ORCID Profile
0000-0003-1228-3047
Current Organisations
University of Melbourne School of Population Health
,
Emmanuel Hospital Association
,
Australian Faculty of Public Health Medicine
,
Box Hill Hospital
,
Burnet Institute
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Preventive Medicine | Health Information Systems (incl. Surveillance) | Public Health and Health Services not elsewhere classified | Public Health and Health Services
Public Health (excl. Specific Population Health) not elsewhere classified | Preventive Medicine |
Publisher: Informa UK Limited
Date: 16-05-2019
DOI: 10.1080/17441692.2019.1616798
Abstract: India has 600 million young people, more than any other country in the world. Mental illness is the leading burden of disease for young people, and those affected experience restrictions in social participation that compromise recovery. The aim of this study was to assess the impact of a peer-led, community-based, participatory group intervention on social inclusion and mental health among 142 young people affected by psycho-social disability (PSD) in Dehradun district, Uttarakhand. Qualitative data were obtained via in-depth interviews and focus-group discussions. A realist evaluation identified contextual factors, mechanisms and outcomes to develop the programme theory. Group participants described intermediate outcomes including establishment of new peer friendship networks, increased community participation, greater self-efficacy (for young women particularly), and improved public image (for young men) that are likely to have contributed to the primary outcomes of greater (self-perceived) social inclusion and improved mental health (as assessed quantitatively). Mechanisms were identified that explain the link between intervention and outcomes. These findings demonstrate the effectiveness of a brief intervention to improve mental health and social inclusion for young people with PSD and are potentially relevant to programme implementers and policy-makers working with young people and promoting social inclusion, in other low- and middle-income settings.
Publisher: Elsevier BV
Date: 08-2010
Publisher: Springer Science and Business Media LLC
Date: 17-12-2020
DOI: 10.1186/S12939-020-01345-7
Abstract: The COVID-19 crisis in India negatively impacted mental health due to both the disease and the harsh lockdown, yet there are almost no qualitative studies describing mental health impacts or the strategies of resilience used, and in particular, no reports from the most vulnerable groups. This study aimed to examine the acute mental health impacts of the COVID-19 crisis as well as coping strategies employed by disadvantaged community members in North India. We used an intersectional lens for this qualitative study set in rural Tehri Garwhal and urban Dehradun districts of Uttarakhand, India. In-depth interviews were conducted in May 2020 during lockdown, by phone and in person using purposive selection, with people with disabilities, people living in slums with psychosocial disabilities and widows (total n = 24). We used the framework method for analysis following steps of transcription and translation, familiarisation, coding, developing and then applying a framework, charting and then interpreting data. The participants with compounded disadvantage had almost no access to mobile phones, health messaging or health care and experienced extreme mental distress and despair, alongside hunger and loss of income. Under the realms of intrapersonal, interpersonal and social, six themes related to mental distress emerged: feeling overwhelmed and bewildered, feeling distressed and despairing, feeling socially isolated, increased events of othering and discrimination, and experiencing intersectional disadvantage. The six themes summarising coping strategies in the COVID-19 crisis were: finding sense and meaning, connecting with others, looking for positive ways forward, innovating with new practices, supporting others in idually and collectively, and engaging with the natural world. People intersectionally disadvantaged by their social identity experienced high levels of mental distress during the COVID-19 crisis, yet did not collapse, and instead described erse and innovative strategies which enabled them to cope through the COVID-19 lockdown. This study illustrates that research using an intersectional lens is valuable to design equitable policy such as the need for access to digital resources, and that disaggregated data is needed to address social inequities at the intersection of poverty, disability, caste, religious discrimination and gender inherent in the COVID-19 pandemic in India.
Publisher: Informa UK Limited
Date: 30-08-2021
DOI: 10.1080/09638288.2021.1965231
Abstract: Caregivers of people with disability experience difficulties in a variety of care domains. Understanding the predictive factors of caregiver strain is important in developing and implementing evidence-based intervention to reduce the difficulties experienced by the carers. The current study is a cross sectional comprehensive one-phase survey conducted in randomly selected sub-districts (taluks) of the Ernakulam district in Kerala. Primary caregivers ( Majority of the caregivers were females (77.3%) and spouses (35.2%). Of the caregivers 27% reported high levels of caregiver strain. The major factors associated with caregiver strain were female gender ( High caregiver burden and strain is experienced by almost a third of people caring for a person with a disability. Comprehensive interventions to reduce caregiver strain should be developed.Implications for rehabilitationThe rehabilitation sector needs to be made aware of the high levels of caregiver strain (especially in carers who were female, unemployed, have health issues and lack formal support).To improve wellbeing for people with disability we firstly need to promote social inclusion and support schemes for caregiver.Co-designed systems are needed to assist carers to access formal and informal support resources, and increase social connectedness.
Publisher: Springer Science and Business Media LLC
Date: 19-07-2012
Publisher: Springer Science and Business Media LLC
Date: 31-01-2020
DOI: 10.1186/S12889-020-8192-0
Abstract: Disabled People’s Organisations (DPOs) are the mainstay of disability responses worldwide. Yet there is no quantitative data assessing their effectiveness in low-and middle-income countries (LMICs). The aim of this study was to measure the effectiveness of DPOs as a low-cost intervention to improve well-being and access to services and facilities for people with disabilities. We undertook a cluster randomised intervention control trial across 39 distinct rural villages in Uttarakhand State, North India. A total of 527 participants were included from 39 villages: 302 people from 20 villages were assigned to the intervention arm and 225 from 19 villages were assigned to the control group. Over a 2-year period, people with disabilities were facilitated to form DPOs with regular home visits. Participants were also given financial support for public events and exposure visits to other DPOs. Seven domains were used to measure access and participation. DPO formation had improved participation in community consultations (OR 2.57, 95% CI 1.4 to 4.72), social activities (OR 2.46, 95% CI 1.38 to 4.38), DPOs (OR 14.78, 95% CI 1.43 to 152.43), access to toilet facilities (OR 3.89, 95% CI 1.31 to 11.57), rehabilitation (OR 6.83, 95% CI 2.4 to 19.42) and Government social welfare services (OR 4.82, 95% CI 2.35 to 9.91) in intervention when compared to the control. People who were part of a DPO had an improvement in having their opinion heard (OR 1.94, 95% CI 1.16 to 3.24) and being able to make friends (OR 1.63, 95% CI 1 to 2.65) compared to those who were not part of a DPO. All other well-being variables had little evidence despite greater improvement in the DPO intervention group. This is the first randomised control trial to demonstrate that DPOs in LMICs are effective at improving participation, access and well-being. This study supports the ongoing role of DPOs in activities related to disability inclusion and disability services. This study also suggests that supporting the establishment, facilitation and strengthening of DPOs is a cost-effective intervention and role that non-governmental organisations (NGOs) can play. ISRCTN36867362 , 9th Oct 2019 (retrospectively registered).
Publisher: Elsevier BV
Date: 06-2010
DOI: 10.1111/J.1753-6405.2010.00518.X
Abstract: To determine the community seropositivity of pandemic (H1N1) 2009 influenza in order to estimate immunity and the community attack rate. Selected clusters of participants (n=706) in the 'Victorian Health Monitor' (VHM), from whom blood s les were taken between August and October 2009, were tested opportunistically for antibodies to pandemic (H1N1) 2009 influenza virus. A titre of > or = 1:40 was chosen as the cut-off for recording seropositivity. The proportion (95% CI) of seropositive participants, aged 18 to <65 years of age, were computed for groups of census collection districts (CDs) across metropolitan Melbourne. The observed pandemic (H1N1) 2009 seropositivity rates for all CDs tested in metropolitan Melbourne was 16.0% (95% CI:12.9-19.1%) in northern Melbourne subset was 14.4% (95% CI:12.4-16.3%) and in eastern subset was 16.2% (95% CI:9.7-22.6%). The pre-pandemic (H1N1) 2009 positivity rate was estimated at 6%. Given this study's estimate of 16.0% seropositivity in adults in metropolitan Melbourne, and given the WHO laboratory's estimate of 6% pre-pandemic positivity, the estimated adult community attack rate was 10% for metropolitan Melbourne. This community attack rate is lower than anticipated and suggests that levels of immunity to Pandemic (H1N1) 2009 might be lower than anticipated. Although limited by a low response rate of 34%, this study suggests low adult seropositivity, which may be useful for public health professionals when encouraging the community to get vaccinated.
Publisher: Wiley
Date: 19-04-2012
DOI: 10.1111/J.1365-4632.2011.05131.X
Abstract: Dermatological conditions account for a substantial proportion of the global burden of disease in low and middle income countries (Bickers D, Lim H, Margolis D, et al. The burden of skin diseases: 2004. A joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology. J Am Acad Dermatol 2006 55: 490-500) and place major pressures on primary healthcare centers (Satimia F, McBride S, Leppard B. Prevalence of skin disease in rural Tanzania and factors influencing the choice of health care, modern or traditional. Arch Dermatol 1998 134: 1363-1366). In mountainous North India, where limited resources are available for skin care, no dermatological data exists on prevalence, treatment patterns, or associations. The study aimed to measure prevalence and treatment of dermatological conditions and associated factors in Uttarakhand so to inform delivery of dermatological care and prevention programs in India. Single stage cluster randomized s ling generated seven cluster units or villages. Household members (n = 1275) from each cluster were interviewed, and where possible, examined and offered treatment. Dermatological conditions were prevalent (45.3%), with 33% being of infectious etiology. Atopic dermatitis (9.2%), scabies (4.4%), tinea corporis (4.1%), and pityriasis alba (3.6%) were most prevalent. Multivariate analysis showed that cohabitation with animals (OR = 1.62, 95% CI-1.35, 1.95) was a predictor of any skin diseases. A health practitioner was not consulted in 64.7% of dermatological conditions, and where consulted, approximately 69% received inappropriate or ineffective treatments. Excessive spending on dermatological care was commonplace. Limitations associated with cross-sectional cluster methodology included the underrepresentation of seasonal conditions and conditions of short duration. Caste proved difficult to randomize across clusters given villages were often composed according to caste. These results demonstrate a high prevalence of dermatological conditions and a pattern of conditions somewhat distinctive to this mountainous area of North India. These findings will assist development of appropriate and cost-effective dermatological services in these mountainous regions.
Publisher: Cold Spring Harbor Laboratory
Date: 20-03-2021
DOI: 10.1101/2021.03.16.21253759
Abstract: KEY MESSAGES There has been concern, and much heated debate, on the possible negative effects of restrictions, stay-at-home orders and lockdowns during the COVID-19 pandemic. Most published studies on health impacts of restrictions and lockdowns are low quality and often severely biased. Focusing on the few studies that approximate a change in restrictions alone (i.e. not the impact of the pandemic per se), we see clear adverse impacts of lockdowns on intimate partner violence and physical activity. Regarding diseases, road traffic crashes decrease, and anxiety increases. A discussion driven by science (not politics) is urgently needed on what lockdowns can deliver, their limitations and how to optimally deploy them – along other public health strategies – in the fight against COVID-19.
Publisher: Informa UK Limited
Date: 14-09-2021
DOI: 10.1080/09638288.2021.1970253
Abstract: Family members are preferred providers of care for people with disability in India. Despite this, research which evaluates the impact of caregiving is limited. This qualitative study provides a comprehensive, in-depth exploration of the lived experience of carers who provide assistance to persons with a disability in Southwest India. In this qualitative study, 20 carers who assist persons with disability were purposively selected to undertake semi-structured interviews across a variety of domains. Data analysis was informed by Attride-Stirling's thematic network analysis. Five global themes were identified which included carers commitment to caring concurrent demands of caregiving mental and physical health of carers networks and sources of non-financial support and finances - strains and supports. This study provides an in-depth exploration of the lived experience of carers in Kerala, India which will inform the future development of interventions to assist primary carers.Implications for rehabilitationFamily members are preferred providers of care for people with disability in India.By understanding the issues that affect carers who assist people with disability, it is possible to develop more effective, targeted, and sustainable interventions, that meet the needs of carers and alleviate some of their burden.Improving the health and wellbeing of carers needs to be urgently addressed in order to improve outcomes for those with disability - whom they care for.
Publisher: Elsevier BV
Date: 12-2009
Publisher: Christian Journal for Global Health
Date: 05-11-2014
DOI: 10.15566/CJGH.V1I2.9
Publisher: Informa UK Limited
Date: 06-2011
DOI: 10.1080/17457300.2010.540335
Abstract: To help bridge the obstacle of inadequate injury fatality data in low and medium income countries (LMICs) a simple cost effective system for mortuary surveillance of fatal injuries is being developed in consultation with the WHO. This will inform, direct and monitor injury prevention (IP) interventions and policies in LMICs. This article uses CDC's 'attributes of a successful surveillance system' to describe the process, the barriers and solutions in development of this mortuary data guideline. The consultative process utilised generated feedback from key stakeholders including forensic pathologists, Ministry of Health officials and injury prevention experts. An International Advisory Group was also convened to guide the guideline development. These assisted the adjustment of the proposed guideline to maximise flexibility, acceptability and stability whilst minimising resource implications. Representativeness and the securing of government support perhaps remain the most significant challenges. Consultation with the advisory group and the wider stakeholders has been effective in developing a widely acceptable, user-friendly, low resource data form to gather useful data. Further strategies to overcome barriers need to be developed over the course of the pilot study and this should be done in consultation with the advisory group and stakeholders.
Publisher: E.U. European Publishing
Date: 10-2019
DOI: 10.18332/TID/110677
Publisher: Elsevier BV
Date: 09-2006
Publisher: BMJ
Date: 12-2009
Publisher: Elsevier BV
Date: 06-2013
DOI: 10.1016/J.AJP.2012.12.006
Abstract: Psychiatric disturbance has been shown to result from stress associated with events related to being a refugee. Children of refugees also experience significant stress but little is known about the prevalence of psychiatric disorders in this group. This survey explores the prevalence of psychiatric disorders in a Tibetan refugee enclave in rural North India. A prevalence survey was conducted using the Beck Anxiety Inventory (BAI) to determine the prevalence of anxiety amongst the Tibetan community. Three hundred fifty forms were distributed amongst the students 335 were completed of which 300 were considered suitable to be collated and analysed. The results revealed that 21% of the study population had significant levels of anxiety classed as moderate or severe using the BAI. Late adolescents had higher levels of significant moderate and severe anxiety than early and middle adolescents x(2) = 92.95 (P < 0.0001). Female participants had higher levels of moderate and severe anxiety but this was not statistically significant (x(2) = 1.286, P = 0.2568). There were high rates of anxiety in this study of Tibetan school aged children. School based anxiety prevention programmes and other interventions should be considered in such vulnerable populations especially amongst females and late adolescents who are disproportionately affected. These findings indicate a need for further evaluation of young Tibetan refugees for definitive diagnosis of anxiety disorders, specific phobias, social anxiety, post traumatic stress disorders and other anxiety disorders.
Publisher: Frontiers Media SA
Date: 2013
Publisher: AMPCo
Date: 10-2013
DOI: 10.5694/MJA13.10722
Publisher: Informa UK Limited
Date: 16-03-2023
Publisher: Elsevier BV
Date: 08-2010
DOI: 10.1111/J.1753-6405.2010.00569.X
Abstract: This descriptive epidemiological analysis aims to explore the benefits, risks and policy balance between a whole-of-population and high-risk reduction approach to reducing antenatal smoking prevalence. Using Victorian hospital antenatal statistics the rate-ratio for smoking in each hypothesised high prevalence group was calculated and combined with the absolute number of births in each high-risk group. The effect on smoking prevalence of whole-of-population reductions and high-risk group reductions was then modelled. In Victoria, there were higher rates of antenatal smoking among single [RR = 4.67 (3.46-4.42)], teenage women [RR (95%CI) = 3.26 (3.00-3.54)] of indigenous ethnicity [RR = 4.39 (3.94, 4.88)] with low income [RR = 4.67 (4.17-5.22)] and low education attainment [RR = 3.89 (3.47-4.36)] who lived in less accessible areas [RR = 2.14 (1.92-2.39)]. However, as each of these high-risk groups represents a relatively small proportion of mothers, most antenatal smokers are aged 25-34, educated, city-based, non-Indigenous and non-impoverished. The majority of Victorian women who smoke in pregnancy do not belong to traditional high-risk groups. Absolute reductions in smoking prevalence in high-risk groups can potentially be achieved by whole-of-population prevalence reductions, despite a potential continuance in high relative risk among these groups. Conversely, an exclusive focus on smoking reduction in high-risk groups may fail to reduce the whole-of-population antenatal smoking prevalence.
Publisher: Springer Science and Business Media LLC
Date: 09-07-2014
Publisher: Informa UK Limited
Date: 04-05-2022
DOI: 10.1080/09638288.2021.1907622
Abstract: To identify the competencies required by Community-Based Rehabilitation (CBR) practitioners in India and determine typical pathways of competency development, including minimum practice standards. Following a literature review of existing frameworks and guidelines for CBR delivery, Delphi methods were used with Indian CBR experts to identify the main competency requirements of CBR personnel. Rubric writing workshops with CBR experts then expressed the performance of these competencies developmentally as learning progressions. The rubrics were converted into an observation form and field tested with 100 CBR personnel of varying expertise levels, through third party assessments by workplace supervisors. Finally, a second Delphi panel determined major competency stages and minimum standards for practice. Three broad job functions pertaining to five focus areas and 37 developmentally described competencies were found important for delivery of quality CBR. Through a standard setting process, for each job function experts reached agreement on major competency stages, including a minimum practice standard. The study suggests India's CBR expertise proceeds in four stages within three broad job functions - Assessment and Intervention, Inclusive Community Development, and Professional and Ethical Behaviour and Practice. The findings have direct implications for designing curricula to facilitate the competency development of CBR personnel.Implications for rehabilitationMeeting the rehabilitation and inclusion needs of people with disability in low and middle-income countries requires adequately trained local personnel.Currently, lack of knowledge and understanding of the competencies required of CBR personnel is affecting training and workforce quality.Consensus amongst Indian experts about a CBR learning pathway indicates possibilities for effective competency-based course design.
Publisher: BMJ
Date: 16-12-2009
DOI: 10.1136/BMJ.B5261
Publisher: AMPCo
Date: 08-2012
DOI: 10.5694/MJA11.10929
Location: No location found
Location: United Kingdom of Great Britain and Northern Ireland
Location: Australia
Location: United Kingdom of Great Britain and Northern Ireland
Location: Australia
Start Date: 06-2017
End Date: 06-2023
Amount: $372,000.00
Funder: Australian Research Council
View Funded Activity