Australian Occupational Therapy Journal (2003) 50, 48–49

Blackwell Science, Ltd

T h e s i s A b s t r a c t s

Thesis AbstractThesis AbstractThesis AbstractMENTAL ILLNESS AND FAMILIES IN CONTEMPORARY HONG KONG: AN ETHNOGRAPHY OF MENTAL ILLNESS AND CHINESE FAMILIES IN HONG KONG AT THE TIME OF TRANSITION OF SOVEREIGNTY

Matthew Kwai-sang Yau

Thesis submitted in partial fulfillment of the requirementsfor the degree of Doctor of Philosophy, School ofOccupation & Leisure Sciences, The University Of Sydney,Sydney, New South Wales, Australia. Supervised byMaureen H Fitzgerald PhD.

Hong Kong, being at the crossroads of East (yin) andWest (yang), has developed its own unique culture under150 years of British colonial rule. The political transitionhas accelerated the pace of searching for a new culturalidentity. It also has created the momentum for the revision,and in some cases the resurgence, of traditional conceptsand interpretations of life among Hong Kong Chinese.These events have affected both the concept of mentalillness and the experiences of families with mentalillness.

This study explored, described and documented theconcept of mental illness, the meanings ascribed to the concept,and the impact of mental illness on the coping and experi-ence of families with mental illness in Hong Kong duringthe period of transition of sovereignty from March 1996 toearly 2000. An ethnographic approach with multiple datasources was adopted. The yin and yang analogy, a uniquelyChinese philosophical framework, was employed as a lensto describe the social reality where the concepts of mentalillness and experiences of families with members withmental illness intersected during this transitional period.

The converging findings indicated that several inter-related factors influence the impact of mental illness onfamilies. They include the historical and political transi-tion; the sociocultural transition in searching for a culturalidentity; transitions in the health-care system; the existingexplanatory models of illness and healing; mass media;public attitudes towards mental illness; and transitions infamily structure and care giving.

It was also demonstrated that although there is anincrease in the public’s awareness of its own mental healthand understanding of mental disorders, the negative atti-tude toward people with mental illness perpetuated by themass media still prevails. This has affected the responsesof the community towards them and their families. ‘Yes,but not in my backyard’ appears to be the most commonpublic attitude toward the re-integration of persons withmental illness into the community.

Mental illness is not an individual’s matter but afamily affair. Family members often have to cope with theillness as a family entity, as everyone is affected by socialstigma and the restricted repertoire of explanatory modelscaused by the dominance of Western medicine andmodern science. Thus, keeping the ‘family secret’ of thedisorder is not uncommon. Furthermore, Chinese familycollectivism has led family members to sacrifice their owngoals to provide care for the ill member and to maintainharmony in the family; occasionally, some of them evenbecome victims of the violence of members with mentalillness.

It was postulated that respecting families’ explanatorymodels and allowing the practice of the alternative healingmethods seen fit by the families, in conjunction with orparallel to Western psychiatry, may help Chinese familieswith mental illness not only live with the disorder but alsohave a better experience. Finally, constructive dialoguebetween Chinese and Western medicine and the adoptionof the yin and yang analogical approach to health and lifeare believed to be complementary perspectives to mentalillness and may help people maintain mental health in thistransitional metropolis.March 2003501Thesis AbstractThesis AbstractThesis AbstractThesis Abstract

PUTTING TECHNOLOGY TO WORK: EXPERIENCES OF PEOPLE USING ASSISTIVE TECHNOLOGY IN THE WORKPLACE

Desleigh de Jonge

Thesis submitted in fulfilment of the requirements for thedegree of Master of Philosophy (Occupational Therapy),Department of Occupational Therapy, The University ofQueensland, Brisbane, Queensland, Australia. Supervisedby Sylvia Rodger BOccThy MEdSt PhD.

Thesis Abstracts 49

This qualitative study examined the experiences of peoplewith disabilities who use assistive technology (AT) in openemployment. This study aimed to describe and understandthe factors the participants perceived as important inintegrating technology into the workplace, as well as thebarriers they encountered in the process. Twenty-sixpeople with a range of congenital and acquired disabilitiesand their employers (N = 10) or coworkers (N = 10) wereinterviewed. The semistructured interviews were tran-scribed and analysed using thematic analysis. A cross-caseanalysis was also undertaken to explore the heterogeneityof the group of participants.

Emergent themes related to the barriers experiencedand support strategies used by the participants. Thesethemes were: identifying the right technology, acquiringthe technology, introducing AT into the workplace, andcustomising the technology. Additionally, the nature ofwork environments and their impact on AT users address-ing their ongoing technology needs was explored. Byidentifying the issues and support strategies for technologyusers in the workplace, appropriate measures can beimplemented to ensure that the spirit of disability dis-crimination legislation is realised in enabling people withdisabilities to be integrated into the workplace. Theapproach of each participant was also analysed in relationto his or her use of resources. This analysis highlightedthe importance of recognising the AT user’s level of inter-est in technology as well as their knowledge and experi-ence of options and resources. An understanding of theheterogeneity of AT users will also enable service pro-viders to develop a range of resources and services tomeet the diverse needs of AT users in their variousworkplaces.March 2003501Thesis AbstractThesis AbstractThesis AbstractThesis Abstract

HOME HAZARDS AND FALLS PREVENTION IN HOME-BASED HEALTH ASSESSMENTS FOR OLDER PEOPLE IN THE COMMUNITY

Lynette Mackenzie

Thesis submitted in partial fulfilment of the requirementsfor the degree of Doctor of Philosophy, Centre for ClinicalEpidemiology & Biostatistics, University of Newcastle,Callaghan, New South Wales, Australia. Supervised byAssociate Professor Julie Byles PhD BMed and AssociateProfessor Nick Higginbotham PhD MA.

Falls prevention and fall injury prevention among olderpeople are high priorities for health services as thepopulation ages. At the time this study commenced,

preventive health assessments had been used by generalpractitioners in the United Kingdom to address potentialthreats to the health of older people in a primary caresetting. The risk of falls was a central focus of preventivehealth assessment in this context. However, evidence of theeffectiveness of this type of intervention at an internationallevel was inconsistent, and no comprehensive studies hadbeen completed in Australia.

The purpose of this study was to describe the develop-ment, implementation and evaluation of a concise homesafety screening tool designed to detect older people athigh risk of falls, injurious falls, near falls and non-fallaccidents within a randomised controlled trial study ofpreventive health assessment in Queensland and NewSouth Wales — the Preventive Care Trial (PCT). The roleof the home environment, in the context of a broad rangeof medical, physical and psychosocial health related fac-tors believed to contribute to falls risk, was identified as asignificant contributor to falls and falls injury in olderpeople. Furthermore, the modification of the home envir-onment, as part of the PCT intervention, was effective inreducing self-reported falls in the PCT intervention group(n = 890).

A review of published home safety tools, field-testingof pooled items, and an expert panel selected the items forthe Home Falls and Accidents Screening Tool (HOMEFAST). Content and construct validity were appraisedusing expert opinion, and an inter-rater reliability study con-firmed the reliable use of the tool. The predictive validityof the instrument was explored in one prospective sub-studyof the PCT sample and in the longitudinal analysis of theintervention group over the 3-year trial period.

Unlike previous studies concerned only with falls andfall injuries, the PCT study outcomes also included self-reported near falls and non-fall accidents. Risk profiles foreach fall event outcome were developed as a result of thisproject. As the findings of the PCT were dependent on theaccuracy of the 6-month recall of fall events, a validationstudy was undertaken to compare retrospective recall anda prospective record of fall events using a calendar bystudy participants. A method to adjust for differences inrecall bias between the intervention group and controlgroup participants was developed and applied to the finalanalysis of the PCT.

The effect of a community-based preventive healthassessment and referral intervention on the reduction offalls risk amongst older people was evaluated. Adjustedoutcome data indicated that the intervention resulted instatistically significant reductions in falls, injurious fallsand near falls, but was not effective in relation to non-fallaccidents.