Nursing and Midwifery

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    The perceived effects of work on health of rubber farmers in southern Thailand : a dissertation presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing, Massey University, Palmerston North, New Zealand
    (Massey University, 2008) Boonphadh, Piyaporn
    This study was conducted in a rubber farming community in Southern Thailand with rubber farmers and their first-line public healthcare providers as the study informants. The study aims were to first, explore perceived effects of work exposures in rubber farming on rubber farmers’ health, second, identify decisions made in response to the effects of work exposures on health, and third, determine influencing factors on the construction of the perception and the process of decision making. Data were obtained using ethnographic research methods, underpinned by an interpretative paradigm. Unstructured interviews and participant observation were employed as the principal means of data collection. Together with the primary methods of data collection, note taking (fieldnotes, fieldwork personal journal, and photographs) and reviewing/analysing existing documents were employed. While data were being collected, initial data analysis was carried out to make sense of information gained and direct further steps of the data collection. After terminating the data collection, ethnographic data analysis suggested by Spradley (1979, 1980) was used to determine themes to meet the aims of the study. The study findings reveal that individual rubber farmers and healthcare providers construct perceptions of effects of rubber farming on rubber farmers’ health and decisions on the actions taken to manage the rubber farmers’ work-related health problems based on their own accounts of compounding factors. Among factors identified, discrepancies between health policy and its practice, coupled with the existence of a hierarchy of power-superior-inferior relationships among individual levels of health authority-emerge as the most powerful factors, inducing the emergence of other factors. Recommendations made as a result of this study draw attention mainly to the minimisation of the discrepancies between health policies and their implications, and the establishment of partnership status among authorised health agencies and between health agencies and rubber farmers in order to improve the quality of occupational safety and health services provided to the rubber farmers.
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    From experiencing social disgust to passing as normal : self-care processes among Thai people suffering from AIDS : a thesis presented in fulfillment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Palmerston North, New Zealand
    (Massey University, 2008) Siriwatanamethanon, Jirapa
    AIDS is a chronic disease that seriously affects health, emotions, social relations and household economy. People living with HIV/AIDS experience great suffering, stigmatisation and discrimination from other people around them because they know that it is incurable, contagious, evokes social disgust and is a complex disease requiring life-long self-care. This researcher explored ways people with HIV/AIDS take care of their health and manage their lives in the context of stigma and discrimination. A grounded theory study was conducted with 30 participants with HIV/AIDS, in Mahasarakham Province, Thailand. Participants were recruited from an HIV/AIDS day care clinic and by snowball sampling. Data were gathered through in-depth interviews, participant observations and field notes made during home visits. Interviews were tape recorded, then transcribed verbatim. “From experiencing social disgust to passing as normal” was generated inductively from the data as the basic social psychological process of Thai people living with HIV/AIDS. From experiencing social disgust to passing as normal comprised four categories: being HIV/AIDS, making choices, keeping well and feeling empowered. The category “being HIV/AIDS”- discovering the meaning of having HIV/AIDS, comprises four concepts: being diagnosed with HIV/AIDS, being stigmatised, suffering, and learning about HIV/AIDS. The category “making choices”- to live a normal life, involves three concepts: avoiding unhappy situations, getting remarried and seeking support. The category “keeping well”- maintaining emotional and physical health, includes eight concepts: religious practices, keeping a cheerful mind, self-treatment, taking care of the body, keeping the environment clean to prevent getting germs, healthy behaviours, getting healthcare services, and attention to, and concern about, medication. The last category “feeling empowered”- personal and social acceptance of illness, includes eight concepts: being encouraged, acknowledging the disease, social acceptance, tamjai, feeling proud of self, feeling good about life, feeling lucky and having hope. In the context of northeastern Thailand, successful management of HIV/AIDS was underpinned by participants making a transition from “experiencing social disgust” to “passing as normal” within their communities. The desire to live a normal life despite having HIV/AIDS motivated participants to undertake effective self-care in order to remain symptom free (thus avoiding visible signs of the disease), and to selectively disclose their illness to avoid the ongoing risk of stigma and discrimination. The findings of this study are useful in that they will provide Thai health professionals with a clearer conceptualisation of self-care among the Thai population. An inductively derived theory of self-care among Thai with HIV/AIDS can be applied and integrated by health professionals into the self-care models for people living with HIV/AIDS including models used in nursing education, research and practice.