Hype, evidence gaps and digital divides: Telehealth blind spots in rural Australia.

Despite high unmet demand for health services across rural Australia, uptake of telehealth has been slow, piecemeal and ad hoc. We argue that widespread failure to understand telehealth as a socio-technical practice is key to understanding this slow progress. To develop this argument, we explore how technocentric approaches to telehealth have contributed to critical blind spots. First, the 'hype' associated with the technological possibilities of telehealth discourages thoughtful consideration of the unanticipated consequences when technologies are rolled out into complex social fields. Second, it contributes to critical gaps in the telehealth evidence base, and particularly a paucity of analyses focussing on the experiences of service users and patients. A third blind spot concerns the limited attention paid to the social determinants of health and digital divides in rural areas. The final blind spot we consider is an apparent reluctance to engage community stakeholders in co-designing and coproducing telehealth services. We used an iterative approach to identify studies and commentary from a range of academic fields to explain the significance of the telehealth blind spots and how they might be addressed. Insights suggest how expanding understanding of the social dimensions of telehealth could enhance its accessibility, effectiveness and responsiveness to community needs and contexts.

Reproductive coercion as a form of family violence against immigrant and refugee women in Australia.

Reproductive coercion (RC), generally considered a form of intimate partner violence (IPV), refers to perpetrator behaviours and actions that are intended to interfere with and control the autonomous decision-making of a person regarding their reproductive health. To date there are few studies that document RC as experienced by immigrant and refugee women. In this article, we explore cases of RC as described by women who were part of a larger qualitative study investigating violence against immigrant and refugee women in southern Australia. The study aimed to identify the types of RC detailed in immigrant and refugee women's narratives, and to illustrate the contexts in which these experiences occurred. Analysis followed Baxter and Jack's (2008) case study methodology; whereby particular "cases" are used to describe a phenomenon in context. Thirteen women from seven countries described experiences that fit definitions of RC. The cases describe various types of RC including violence during pregnancy with the intent of causing miscarriage, forced abortion, contraception sabotage and forced pregnancy. As well as intimate partners, some women described multiple perpetrators being complicit in their experience of RC, especially in regard to controlling women's access to, and interactions with health services. More information is needed about immigrant and refugee women's experiences of RC, and how vulnerability to multi-perpetrator violence affects health service access. In particular knowledge about how multi-perpetrator RC can affect consent processes for women who already face barriers to health care requires attention. Further research is required to address knowledge gaps about appropriate prevention and advocacy work about RC in refugee and migrant communities, and what training is needed for professionals in the family violence sector, women's health services, women's organisations, multicultural and ethno-specific services.

Quantity or quality? Assessing relationships between perceived social connectedness and recorded encounters.

INTRODUCTION: Higher levels of social connectedness are associated with better physical and mental health outcomes, but measures of connectedness are often study specific. Prior research has distinguished between perceived and received (quantifiable) measures of social connectedness, with differing impacts on health, sometimes mediated by place of residence. This analysis investigated the relationship between perceptions of social support/connection and quantifiable measures of social encounters, by neighbourhood, to inform understanding of place-based differences in connectedness and health outcomes. METHODS: Negative binomial regression models were used to determine associations between perceptions of social connectedness (perceived community connections and social involvement) and the number of recorded daily social encounters as a proxy for received support/connectedness. Analyses were undertaken across two Local Government Areas (LGAs) in Melbourne with disparate socio-economic profiles to examine potential modification of social connectedness measures by neighbourhood of residence. RESULTS: Two measures of perceived connectedness had a clear relationship with recorded daily social encounters-feeling a sense of community belonging (RR 1.20 (1.04, 1.37), p = 0.010) and having family or friends close by (RR 1.30 (1.10,1.54), p = 0.002 "neither" compared to "disagree", (RR 1.15 (1.04, 1.26), p = 0.006 "agree" compared to "disagree"). Involvement in a local church, sporting or social club was associated with a greater number of daily social encounters for respondents who participated a few times a year (RR 1.17 (1.05,1.32), p = 0.006) or often (RR 1.23 (1.12,1.36), p<0.001) compared to never. In the less affluent LGA, active contributions to neighbours and community through assistance and volunteering were a frequent driver of social connection. Differences in patterns between the two areas were found with some measures of perception showing stronger relationships with recorded daily encounters in one area but not the other. CONCLUSIONS: These results indicate substantial complexity in the relationship between perceptions of social connectedness and recorded daily social encounters/received connectedness, meaning that one cannot be reliably extrapolated from the other. Drivers of individuals' social connections also varied by area of residence. These findings offer new insights into potential mediators of the association between connectedness and wellbeing.

Exploring the mental health benefits of participation in an Australian anti-racism intervention.

There is a vast body of research demonstrating the deleterious effects of racism on health. Despite this, there is limited research that considers the health benefits of anti-racism interventions. We assess the mental health effects for young people participating in an anti-racism intervention that was based on the principles of intergroup contact theory and delivered through five projects addressing specific issues and contexts. An evaluation of the intervention used a before-and-after design. The analyses reported here focus on data collected from participants who completed both pre- and post-intervention surveys (n = 246). Analyses examine the characteristics of participants, the environment for intergroup contact (equal status between ethnic groups, shared goals, co-operation and institutional support for intergroup relationships) and basic psychological needs (competence, relatedness and autonomy) as defined by Self-Determination Theory. The results suggest that the projects met the criteria for promoting positive intergroup contact. There was also evidence that participants' involvement in these projects had positive effects on their autonomy, with particular improvements among people with ethnicities other than 'Australian'. The findings suggest that anti-racism interventions can have positive mental health effects for participants. These benefits redress some of the individual-level effects of racism experiences by supporting young people to develop confidence and self-esteem.

Social encounter profiles of greater Melbourne residents, by location--a telephone survey.

BACKGROUND: Models of infectious disease increasingly seek to incorporate heterogeneity of social interactions to more accurately characterise disease spread. We measured attributes of social encounters in two areas of Greater Melbourne, using a telephone survey. METHODS: A market research company conducted computer assisted telephone interviews (CATIs) of residents of the Boroondara and Hume local government areas (LGAs), which differ markedly in ethnic composition, age distribution and household socioeconomic status. Survey items included household demographic and socio-economic characteristics, locations visited during the preceding day, and social encounters involving two-way conversation or physical contact. Descriptive summary measures were reported and compared using weight adjusted Wald tests of group means. RESULTS: The overall response rate was 37.6%, higher in Boroondara [n = 650, (46%)] than Hume [n = 657 (32%)]. Survey conduct through the CATI format was challenging, with implications for representativeness and data quality. Marked heterogeneity of encounter profiles was observed across age groups and locations. Household settings afforded greatest opportunity for prolonged close contact, particularly between women and children. Young and middle-aged men reported more age-assortative mixing, often with non-household members. Preliminary comparisons between LGAs suggested that mixing occurred in different settings. In addition, gender differences in mixing with household and non-household members, including strangers, were observed by area. CONCLUSIONS: Survey administration by CATI was challenging, but rich data were obtained, revealing marked heterogeneity of social behaviour. Marked dissimilarities in patterns of prolonged close mixing were demonstrated by gender. In addition, preliminary observations of between-area differences in socialisation warrant further evaluation.

Working better together: new approaches for understanding the value and challenges of organizational partnerships.

Inter-agency partnerships are critical for addressing the interrelated circumstances associated with the social and health determinants of health inequalities. However, there are many challenges in evaluating partnership processes and outcomes. We discuss a mixed methods study that explored partnership processes in an innovative program that aims to promote social and economic inclusion for young newly arrived refugees. A theoretically informed evaluation was designed and data collected in three ways: an organizational ethnographic approach; a partnership self-assessment tool and semi-structured interviews. Partnership assessments and interviews were collected at two points in time providing progressive process data. Analyses explore divergent levels of staff satisfaction with the partnership's operations, particularly between staff working in program development (strategic management) and program delivery (service provision) roles. Follow-up data collection indicated satisfaction with partnership processes had improved. The partnership did achieve its aim of increasing the level of cooperation between service providers to support young people from refugee backgrounds. This paper presents insights into how to evaluate inter-agency partnerships and reports both methodological and empirical findings. It provides an approach for a better understanding of the levels at which individuals operate within such partnerships, indicates areas where support and attention is needed.

Evaluating health impacts: Results from the neighbourhood renewal strategy [corrected] in Victoria, Australia.

AIMS: Neighbourhood Renewal [NR] Strategy is currently underway in the Victoria's most disadvantaged neighbourhoods. Neighbourhood Renewal utilises an 'area-based' approach to reducing inequalities between NR sites and the Victorian state average across a range of social, educational and health outcomes. We examine the impact of this intervention on health and life satisfaction in the five metropolitan sites involved in first phase of the project. DESIGN: We employed a before-and-after study design using two cross sectional community surveys to assess changes in health and life satisfaction. The study sample includes people living in NR areas and people living in other areas of the same Local Government Area (LGA). Survey responses from the five metropolitan NR and their surrounding were used in this analysis. RESULTS: NR residents involved in the program had worse health than people living in the LGA in all analyses. There was no evidence of an NR effect at a whole of area level. However, the health (OR=2.15, 95%CI 1.23-3.74) and life satisfaction (OR=1.79 95%CI 1.38-1.52) of people living in NR areas who participated in the intervention improved relative to people in the LGA. CONCLUSIONS: The results suggest that area-based health interventions are an important tool in the portfolio of strategies to reduce health inequalities.

Living in 'Birdsville': exploring the impact of neighbourhood stigma on health.

AIMS: The stigma of living in a disadvantaged area is a consistent theme in discussions with residents of neighbourhood renewal (NR) areas in Victoria, Australia. Despite this, stigma is rarely examined explicitly in studies of neighbourhood disadvantage and health. This study will address four questions: (1) How do residents of disadvantaged areas describe their experiences of neighbourhood stigma? (2) Do experiences of neighbourhood stigma vary within neighbourhoods? (3) Is neighbourhood stigma related to health? (4) Is the relationship between neighbourhood stigma and health explained by other social factors that may contribute to poorer health? DESIGN: Cross-sectional community interviews comparing people living in NR areas (n = 4029) to people living in other parts of the same local government areas (LGAs) (n = 1857). Recruitment was achieved using community interviewers in NR areas and stratified random sampling in LGAs. MAIN OUTCOME MEASURES: A neighbourhood stigma variable, self-reported health, and satisfaction with life. RESULTS: About half (47.7%) of residents living in NR neighbourhoods compared to 9.4% of residents living elsewhere in the same LGAs felt that their neighbourhoods did not have a good reputation in surrounding areas. In NR areas, reported neighbourhood stigma was higher among people born in a non-English speaking country, receiving benefits or pensions, educated above year 10, or who reported having a disability. Reported neighbourhood stigma decreased with age. Stigma was associated with being in fair/poor health status (OR = 1.33, 1.06-1.89) and life satisfaction (OR = 0.66, 0.55-0.8). CONCLUSIONS: Neighbourhood stigma may be a useful addition to the portfolio of variables that describe 'place' and its relationship with health.

Was it good for you too? Impediments to conducting university-based collaborative research with communities experiencing disadvantage.

OBJECTIVE: Collaborative and participatory research (CPR) models are increasingly recognised as methodologically, ethically and practically appropriate to conducting health and welfare research involving disadvantaged communities. This paper identifies impediments to CPR and proposes measures to support and encourage future CPR in Australian universities. METHODS: This paper draws on a small qualitative study of university-based CPR projects in Melbourne. The study involved a literature review and interviews with 23 participants, comprising university-based researchers and community liaison officers, and community representatives involved in university-based research projects. RESULTS: The paper outlines four main difficulties encountered by university-based researchers and community liaison staff in conducting CPR. These are: managing community sensitivities, the time-consuming nature of the work and diverse tasks involved, difficulty securing adequate research funding, and a concern that CPR was detrimental to academic careers. CONCLUSION: CPR in universities might be supported in the future through providing CPR training for researchers, employing additional community liaison staff, recognising community reports within the Australian research quality evaluation system Excellence in Research for Australia, adopting supportive policies within universities and provision of dedicated CPR funding. IMPLICATIONS: In the current Australian university context of competitive funding, further research into CPR nationally, alongside dedicated resources and policies are required to maximise the benefits of this approach.

Challenging roles: insights into issues for men caring for family members with mental illness.

Assumptions informing expectations of caring may not reflect the diversity of circumstances in which informal care is provided, and scant attention has been given to the experiences of men providing care to family members. This study reports on qualitative findings from a study that explored these issues among rural men caring for partners or children with a range of mental illnesses. The findings suggest that the primary relationship between carers and care recipients influences the ways in which the men understand and practice their caring roles. Fathers consistently described proactive approaches to caring and were strongly focused on managing the illness condition. There was some complementarity between parenting and caring roles that is likely to explain why they reported a high use of, and satisfaction with, mental health services. Husbands tended to take reactive approaches to caring in which they were more concerned with managing situations that were associated with their partners' illnesses. Husbands reported limited contact with treatment and support services and perceived them as inappropriate to their circumstances. All of the men were presented with complex tensions in their caring roles, and the men's accounts of caring that are presented offer useful insight into the contexts in which men are increasingly taking on caring roles in families and inform efforts to support men in this capacity.

People, places and policies - trying to account for health inequalities in impoverished neighbourhoods.

OBJECTIVE: We consider associations between individual, household and area-level characteristics and self-reported health. METHOD: Data is taken from baseline surveys undertaken in 13 socio-economically disadvantaged neighbourhoods in Victoria (n=3,944). The neighbourhoods are sites undergoing Neighbourhood Renewal (NR), a State government initiative redressing place-based disadvantage. ANALYSIS: This focused on the relationship between area and compositional factors and self-reported health. Area was coded into three categories; LGA, NR residents living in public housing (NRPU) and NR residents who lived in private housing (NRPR). Compositional factors included age, gender, marital status, identifying as a person with a disability, level of education, unemployment and receipt of pensions/benefits. RESULTS: There was a gradient in socio-economic disadvantage on all measures. People living in NR public housing were more disadvantaged than people living in NR private housing who, in turn, were more disadvantaged than people in the same LGA. NR public housing residents reported the worst health status and LGA residents reported the best. CONCLUSIONS: Associations between compositional characteristics of disability, educational achievement and unemployment income and poorer self-reported health were shown. They suggested that area characteristics, with housing policies, may be contributing to differences in self-reported health at the neighbourhood level. IMPLICATIONS: The clustering of socio-economic disadvantage and health outcomes requires the integration of health and social support interventions that address the circumstances of people and places.

Sources of stress in impoverished neighbourhoods: insights into links between neighbourhood environments and health.

OBJECTIVE: This paper explores associations between residents' perceptions of social incivilities and physical disorders in local environments and self-reported health status. METHOD: Surveys were conducted with 4,029 residents from 13 Neighbourhood Renewal sites and 1,857 residents of corresponding Local Government Areas in Victoria. An open-ended question asked respondents to nominate the worst things about living in their neighbourhood and this qualitative data was analysed for the range of perceptions of incivilities. Quantitative data analysis considered associations between incivilities in neighbourhood environments and self-reported health status. RESULTS: Issues conceptualised as social incivilities (drug and alcohol use, dangerous driving, the behaviour of other people, feeling unsafe, noise, racism) accounted for 58% of issues nominated. Quantitative analyses suggested that increased exposure to issues related to aspects of neighbourhood safety were associated with living in a disadvantaged neighbourhood. Perceptions of lower levels of neighbourhood safety were, in turn, associated with poorer health. CONCLUSIONS: Cumulative and compounding aspects of local environments that heighten feelings of insecurity and anxiety may be mechanisms through which places affect health. IMPLICATIONS: While the characteristics of populations are important determinants of health outcomes, the findings endorse the value of incorporating complementary place-based approaches for addressing mechanisms that contribute to health inequalities in local environments.

'Money, stress, jobs': residents' perceptions of health-impairing factors in 'poor' neighbourhoods.

While the spatial distribution of health and disease is largely associated with individual-level indicators, neighbourhood-level factors appear to exert some independent and mediating influence on health-related processes. This study, conducted in four socio-economically disadvantaged sites in Australia and part of a larger project, analysed residents' perceptions of neighbourhood factors that influence health. Responses identified four key categories of issues that varied across neighbourhood settings. Residents of high-rise towers were more likely than other residents to nominate proximal aspects of the neighbourhood as having a perceived negative influence on health. The findings support other research that suggests that local physical and social environments influence health via psychosocial processes.

Stories in the flesh and voices in the head: reflections on the context and impact of research with disadvantaged populations.

In this article, the author reflects on her involvement in qualitative health among disadvantaged and disenfranchised groups whose life experiences are, for the most part, very different from her own. Despite the differences, she is persuaded that it is possible to have an empathetic understanding of other people's experiences through research. Recalling experiences from her own research encounters, she shows the ways in which these encounters as embodied and situated interactions generate a powerful methodological potential for gaining insight into other people's lives. She suggests strategies for preserving the layers of context and meaning that can otherwise be lost when research encounters are transformed into research data. Furthermore, the methodological power of qualitative research can mean that research encounters are intense and emotional experiences for researchers. Therefore, she offers some strategies for managing the emotional potency of some of the more distressing life stories that social researchers might come to know.