, workable and equitable improvements in community services, healthcare delivery, employment and educational outcomes.  It is also about determining the policies and procedures that best respond to the social, emotional and environmental determinants of health.

La Trobe's researchers have the experience, passion and the knowledge to help make that ambition a reality – to develop solutions that make positive changes to the health and wellbeing of communities.

This report provides a summary of the exciting and ambitious research projects that have been funded by BHC in 2013/14.

Introduction

Building Healthy Communities (BHC) is one of the five Research Focus Areas at La Trobe University. BHC was established in late 2013 with the aim to foster collaboration among academics, government, industry and community organisations to undertake innovative and practical research to inform practice and enhance health and wellbeing in communities in Australia and in the Asia Pacific.

Promoting population health and wellbeing is one of the most significant challenges facing Australia and is recognised as a research priority by the Australian Government.  We need research that will optimise the effective delivery of health care and related systems and services, maximise social and economic participation in society and improve the health and wellbeing of all Australians.

The researchers in BHC are working to better improve health outcomes by understanding the underlying causes, interconnections and impacts of health services and health systems.  BHC researchers are committed to comprehensive interdisciplinary collaborative effort with multidisciplinary expertise. BHC researchers are committed to research that is rapidly disseminated and translated to make a practical and profound difference to the health and wellbeing of communities throughout Australia and the region.

Strong partnerships already exist within the University and with local, national and international partners from industry, government, not-for-profit organisations, hospitals and health service providers but we want to strengthen and deepen these partnerships and find new ways of fostering debate and collaboration.

The themes that guide our research fall under four major interconnected themes:

  1. Optimising health and wellbeing through social and economic policies as well as health, educational and human services
  2. Meeting the health needs of disadvantaged groups
  3. Promoting health and wellbeing across the life course
  4. Supporting the health, social and educational systems in the Asia Pacific region

The values of equity, social inclusion, social justice and human rights are fundamental to our research focus. We seek to contribute to the creation and sustainability of communities in which:

  • Early disadvantage is reduced and ameliorated
  • Ageing is not regarded as a problem
  • Individuals and groups are free from stigma and discrimination
  • Diversity and difference are celebrated

In 2013/14 BHC has funded 19 research projects, involving over 40 researchers from various disciplines including psychology, nursing, law, economics, management, and sociology. A brief description of these projects is provided in this report.

As Director of BHC, I invite you to take a closer look at our funded projects and be inspired by the diversity and scope of the work underway.  If you are interested in learning more about any of the projects, we would love to hear from you. We are seeking to foster partnerships with business, international organisations, state and local government departments, not-for-profit organisations, leading international universities, philanthropic organisations, and our indigenous, local, regional, national and international communities.   We also want to hear from new or established researchers and potential postgraduate students interested in joining our teams and benefiting from our world-class research facilities and generous scholarship funds.

Director, Research Focus Area, Building Healthy Communities, Professor of Health Economics

Department of Public Health

School of Psychology and Public Health

La Trobe University, Victoria 3086

T: +61 3 9479 5098

M: +61 429202997

E: a.shiell@latrobe.edu.au

Funded projects

Download PDF version: Current Building Healthy Communities RFA Funded Projects 2013-2015 [PDF 984KB]

Getting workers with disabilities employed: the role of strategic human resources management

Lead Investigator: Professor Tim Bartram

Professor Tim Bartram

Human Resource Management, La Trobe Business School

People with disability have high levels of unemployment, and those who are employed are often under-employed and in low paid positions. Australia's employment outcomes for people with disability are significantly lower than the OECD average (Productivity Commission, 2011). A major goal of the social policy is to increase the economic and social participation of people with disabilities (National Disability Strategy, 2001; National Disability Insurance Scheme Act, 2013). A significant body of international research demonstrates the social and economic benefits gained from employment, particularly those with cognitive impairment; which include social connections self esteem, meaningful occupation and financial independence (Jahoda, 1981; Weyman & Revell, 2005). Lysalt et al., 2013 propose three target points for intervention to improve opportunities for people with disabiilty: policy; the workplace; and schools. In Australia perspectives from the workplace have been largely unexplored, although a Federal government 2011 survey suggeted employers' generally held positive attitudes towards the employment of people with disabilities.

There is a dearth of literature exmaining the role of HRM in the effective mangement of workers with disabilities both internationally and in Australia. Greater understanding about effective recruitment and selection, design of work, training and development, occuational health and safety and performance management of workers with disabilities is needed. Moreover, there is evidence to suggest that a number of employers believe that there are signficant challenges associated with emplyoment of people with disabilities. (Lenngnick-Hall, Gaunt and Kulkarni, 2008). In contrast, the extant literature indicates that workers with disabilities are often conscientious, hardworking and high performers (Koss-Feder, 1999; Schur, 2002). Studies comparing the productivity of workers with disabilities to workers without disabilities are rare, but typically demonstrate that workers with disabilities have equal or higher ratings on the job as compared with workers without disabilities (Koss-Feder, 1999; Schur, 2002).

Hospital encounters of people with cognitive disability — a pilot study

Lead Investigator: Professor Chris Bigby

Professor Chris Bigby

School of Health Sciences

A seminal Australian study (Beange et al., 1995) revealed numerous treatable health conditions of people with intellectual disability were undiagnosed or mismanaged. Despite frequent use of primary care services (Iacono & Sutherland, 2006), the health inequalities of people with intellectual disability persist (Cooper et al., 2011). International research suggests they are frequent users of hospital services (Walsh et. al., 1997), experience shorter stays, more frequent readmission, inadequate discharge planning and greater likelihood of hospitalisations for conditions treatable by primary health care facilities (e.g., Balogh et al., 2013; Walsh et al., 1997; Cooper et al., 2011). The limited research highlights that poor hospital experiences can be attributed to inadequate understanding by hospital staff, problems addressing their communication difficulties, and failure to provide appropriate assessment and treatment (Brown et al., 2012; Iacono & Davis, 2003). A UK report (Mencap, 2007) described the disturbing hospital treatment and death of 6 adults with intellectual disability, arguably due to institutional discrimination. The 16 studies identified in our systematic review demonstrate poor experiences, but fail to explore the whole patient journey, or provide sufficient data to enable investigation of contributing factors. No studies were found addressing hospital encounters of people with TBI unrelated to the original injury or rehabilitation. However, one recently completed study (Calloway et al., 2013), found 10 of 40 adults (25%) with TBI living in supported accommodation in Victoria had non-elective admissions to hospitals in the preceding 12-month period.

This study will identify factors shaping health outcomes and quality of care received by people with cognitive disabilities. In collaboration with hospitals, this knowledge will be used to design and evaluate required change at individual- organisational- and system-levels. Effective translation will lead to the development of clinical guidelines and the adaptation of procedures to improve the way all parts of hospital systems respond to people with cognitive disabilities. This will have the potential to make the delivery of hospital services to this group more cost effective by, for example, reducing critical incidents, cutting rates of re-admission, and improving patient pathways through health network services.

Implementation of evidence-based practice in clinical and community settings: building pathways

Lead Investigator: Dr Leeanne Carey

Dr Leeanne Carey

Faculty of Health Sciences

Stroke is a leading cause of chronic adult disability. One-in-6 people suffer a stroke. 77% have motor impairment and 67% lose the sense of touch, affecting use of their limbs in daily life and return to previous life activities. The lifetime costs and burden on the individual, their carers, and the Australian community are cumulative, ongoing and profound. The National Stroke Audit of Rehabilitation Services recommends equitable access to evidence-based care. Yet, translation of stroke rehabilitation research into clinical practice, including community and rural areas, remains a challenge. This has a negative impact on the health and well-being of stroke survivors in their community. The current evidence-practice gap has been highlighted in two recent National audits. Action needs to be taken now. New, high-level evidence demonstrates the effectiveness of a novel intervention to help the stroke survivors regain a sense of touch, improve use of the hand in daily activities and return to previous valued activities. The approach known as 'SENSe', is innovative and designed to forge new connections in the brain. It has been described as 'life changing' from stroke survivors and is recommended in our national stroke guidelines.

The main objective of this project is to develop a template for implementation of evidence-based rehabilitation in clinical, community and rural settings. This will be achieved in the first instance through implementation of the SENSe intervention; a novel evidence-based approach to help stroke survivors regain a sense of touch. The evidence-practice gap in sensory rehabilitation has been highlighted in a Cochrane review and our recent national survey.

The SENSe intervention is supported by high-level evidence of effectiveness, is recommended in the NHMRC-endorsed national clinical guidelines. However, stroke survivors are not currently receiving this care and as yet therapists do not have the necessary tools or skills for effective implementation. A multi-media package has now been developed to 'up-skill' therapists, comprising a clinical practice protocol and specialised assessment and training equipment. This project will develop a template for implementation of evidence-based rehabilitation in clinical and community settings. Other aims are to:

  • Improve health outcomes for stroke survivors through improved access to evidence-based sensory rehabilitation.
  • Implement an effective intervention in clinical and community practice settings
  • Establish a team of 'champion' research-clinicians and develop a 'community of practice' to support translation.

Unobtrusive continuous community health monitoring developing acceptable sensing for diabetes

Lead Investigator: Associate Pro Vice Chancellor, Research, Jane Farmer

Dr Jane Farmer

Faculty of Health Science

This project addresses diabetes prevention, a fast-growing contemporary community health priority. Rates of overweight and obesity, key risk factors for Type 2 diabetes, are 1.2 times higher in rural Victoria than in metropolitan areas. Recognising this, Bendigo (where this study will engage with the community and local health services) is included in the Victorian Department of Health 'Healthy Communities Victoria' initiative. CI Farmer has reviewed how cities measure community health behaviour initiatives and identified a tendency to frame success as overall weight loss or blood pressure reductions. Our goal is to develop a community-based approach that links directly and ongoing, with the outcome of interest. Capacity to screen at-risk individuals for pre-clinical disease markers is important in preventing Type 2 diabetes. Implemented in the community, such screening could also allow: a) real-time assessment of population-based interventions; and b) construction of big data banks of physiological measures, providing rich epidemiological data and capacity for predictive modelling.

This project takes sensor technology developed by CI Hogan and will develop this to detect the presence of glucose in urine, a threshold indicator of high blood glucose levels. The project will devise options for unobtrusive urinalysis (e.g. through a smart sensor positioned in a toilet or a carried smart sensor) and test these for acceptability through community discussions.

The project will scope other physiological measures and their capacity for unobtrusive measurement, through a literature review so that the potential to extend the work to other community-based physiological measurement can be assessed. The project will engage citizens for their feedback and collaboration.

The project is a proof of concept to develop an unobtrusive smart sensor for community-based use to continuously measure the presence of glucose via urinalysis. It will develop the technology to measure glucose presence using an ECL-based paper-microfluidic sensor and identify option(s) for using a device in unobtrusive measurement. Acceptability for applying the technology in the community will be assessed.

In this project chemists and nano-technologists are united with podiatrists, exercise scientists, epidemiologists and community health researchers to link basic science development to the potential of community health improvement. About 8% of people aged over 25 in Victoria have diagnosed or undiagnosed diabetes. Combined, diabetes and its complications account for > 10% of total disease burden in the community, a figure expected to increase. Early intervention through cost-effective community-based screening may be key to successful diabetes prevention. This project seeks to provide the first step towards such an approach.

Strengthening playconnect: specialist playgroups for families with autism

Lead Investigator: Dr Kristelle Hudry

Dr Kristelle Hudry

Faculty of Health Sciences

Autism affects over 1% of Australian children and is typically diagnosed after 3-years of age (Barbaro & Dissanayake, 2010). Early diagnosis and intervention are associated with improved outcomes for children and parents (Howlin & Moore, 1997; Vivanti et al., 2013). While various interventions show efficacy within large, carefully-controlled trials (Dawson & Rogers, 2010; Green et al., 2010), only very limited research currently considers sustainable, affordable, community-based models of delivery (Vivanti et al., 2013).

Playgroup Australia, the national peak body for community playgroups, was funded from 2010 by the Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA) to provide PlayConnect; specialist groups for families of children with autism. Playgroup Australia's CEO recently contacted CIs Hudry and Dissanayake of the Olga Tennison Autism Research Centre (OTARC), seeking partnership to evaluate and strengthen PlayConnect.

Playgroup Australia operates a uniquely-Australian grassroots service, supporting family well-being, and building and strengthening Australian communities. Embedded within this model and operating with wide geographical reach (including regional/rural areas), PlayConnect playgroups are dedicated to families with children with suspected/newly-diagnosed autism. PlayConnect has yet to be formally evaluated and while managers express confidence in the program's effectiveness for some families, they acknowledge the need for rigorous, objective evaluation of the service. They also seek partnership with autism early-intervention experts in order to strengthen PlayConnect, ensuring it achieves its full potential to support families with children with autism.

Understanding exactly how PlayConnect operates and how it is accessed and received by families will elucidate ways in which supports can be most effectively provided to families during the highly-stressful period surrounding childhood diagnosis. This will also elucidate where improvements are required and how these might be achieved. Collaborating on this evaluation will develop a strong, interdisciplinary partnership between LTU researchers and Playgroup Australia managers, through which future ARC-LP funding will be sought to rigorously trial the identified options to strengthen the service.

The project aims:

  1. To evaluate PlayConnect, Playgroup Australia's specialist service for families of children with autism, including:
  2. Documenting strengths and identifying areas requiring improvement to best support these families.
  3. Determining the feasibility of conducting a future Randomised-Controlled Trial (RCT) to improve the service.
  4. To develop a multi-disciplinary partnership among LTU CIs and Playgroup Australia managers, working toward the submission of an ARC-Linkage Project (ARC-LP) application to fund the RCT.

Translating autism research excellence to a regional service through telehealth

Lead Investigator: Professor Teresa Iacono

Dr Teresa Iacono

La Trobe Rural Health School, Faculty of Health Sciences

This project will address a persistent problem identified in the literature of the failure to translate research excellence demonstrated in Universities and implemented in affiliated clinics, to practice in communities beyond these settings. Of particular concern is that rural communities do not benefit from this research and expertise, but instead experience fragmented service delivery, especially in relation to specialist areas, of which autism is a primary example. We will address this problem through a telehealth-delivered service for young children with autism and, most importantly, evaluate the impact on families and clinicians in a regional community context.

Families of children with autism in regional/rural areas are frustrated by being unable to access quality evidence-based autism services, while being aware of the substantial expertise within the Olga Tennison Autism Research Centre (OTARC), La Trobe University Melbourne. Many families travel from rural Victoria, including Bendigo, to access OTARC's services. LTU is in an ideal position to translate cutting edge research outcomes from OTARC and their national and international collaborators to rural communities through existing research and community relationships.

This project will (a) implement an autism assessment and intervention telehealth service based on current empirical evidence; and (b) obtain data at the levels of child, family, and community services against which the impact of the telehealth service on regional and rural communities can be tested in a larger scale implementation.

The researchers will build on a model developed and researched by UC David MIND Institute shown to have the potential for translation to Australian rural communities (Rogers et al., 2012; Vismara et al., 2013 a,b). They demonstrated that autism specific intervention provided through telehealth achieves similar outcomes as that delivered face-to-face, thereby extending the lifelong benefits of early intervention to families living at distances from key centres. Enabling such translation of research to practice is essential, given recent evidence that community-based clinicians make use of a combination of evidence-based and non-evidence based ASD interventions, with children from low socioeconomic backgrounds starting intervention up to 10 months later than other children and receiving fewer hours of treatment (Benvenuto et al., 2013).

Saving aboriginal children: a history of aboriginal preschools in Australia

Lead Investigator: Dr Jennifer Jones

Faculty of Humanities and Social Sciences

Saving Aboriginal children has been the focus of non-Aboriginal philanthropic effort since first settlement. This project examines how Aboriginal control transformed this history. Preschools were established in rural Aboriginal communities by the international charity, Save the Children Fund (SCF), 1956 to 1976. Local SCF branches drew together Aboriginal and non-Aboriginal women to establish twenty three pre-schools and two welfare centres in New South Wales, Victoria, Queensland and South Australia. Such collaborations improved Aboriginal living conditions and challenged the rural colour bar. Most became treasured institutions within their rural communities. They fostered Aboriginal employment and made long lasting inroads into Aboriginal disadvantage; significant achievements given the prevalence of assimilationsist ideals, 'Aboriginal deficit' models in education and social welfare, and the undergirding concept of child rescue in the era. Calls for Aboriginal autonomy and self determination, which became prominent in the 1970's, challenged many philanthropic assumptions. The transfer of SCF preschools to Aboriginal community control took place between 1987 and 1990. .Today, twenty former SCF early childhood education services still deliver culturally appropriate services and remain viable where other Aboriginal controlled organisations have failed. This project will compare and contrast the histories of SCF Aboriginal preschools and welfare centres: before and after self management. The project will also consider how such 'pockets' of success and resilience in Aboriginal communities are influenced by state jurisdictions and the oversight of early-childhood education or Social Work paradigms.

This project will contribute knowledge about how and why resilience and long-term success in Aboriginal governance is experienced in some communities, but not in others. The inter-disciplinary and multi-state historic approach identifies differing experiences in the transition to Aboriginal autonomy. Gaining autonomy required strategic negotiation of deeply engrained structural inequality. Understanding the development of a sustainable balance between resistance and accommodation will influence future policy and service delivery in the Indigenous sector. Former SCF Aboriginal preschools have successfully fostered wellbeing within geographically and historically diverse rural, remote and regional Aboriginal communities over multiple generations. Their stories of struggle and success in historically under-served and disadvantaged communities will be 'firsts' in the fields of Aboriginal women's history, voluntary action and the history of education.

Building healthy communities: equity and women's access to worker's compensation

Lead Investigator: Dr Tessa Keegal

Dr Tessa Keegal

Faculty of Health Sciences

Work is a fundamental determinant for building healthy communities, both promoting and detracting from health across a range of different pathways throughout the life course. However the experiences of work and health can be very different for women compared to men, frequently in ways which exacerbate socio-economic health inequalities. Workers' compensation in Australia is designed to compensate workers who are injured or develop an illness through their employment for loss of wages and health care related to their injury.

The Building healthy communities: Equity and women's access to workers' compensation project aims to determine if women are successful in accessing workers' compensation after a work-related illness or injury at the same rates as men. Previous research has demonstrated there are differences by gender for patterns of successful workers' compensation claims, particularly when considering specific conditions  or occupations.  It is also recognised that women may need to overcome extra barriers when attempting to access workers' compensation,  and that this may constitute a violation of human rights.  In work which the research team has conducted previously they found men and women had very similar rates for onset of a specific occupational disease (contact dermatitis). However when compared to workers' compensation claims we found that men were more likely to have successful workers' compensation claims compared to women. These differences by gender in workers' compensation rates have also been found for other injuries and occupational diseases.

This project conducts analyses of differences in access to workers' compensation using data from three seperate sources:

  1. The Victorian Compensation Research Dataset (CRD);
  2. The Household and Labour Dynamics Australia (HILDA)
  3. The Multi-Purpose Household Survey (MPHS).

The CRD, held by the Institute for Safety Compensation and Recovery Research (ISCRR) holds details of all workers' compensation claims submitted to WorkSafe Victoria for the past fifteen years. The HILDA study is Australia's first large-scale national household panel survey. HILDA collected information on forms of employment and unemployment, access to workers' compensation, and return to work outcomes. The MPHS is an annual supplement to the Australian Labour Force Survey which is conducted by the Australian Bureau of Statistics.

Strategic planning for an NHMRC CRE in community coproduction

Lead Investigator: Associate Professor Amanda Kenny

Professor Amanda Kenny

La Trobe Rural Health School, Faculty of Health Sciences

Co-production is a means of 'delivering public services in an equal and reciprocal relationship between professionals, people using services, their families and their neighbours' [1]. Coproduction is featured in health reform, with policy makers arguing that it is central to address significant challenges associated with economic rationalism, ageing populations, chronic conditions and increasing community expectations.  We contend that coproduction offers the potential for supporting innovative, sustainable communities, and partnerships that influence policy, service provision, knowledge, skills and behaviours.

Policy directives require communities to be actively engaged in coproduction activities, but there is little knowledge on how this can be achieved. Researchers, professionals and communities grapple with creating inclusive participatory processes for improved policy, service, and community outcomes.

This grant supports a cross faculty/university workshop, and the development of a strategy and set of actions to build toward an NHMRC Centre of Research Excellence (CRE) in co-production in community health and planning.

The proposed CRE will be multi-disciplinary with influence over local, state and national policy, research, practice, and community knowledge and behaviour to improve health outcomes, and promote/or improve translation of research outcomes into policy/practice with a strong focus on capacity building.

Managing memory in older age in regional and remote communities

Lead Investigator: Dr Glynda Kinsella

Dr Glynda Kinsella

Faculty of Science, Technology and Engineering (Psychology)

In our ageing society, capacity to live independently is important for sustaining health and quality of life into older age. Many older people experience troublesome age-related changes in memory 1 and seek guidance about how best to manage everyday challenges. It is estimated that up to 20% in older age community samples will display mild cognitive impairment, a risk factor for later development of Alzheimer's disease. This highlights the need for interventions for age-related memory difficulties, especially as cognitive activity is identified as a protective factor in maintaining cognitive health into older age.

Memory training (or brain training) for older adults through practice on memory tasks (typically computer-based) has produced compelling results. However, the approach remains highly contentious, with critics citing lack of generalization to everyday functioning. This is important as the goal is to reduce memory difficulties in daily activities rather than on memory tests. The researchers recent NHMRC-funded randomized trial has successfully evaluated a memory program for older adults. The LaTCH (La Trobe – Caulfield Hospital) Memory Group Program is a six-week intervention, focusing on knowledge about memory strategies and how to effectively use such strategies. The researchers found: (i) improved knowledge and use of strategies; (ii) achievement of personal everyday memory goals; and, (iii) greater contentment and self-efficacy about memory. Effects for people with mild cognitive impairment were moderate but still positive.

Having established the efficacy of the intervention the researchers are now translating the research to practice by training staff at Alzheimer's Australia VIC and Western Health Service to deliver the program. However, in its current form the program is not easily accessible by communities in regional and remote areas.  The proposed study addresses this gap.

Improving literacy for indigenous children in Victoria

Lead Investigator: Associate Professor Catherine Lang

Dr Catherine Lang

The Indigenous Literacy and Education Centre (ILEC) is the result of a partnership between the Aboriginal Literacy Foundation (ALF) and La Trobe University. ILEC was established by the partners at La Trobe's Bundoora campus at the end of 2014 with support from the Building Healthy Communities RFA. ILEC's aim is to expand its Indigenous tutorial and mentoring program, which, if sponsored will extend across seven (7) sites within Victoria ensuring that as many Indigenous students as possible in Victoria benefit from the program. These sites will include La Trobe's Bundoora, Bendigo, Mildura, Albury-Wodonga and Shepparton campuses, and the ALF's Melbourne and Ballarat offices.

This collaborative program between the ALF and La Trobe brings together the experience and expertise of the ALF and the educational reputation, capability, and infrastructure of La Trobe. It presents a substantial opportunity to collaborate with local Indigenous communities to significantly develop Indigenous education in Victoria. The next stage of the partnership is to seek financial support from philanthropic bodies like the Felton Bequest, to ensure positive and on-going academic support within Indigenous communities. With this additional support, the program will be extended to all parts of Victoria and bring more than 300 new tutors and mentors, including La Trobe's pre-service teachers, to the challenge of lifting Indigenous literacy and general academic outcomes in Victoria.

Testing and developing a community resilience tool in rural communities

Lead Investigator: Dr Anthony Lyons

Dr Anthony Lyons

Faculty of Health Sciences

This cross-disciplinary project pilots a community resilience survey tool and assesses associations between collective resilience, community activities and health and wellbeing in two rural Victorian communities. The collective resilience survey tool is a new and important development as current tools focus on individual-level resilience while government policy emphasises collective resilience for overcoming community problems.

Collective resilience is a group or community's capacity to successfully respond to sustainability and/or wellbeing challenges (Magis, 2010). Researchers argue that resilient communities are better able to respond to challenges such as natural disasters, climate change, and social/economic issues that have a major impact on community wellbeing (Chaskin, 2008; Norris, 2008). Building collective resilience is increasingly promoted by policymakers as central to building healthy communities, but there is a lack of tools to measure baseline and changes to collective resilience.  Measuring collective resilience is key to identifying the need for capacity-building intervention and to measure changes as interventions are implemented.

The social fabric of rural communities can be complex, comprising diverse community groups, from formal societies to friendship circles. The resilience of groups appears crucial to overall community resilience (Buikstra, 2010; Shucksmith, 2000). While government policy promotes community and group level, i.e. collective resilience, existing measures focus on individual resilience.

In this study, the innovative Collective Resilience Assessment (CRA) tool, developed by CIs Lyons and Fletcher is piloted. The association between collective resilience, community activity and health and wellbeing in two rural Victorian communities will be assessed.

The project unites EPRs and ECRs from ARCSHS, La Trobe Rural Health School (LRHS), community planning (FHUSS), and the University of Melbourne. HUSS researchers have expertise in participatory mapping and GIS, and will overlay drawn and interview data on a town map to show collective resilience in relation to community locations. LRHS researchers study how communities can co-produce health and wellbeing by understanding their health issues. A/Prof Bourke (University of Melbourne) brings expertise on resilience in rural communities. This project complements existing work of all the researchers, while developing interdisciplinary capacity for a future large competitive grant application.

Outcomes

This project involved the development of a tool for measuring the resilience of groups and communities such as clubs, organisations, workplaces or even entire towns or cities, otherwise known as collective resilience. We developed the world's first scale to assess collective resilience, a 5-point scale that can be used in a wide range of groups and communities, small or large, which focuses on a group's sense of agency and adaptability in responding to challenges. We tested the scale in a national sample of Australian men and women and discovered that people who were members of a resilient group or community had better mental health and well-being, including lower psychological distress, greater psychological well-being, and greater life satisfaction.

We then collected data on collective resilience in a medium-sized town in western Victoria and conducted a series of one-on-one interviews to drill further into experiences of collective resilience and how residents understood and explained the resilience of their town. We found that although the town had high collective resilience overall, the interviews put important context around this and showed that resilience often depended on the kinds of groups that made up the town and the people who belonged to these groups.

In all, this project makes available a validated easy-to-use measure for assessing the resilience of groups and communities and shows how collective resilience is strongly tied to people's well-being, thus highlighting the potential importance of collective resilience in building healthy communities.

You can read more about the Fletcher-Lyons Collective Resilience Scale here

Improving the health of aboriginal children through breastfeeding

Lead Investigator: Associate Professor Helen McLachlan

Dr Helen McLachlan

Judith Lumley Centre, Faculty of Health Sciences

In Australia, Aboriginal and Torres Strait Islander (ATSI) women have lower breastfeeding rates than non-ATSI women, with the exception of those living in remote settings low Australian targets of 90% . The 2004–2005 National ATSI Health Survey reported that 76% of Indigenous children aged less than four years living in non-remote areas had ever been breastfed compared with 88% of non-Indigenous children. These rates are well below Australian targets of 90%. Increasing breastfeeding is one of the simplest ways of improving the short and long-term health of ATSI children. Indigenous Australians have significantly poorer health than the general Australian population; a life expectancy 12 years shorter for males and 10 years shorter for females, and avoidable mortality rates four times that of the non-Indigenous population. Indigenous Australians also have higher rates of acute and chronic illnesses, for many of which breastfeeding is protective, such as diabetes, heart and circulatory disease, renal disease, asthma, and hearing loss/ear disease.

The Australian Parliamentary inquiry into breastfeeding recommended that leadership is needed in the area of monitoring, surveillance and evaluation of breastfeeding rates and practices in ATSI populations in both remote and other areas. In the recent Victorian Government report on strategic directions for Aboriginal health 2012–2022, a key priority was to increase breastfeeding rates for mothers of Aboriginal babies. The Australian Government's Office for ATSI Health and Healthy Public Policy Unit commissioned two reports as part of a strategy to encourage longer breastfeeding. Identified gaps in research and evaluation included determinants of infant feeding and social/economic barriers to breastfeeding in ATSI communities; and the need for better epidemiological data on breastfeeding via routine health information systems.

In partnership with the Victorian Aboriginal Community Controlled Health Organisation (VACCHO), this project will:

  • Explore strategies that may increase breastfeeding rates among Aboriginal women in Victoria
  • Collect and report on breastfeeding outcome data for Aboriginal women in Victoria;
  • Explore the feasibility of implementing  models of maternity care that provide continuity of midwife care to Aboriginal women in Victoria (known as caseload midwifery - these models show promise in terms of increasing breastfeeding in some populations).

This project is conducted by a multidisciplinary team from a range of health professional backgrounds including midwifery, nursing, General Practice, public policy, Indigenous health and women's health.

Understanding behaviour change in wash (water, sanitation, hygiene) projects in Nepal

Lead Investigator: Dr Celia McMichael

Dr Celia McMichael

School of Humanities and Social Sciences

The overall aim of this collaborative pilot research project is to gain improved understanding of the motivators and challenges for sustained hygiene behaviour change in relation to water, sanitation and hygiene (WASH) in Nepal. The project is focused on the Bajhang district of Nepal, and Nepal Red Cross (N-RC) and Australian Red Cross (A-RC) will be partners in this work.

This pilot project proposal has emerged from, and will be supported by, a close collaboration between our research team and the Australian Red Cross (A-RC). Australian Red Cross has secured funding from AusAid for a new 4-year water, sanitation and hygiene (WASH) project in Nepal, in Bajhang district in the Far West Region, which will begin in late 2013. The district has a moderate-average access to water (76%) and very poor sanitation coverage (16%), with a very high level of diarrhoeal disease and death, particularly in children. This collaborative A-RC project aims to improve health, gender and social inclusion outcomes through the following measures: declaring 'open (air) defecation free' areas; improved general sanitation and hygiene in households; access to safe drinking water as well as adequate water for household use; inclusion of people with disabilities and socially marginalised people in WASH decision-making; inclusion of women in training and participation; and, universal access to toilets in schools. The A-RC project builds on well-established connections in Nepal including with the Ministry of Urban Development, the Department of Water Supply and Sewerage, UNICEF, District Development Committees, Nepal Red Cross Society, and community-based organisations.

Globally, most WASH programs use participatory methodologies and health messaging to promote hygiene behaviour change. The A-RC operationalises the International Federation of the Red Cross (IFRC) Behaviour Change Framework to guides its WASH work, which emphasises: hand-cleaning with soap/ash, maintaining good water quality, food hygiene, use of latrines, and personal hygiene. The project will address a need for increased understanding of the ways in which local environmental, social and cultural contexts motivate or hinder sustained behaviour change. This pilot project will make an important initial contribution to the understanding of the whole team about how to improve effectiveness of WASH programs in Nepal and other countries.

Improving girls' body satisfaction and well-being through social media literacy

Lead Investigator: Professor Susan Paxton

Dr Susan Paxton

Faculty of Science, Technology and Engineering (Psychology)

Body dissatisfaction in adolescent girls can lead to serious negative consequences including depressive symptoms and low self-esteem (Paxton, Neumark-Sztainer, Hannan, & Eisenberg, 2006), and eating disorders (Stice, Marti, & Durant, 2011). Consequently, classroom based prevention interventions have been developed.

Interventions target sociocultural risk factors for body dissatisfaction. These include peer-related factors (e.g., appearance comparison) and media-related factors (e.g., internalisation of media appearance ideals). Exposure to the thin ideal media, including on the internet, increases body dissatisfaction (Grabe, Ward, & Hyde, 2008; Tiggemann & Miller, 2010). This effect is mediated by both appearance comparison and internalisation of media ideals (McLean, Paxton, & Wertheim, 2013).

Prevention interventions that use a media literacy approach to counter the effect of media exposure by reducing the tendency to engage in appearance comparisons and internalisation of media ideals have been found to be effective (Richardson & Paxton, 2010; Yager, Diedrichs, Ricciardelli, & Halliwell, 2013). There is, however, a need to take the next step in media literacy approaches to prevention to focus on social media. Recent research indicates that time spent on social media, rather than internet use in general, is associated with body dissatisfaction (Tiggemann & Miller, 2010; Tiggemann & Slater, 2013). Furthermore, Facebook users have been found to have significantly higher body dissatisfaction than non-users (Tiggemann & Slater, 2013). Clearly, social media is an important target for prevention.

Thus, this project draws on the researchers' experience in prevention and social media research to develop and evaluate a social media prevention intervention for body dissatisfaction for young adolescent girls. This intervention will use a media literacy approach; change in body dissatisfaction following the intervention and the media literacy processes that are related to mental health outcomes for participants will be evaluated.

This project will be the first study to evaluate benefits of an intervention addressing social media literacy in relation to body image. With high uptake of social media among adolescents (Espinoza & Juvonen, 2011; Huang et al., in press), this area clearly needs attention. The project will significantly improve research in this area by evaluating change in media literacy, and whether this change mediates outcomes. Findings will be immediately applicable in education settings.

Impact of childhood trauma on health outcomes in older women

Lead Investigator: Dr Margot Schofield

Dr Margot Schofield

School of Health Sciences

The experience of childhood trauma is a prevalent health risk. More than 50% of adults in the US National Comorbidity Study reported experiencing at least one early traumatic life event (Kessler et al., 1995). Trauma can result from a single event to cumulative traumatic events experienced over long periods of time. Such events include ongoing physical and sexual abuse, and witnessing violence and severe conflict. A child's responses to traumatic experiences can be psychological and/or physiological and the impact can be felt on physical and mental health well into adulthood (Gagnon & Hersen, 2000; Kraaij et al., 1997).

Relatively little is known about the impact of childhood trauma into old age, and what factors may influence that relationship. This study addresses a significant gap in the literature by examining the long-term burden associated with early trauma across the life course. Furthermore, it will be the first longitudinal study to examine mortality and disability outcomes.

This project has two aims. First, we seek to undertake a systematic review of research that has examined the impact of childhood trauma on health outcomes in older age.

Second, we aim to examine the relationship between experience of childhood trauma and mortality and disability in old age, by analysing 5 waves of longitudinal data collected from the older cohort of women in the Australian Longitudinal Study on Women's Health (ALSWH), through linkage with the National Death Index (NDI).

Telephone peer support to prevent postnatal depression

Lead Investigator: Dr Touran Shafiei

Dr Touran Shafiei

Judith Lumley Centre, Faculty of Health Sciences

Postnatal depression is a major health issue with prevalence between 10% and 20%. A recent Australian population-based study found the prevalence of 17.4% for probable postnatal depression at six months. Given over 300,000 women give birth in Australia every year, an estimated 45,000 Australian women per year are affected, posing a significant health and economic burden.

Postnatal depression has serious potential adverse consequences for a woman's health and the health of her infant and other family members, impacting on early maternal-infant interactions and perceptions of infant behaviour as well as on the child's emotional, cognitive and behavioural development. Likewise, it can have adverse effects on the marital relationship and the partner's emotional health. Although uncommon, the most catastrophic effects of postnatal depression are maternal suicide and infanticide. Suicide related to postnatal depression is the most common cause of maternal death in the year following childbirth. Australian data from 1997-2005 shows that suicide accounted for 11% of all maternal deaths, the third most common cause of all maternal deaths behind cardiac conditions and amniotic fluid embolisms.

Although numerous risk factors contribute to the onset of postnatal depression, studies have consistently highlighted the importance of social factors. There is strong evidence that inadequate social support is a risk factor for the development of postnatal depression. Consistently immigrant status and postnatal depression are linked, with increased social isolation and lack of support being common among depressed immigrant mothers.

While there are a variety of treatments for postnatal depression including psychosocial and psychological interventions, little work has been done on preventative strategies. A Canadian randomised controlled trial conducted by CI Dennis found telephone peer support from another mother in the early postpartum period was effective in preventing the onset of postnatal depression in women considered to be at high risk of depression – 14% of women in the intervention group developed probable postnatal depression compared with 25% in the control group. This trial has not been replicated to date, and it is not known if it would be feasible in the Australian context nor in a culturally and linguistically diverse (CALD) population. The current project explores the feasibility and acceptability of this intervention in Australia, including in the CALD population.

Impact of National Disability Insurance Scheme (NDIS) on hearing-impaired children

Lead Investigator: Dr Andrea Simpson

Dr Andrea Simpson

Faculty of Health Sciences

The implementation of the National Disability Insurance Scheme (NDIS) has been hailed as one of the most significant social policies from the Australian government in recent years with the government committing $1 billion over 4 years for the first stage. The scheme provides individualised support for individuals with disability and is currently being piloted in each of Australia's states with national rollout expected by July 2016.

Considering that such a scheme will change the lives of people living with disabilities and their families, as well as how existing services will work with people with disabilities, it is crucial to examine the impact of such a policy.

Hearing loss has been chosen as the focus of this project as it is one of the more common disabilities identified at birth with permanent hearing loss identified in approximately 1 in every 1,000 births (VIHSP, 2014). In Victoria alone, this equates to between 60-70 babies per year in need of intervention (VIHSP, 2014). Hearing loss results in difficulties with communication that have a flow on effect to participate in learning, working, and building social connections with others. Access Economics (2006) estimated that the financial cost of hearing loss was approximately $11.75 billion, or 1.4% of Australia's GDP, largely as a consequence in loss of productivity for those living with hearing loss.

Fortunately with early diagnosis and treatment, the large majority of children with hearing loss are able to communicate equivalently to their hearing peers, assuming appropriate intervention takes place before the child is 2 years of age (CAHE Review team, 2009).

Up until the introduction of the NDIS scheme, for children with hearing loss, government funding has been fairly uniform and usually paid to service providers. The NDIS will result in individualized, tailor made packages with the monetary amount determined by 'functionality'. The impact of this policy shift on children with hearing loss is unknown, but has the risk of different families receiving varying degrees of care and service provision. Specifically the demographic and personal factors leading to packages and the impact of different packages on communication outcomes for these children requires further investigation.

In collaboration with external service providers, such as Taralye, this project will gather pilot information on the potential impact of the NDIS scheme. Results will inform the rationale for a larger project which could inform government policy on the impact of the scheme on families with children with hearing loss. This larger project has the potential to impact on policy, service provision as well as communication outcomes for individual families.

Access and equity in medical abortion provision in Australia (CATI)

Lead Investigator: Professor Angela Taft

Dr Angela Taft

Judith Lumley Centre, Faculty of Health Sciences

This project is the first stage of a well-developed collaboration between multi-disciplinary sexual and reproductive health academics across La Trobe and more broadly, with MS Health (Marie Stopes International Australia and Women's Health Victoria for submission to a 2014 NHMRC Partnership or ARC Linkage grant. Our overall project will evaluate the impact on access and equity of publicly funded medical abortion.

Around 80,000+ terminations of pregnancy (TOP) are performed each year in Australia. The new option of medical TOP is now available as the Therapeutic Goods Administration (TGA) included mifepristone on the Australian Register of Therapeutic Goods in 2012. The TGA recommends using mifepristone for pregnancies of up to 49 days gestation by combining 200 mg of mifepristone with misoprostol, a prostaglandin used to induce labour. The whole process can be performed under supervision of medical staff and misoprostol can be taken at home or in a clinical setting, depending on state and territory laws.

Prior to the TGA's inclusion of mifepristone on TGA's register, the drug was available to practitioners under the Authorised Prescriber (AP) scheme. In 2012, the number of practitioners having AP approval for mifepristone was estimated at 140+ , but now GPs can apply to become prescribers.  To become a prescriber, practitioners must undergo online training and all prescribers must register with MS Health, the licensed drug providers. Recommended practice in Australia is to perform an ultrasound prior to medical TOP in order to date the pregnancy and detect ectopic pregnancies. The inclusion of mifepristone on the PBS commenced on August 1st, 2013.

This project seeks to provide evidence about the human and financial costs of medical TOPs to inform national and state reproductive health policies, policymakers and advocates.