Doctoral Theses
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The Doctoral Theses collection contains digital copies of AUT doctoral theses deposited with the Library since 2004 and made available open access. All theses for doctorates awarded from 2007 onwards are required to be deposited in Tuwhera Open Theses unless subject to an embargo.
For theses submitted prior to 2007, open access was not mandatory, so only those theses for which the author has given consent are available in Tuwhera Open Theses. Where consent for open access has not been provided, the thesis is usually recorded in the AUT Library catalogue where the full text, if available, may be accessed with an AUT password. Other people should request an Interlibrary Loan through their library.
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Browsing Doctoral Theses by Supervisor "Andajani, Sari"
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- ItemCreating Space for Young Men Who Have Sex With Men (YMSM) to Develop Ideas on Using the Internet for HIV Prevention(Auckland University of Technology, 2018) Lubis, Dinar SaurmauliThe prevalence rate of Human Immunodeficiency Virus (HIV) infection among men who have sex with men (MSM) in Bali, Indonesia, is currently estimated at 20% (Bali Province Health Office [BPHO, 2016c]). This is significantly higher than HIV prevalence among this cohort at the national level (8.5%) and in other South-East Asian countries such as the Philippines (1.7%), Thailand (7.1%) and Vietnam (4.0%). Given relatively high rates of HIV infection among YMSM in Bali, preventing the spread of the disease among this community is vital. In recent years, Internet-based initiatives have been gaining popularity as tools for HIV prevention among YMSM as they potentially provide a convenient, easily accessible and anonymous social space for individuals requiring information and advice compared to face-to-face venues – as well as potentially providing much-needed advocacy and support. However, research on Internet-based initiatives for HIV prevention is still in its infancy, and this is true for Indonesia. Further, in order to be effective HIV prevention must be based on YMSM’s unique needs and characteristics, as evidence shows that it is essential to relate the target group’s needs to the social context. Normative sexuality in communities which endorse a heterosexual norm, often have an implication for risk and vulnerability of YMSM as well as for HIV prevention. This study adopted empowerment oriented participatory methodology to enable individuals within the YMSM community itself to contribute to the formulation of effective initiatives. The research question was How can Bali’s YMSM community be empowered to develop Internet-based HIV prevention?. The participants of this study was nine YMSM of Bali. This study employs Habermas’ critical social theory as framework and a participatory action research (PAR) research as methodology. In PAR, participants are positioned as co-researchers or partners during the research process, rather than as passive respondents. Nine participants from Bali’s YMSM community were recruited to participate in the research. The research process began by (i) creating a suitable research space, (ii) sharing the details of the research topic with the participants, (iii) developing a research plan with them, (iv) taking action, (v) reflection, and, (vi) evaluation. The Habermas’ communicative action theory deepens the examination of this study into the complexity of the HIV epidemic and prevention practice which has roots in community structures and HIV systems where HIV prevention is practice, produced, and reproduced. The participatory action research has opened up opportunities to create collaborative action by co-designing the HIV prevention initiative for YMSM in the Internet. Using PAR as a tool for collaborative research had provided enlightenment on the need to shift YMSM’s roles in HIV prevention, from being clients to being collaborators. The original contribution of this study to the body of knowledge is on how pivotal to create space for YMSM’s lifeworlds in informing a better and culturally acceptable Internet based-HIV prevention initiatives for YMSM. The findings of the current study have implications on policy and practice for Internet-based HIV prevention techniques both in Bali and beyond. The policy and programme recommendations include the need to create spaces for the YMSM in the HIV prevention as prosumers; the need to produce guidelines to conduct an Internet-based HIV prevention in Bali which is relevant to the lifeworld of YMSM; and ensuring the digital right of YMSM to access HIV information and to engage in Internet-based HIV prevention activities in the Internet.
- ItemDecision Making and Contraception: Perceptions and Experiences of Thai-Isan Adolescents(Auckland University of Technology, 2019) Chanthasukh, SansaneeAdolescent pregnancy became a nationally recognised public health priority in Thailand in 2008, at first National Health Assembly of Thailand. The prevalence of contraceptive use by Thai adolescents still remains low, compared to adults. Contraceptive use could significantly reduce the physical, emotional and financial risks associated with early life pregnancies for Thai adolescents. Many previous studies have recruited female participants aged 18–49 years, but little is known about how adolescents in the 15–19-year-old age group make their decisions about contraceptives and what factors influence their choices. Furthermore, few published studies have described what adolescents expect or need in order to meet their sexual and reproductive health needs to make informed decisions. The issue of human rights has not been explored, either. This research used a qualitative approach to explore perceptions and experiences of Thai adolescents during the contraceptive decision-making process and factors that influenced those choices. This approach allowed me to hear the previously unheard opinions of Thai adolescents regarding their sexual and reproductive health, and their rights. Thirty-eight secondary school-age adolescents participated in the study; 29 took part in focus group discussions (FGDs), and 11 consented to in-depth interviews. Another nine teenagers who were not part of FGDs also engaged in in-depth interviews. Audio-recordings were transcribed verbatim in Thai. Data was analysed using thematic analysis. Regardless of initial contraceptive discussions and decisions made before initiating sexual relationships, final contraceptive decisions made were unplanned and happened just before each sexual encounter. Typically, males were expected to provide condoms, and girls were expected to request condoms though males were likely to negotiate for no condoms. When the female failed to negotiate or willingly allowed her boyfriend to have sex with no condoms, withdrawal rules were likely to apply. Emergency pills were used when the female was uncertain about successful use of the withdrawal method and when one or both partners had drunken unprotected sex. Long acting hormonal implants were used after abortion on parental demand. Fear of the negative consequences of pregnancy, such as burdening parents and being punished by parents, was a factor influencing prevention of unplanned pregnancies. Condoms were likely to be their first choice. All participants knew that condoms were more effective than the withdrawal method, but many were ill-informed about hormone pills. Accessibility and cost of condoms affected adolescents’ choice of method. Female’s negotiation skills affected contraceptive decisions. Interestingly, having an older girlfriend or fear of HIV/AIDS infection could lead young males to use condoms. Young females’ fears of being in social and financial difficulties, or of being unable to fulfil cultural expectations as the firstborn daughter, affected their decisions. The sexual and reproductive needs and the human rights requirements of adolescents in Thailand have not yet been met. Participants suggested that allowing them to express their views might help increase understanding between adolescents and previous generations. They felt that people in their age group should have an understanding of their own sexuality, and should be consulted about sex and contraceptive use by older adults. Participants felt that some social beliefs/values should be changed to increase accessibility to condoms and other effective contraceptive methods. Confidentiality and privacy were recurring issues in discussions about youth-friendly sexual health services currently provided in Thailand. The findings of this study suggest that applying a holistic approach to improve adolescents’ decisions about contraception would benefit Thai society as a whole. It is recommended that policy-makers in Thailand should integrate morals-cultural based, rights-based and gender-based public health interventions to increase adolescents’ knowledge about contraceptives, to help them access effective contraceptive methods, and to allow them to make informed decisions about their reproductive health.
- ItemExploring Young African Migrant Women Conceptualisation of Their Health, Healthcare Experiences, and Improvement of Services in Aotearoa, New Zealand(Auckland University of Technology, 2022) Kanengoni, BlessingThe increasing diversity of the Aotearoa New Zealand population has noticeably impacted on healthcare service provision, access, and utilisation, with health service underutilisation more prevalent among young immigrants. The research presented in this thesis explored the shared experiences and insights of young African migrant women between the ages of 16 and 35 years regarding Aotearoa New Zealand youth healthcare services. This objective was pursued by creating a platform for an open and creative dialogue for the participants to rewrite their narratives and reposition their knowledge to interact or negotiate with mainstream knowledge on equal terms; as well as challenge the shapes and forms of discrimination and segregation, barriers to access and engagement with services, and the prospect of what must be the betterment of their wellbeing. I applied a decolonising theoretical framework in line with African epistemology. The philosophical teachings of these theories are vast; in this study, I focused on the key tenets that reflect the research context, the participants’ life worlds and my positionality. The decolonising process involved asking how my research would: 1) challenge dominant ideologies; 2) ensure collective community validity of knowledge; 3) reflect the significance of race and racism and their interconnectedness with gender; and 4) empowered the participants for social change which suited the population being studied, whose culture and traditions are passed down orally. Data were collected by using storytelling sharing circles – a focus group method common in Africa contexts and practiced in research amongst Indigenous people for generations in various parts of the world. Findings were thematically analysed with a decolonising lens to ensure minimal misinterpretation of findings or loss of meaning. A triangulation approach was employed which used field notes involving observation and in-depth reflection to evidence meaning and aid in the understanding of contextual information, encounters, and information gathered during individual storytelling, and the storytelling circles. Sixteen young African women of African origin and identity participated in the main study. The research encountered hurdles in the collective and collaborative research processes. Eight participants were interviewed individually to capture data behind the unforeseen challenges. Only four of the 16 participated until the end of the research project. They developed a video artefact, which openly discussed their culture, ways of thinking and behaviour, and how these influenced their access to and use of youth health services, and their recommendations. Four common themes emerged: (1) making meaning of our health and wellbeing; (2) young African women’s experience and views of Aotearoa New Zealand health services; (3) participants’ shared prosperity and aspirations for positive health outcomes; and (4) barriers to democratic participation and collective action. The findings show a visible epistemological tension—both in the application of African philosophical principles in conducting research and contesting and contrasting the participants’ cultured bodily expression or embodiment against the mainstream biomedical narratives perpetuated by Aotearoa New Zealand’s services providers. The concepts of ‘embodiment’ and ‘embodied belonging’ provided a more nuanced understanding of how migration, exclusion, and marginalisation contribute to shape health-related inequities for young African women’s lives; the conditions of their existence and bodies which do not just tell stories but hold histories; and how their struggle for integration sought to regain health and sustain their wellbeing which cannot be divorced from religion and spirituality, and their social positioning as young African Black migrant women. These findings have implications for research, policies, and clinical practice. For instance, the study’s findings provide an evidence-based definition of health and wellbeing for young African migrant women to combat a ‘one-size-fits-all’ definition which has implications for the design of a model of care for this group. The study also unearthed different social factors operating concurrently and, therefore, accounts for a dimension of non/belonging and its effects on the domain of health, illness, and healthcare delivery for migrants. In this research, the discourse of African philosophy demonstrates its ability to serve as a guide for research with other marginalised groups and Indigenous people because it addresses issues pertinent to most formerly colonised (and collective) societies.
- ItemMy Baby Deserves Love, Not HIV: Enabling HIV-positive Indonesian Women to Access Prevention of Mother-to-Child Transmission of HIV Services(Auckland University of Technology, 2020) NajmahGetting married and having children is part of the social, cultural, and religious norms of Indonesian people, including those of women living with Human Immunodeficiency Virus (HIV). Pregnancies occur amongst these women. Unfortunately, only 10% of all pregnant women living with HIV, access Prevention of Mother-to-Child Transmission of HIV, or PMTCT services, annually. Without intervention, half of all babies born to mothers with HIV are at risk of contracting HIV through the mother’s pregnancy, delivery or from breastfeeding and three in four children’s deaths from Acquired Immunodeficiency Syndrome (AIDS) occurred before the age of five years. My research considers how to enable HIV-positive women to access PMTCT services, specifically focussing on heterosexually married mothers. I believe HIV-positive women are the real experts in terms of what they need to enhance their access to PMTCT services. My research allowed me to work with 18 HIV-positive women, 26 health workers, nine Non-Governmental Organisation (NGO) workers, and over 12 HIV policymakers through a series of focus group discussions, informal interviews, and visual methods. Three original theoretical contributions in this dissertation are the concept of marital deception, the concept of intersectionality and women’s vulnerability to HIV and the concept of HIV-related stigma or shame in the Indonesian context. My research shows that every Indonesian woman is at risk of HIV. HIV transmission is a complex issue, especially for mothers and wives within a patriarchal Islamic society. It is usually the man who contracts HIV through high-risk behaviours and passes it on to his wife, often with his knowledge, although sometimes unknowingly. After being confirmed as HIV positive, women may feel ostracised and resist accessing HIV care for fear of discrimination. The shame related to HIV means people may not talk about HIV within a family, community or even in health settings. Sadly, without HIV testing and intervention, a pregnant woman with HIV, therefore, her risk being unaware of her own HIV status and may risk HIV transmission to her child. This research reveals intersected barriers to accessing PMTCT services and indicates the need for holistic solutions to enhance accessibility to these services to reduce HIV risk to an estimated 30 babies at risk of HIV every day in Indonesia. This thesis has provided deeper insights into Feminist-Participatory Action Research (FPAR) as an important methodology to create a safe collective space for marginalised women and reveal factors that enable HIV-positive women to access PMTCT, such as the acknowledgment of wives and mothers at risk of HIV and the need to accommodate the socio-cultural and moral contexts of women’s lives within PMTCT programmes. This study will be the beginning of ongoing research into women’s participation in HIV programmes and HIV policy development and inspire further research. By producing audio-visual materials, the women’s aspirations can travel visually and verbally and act as influence on the provision of appropriate access to PMTCT services.
- Item“Sex…is a good thing”: Creating a Space for the Voices of Young Zimbabweans To Shape School-Based HIV Prevention-Orientated Sexuality Education(Auckland University of Technology, 2019) Maibvisira, CarolThere are gaps in research exploring young people’s strategies for school-based HIV prevention-oriented sexuality education (herein referred to as sexuality education), including in African contexts like that of Zimbabwe. Such sexuality education is a fundamental component in the control of the Human Immunodeficiency Virus (HIV) epidemic. HIV is a sexually transmitted infection that incurs lifelong health problems and, if untreated, leads to death. The issue of young people living with HIV is of global and regional concern, especially for Sub-Saharan Africa. A focus on HIV prevention strategies prioritising young people is paramount. In 2017, individuals aged 15-24 years accounted for approximately 33% of new global HIV infections. In Zimbabwe, of those newly infected in 2017, nearly 32% were young people aged 15-24 years. Sexuality education is a vital policy and societal response that aims to provide health knowledge and advice focused on influencing youth behaviour by encouraging practices and advocacy aimed at safer sex. Despite the high proportion of young Zimbabweans becoming newly infected, there are few examples of young Zimbabweans shaping sexuality education design and delivery. This study focused on sexuality education in secondary schools as this is the main domain for delivery. The study used participatory action research (PAR), an action-driven methodology suited for collaborating with young people by creating a space for the expression of their experiences and strategies. PAR sought to explore young Zimbabwean designs for a ‘perfect’ school-based sexuality education lesson. The research involved collaboration with eight women and eight men aged 18-24 years from Bulawayo city. Students from Amakhosi Performing Arts Academy were recruited given that they had recent experience of school-based sexuality education, were articulate and expressive. As co-researchers, they took part in shaping the activities, and 10 action-orientated focus group discussions. PAR methods, including drama, poster creation and poetry, were used for self and collective expression. As young people were recruited from a performing arts background they particularly responded to the use of the drama method. Drama created a collaborative space for animating and making visible the daily realities of their sexual lives in the context of their proposals for school-based sexuality education. Young Zimbabweans recalled experiences of sexuality education lessons as mainly involving authoritarian teaching, especially when talking about sex. This stemmed from a standardised curriculum focused on sexual abstinence and the disease dangers of sex. Yet, co-researchers dramatised sex as “a good thing”, and “natural” to development into adulthood. Using dramatic exaggeration, shock and humour, young people critiqued pro-abstinence teaching as euphemistic, contradictory, and endangering their sexual health as it encouraged “youth [to] do sex [in] hiding”, as “afraid” of being found out, given that their premarital sexual lives are regarded as socially deviant. Co-researchers proposed a perfect sexuality education lesson as one designed by young people, making students feel safe and confident to talk about sex as “good”, pleasurable, and intimate. Harnessing the real-world and highly contextualised nature of the dramas, a theatre like framework of characters, setting, words, and actions around ‘teacher, student, and lesson content’ was used to structure the data analysis. The study findings, and methodological framework used, have implications for new models of school-based sexuality education in African contexts like that of Zimbabwe. This study joins an emerging impetus of innovative research using PAR to partner with young people to shape sexuality education and other important mechanisms for enhancing health and wellbeing. Findings highlighted the capacity of drama as a youth-driven critical learning tool to reflect on and shape sexuality education. Drama enabled youth voices and provided a space to demonstrate their complex daily realities relevant to sexual health promotion. Given the significant growth in cheap and accessible internet enabled mobile phones in Africa, young people will be in a better position to proactively learn, share, and create sexuality knowledge outside the classroom. As user-driven digital spaces gain prominence, formal institutions like that of schools need to explore new opportunities for partnering with young people, blending digital and new style classroom methods, such as drama for sexuality education. Future policy response should be guided by an African youth-centred model of sexuality education as important to HIV prevention.