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Health Care Utilisation and Self-Care Behaviours Among People With Type 2 Diabetes In Nepal
No full textBackground: Globally, the prevalence of Type 2 Diabetes Mellitus (T2DM) has increased significantly, mostly in low- and middle-income countries including Nepal. The health care system in Nepal is not yet well prepared to address the growing problem of diabetes and the available health services are mostly urban-centered. Good self-care behaviours, for example diet, physical activity and use of medication and regular access to health care services play a vital role in preventing and managing T2DM, yet their practice in Nepal is inadequate. While health behavioural interventions are proven effective in managing T2DM in various socio-economic settings, such interventions have not yet been developed and implemented in Nepal, particularly in a community setting. To address this gap, a community-based behavioural intervention was undertaken to manage T2DM in Nepal. This PhD research project is a sub-study to assess the effectiveness of this behavioural intervention in improving the use of health care services and the practice of self-care. Methods: This PhD thesis includes five sub-studies. These are as follows: i) a systematic review assessing the practice of self-care behaviours among people with Type 2 Diabetes Mellitus in South Asia. ii) an examination of the use of health care services and associated factors among people with Type 2 Diabetes Mellitus in Nepal (using baseline data of the intervention trial). iii) an examination of the practice of self-care behaviours and associated factors among people with Type 2 Diabetes Mellitus in Nepal (using baseline data of the intervention trial). iv) assessing the effectiveness of the behavioural intervention in increasing health care service utilisation. v) assessing the effectiveness of the behavioural intervention in increasing selfcare behaviours. Sub-study “i” was conducted adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Sub-studies “ii” and “iii” assessed the utilisation of health care services and practices of self-care behaviours and their associated factors using multiple logistic regression analysis. The effect of the health behavioural intervention for sub-studies “iv” and “v" was assessed using generalised estimating equation (GEE) models with cluster adjustment. Results: i) The prevalence of the practice of self-care behaviours among people with T2DM in South Asia is low. The pooled prevalence of adherence to blood glucose monitoring was 65% (95% CI=49-80); 64% for medication adherence (95% CI=53-74); 53% for physical activity (95% CI=39-66); 48% for diet (95% CI=38-58); 42% for foot care (95% CI=30-54). ii) Data from 481 study participants were analysed in the intervention trial at baseline. In terms of health care service use, 66.1% of participants visited health service providers, 3.5% visited specialists, 2.1% were hospitalised and 1.9% visited an emergency department. Visit to health facilities was significantly higher among those aged 50-59 (ORA:1.64, CI:1.01-2.67), practising Hinduism (ORA:2.4, CI:1.20-4.81) and earning NPR (Nepalese Rupee) ≥30,000 (≥US Dollar 227.71) (ORA:1.82, CI:1.05-3.15) as compared to those aged ≥60, practising other religions, and with monthly family income NPR ≤10,000 (≤USD 76.23), respectively. iii) In terms of self-care behaviours, 80% of participants engaged in physical activity, 49.9% reported a healthy diet, 48.2% adhered to their medication intake, 32.2% monitored their blood glucose and 1.7% engaged in foot care. Physical activity was significantly higher among those aged 40-49 (ORA: 3.54, CI: 1.57-7.99) and 50-59 (ORA: 1.84, CI: 1.05-3.23) as compared to those 60 and above; and significantly lower among semi-urban residents (ORA: 0.37, CI: 0.21-0.67) than their rural counterparts. Non-tobacco users were more likely to adhere to a healthy diet (ORA: 1.61, CI: 1.00-2.61) than those consuming tobacco. Blood glucose monitoring was significantly higher among those who received a basic (ORA: 2.01, CI: 1.09-3.71), or higher level of education (ORA: 2.58, CI: 1.30-5.09) and among those with controlled glycated haemoglobin (HbA1c) level compared to those without formal education and uncontrolled HbA1c level, respectively. Medication adherence was significantly higher among those using alcohol (ORA: 1.74, CI: 1.03-2.95) and with comorbid conditions (ORA: 1.79, CI: 1.18-2.71) as compared to those not using alcohol and without comorbid conditions respectively. iv) After receiving the intervention, the percentage of health service provider visits increased from 65.12% to 84.18%, specialist visits increased from 4.62% to 53.83%, hospital admissions increased from 2.10% to 2.78% and emergency department visits increased from 2.10% to 4.94%. There were no significant pre-post improvements of the intervention on health care use. Visits to the health facility significantly increased among the intervention participants attending more sessions (adjusted odds ratio [ORA] = 1.16, 95% CI:1.05-1.28). v) After receiving the intervention, the percentage taking a healthy diet decreased from 52.37% to 36.06%, medication adherence decreased from 50% to 36.72%, foot care decreased from 1.68% to 1.07% while the physical activity and blood glucose monitoring increased from 81.09% to 90.99% and 32.77% to 49.21%, respectively. There were no significant pre-post improvements of the intervention on self-care behaviours. Conclusion: The level of engagement in self-care behaviours and health care use among people with T2DM in South Asia and Nepal is low. The findings from the community-based behavioural intervention revealed a small positive effect on the use of health care services and the practice of self-care behaviours among people with T2DM, however, the changes were not significant. This study highlights the need for further research to explore the underlying barriers preventing the practice of self-care behaviours and health care use. The findings from this work can be used to design and implement more effective behavioural interventions to improve diabetes self-care behaviour and health care use among people with T2DM in South Asia.</p
Trauma-informed post-secondary teaching practice: Phoenixing from the ashes of COVID-19
No full textThe project aims to identify barriers and enablers of learning and teaching in the context of student psychological trauma and to provide solutions and recommendations to identified issues. A survey and interviews will be conducted to meet this aim.</p
Simultaneous adsorptive removal of Pb2+, Cd2+, Cu2+, and Zn2+ using raw Norway Spruce biomass: A low-cost and eco-friendly solution for wastewater treatment
No full textThis study evaluated the unmodified Norway Spruce Wood Residue (NSWR), an abundant lignocellulosic biomass, for the simultaneous removal of Pb2+, Cd2+, Zn2+, and Cu2+ from a quaternary aqueous system. A series of batch adsorption experiments were performed to assess the influence of key operational parameters (pH, contact time, adsorbent dose, temperature, particle size, initial concentration), with equilibrium data subsequently fitted to Langmuir and Freundlich isotherm models, and the NSWR characterized using FTIR and EDS analyses. The results demonstrated maximum Langmuir adsorption capacities following the order Pb2+ (10.3 mg/g) > Cu2+ (7.9 mg/g) > Cd2+ (6.3 mg/g) > Zn2+ (6.0 mg/g), corresponding to high removal efficiencies (up to 99% for Pb2+). Adsorption was rapid initially (~60% removal within 20 min) and favored slightly acidic conditions (pH 5–6) and moderately elevated temperatures (45°C). The Langmuir model provided an excellent fit to the data (R2 ≈ 0.99), indicating favorable monolayer chemisorption, likely driven by a combination of cation exchange supported by EDS and interactions with surface functional groups. Conclusively, unmodified NSWR shows significant promise as an effective, inexpensive, and eco-friendly biosorbent for treating water contaminated with multiple heavy metals, presenting a viable waste valorization strategy for sustainable water management.</p
Sustainable development: How ESG score shapes corporate risk-taking in politically linked firms
No full textThis study explores how ESG implementation affects the relationship between politically connected boards of commissioners
and risk-taking behavior in Indonesia. It aims to understand how these firms' sustainable development, as reflected by their
ESG performance, influences their approach to risk management and decision making. We applied ordinary least squares (OLS)
regression to investigate these relationships. Political connection data were manually collected based on the company annual
report. For the ESG scores, corporate risk, and other financial information from 2018 to 2023 were collected from DataStream.
Next, the Generalized Method of Moments (GMM) and lagged variables are utilized to address potential endogeneity concerns.
Politically connected firms through the board of commissioners can mitigate corporate risk; this effect is amplified by ESG implementation. Consequently, companies are encouraged to adopt ESG practices to maximize the beneficial influence of political
connections. These findings remain robust, even after addressing potential endogeneity problems. This study has implications
for business practitioners, policymakers, and academics in the development of ESG regulation in countries with high levels of
political connections. Specifically, this study can serve as a reference for creating more transparent governance to support ESG
implementation in emerging markets. The findings may also help investors or creditors gain a better understanding of how ESG
affects the association between political connections and corporate risks in emerging markets; consequently, better investing and
lending decision-making. This study offers originality by highlighting the intersection of political connections and ESG implementation in emerging markets, an area previously underexplored in the literature.</p
Two sides of the same coin: Person-centred systems versus person-centred nursing practice. Theory, barriers and opportunities
No full textBackground: Person-centred care is a well-known concept in nursing practice. It is understood that person-centred care represents a way of providing care, which considers the person’s social, emotional and physical health. Person-centred care is tailored care, which meets individual’s needs, while also including them in decision-making.
Aims: Despite this, the practice of person-centred care can be stifled by system constraints which impact largely on the nursing profession. This paper aims to explore such challenges, highlighting the disconnect between theory and practice.
Methods: Adapted from the work of Fairclough, this discourse analysis critically reviews a cross section of texts related to person-centred care and offers a critique for discussion.
Results: This paper has found a divergence between person-centred care (system) and person-centred practice (nursing care), highlighting the tension between the theories and practice.
Conclusion and contribution to nursing: This paper highlights not only the challenges but also the opportunities in embedding person-centred care into system design, and considers further changes required to enable nurses to practice care which supports the whole needs of the person. It suggests that leveraging nursing expertise and experience may provide an avenue for system change.</p
Editorial: Writing from the fringes
No full textThis special issue of TEXT originates from the 2023 AAWP conference at the University of Canberra. The conference theme, “We Need to Talk,” contributed to a broader local and global discussion on the role of creative thinking and practice in addressing today’s pressing global challenges. Navigating the modern world—particularly for marginalised and “fringe-oriented” communities—appears increasingly complex. Simultaneously, ongoing debates and contentious questions encourage reflection on personal identity, especially in relation to communication, creativity, and the exploration of liminal spaces in art. These concerns, and their significance, are central to ‘Writing from the Fringes’.
Guest Editors: Eileen Herbert-Goodall, Jen Webb and Kimberly K. Williams</p
Metamorphic relation generation: State of the art & research directions
No full textMetamorphic testing has become one mainstream technique to address the notorious oracle problem in software testing, thanks to its great successes in revealing real-life bugs in a wide variety of software systems. Metamorphic relations, the core component of metamorphic testing, have continuously attracted research interests from both academia and industry. In the last decade, a rapidly increasing number of studies have been conducted to systematically generate metamorphic relations from various sources and for different application domains. In this article, based on the systematic review on the state of the art for metamorphic relations' generation, we summarize and highlight visions for further advancing the theory and techniques for identifying and constructing metamorphic relations, and discuss promising research directions in related areas.</p
Exploring the barriers to farmer participation in soil carbon projects under the Australian Carbon Credit Unit Scheme
No full textThe Australian Carbon Credit Unit Scheme was established to incentivise reductions in emissions or carbon storage. However, there has been low participation by farmers in soil carbon projects since the first soil carbon method was established for agriculture in 2014, even though carbon prices are high and management changes to sequester carbon on farms should be complementary to other business outcomes. This study explores the barriers that might limit participation in soil carbon projects. A novel approach is that instead of interviewing landholders, we worked with agents, service providers and agencies in Australia to gain their insights about the participation challenges for farmers. The main barriers identified are information gaps, risk and uncertainty about returns, high upfront costs, poor knowledge, limited business cases and program complexity. Potential opportunities to overcome barriers include increasing awareness of and access to factual and science-based information, reducing risk and uncertainties, reducing measurement and practice change costs, increasing financial support and incentives, quantifying environmental benefits and complementary benefits of the practices, and simplifying the methods and program systems. This study also suggests better business models for carbon projects need to be developed, with adjustable scenarios, so that farmers can tailor them to their enterprise.</p
The current state and future needs of decision making: knowledge, practice, tools and training options
No full textDecision making in emergency management (EM) is challenging. Australian EM organisations need to ensure that they appropriately train, develop and support their personnel so that they can make effective decisions in challenging situations. This report synthesizes the findings from the first phase of the Natural Hazards Research Australia (NHRA) decision making research project and provides a situational analysis of operational EM decision making in Australia. The report first summarises three literature reviews that examine: emerging issues (stress and fatigue, interoperability and ethical decision making) (Butler et al., 2024); use of cognitive aids (Penney et al., 2024); and EM decision making training (McLennan et al., 2024). The results of a survey and a series of semi-structured interviews are presented, providing a detailed examination of EM decision making in Australia. One-hundred and fifty-four participants completed all of the questions in the survey (84 per cent of the participants were male, 15.5 per cent were female and 0.5 per cent were non-binary). Thirty-six people participated in the semi-structured interviews (86 per cent of the participants were male and 14 per cent were female). The data showed: There is a clear opportunity to enhance EM decision making training. While the majority of participants felt that the general training they had received from their organisation had improved their ability to make safe and effective operational decisions, it was clear that the majority of participants also felt that the approach to operational decision making taught during any training was sometime or mostly ineffective. The large majority of participants follow their organisations’ rules and procedures, however there can sometimes be a mismatch between what the rules and procedures say and the best decision based on participants’ knowledge, experience and training. This and lack of resources were major reasons why participants sometimes didn’t follow organisational policies and procedures. EM decision makers generally use a combination of recognitional and analytical processes to make decisions. While some participants identified problems with using recognitional and analytical processes, most seem to be unaware of the strengths and limitations of the different types of decision making and how they work together to create decisions. While the majority of participants thought that decision making tools provided by their organisation were clear and easy to use, a number of problems with such tools were identified (such as taking too long, being difficult to use and not applying in most situations). Based on these findings, ideas about options that can be used to enhance EM decision making training and practice are proposed.</p
Understanding Female White Migrant Academics' Career Narratives
No full textThis paper presents how a team of women researchers, with differing intersectional characteristics of race, family support, age, migration background, and career achievement, individually and (subsequently) collaboratively interpreted the career narratives of three white Western women migrant academics. Through auto-ethnographical accounts, we share how each of the researchers' intersectionalities shaped their respective initial interpretations. Moreover, through joint collaborative questioning and analysis of their individual perspectives, the process of their collaborative “doing” of feminist standpoint research uncovered unconscious privilege and power dynamics among the co-authors, leading to intense individual and collective reflexivity. A diverse intersectional research team facilitates a dynamic interplay between scholars' social locations and their evolving interpretations, moving beyond static understandings of standpoint. This underscores the bidirectional nature of knowledge production: Although social situatedness informs interpretation, engagement with diverse perspectives also reshapes scholars' own standpoints. Doing collaborative intersectional feminist standpoint research, therefore, leads to more comprehensive richer analysis where the power relations within a research team are also interrogated to spotlight inequality and exclusionary norms in academia. Drawing reflexively on our own diversity and intersectionalities can bring to light gender, motherhood, social class, ethnic, or racial marginalized positions and aid in understanding the othering process in career progression within academia. This reflexive collaborative research process involves intensive identity work, which is both emotionally exhausting and enlightening, prompting a united position on the intersectional inequalities among female academic migrants and the need for systemic change that questions dominant power structures and advocates an intersectional-focused, inclusive, and broader evidence-based academy.</p