Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990-2019 : A systematic analysis for the Global Burden of Disease Study 2019
- Authors: Rahman, Muhammad Aziz
- Date: 2020
- Type: Text , Journal article
- Relation: Lancet Vol. 396, no. 10258 (2020), p. 1250-1284
- Full Text:
- Reviewed:
- Description: Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (>= 65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0-100 based on the 2.5th and 97.5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target-1 billion more people benefiting from UHC by 2023-we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45.8 (95% uncertainty interval 44.2-47.5) in 1990 to 60.3 (58.7-61.9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2.6% [1.9-3.3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010-2019 relative to 1990-2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0.79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388.9 million (358.6-421.3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3.1 billion (3.0-3.2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968.1 million [903.5-1040.3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people-the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close-or how far-all populations are in benefiting from UHC. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd. **Please note that there are multiple authors for this article therefore only the name of the Federation University Australia affiliate is provided in this record**
- Description: Lucas Guimaraes Abreu acknowledges support from Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior -Brasil (Capes) -Finance Code 001, Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq) and Fundacao de Amparo a Pesquisa do Estado de Minas Gerais (FAPEMIG). Olatunji O Adetokunboh acknowledges South African Department of Science & Innovation, and National Research Foundation. Anurag Agrawal acknowledges support from the Wellcome Trust DBT India Alliance Senior Fellowship IA/CPHS/14/1/501489. Rufus Olusola Akinyemi acknowledges Grant U01HG010273 from the National Institutes of Health (NIH) as part of the H3Africa Consortium. Rufus Olusola Akinyemi is further supported by the FLAIR fellowship funded by the UK Royal Society and the African Academy of Sciences. Syed Mohamed Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. Marcel Ausloos, Claudiu Herteliu, and Adrian Pana acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDSUEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. Till Winfried Barnighausen acknowledges support from the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. Juan J Carrero was supported by the Swedish Research Council (2019-01059). Felix Carvalho acknowledges UID/MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/MCTES through national funds. Vera Marisa Costa acknowledges support from grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundacao para a Ciencia e a Tecnologia (FCT), IP, under the Norma TransitA3ria DL57/2016/CP1334/CT0006. Jan-Walter De Neve acknowledges support from the Alexander von Humboldt Foundation. Kebede Deribe acknowledges support by Wellcome Trust grant number 201900/Z/16/Z as part of his International Intermediate Fellowship. Claudiu Herteliu acknowledges partial support by a grant co-funded by European Fund for Regional Development through Operational Program for Competitiveness, Project ID P_40_382. Praveen Hoogar acknowledges the Centre for Bio Cultural Studies (CBiCS), Manipal Academy of Higher Education(MAHE), Manipal and Centre for Holistic Development and Research (CHDR), Kalghatgi. Bing-Fang Hwang acknowledges support from China Medical University (CMU108-MF-95), Taichung, Taiwan. Mihajlo Jakovljevic acknowledges the Serbian part of this GBD contribution was co-funded through the Grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. Aruna M Kamath acknowledges funding from the National Institutes of Health T32 grant (T32GM086270). Srinivasa Vittal Katikireddi acknowledges funding from the Medical Research Council (MC_UU_12017/13 & MC_UU_12017/15), Scottish Government Chief Scientist Office (SPHSU13 & SPHSU15) and an NRS Senior Clinical Fellowship (SCAF/15/02). Yun Jin Kim acknowledges support from the Research Management Centre, Xiamen University Malaysia (XMUMRF/2018-C2/ITCM/0001). Kewal Krishan acknowledges support from the DST PURSE grant and UGC Center of Advanced Study (CAS II) awarded to the Department of Anthropology, Panjab University, Chandigarh, India. Manasi Kumar acknowledges support from K43 TW010716 Fogarty International Center/NIMH. Ben Lacey acknowledges support from the NIHR Oxford Biomedical Research Centre and the BHF Centre of Research Excellence, Oxford. Ivan Landires is a member of the Sistema Nacional de InvestigaciA3n (SNI), which is supported by the Secretaria Nacional de Ciencia Tecnologia e Innovacion (SENACYT), Panama. Jeffrey V Lazarus acknowledges support by a Spanish Ministry of Science, Innovation and Universities Miguel Servet grant (Instituto de Salud Carlos III/ESF, European Union [CP18/00074]). Peter T N Memiah acknowledges CODESRIA; HISTP. Subas Neupane acknowledges partial support from the Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital. Shuhei Nomura acknowledges support from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (18K10082). Alberto Ortiz acknowledges support by ISCIII PI19/00815, DTS18/00032, ISCIII-RETIC REDinREN RD016/0009 Fondos FEDER, FRIAT, Comunidad de Madrid B2017/BMD-3686 CIFRA2-CM. These funding sources had no role in the writing of the manuscript or the decision to submit it for publication. George C Patton acknowledges support from a National Health & Medical Research Council Fellowship. Marina Pinheiro acknowledges support from FCT for funding through program DL 57/2016 -Norma transitA3ria. Alberto Raggi, David Sattin, and Silvia Schiavolin acknowledge support by a grant from the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C Besta, Linea 4 -Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche). Daniel Cury Ribeiro acknowledges support from the Sir Charles Hercus Health Research Fellowship -Health Research Council of New Zealand (18/111). Perminder S Sachdev acknowledges funding from the NHMRC Australia. Abdallah M Samy acknowledges support from a fellowship from the Egyptian Fulbright Mission Program. Milena M Santric-Milicevic acknowledges support from the Ministry of Education, Science and Technological Development of the Republic of Serbia (Contract No. 175087). Rodrigo Sarmiento-Suarez acknowledges institutional support from University of Applied and Environmental Sciences in Bogota, Colombia, and Carlos III Institute of Health in Madrid, Spain. Maria Ines Schmidt acknowledges grants from the Foundation for the Support of Research of the State of Rio Grande do Sul (IATS and PrInt) and the Brazilian Ministry of Health. Sheikh Mohammed Shariful Islam acknowledges a fellowship from the National Heart Foundation of Australia and Deakin University. Aziz Sheikh acknowledges support from Health Data Research UK. Kenji Shibuya acknowledges Japan Ministry of Education, Culture, Sports, Science and Technology. Joan B Soriano acknowledges support by Centro de Investigacion en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Rafael Tabares-Seisdedos acknowledges partial support from grant PI17/00719 from ISCIII-FEDER. Santosh Kumar Tadakamadla acknowledges support from the National Health and Medical Research Council Early Career Fellowship, Australia. Marcello Tonelli acknowledges the David Freeze Chair in Health Services Research at the University of Calgary, AB, Canada.
- Authors: Rahman, Muhammad Aziz
- Date: 2020
- Type: Text , Journal article
- Relation: Lancet Vol. 396, no. 10258 (2020), p. 1250-1284
- Full Text:
- Reviewed:
- Description: Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (>= 65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0-100 based on the 2.5th and 97.5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target-1 billion more people benefiting from UHC by 2023-we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45.8 (95% uncertainty interval 44.2-47.5) in 1990 to 60.3 (58.7-61.9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2.6% [1.9-3.3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010-2019 relative to 1990-2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0.79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388.9 million (358.6-421.3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3.1 billion (3.0-3.2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968.1 million [903.5-1040.3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people-the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close-or how far-all populations are in benefiting from UHC. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd. **Please note that there are multiple authors for this article therefore only the name of the Federation University Australia affiliate is provided in this record**
- Description: Lucas Guimaraes Abreu acknowledges support from Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior -Brasil (Capes) -Finance Code 001, Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq) and Fundacao de Amparo a Pesquisa do Estado de Minas Gerais (FAPEMIG). Olatunji O Adetokunboh acknowledges South African Department of Science & Innovation, and National Research Foundation. Anurag Agrawal acknowledges support from the Wellcome Trust DBT India Alliance Senior Fellowship IA/CPHS/14/1/501489. Rufus Olusola Akinyemi acknowledges Grant U01HG010273 from the National Institutes of Health (NIH) as part of the H3Africa Consortium. Rufus Olusola Akinyemi is further supported by the FLAIR fellowship funded by the UK Royal Society and the African Academy of Sciences. Syed Mohamed Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. Marcel Ausloos, Claudiu Herteliu, and Adrian Pana acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDSUEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. Till Winfried Barnighausen acknowledges support from the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. Juan J Carrero was supported by the Swedish Research Council (2019-01059). Felix Carvalho acknowledges UID/MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/MCTES through national funds. Vera Marisa Costa acknowledges support from grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundacao para a Ciencia e a Tecnologia (FCT), IP, under the Norma TransitA3ria DL57/2016/CP1334/CT0006. Jan-Walter De Neve acknowledges support from the Alexander von Humboldt Foundation. Kebede Deribe acknowledges support by Wellcome Trust grant number 201900/Z/16/Z as part of his International Intermediate Fellowship. Claudiu Herteliu acknowledges partial support by a grant co-funded by European Fund for Regional Development through Operational Program for Competitiveness, Project ID P_40_382. Praveen Hoogar acknowledges the Centre for Bio Cultural Studies (CBiCS), Manipal Academy of Higher Education(MAHE), Manipal and Centre for Holistic Development and Research (CHDR), Kalghatgi. Bing-Fang Hwang acknowledges support from China Medical University (CMU108-MF-95), Taichung, Taiwan. Mihajlo Jakovljevic acknowledges the Serbian part of this GBD contribution was co-funded through the Grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. Aruna M Kamath acknowledges funding from the National Institutes of Health T32 grant (T32GM086270). Srinivasa Vittal Katikireddi acknowledges funding from the Medical Research Council (MC_UU_12017/13 & MC_UU_12017/15), Scottish Government Chief Scientist Office (SPHSU13 & SPHSU15) and an NRS Senior Clinical Fellowship (SCAF/15/02). Yun Jin Kim acknowledges support from the Research Management Centre, Xiamen University Malaysia (XMUMRF/2018-C2/ITCM/0001). Kewal Krishan acknowledges support from the DST PURSE grant and UGC Center of Advanced Study (CAS II) awarded to the Department of Anthropology, Panjab University, Chandigarh, India. Manasi Kumar acknowledges support from K43 TW010716 Fogarty International Center/NIMH. Ben Lacey acknowledges support from the NIHR Oxford Biomedical Research Centre and the BHF Centre of Research Excellence, Oxford. Ivan Landires is a member of the Sistema Nacional de InvestigaciA3n (SNI), which is supported by the Secretaria Nacional de Ciencia Tecnologia e Innovacion (SENACYT), Panama. Jeffrey V Lazarus acknowledges support by a Spanish Ministry of Science, Innovation and Universities Miguel Servet grant (Instituto de Salud Carlos III/ESF, European Union [CP18/00074]). Peter T N Memiah acknowledges CODESRIA; HISTP. Subas Neupane acknowledges partial support from the Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital. Shuhei Nomura acknowledges support from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (18K10082). Alberto Ortiz acknowledges support by ISCIII PI19/00815, DTS18/00032, ISCIII-RETIC REDinREN RD016/0009 Fondos FEDER, FRIAT, Comunidad de Madrid B2017/BMD-3686 CIFRA2-CM. These funding sources had no role in the writing of the manuscript or the decision to submit it for publication. George C Patton acknowledges support from a National Health & Medical Research Council Fellowship. Marina Pinheiro acknowledges support from FCT for funding through program DL 57/2016 -Norma transitA3ria. Alberto Raggi, David Sattin, and Silvia Schiavolin acknowledge support by a grant from the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C Besta, Linea 4 -Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche). Daniel Cury Ribeiro acknowledges support from the Sir Charles Hercus Health Research Fellowship -Health Research Council of New Zealand (18/111). Perminder S Sachdev acknowledges funding from the NHMRC Australia. Abdallah M Samy acknowledges support from a fellowship from the Egyptian Fulbright Mission Program. Milena M Santric-Milicevic acknowledges support from the Ministry of Education, Science and Technological Development of the Republic of Serbia (Contract No. 175087). Rodrigo Sarmiento-Suarez acknowledges institutional support from University of Applied and Environmental Sciences in Bogota, Colombia, and Carlos III Institute of Health in Madrid, Spain. Maria Ines Schmidt acknowledges grants from the Foundation for the Support of Research of the State of Rio Grande do Sul (IATS and PrInt) and the Brazilian Ministry of Health. Sheikh Mohammed Shariful Islam acknowledges a fellowship from the National Heart Foundation of Australia and Deakin University. Aziz Sheikh acknowledges support from Health Data Research UK. Kenji Shibuya acknowledges Japan Ministry of Education, Culture, Sports, Science and Technology. Joan B Soriano acknowledges support by Centro de Investigacion en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Rafael Tabares-Seisdedos acknowledges partial support from grant PI17/00719 from ISCIII-FEDER. Santosh Kumar Tadakamadla acknowledges support from the National Health and Medical Research Council Early Career Fellowship, Australia. Marcello Tonelli acknowledges the David Freeze Chair in Health Services Research at the University of Calgary, AB, Canada.
Moving forward with dignity : exploring health awareness in an isolated deaf community of Australia
- Terry, Daniel, Lê, Quynh, Nguyen, Hoang
- Authors: Terry, Daniel , Lê, Quynh , Nguyen, Hoang
- Date: 2016
- Type: Text , Journal article
- Relation: Disability and Health Journal Vol. 9, no. 2 (2016), p. 281-288
- Full Text:
- Reviewed:
- Description: Background Those within the Deaf community are disadvantaged in a number of aspects of day-to-day life including their access to health care. At times, they may encounter barriers to health care even before they reach the consultation room. As a consequence, they may receive insufficient and inappropriate health care which may lead to poorer health outcomes. Objective A study was conducted to explore health awareness and access to health information and services of Deaf people living in Tasmania, Australia and identify ways of enhancing the interaction between the Deaf and the wider community. Methods A questionnaire was administered, including a number of demographic, health awareness and health service usage questions. In addition, semi-structured interviews and focus groups were conducted with service providers and the Deaf community between March and August 2014. An interpreter was present to translate the questions into Auslan and who then translated the Deaf participant's discussion into English for the researcher. Data were then analyzed using research software SPSS v20.0 and NVivo 10.0. Results Health as a concept was poorly understood, including mental health, sexual health and health concerning alcohol and drug abuse. Regarding health care resources, due to a sense of security, trust and confidence, the family physician or general practitioner was the single most important health care provider among the Deaf. Conclusions The Deaf remain underserved by the current health care system; however, through resourcefulness and life experiences, the Deaf have developed coping and management strategies to move forward with dignity in education, meaningful employment and health access. © 2016 Elsevier Inc. All rights reserved.
- Authors: Terry, Daniel , Lê, Quynh , Nguyen, Hoang
- Date: 2016
- Type: Text , Journal article
- Relation: Disability and Health Journal Vol. 9, no. 2 (2016), p. 281-288
- Full Text:
- Reviewed:
- Description: Background Those within the Deaf community are disadvantaged in a number of aspects of day-to-day life including their access to health care. At times, they may encounter barriers to health care even before they reach the consultation room. As a consequence, they may receive insufficient and inappropriate health care which may lead to poorer health outcomes. Objective A study was conducted to explore health awareness and access to health information and services of Deaf people living in Tasmania, Australia and identify ways of enhancing the interaction between the Deaf and the wider community. Methods A questionnaire was administered, including a number of demographic, health awareness and health service usage questions. In addition, semi-structured interviews and focus groups were conducted with service providers and the Deaf community between March and August 2014. An interpreter was present to translate the questions into Auslan and who then translated the Deaf participant's discussion into English for the researcher. Data were then analyzed using research software SPSS v20.0 and NVivo 10.0. Results Health as a concept was poorly understood, including mental health, sexual health and health concerning alcohol and drug abuse. Regarding health care resources, due to a sense of security, trust and confidence, the family physician or general practitioner was the single most important health care provider among the Deaf. Conclusions The Deaf remain underserved by the current health care system; however, through resourcefulness and life experiences, the Deaf have developed coping and management strategies to move forward with dignity in education, meaningful employment and health access. © 2016 Elsevier Inc. All rights reserved.
How can the expansion of the apprenticeship system in India create conditions for greater equity and social justice?
- Smith, Erica, Kemmis, Ros Brennan, Comyn, Paul
- Authors: Smith, Erica , Kemmis, Ros Brennan , Comyn, Paul
- Date: 2014
- Type: Text , Journal article
- Relation: Australian Journal of Adult Learning Vol. 54, no. 3 (2014), p.
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- Reviewed:
- Description: This paper reports on aspects of a recent project carried out for the International Labour Organization (ILO) and the World Bank, which was designed to feed into the process of updating and expanding India’s apprenticeship system. The apprenticeship system in India is extremely small for the country’s population, even taking into account the high proportion of jobs that are in the informal economy, and is subject to very rigid regulation. Expansion of the system has been seen as vital in order to improve the supply of skills to the rapidly expanding economy, and also to address issues of disparity in labour market participation and equity for certain groups in Indian society. The paper firstly explains how findings about apprenticeship systems from ten other countries, together with analysis of the Indian situation, were used to present options for consideration by the Indian government. It then analyses these options for their social justice and equity implications.
- Authors: Smith, Erica , Kemmis, Ros Brennan , Comyn, Paul
- Date: 2014
- Type: Text , Journal article
- Relation: Australian Journal of Adult Learning Vol. 54, no. 3 (2014), p.
- Full Text:
- Reviewed:
- Description: This paper reports on aspects of a recent project carried out for the International Labour Organization (ILO) and the World Bank, which was designed to feed into the process of updating and expanding India’s apprenticeship system. The apprenticeship system in India is extremely small for the country’s population, even taking into account the high proportion of jobs that are in the informal economy, and is subject to very rigid regulation. Expansion of the system has been seen as vital in order to improve the supply of skills to the rapidly expanding economy, and also to address issues of disparity in labour market participation and equity for certain groups in Indian society. The paper firstly explains how findings about apprenticeship systems from ten other countries, together with analysis of the Indian situation, were used to present options for consideration by the Indian government. It then analyses these options for their social justice and equity implications.
Informal healthcare sector and marginalized groups: Repeat visits in rural North India
- Authors: Iles, Richard
- Date: 2018
- Type: Text , Journal article
- Relation: PLoS One Vol. 13, no. 7 (2018), p. e0199380-e0199380
- Full Text: false
- Reviewed:
- Description: The interrelationship between the public and private sectors, and formal and informal healthcare sectors effects market-level service quality, pricing behaviour and referral networks. However, health utilisation analysis of national survey data from many low and middle income countries is constrained by the lack of disaggregated health provider data. This study is concerned with the pattern of repeat outpatient consultations for a single episode of fever from public and private qualified providers and private unqualified providers. Cross-sectional survey data from 1173 adult respondents sampled from three districts within India's most populous state-Uttar Pradesh is analysed. Data was collected during the monsoon season-September to October-in 2012. Regression analysis focuses on the pattern of repeats visits for a single episode of mild-sever fever as the dependent variable. Results show that Women and Muslims in rural north India are more likely to not access healthcare, and if they do, consult with low quality unqualified outpatient healthcare providers. For fever durations of four or more days, men are more likely to access unqualified providers compared to women. Results of the current study supports the literature that women's utilisation of outpatient healthcare for communicable illnesses in LMICs is often less than men. A relative lack of access to household resources explains why fever duration parameter estimates for women and men differ.
Access and engagement of First Nations women in maternal and child health services
- Authors: Austin, Catherine
- Date: 2023
- Type: Text , Thesis , PhD
- Full Text:
- Description: This thesis explores and describes the engagement of First Nations women, with children from birth to five years of age, with Maternal and Child Health (MCH) services in Victoria, Australia. Identification of the factors that facilitate, support or hinder these women’s engagement with MCH services could strengthen the model of care to effectively engage First Nations women with these services. Access in the early years of a child’s life to integrated, effective, community-based services is a well-established predictor of a child’s successful transition to school and their lifelong education and employment outcomes. Such access is crucial in a child’s first 2,000 days (the period from conception to the child’s fifth year), which forms the foundation for a child’s lifetime development and health. Prior evaluative studies have shown that participation in MCH services in Victoria improves the health outcomes for children and families, particularly First Nations families. However, First Nations women and their children in Victoria show poorer health outcomes and lower participation in MCH services compared to non-Indigenous persons; this suggests a need to improve the current Victorian MCH service model. This thesis contributes recommendations for such improvements. The literature review (Chapter 2) identified the absence of a synthesis of qualitative studies of models of care to help guide MCH practice and innovation for all families, especially those at risk of child abuse and neglect. To address this gap, a three-phase qualitative study was conducted in the Glenelg Shire, Victoria, Australia, using narrative inquiry integrated with the Indigenous philosophy ‘Dadirri’. ‘Dadirri’, which emphasises deep and respectful listening, guided the development of the research design; this methodology assisted in understanding Indigenous culture and its sensitivities, building trust with the First Nations peoples involved in the studies, developing open-ended and conversational dialogue, and building respectful relationships. This method enabled First Nations women’s voices to be heard and the collection of rich data based on participants’ perspectives of and experiences with MCH services in Victoria. Study One (Chapter 4) recruited First Nations women residing in the Glenelg Shire, with at least one child aged birth to five years, to explore their perceptions and experiences of MCH services and barriers to accessing and engaging with MCH services. Study Two (Chapter 5) compared Study One data with accounts from MCH nurses working in Glenelg Shire. Study Three (Chapter 6) reviewed a piloting of the Early Assessment Referral Links (EARL) concept (developed by the researcher) that aims to improve First Nations women and their children’s access to and engagement with MCH services. EARL involved the core principles of narrative inquiry integrated with ‘Dadirri’. Study One and Two found that enabling factors for access and engagement include interventions that are culturally sensitive and effective; recognise the social determinates of health (SDOH) and social and emotional wellbeing; are timely, appropriate, culturally strong, flexible, holistic and community-based; support continuity of care and communication; and encourage early identification of risk, particularly of family violence (FV), and further assessment, intervention, referral and support in the child’s first 2,000 days. Barriers to access and engagement include an ineffective service model built on mistrust, poor communication due to cultural differences between client and provider (particularly around identification and disclosure of woman’s risk of FV), lack of continuity of care between services, limited flexibility of service delivery to suit individual needs, and a service model that does not recognise the importance of the SDOH and social and emotional wellbeing. Study Three results showed that participation of First Nations families in MCH services was consistently above the state average during the pilot period, and several First Nations families were referred to EARL stakeholders and other health professionals during the pilot. Further, there were increases in First Nations children being breastfed, fully immunised and attending Early Start Kindergarten, and identification of First Nations children at risk of abuse or neglect improved (with a significant increase in referrals for FV and child protection and significant decrease in episodes of out-of-home care). This thesis’s findings can support policy development. This research shows that timely, effective, holistic engagement with First Nations women in their child’s first 2,000 days, that respects their culture and facilitates genuine partnerships built on co-design and shared decision-making with the Indigenous community, needs to be an essential part of the MCH service model. Additionally, this thesis recommends adopting a strengths-based approach that respects First Nations peoples’ child-rearing practices and culture, and providing necessary training to MCH nurses who work with First Nations families. Keywords: child family health, continuity of care, First Nations women
- Description: Doctor of Philosophy
- Authors: Austin, Catherine
- Date: 2023
- Type: Text , Thesis , PhD
- Full Text:
- Description: This thesis explores and describes the engagement of First Nations women, with children from birth to five years of age, with Maternal and Child Health (MCH) services in Victoria, Australia. Identification of the factors that facilitate, support or hinder these women’s engagement with MCH services could strengthen the model of care to effectively engage First Nations women with these services. Access in the early years of a child’s life to integrated, effective, community-based services is a well-established predictor of a child’s successful transition to school and their lifelong education and employment outcomes. Such access is crucial in a child’s first 2,000 days (the period from conception to the child’s fifth year), which forms the foundation for a child’s lifetime development and health. Prior evaluative studies have shown that participation in MCH services in Victoria improves the health outcomes for children and families, particularly First Nations families. However, First Nations women and their children in Victoria show poorer health outcomes and lower participation in MCH services compared to non-Indigenous persons; this suggests a need to improve the current Victorian MCH service model. This thesis contributes recommendations for such improvements. The literature review (Chapter 2) identified the absence of a synthesis of qualitative studies of models of care to help guide MCH practice and innovation for all families, especially those at risk of child abuse and neglect. To address this gap, a three-phase qualitative study was conducted in the Glenelg Shire, Victoria, Australia, using narrative inquiry integrated with the Indigenous philosophy ‘Dadirri’. ‘Dadirri’, which emphasises deep and respectful listening, guided the development of the research design; this methodology assisted in understanding Indigenous culture and its sensitivities, building trust with the First Nations peoples involved in the studies, developing open-ended and conversational dialogue, and building respectful relationships. This method enabled First Nations women’s voices to be heard and the collection of rich data based on participants’ perspectives of and experiences with MCH services in Victoria. Study One (Chapter 4) recruited First Nations women residing in the Glenelg Shire, with at least one child aged birth to five years, to explore their perceptions and experiences of MCH services and barriers to accessing and engaging with MCH services. Study Two (Chapter 5) compared Study One data with accounts from MCH nurses working in Glenelg Shire. Study Three (Chapter 6) reviewed a piloting of the Early Assessment Referral Links (EARL) concept (developed by the researcher) that aims to improve First Nations women and their children’s access to and engagement with MCH services. EARL involved the core principles of narrative inquiry integrated with ‘Dadirri’. Study One and Two found that enabling factors for access and engagement include interventions that are culturally sensitive and effective; recognise the social determinates of health (SDOH) and social and emotional wellbeing; are timely, appropriate, culturally strong, flexible, holistic and community-based; support continuity of care and communication; and encourage early identification of risk, particularly of family violence (FV), and further assessment, intervention, referral and support in the child’s first 2,000 days. Barriers to access and engagement include an ineffective service model built on mistrust, poor communication due to cultural differences between client and provider (particularly around identification and disclosure of woman’s risk of FV), lack of continuity of care between services, limited flexibility of service delivery to suit individual needs, and a service model that does not recognise the importance of the SDOH and social and emotional wellbeing. Study Three results showed that participation of First Nations families in MCH services was consistently above the state average during the pilot period, and several First Nations families were referred to EARL stakeholders and other health professionals during the pilot. Further, there were increases in First Nations children being breastfed, fully immunised and attending Early Start Kindergarten, and identification of First Nations children at risk of abuse or neglect improved (with a significant increase in referrals for FV and child protection and significant decrease in episodes of out-of-home care). This thesis’s findings can support policy development. This research shows that timely, effective, holistic engagement with First Nations women in their child’s first 2,000 days, that respects their culture and facilitates genuine partnerships built on co-design and shared decision-making with the Indigenous community, needs to be an essential part of the MCH service model. Additionally, this thesis recommends adopting a strengths-based approach that respects First Nations peoples’ child-rearing practices and culture, and providing necessary training to MCH nurses who work with First Nations families. Keywords: child family health, continuity of care, First Nations women
- Description: Doctor of Philosophy
Women's access needs in maternity care in rural Tasmania, Australia : a mixed methods study
- Hoang, Ha, Le, Quynh, Terry, Daniel
- Authors: Hoang, Ha , Le, Quynh , Terry, Daniel
- Date: 2014
- Type: Text , Journal article
- Relation: Women and Birth Vol. 27, no. 1 (2014), p. 9-14
- Full Text:
- Reviewed:
- Description: Objectives: This study investigates (i) maternity care access issues in rural Tasmania, (ii) rural women's challenges in accessing maternity services and (iii) rural women's access needs in maternity services. Methods: A mixed-method approach using a survey and semi-structured interviews was conducted. The survey explored women's views of rural maternity services from antenatal to postnatal care, while interviews reinforced the survey results and provided insights into the access issues and needs of women in maternity care. Findings: The survey was completed by n=210 women, with a response rate of 35%, with n=22 follow-up interviews being conducted. The survey indicated the majority of rural women believed antenatal education and check-ups and postnatal check-ups should be provided locally. The majority of women surveyed also believed in the importance of having a maternity unit in the local hospital, which was further iterated and clarified within the interviews. Three main themes emerged from the interview data, namely (i) lack of access to maternity services, (ii) difficulties in accessing maternity services, and (iii) rural women's access needs. Conclusion: The study suggested that women's access needs are not fully met in some rural areas of Tasmania. Rural women face many challenges when accessing maternity services, including financial burden and risk of labouring en route. The study supports the claim that the closure of rural maternity units shifts cost and risk from the health care system to rural women and their families. © 2013 Australian College of Midwives.
- Authors: Hoang, Ha , Le, Quynh , Terry, Daniel
- Date: 2014
- Type: Text , Journal article
- Relation: Women and Birth Vol. 27, no. 1 (2014), p. 9-14
- Full Text:
- Reviewed:
- Description: Objectives: This study investigates (i) maternity care access issues in rural Tasmania, (ii) rural women's challenges in accessing maternity services and (iii) rural women's access needs in maternity services. Methods: A mixed-method approach using a survey and semi-structured interviews was conducted. The survey explored women's views of rural maternity services from antenatal to postnatal care, while interviews reinforced the survey results and provided insights into the access issues and needs of women in maternity care. Findings: The survey was completed by n=210 women, with a response rate of 35%, with n=22 follow-up interviews being conducted. The survey indicated the majority of rural women believed antenatal education and check-ups and postnatal check-ups should be provided locally. The majority of women surveyed also believed in the importance of having a maternity unit in the local hospital, which was further iterated and clarified within the interviews. Three main themes emerged from the interview data, namely (i) lack of access to maternity services, (ii) difficulties in accessing maternity services, and (iii) rural women's access needs. Conclusion: The study suggested that women's access needs are not fully met in some rural areas of Tasmania. Rural women face many challenges when accessing maternity services, including financial burden and risk of labouring en route. The study supports the claim that the closure of rural maternity units shifts cost and risk from the health care system to rural women and their families. © 2013 Australian College of Midwives.
Asian migrants' lived experience and acculturation to western health care in rural Tasmania
- Terry, Daniel, Ali, Mohammed, Lê, Quynh
- Authors: Terry, Daniel , Ali, Mohammed , Lê, Quynh
- Date: 2011
- Type: Text , Journal article
- Relation: Australian Journal of Rural Health Vol. 19, no. 6 (2011), p. 318-323
- Full Text:
- Reviewed:
- Description: Objectives: The study was designed to explore the lived experience of Asian migrants' health care-seeking behaviour in Tasmania, to discern the acculturation process by which Asian migrants are enabled to use the health system and to identify strategies, which assist migrants to understand and use the health system better. Methods: Qualitative research was adopted. Semistructured interviews were conducted with 36 Asian migrants residing in North, South and North West Tasmania, which were recruited through purposive sampling. Results: Six main themes emerged from the interviews: the acculturation process, interactions with the health care system, access issues, culturally appropriate health care, positive health care in Tasmania and suggestions for improving health care. Conclusions: The findings indicated that Asian migrants' views affected their health care-seeking behaviours because of the lack of information, poor communication, limited access and choices in Tasmania. Interestingly, those married to local Tasmanians had the shortest trajectory to health system acculturation. The study recommended developing health and well-being for Asian migrants by increasing access to information regarding navigating the health system and improving access to and awareness of language services. In addition, ensuring adequate, appropriately written, culturally specific and congruent information should be available to assist migrants' transition into a new health care system. Lastly, greater cultural awareness within the health profession to meet the needs of culturally specific individuals and communities is required when they seek care. © 2011 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.
- Authors: Terry, Daniel , Ali, Mohammed , Lê, Quynh
- Date: 2011
- Type: Text , Journal article
- Relation: Australian Journal of Rural Health Vol. 19, no. 6 (2011), p. 318-323
- Full Text:
- Reviewed:
- Description: Objectives: The study was designed to explore the lived experience of Asian migrants' health care-seeking behaviour in Tasmania, to discern the acculturation process by which Asian migrants are enabled to use the health system and to identify strategies, which assist migrants to understand and use the health system better. Methods: Qualitative research was adopted. Semistructured interviews were conducted with 36 Asian migrants residing in North, South and North West Tasmania, which were recruited through purposive sampling. Results: Six main themes emerged from the interviews: the acculturation process, interactions with the health care system, access issues, culturally appropriate health care, positive health care in Tasmania and suggestions for improving health care. Conclusions: The findings indicated that Asian migrants' views affected their health care-seeking behaviours because of the lack of information, poor communication, limited access and choices in Tasmania. Interestingly, those married to local Tasmanians had the shortest trajectory to health system acculturation. The study recommended developing health and well-being for Asian migrants by increasing access to information regarding navigating the health system and improving access to and awareness of language services. In addition, ensuring adequate, appropriately written, culturally specific and congruent information should be available to assist migrants' transition into a new health care system. Lastly, greater cultural awareness within the health profession to meet the needs of culturally specific individuals and communities is required when they seek care. © 2011 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.
Boundary crossers : how providers facilitate ethnic minority families' access to dementia services
- Brijnath, Bianca, Gilbert, Andrew, Antoniades, Josefine, Croy, Samantha, Kent, Mike, Ellis, Katie, Browning, Colette, Goeman, Dianne, Adams, Jon
- Authors: Brijnath, Bianca , Gilbert, Andrew , Antoniades, Josefine , Croy, Samantha , Kent, Mike , Ellis, Katie , Browning, Colette , Goeman, Dianne , Adams, Jon
- Date: 2022
- Type: Text , Journal article
- Relation: Journals of Gerontology - Series B Psychological Sciences and Social Sciences Vol. 77, no. 2 (2022), p. 396-406
- Full Text: false
- Reviewed:
- Description: Objectives: Providers who work closely with ethnic minority people with dementia and their families are pivotal in helping them access services. However, few studies have examined how these providers actually do this work. Using the concept of "boundary crossers,"this article investigates the strategies applied by these providers to facilitate access to dementia services for ethnic minority people with dementia and their families. Methods: Between 2017 and 2020, in-depth video-recorded interviews were conducted with 27 health, aged care, and community service providers working with ethnic minority people living with dementia across Australia. Interviews were conducted in one of seven languages and/or in English, then translated and transcribed verbatim into English. The data were analyzed thematically. Results: Family and community stigma associated with dementia and extra-familial care were significant barriers to families engaging with services. To overcome these barriers, participants worked at the boundaries of culture and dementia, community and systems, strategically using English and other vernaculars, clinical and cultural terminology, building trust and rapport, and assisting with service navigation to improve access. Concurrently, they were cognizant of familial boundaries and were careful to provide services that were culturally appropriate without supplanting the families' role. Discussion: In negotiating cultural, social, and professional boundaries, providers undertake multidimensional and complex work that involves education, advocacy, negotiation, navigation, creativity, and emotional engagement. This work is largely undervalued but offers a model of care that facilitates social and community development as well as service integration across health, aged care, and social services. © 2021 The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.
Family support and ease of access link socio-economic status and sports club membership in adolescent girls : A mediation study
- Eime, Rochelle, Harvey, Jack, Craike, Melinda, Symons, Caroline, Payne, Warren
- Authors: Eime, Rochelle , Harvey, Jack , Craike, Melinda , Symons, Caroline , Payne, Warren
- Date: 2013
- Type: Text , Journal article
- Relation: International Journal of Behavioral Nutrition and Physical Activity Vol. 10, no. (2013), p. 1-12
- Full Text:
- Reviewed:
- Description: Background: Much research has been conducted into the determinants of physical activity (PA) participation among adolescent girls. However, the more specific question of what are the determinants of particular forms of PA participation, such as the link between participation through a sports club, has not been investigated. Accordingly, the aim of this study was to investigate the relationships between participation in a sports club and socio-economic status (SES), access to facilities, and family and peer support, for female adolescents.Methods: A survey of 732 female adolescent school students (521 metropolitan, 211 non-metropolitan; 489 Year 7, 243 Year 11) was conducted. The survey included demographic information (living arrangements, ethnicity indicators, and indicators of SES such as parental education and employment status and locality); access to facilities; and family and peer support (travel, encouragement, watching, praise, joint participation). For each characteristic, sports club participants and non-participants were compared using chi-square tests. Multiple mediation analyses were used to investigate the role of access, family and peer support in the link between SES and sport participation.Results: There were significant associations (p<0.05) between sports club participation and: all demographic characteristics; all measures of family and peer support; and access to sport-related facilities. Highest levels of participation were associated with monolingual Australian-born families, with two parents, at least one of whom was well-educated, with both parents employed, and high levels of parental assistance, engagement and support. Participation in club sport among both younger and older adolescent girls was significantly positively associated with the SES of both their neighbourhoods and their households, particularly in metropolitan areas. These associations were most strongly mediated by family support and by access to facilities.Conclusions: To facilitate and promote greater participation in club sport among adolescent girls from low SES neighbourhoods and households, strategies should target modifiable determinants such as facility access and parental support. This will involve improving access to sports facilities and promoting, encouraging and assisting parents to provide support for their daughters' participation in sport clubs. © 2013 Eime et al.; licensee BioMed Central Ltd.
- Description: 2003011031
- Authors: Eime, Rochelle , Harvey, Jack , Craike, Melinda , Symons, Caroline , Payne, Warren
- Date: 2013
- Type: Text , Journal article
- Relation: International Journal of Behavioral Nutrition and Physical Activity Vol. 10, no. (2013), p. 1-12
- Full Text:
- Reviewed:
- Description: Background: Much research has been conducted into the determinants of physical activity (PA) participation among adolescent girls. However, the more specific question of what are the determinants of particular forms of PA participation, such as the link between participation through a sports club, has not been investigated. Accordingly, the aim of this study was to investigate the relationships between participation in a sports club and socio-economic status (SES), access to facilities, and family and peer support, for female adolescents.Methods: A survey of 732 female adolescent school students (521 metropolitan, 211 non-metropolitan; 489 Year 7, 243 Year 11) was conducted. The survey included demographic information (living arrangements, ethnicity indicators, and indicators of SES such as parental education and employment status and locality); access to facilities; and family and peer support (travel, encouragement, watching, praise, joint participation). For each characteristic, sports club participants and non-participants were compared using chi-square tests. Multiple mediation analyses were used to investigate the role of access, family and peer support in the link between SES and sport participation.Results: There were significant associations (p<0.05) between sports club participation and: all demographic characteristics; all measures of family and peer support; and access to sport-related facilities. Highest levels of participation were associated with monolingual Australian-born families, with two parents, at least one of whom was well-educated, with both parents employed, and high levels of parental assistance, engagement and support. Participation in club sport among both younger and older adolescent girls was significantly positively associated with the SES of both their neighbourhoods and their households, particularly in metropolitan areas. These associations were most strongly mediated by family support and by access to facilities.Conclusions: To facilitate and promote greater participation in club sport among adolescent girls from low SES neighbourhoods and households, strategies should target modifiable determinants such as facility access and parental support. This will involve improving access to sports facilities and promoting, encouraging and assisting parents to provide support for their daughters' participation in sport clubs. © 2013 Eime et al.; licensee BioMed Central Ltd.
- Description: 2003011031
Narratives of access: A critical exploration of how institutional interactions with students affect regional student participation in higher education.
- Ostini, Jenny, Partridge, Helen, Kelly, Kate, Owen, Sue, Jeffries, Sandra
- Authors: Ostini, Jenny , Partridge, Helen , Kelly, Kate , Owen, Sue , Jeffries, Sandra
- Date: 2020
- Type: Text , Journal article
- Relation: Student Success Vol. 11, no. 1 (2020), p.
- Full Text:
- Reviewed:
- Description: This article examines the narratives that drive university staff understanding of the concerns and experiences of regional and remote students at five universities in Australia. Interviews were conducted with thirty university staff members over a period of three months in 2018. Reflexive thematic analysis of the stories told by staff of supporting regional students found that staff used the lens of access to create meaningful stories for themselves and others in how they supported students. Access is defined as a multi-faceted term encompassing access to people, Internet, study materials and equipment and study environments. Access is facilitated by a sense of belonging or identity as a student and limited by the lack of this. Our analysis of “belongingness” draws on Bourdieu’s concepts of habitas to start to unpick the interactions between higher education institutions and the student that develop student identities as scholars and centres the narrative on the student as a person, wrestling to gain many forms of access within complex social situations.
- Authors: Ostini, Jenny , Partridge, Helen , Kelly, Kate , Owen, Sue , Jeffries, Sandra
- Date: 2020
- Type: Text , Journal article
- Relation: Student Success Vol. 11, no. 1 (2020), p.
- Full Text:
- Reviewed:
- Description: This article examines the narratives that drive university staff understanding of the concerns and experiences of regional and remote students at five universities in Australia. Interviews were conducted with thirty university staff members over a period of three months in 2018. Reflexive thematic analysis of the stories told by staff of supporting regional students found that staff used the lens of access to create meaningful stories for themselves and others in how they supported students. Access is defined as a multi-faceted term encompassing access to people, Internet, study materials and equipment and study environments. Access is facilitated by a sense of belonging or identity as a student and limited by the lack of this. Our analysis of “belongingness” draws on Bourdieu’s concepts of habitas to start to unpick the interactions between higher education institutions and the student that develop student identities as scholars and centres the narrative on the student as a person, wrestling to gain many forms of access within complex social situations.
The intersection of geography, topography and mindset : a nuanced understanding of regional, rural and remote students’ tertiary education participation in Australia
- Webb, Susan, Knight, Elizabeth, Lahiri-Roy, Reshmi, Koshy, Paul
- Authors: Webb, Susan , Knight, Elizabeth , Lahiri-Roy, Reshmi , Koshy, Paul
- Date: 2024
- Type: Text , Journal article
- Relation: Australian and International Journal of Rural Education Vol. 34, no. 3 (2024), p. 1-18
- Full Text:
- Reviewed:
- Description: This paper explores the notion of rurality in Australian tertiary education as part of an investigation into the subtle but distinct differences in participation thinking and patterns among young people in regional, rural and remote communities. Drawing on qualitative data gathered as part of a wider research project for the National Centre for Vocational Education Research, the paper examines whether student participation in tertiary education is shaped by factors more deeply related to a sense of connection to community, the relationality and reflexivity as related to the context, as well as proximity to major tertiary education infrastructure, such as campuses. This analysis of place challenges traditional geographical lenses that emphasise regional, rural and remote—or ‘RRR’—location in and of itself. Hence, the paper contributes to a more nuanced understanding of language in relation to RRR location as used in Australian policy, providing insights into the contested nature of the Australian term RRR, the concept of rurality in the wider literature, and concomitantly, investigating the impact of the same on youth participation in Australian tertiary education. © The Author's, 2024.
- Authors: Webb, Susan , Knight, Elizabeth , Lahiri-Roy, Reshmi , Koshy, Paul
- Date: 2024
- Type: Text , Journal article
- Relation: Australian and International Journal of Rural Education Vol. 34, no. 3 (2024), p. 1-18
- Full Text:
- Reviewed:
- Description: This paper explores the notion of rurality in Australian tertiary education as part of an investigation into the subtle but distinct differences in participation thinking and patterns among young people in regional, rural and remote communities. Drawing on qualitative data gathered as part of a wider research project for the National Centre for Vocational Education Research, the paper examines whether student participation in tertiary education is shaped by factors more deeply related to a sense of connection to community, the relationality and reflexivity as related to the context, as well as proximity to major tertiary education infrastructure, such as campuses. This analysis of place challenges traditional geographical lenses that emphasise regional, rural and remote—or ‘RRR’—location in and of itself. Hence, the paper contributes to a more nuanced understanding of language in relation to RRR location as used in Australian policy, providing insights into the contested nature of the Australian term RRR, the concept of rurality in the wider literature, and concomitantly, investigating the impact of the same on youth participation in Australian tertiary education. © The Author's, 2024.
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