Harvey, Desley Jan (2011) Exploring remote women's experiences of health and wellbeing: a grounded theory study in remote North-West Queensland, Australia. PhD thesis, James Cook University.

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Abstract

This study explored how women living in remote areas of north-west Queensland, Australia, achieve health and wellbeing. The challenges that people living in rural and remote areas face in accessing services and achieving health contribute to poorer health outcomes compared to people living elsewhere in Australia. These challenges can be exacerbated by exposure to climatic extremes, the adverse effects of economic restructuring and distance from population and service centres. The negative impact on health is most pronounced in remote areas. There is evidence from national surveys of women that, despite the challenges, women living in remote areas consider themselves to be healthy and have equivalent or even better mental health than urban women. Speculation as to why this is so has focused on the characteristics of the women themselves and the nature of rural and remote communities. There is very little empirical research aimed at developing a deeper understanding of how rural and remote women achieve health. The study addresses this gap by exploring the meaning of health and wellbeing and the conditions which create it from the perspective of women living in remote north-west Queensland. The Australian National Women‘s Health Policy 2010 is based on the premise that women's health can only be understood within the broader context in which women live and work. The research demonstrates an approach to operationalising this approach to women‘s health by studying remote women in their social and geographical context.

This was a woman-centred, grounded theory study based on a constructivist epistemology and a critical ecological theoretical lens. The thesis begins with my positioning as a health practitioner with a disciplinary background in social work and a practice in health promotion in remote north-west Queensland. The research process proceeded through three phases. In phase one, a synthesis of a sample of six qualitative studies related to remote women's health using meta-ethnographic methods was conducted instead of a conventional literature review. The studies selected for synthesis were analysed using reciprocal translation methods consistent with a grounded theory approach. This phase identified sensitising concepts: belonging, isolation, coping with adversity and rural identity, which were utilised for analysing the data gathered in phase two of the study and for discussing the emergent theory in relation to the literature in phase three. In the thesis, a detailed account of the methodological decision-making that led to the selection of the methodology for the study is presented. Phase two of the study involved field work in locations geographically classified as remote. A combination of quota sampling, convenience sampling and theoretical sampling was used to recruit women to the study. In-depth interviews were conducted with twenty-three women over a twelve month period. Data was analysed using rigorous, systematic grounded theory methods. Phase three involved theorising and authenticating the emergent theory with reference to women's narratives and the health and social science literature.

The study findings are presented as a grounded theory of the capacity for flourishing. Flourishing describes an optimum achievable state of health and wellbeing as that is defined by each woman. The theory delineates a dynamic, multidimensional, integrated and contextualised process of adjustment and change arising from the interaction between women and their environment. The process integrates two axes: a being and doing axis and a person and environment axis, and four dimensions of flourishing: control, connecting, belonging and identity. Individual, contextual and structural factors which enable and constrain flourishing are described. The capacity for flourishing is embedded in these factors.

The grounded theory is positioned in relation to Australian and international literature relating to rural and remote women's health and wellbeing. The study contributes to the literature by proposing a theory of how women achieve health and wellbeing that is relational and created through the interaction between women and their environment. The study extends the literature by conceptualising holistic health as flourishing. The study affirms the relevance of a sense of belonging to remote women's health and wellbeing. The study extends the literature in relation to the importance of connectedness to health by delineating a process for making connections. The study findings challenge current discourses in relation to rural women's identity. They also highlight the lack of attention to the concept of control in the rural and remote women's health literature.

The findings suggest the need to move towards more holistic, contextual and health promoting approaches to understanding and supporting remote women's health and wellbeing. Future research utilising the concepts of flourishing and place in different remote geographical contexts is recommended.

Item ID:	29271
Item Type:	Thesis (PhD)
Keywords:	women's health; wellbeing; grounded theory; social work; remote area health; sense of place
Date Deposited:	12 Sep 2013 02:12
FoR Codes:	16 STUDIES IN HUMAN SOCIETY > 1607 Social Work > 160799 Social Work not elsewhere classified @ 100%
SEO Codes:	92 HEALTH > 9202 Health and Support Services > 920205 Health Education and Promotion @ 50% 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920499 Public Health (excl. Specific Population Health) not elsewhere classified @ 50%
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