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Biomedical subjects

Lenore Manderson

Publications and source records attributed to Lenore Manderson.

At least 19 recordsLinked to original sources
PubMed2007

Complex emotions, complex problems: understanding the experiences of perinatal depression among new mothers in urban Indonesia.

In this article, we explore how Javanese women identify and speak of symptoms of depression in late pregnancy and early postpartum and describe their subjective accounts of mood disorders. The study, conducted in the East Java region of Indonesia in 2000, involved in-depth interviews with a subgroup of women (N = 41) who scored above the cutoff score of 12/13 on the Edinburgh Postnatal Depression Scale (EPDS) during pregnancy, at six weeks postpartum, or on both occasions. This sample was taken from a larger cohort study (N cohort = 488) researching the sociocultural factors that contribute to women's emotional well-being in early motherhood. The women used a variety of Indonesian and Javanese terms to explain their emotional states during pregnancy and in early postpartum, some of which coincided with the feelings described on the EPDS and others of which did not. Women attributed their mood variations to multiple causes including: premarital pregnancy, chronic illness in the family, marital problems, lack of support from partners or family networks, their husband's unemployment, and insufficient family income due to giving up their own paid work. We argue for the importance of understanding the context of childbearing in order to interpret the meaning of depression within complex social, cultural, and economic contexts.

Adolescent↗
PubMed2006

Impact, distress and HRQoL among Malaysian men and women with a mobility impairment.

BACKGROUND: Although non-communicable and chronic disease now accounts for 47% of the global burden of disease, little is known of the everyday experiences and social aspects of disability and disablement in middle and low income countries. This article aims to address this gap by exploring the subjective experience of mobility impairment in Malaysia. Specifically, it examines health-related quality of life and the impact and distress related to impaired mobility, and investigates any gender differences in relation to the experience of disability. METHODS: The data were collected as part of an interdisciplinary, multi-country study known as RESILIENCE (Research into Social Inclusion, Locomotive Impairment and Empowerment through Networking, Collaboration and Education). Cluster sampling was used to administer the EQ-5D and the Perceived Impact of Problems Profile (PIPP) to 210 adults from Selangor state, west coast Peninsular Malaysia. RESULTS: The participants consisted of 94 males and 116 females, aged between 18-90 years (mean 60 years), with the majority being Malay. The majority of participants were also married, from rural areas and had primary education only. Very few participants lived alone. In addition, males were more likely to attribute their impaired mobility to an accident. The majority of participants with mobility impairment experienced a moderate to high level of pain/discomfort (79%) and anxiety/depression (72%), and at least some problems with performing usual activities (71%), as measured by the EQ-5D. In addition, using the Perceived Impact of Problems Profile (PIPP), participants also reported high levels of impact and distress related to participation in community life. In general, males reported higher impact and distress across several items, most significantly in regard to participation in community activities, moving around the neighbourhood, ability to live independently, and ability to assist their family members. CONCLUSION: This paper provides preliminary data regarding the health-related quality of life among Malaysians with impaired mobility, and highlights the multifaceted impact of disability and the importance of acknowledging the diverse cultural contexts in which disability can occur. It also raises questions regarding gender differences in the subjective experience of disability in Malaysia.

Activities of Daily Living↗
PubMed2006

Measuring the impact and distress of health problems from the individual's perspective: development of the Perceived Impact of Problem Profile (PIPP).

BACKGROUND: The aim of this study was to develop and conduct preliminary validation of the Perceived Impact of Problem Profile (PIPP). Based on the biopsychosocial model of health and functioning, the PIPP was intended as a generic research and clinical measurement tool to assess the impact and distress of health conditions from the individuals' perspective. The ICF classification system was used to guide the structure of the PIPP with subscales included to assess impact on self-care, mobility, participation, relationships and psychological well-being. While the ICF focuses on the classification of objective health and health related status, the PIPP broadens this focus to address the individuals' subjective experience of their health condition. METHODS: An item pool of 23 items assessing both impact and distress on five key domains was generated. These were administered to 169 adults with mobility impairment. Rasch analysis using RUMM2020 was conducted to assess the psychometric properties of each set of items. Preliminary construct validation of the PIPP was performed using the EQ5D. RESULTS: For both the Impact and Distress scales of the PIPP, the five subscales (Self-care, Mobility, Participation, Relationships, and Psychological Well-being) showed adequate psychometric properties, demonstrating fit to the Rasch model. All subscales showed adequate person separation reliability and no evidence of differential item functioning for sex, age, educational level or rural vs urban residence. Preliminary validity testing using the EQ5D items provided support for the subscales. CONCLUSION: This preliminary study, using a sample of adults with mobility impairment, provides support for the psychometric properties of the PIPP as a potential clinical and research measurement tool. The PIPP provides a brief, but comprehensive means to assess the key ICF components, focusing on the individuals' perspective of the impact and distress caused by their health condition. Further validation of its use across different health conditions and varying cultural settings is required.

Activities of Daily Living↗
PubMed2006

Control and adherence: living with diabetes in Bangkok, Thailand.

Diabetes is managed via a regimen of control. Physicians advise adults living with type 2 diabetes to control blood sugar levels by controlling diet, maintaining regular exercise, and complying with medication. The extent to which individuals are able to adhere to such recommendations varies. In this article, we explore lay perceptions of diabetes and its control, drawing on data from an ethnographic study conducted in Bangkok, Thailand. Between August 2001 and February 2003 the first author spent time with twelve man and women living with type 2 diabetes, their spouses, children and health providers. An additional 21 people were interviewed to extend the data and test for generalisibility. It was found that individual explanations of control, and adherence or resistance to medical advice, are interpreted and adapted in ways consistent with Buddhist philosophy and Thai norms that govern everyday life. Notions of moderation and cultural values of being and behaving, and ideals of interaction, provide a philosophical basis and practical guidelines for control.

Adult↗
PubMed2006

Complementary medicine use by Australian women with gynaecological cancer.

AIMS AND OBJECTIVES: Social and cultural factors are identified that impact on complementary therapy use among Australia-born and immigrant women diagnosed with gynaecological cancer. METHODS: A qualitative study design including in-depth interviews with women diagnosed with gynaecological cancer (N=53) and participant observation was conducted. RESULTS: Approximately one-third of women utilized complementary and alternative medicine, with this being determined by current health concerns and health beliefs related to the efficacy of different modalities. Four types of complementary therapy users emerged: consequential, therapeutic, informed and exploratory. CONCLUSION: There was a relatively low uptake of complementary treatments. Choice was influenced by women's socio-demographic background, clinical and personal history, lack of personal experiences of gynaecological cancer among study participants' kin and friends, and lack of popular alternative literature on such cancer.

Adult↗
PubMed2006

Maternal identity change as a consequence of antenatal hospitalization.

Despite low fertility rates in Western countries, maternity remains one of the major goals of women from various socioeconomic backgrounds. While most women will have low-risk pregnancies, common serious disorders of pregnancy, such as preeclampsia, premature rupture of the membranes, placenta previa, or fetal growth restriction, may compromise maternal and infant outcomes. The experiences of urban and rural women in Australia who have had difficulties in maintaining their pregnancies are analyzed in this article. We study the impact of individual and social factors that facilitate or impede women's adjustment to the risks associated with these disorders. The analysis of in-depth interviews with 27 women hospitalized antenatally indicates that most women were unfamiliar with the diagnoses and acted as passive "decision takers," complying with medical advice to remain in the hospital. Admission to a tertiary hospital ward that provided care to women with pregnancy disorders promoted the formation of a new identity, that of a woman whose pregnancy did not follow the expected path. Further, hospitalization offered women the opportunity to interact with others in similar difficult situations and, hence, feel less isolated.

Adaptation, Psychological↗
PubMed2006

Treatment decisions: a qualitative study with women with gynaecological cancer.

This qualitative study investigated women's participation in decisions regarding treatment of gynaecological cancer. Thirty women, receiving health care in two tertiary hospitals in Australia, were interviewed face-to-face. For women with gynaecological cancer, the most influential factors in treatment decisions are still the surgeon's recommendation and fear of dying from cancer.

Australia↗
PubMed2006

The social dynamics of the interview: age, class, and gender.

Researchers have paid only limited attention to how social structural factors influence the course and content of interviews. Speech, comportment, and values inherent to gender and other social, structural, and contextual factors, such as age, socioeconomic positioning, and ethnicity, all influence the direction, flow, and content of interviews, informing how we might interpret the information collected in the process. Drawing on interviews conducted within an Australian study on chronic illness and disability, the authors explore the performative nature of the interview and how interviewers and interviewees respond to the structural factors shaping the social dynamics of the interview to produce accounts of social life.

Adaptation, Psychological↗
PubMed2006

Social support and self-management of type 2 diabetes among immigrant Australian women.

OBJECTIVE: To elucidate the social meanings and interpretations that immigrant women attach to the diagnosis of type 2 diabetes, and the social support and professional advice that they receive following this diagnosis. METHODS: In-depth interviews were conducted with 16 immigrant women living in Melbourne, Australia, from communities with a higher than average incidence of type 2 diabetes. Women were recruited purposively through general practitioners and community organizations. The women's initial reaction to the diagnosis of diabetes, understandings of the behavioural changes required to control symptoms and prevent complications and the nature of the social and professional supports were discussed. Interviews were audio-taped, transcribed, coded and analysed thematically by both authors. RESULTS: Some women were critical of their doctors but also manipulated their encounters to avoid receiving unwelcome information about the progress of the disease and consequent required changes in management. Social interactions influenced women's adjustments to diagnosis and informed their communication and adaptation of their lives. Choice of support varied by cultural background, but many respondents reflected on the thin line between support and interference. All women found most understanding from others living with diabetes. DISCUSSION: The social context of people with type 2 diabetes is important in facilitating or inhibiting the management of the condition. Variations in attitudes to family and professionals influenced adherence to advice and emphasized the need for appropriate support to women to sustain behavioural change.

Australia↗
PubMed2006

Typologies of rural lay-health advocacy among rural women in Australia.

BACKGROUND: Public health advocacy effects changes in health behaviors and outcomes through applying health promotion expertise to specific groups. Advocacy occurs through the provision of tools to empower those who are either experiencing, or at risk of, a particular health status. RESEARCH OBJECTIVES: Health-care experiences of women living in rural Victoria, Australia, were explored in the context of generally poor access to reproductive health services. Women's experiences are investigated within the theoretical framework of lay-health advocacy, i.e. relying on individual health care experience and knowledge to promote and improve the health care of others. METHODOLOGY: The study applied a qualitative design, and a self-identified sample of women was recruited through network sampling techniques. Fifty-seven women participated in in-depth interviews. RESULTS: Three types of lay-health advocacy emerged. Advocacy-seekers expected the researchers to use their experiences of poor health-care to educate health professionals to provide better quality care. Advocacy providers used their knowledge and experiences to take an active part in promoting the health-care of other women. Story-tellers expected their narratives to empower other women or unidentified social groups to feel less isolated in their health care experiences. DISCUSSION: In providing narratives of their health-care, women were critical of social inequalities facing people living in rural Australia. Lay-health advocates offer a cost-effective and appropriate option for reducing adverse health outcomes within resource-poor settings. Informed by women's narratives, we suggest strategies to enhance rural women's health-care.

Adult↗
PubMed2006

Cervical cancer services for Indigenous women: advocacy, community-based research and policy change in Australia.

Collaborative research undertaken in the state of Queensland, Australia, resulted in major changes in cervical cancer screening and treatment for Indigenous women. Guided by an Indigenous statewide reference group and with an Indigenous researcher playing a lead role, qualitative data were collected using interviews, focus groups, larger community meetings; and case studies were conducted with health workers and community members from diverse rural, remote and urban communities, to explore the different cultural and structural factors affecting understanding and awareness of cervical cancer and Indigenous women's use of and access to health services for screening, diagnosis and treatment. These data were supplemented by an analysis of clinical data and health service checklists. We discuss the methodology and summarize the key social and structural factors that discourage women from presenting for screening or returning for follow-up. These include women's misunderstanding of cervical cancer screening, fear of cancer, and distrust of health services, poor recall and follow-up systems, and the economic and social burden to women to presenting for treatment. We describe how the research process and subsequent activities provided Indigenous women with a vehicle for their own advocacy, resulting in important policy and program changes.

Community Health Planning↗
PubMed2005

The social and economic context and determinants of schistosomiasis japonica.

A variety of biological and social factors govern schistosomiasis japonica in China. Social factors include those at a national and regional level, such as policies and patterns of development, which impact on local economic activities, and affect community, household and personal risk factors of infection. Drawing on research conducted in China, we illustrate how social structural and related factors influence individual risk and prevalence of infection. At a macro-level, political changes have occurred resulting in the shift from collective to family-based production, leading to clustering of infection in families. Industrialization and urbanization, and associated increased population mobility, have also influenced patterns of transmission and infection. Types of activities and local production patterns determine the exposure of individuals to schistosome-infested water sources. Fishermen have the most frequent water contact, aquatic workers the second and farmers the third; the relative risk of Schistosoma japonicum infection follows the same order. Among farmers, human infection is significantly related to agricultural production in rice fields infested with the intermediate host snail, and to rates of the infection in livestock. Risk of S. japonicum infection is also influenced by the domestic environment, including both the location of the house in relation to snail-colonized water sources, access to safe water, and improved sanitation. Household wealth and income determine family ability to provide and maintain safe water and sanitation, while determining or interacting with other variables. At an individual level, sex, age, educational level and ethnicity are all associated with different patterns of water use and water contact behaviour thereby affecting infection rates. Schistosomiasis impairs the growth and nutrition of children and the physical work capacity of adults, and so affects economic development. Given this, we note the importance of further research and social and contextual aspects of schistosomiasis infection in order to develop and sustain sound control strategies.

Child↗
PubMed2005

School-based interventions to enhance knowledge and improve case management of schistosomiasis: a case study from Hunan, China.

This paper discusses an intersectoral health-related intervention, using cartoons and video-recording, print materials and face-to-face educational methods, to increase children's knowledge of schistosomiasis, which in turn might improve the case management of early diagnosis and treatment. The main components of the project were (i) the collaboration between the departments of public health and education and (ii) a randomized, controlled, school-based field trial conducted in the Dongting Lake region, China. Children in the experimental group (n=604) and their parents participated in the educational programme. Control children (n=527) received a 2 hour lecture about the disease. All participants were pre-tested, and retested five months after the conduct of the educational intervention. The results show significant changes among children and their parents in the experimental group related to knowledge about schistosomiasis and beliefs towards screening and treatment of the disease. Children in the experimental group also had better compliance than children in the control group for regular screening for schistosomiasis. These findings indicate that carefully designed education programmes are useful for providing both children and their families with information about the prevention and treatment of schistosomiasis. Intersectoral collaboration holds promise to deliver research-based interventions for enhanced knowledge of schistosomiasis and improved case management.

Adolescent↗
PubMed2005

Boundary breaches: the body, sex and sexuality after stoma surgery.

People with limited or no bladder or bowel control, who have had a stoma to manage elimination, have a particular awareness of the proximity of the sites of pleasure and excretion. Drawing on interviews and related ethnography conducted in Australia from 1998 to 2001, this paper explores how men and women with permanent continence problems negotiate their sexuality around their bodily unreliability. Pleasurable sex, idealized, involves losing control. People who are incontinent or rely on a stoma, however, must monitor their bladder and bowel, disguising the stoma and bag and controlling their body in sex as in other circumstances. The need to negotiate bodily boundaries with established partners, or to disclose to new sexual partners, results in self-consciousness and social unease, and people need to reconstruct notions of privacy and dignity so that breaches in bodily control do not undermine the sexual relationship. For many, the stoma undermines self-esteem and body image, while its management confuses the status of the individual as "normal" and the partner as carer or lover.

Adult↗
PubMed2005

"Like roulette": Australian women's explanations of gynecological cancers.

Drawing on data from interviews and other ethnographic research, we examine how Australian women from different ethnic and cultural backgrounds make sense of having gynecological cancer. Alternative explanatory models often co-exist in a single narrative, but there is significant consistency in the etiology of cancer among Australian-born and immigrant women. In acknowledging the unpredictability of cancer and the prognosis of particular disease, women contextualize their own experience as a matter of luck, outside their control or influence. Most often women relate their own occurrence of cancer to their social setting and relational factors rather than personal behavior, but at the same time, they acknowledge the interaction of external forces and individual factors, particularly in the case of diet and stress. Women can control diet to some extent, although many note the irony of having developed cancer even when they have eaten well. Stress, on the other hand, is largely considered as external to and beyond women's control. Women speak of stress as a characteristic of contemporary social life, as well as their own public and domestic, physical and emotional lives; for these women stress in any of these areas can create physical vulnerability that may result in cancer. Since women associate cancer with loss of control, the idea of cancerous cells out-of-control within their bodies operates as a metonym of women's views of themselves interpersonally and socially.

Adaptation, Psychological↗
PubMed2004

Stillbirth, neonatal death and reproductive rights in Indonesia.

Globally, newborn deaths account for two-thirds of all deaths in the first year of life and 40% of under-five mortality. As infant mortality declines, the proportion of neonatal deaths has been increasing because of the failure to address the causes. The data in this paper derive from a longitudinal study of motherhood and emotional well-being of women in Indonesia; 488 women were interviewed in late pregnancy, and 290 at six weeks post-partum. This paper reports on in-depth interviews with four women who reported a stillbirth and six who reported a neonatal or infant death. They were asked about their understanding of why their baby had died and the information, care and support given to them. The study suggests that maternal and child health clinics fail to protect and fulfill pregnant women's reproductive rights, specifically the right to information and care for themselves and their infants, informed consent, counselling and to be treated with respect. This can be achieved through training and education for health professionals and policymakers, and by educating women about their rights as patients. It is essential that countries with high infant and maternal mortality provide post-partum care that includes support for those who experience stillbirth and neonatal death, including information, counselling and home visits.

Female↗
PubMed2004

Embodied changes and the search for gynecological cancer diagnosis.

The detection and successful treatment of cancers is dependent on timely presentation with abnormal and often subtle symptoms. In this article, we draw on research conducted with Australian immigrant women in 2001-02 who experienced delays in diagnosis of gynecological cancer. Data from in-depth interviews with women with gynecological cancer indicated a common trajectory of an "illness career" whereby the search for diagnosis was often painful and lengthy, either because women normalized the abnormal signs or because their experiences of bodily abnormality, pain, and dysfunction contrasted with medical explanations. This delay was sometimes exacerbated by structural barriers. As a result, diagnosis was often protracted, during which time women presented with symptoms that were dismissed or resulted in the misdiagnosis, with a resultant loss of confidence in clinical services.

Aged↗