My Place through My Eyes: A social constructionist...

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i My Place through My Eyes: A social constructionist approach to researching the relationships between socioeconomic living contexts and physical activity. Queensland University of Technology Humanities Research Program Name of Candidate: Julie-Anne Carroll (BA, Post Grad Dip, Masters) Principal Supervisor: Associate Professor Barbara Adkins Associate Supervisor: Associate Professor Elizabeth Parker 2008 Additional Support: This research was supported under the Australian Research Council's Discovery Projects funding scheme, project number DP0663854, "New Media in the Urban Village: Mapping Communicative Ecologies and Socio- Economic Innovation in Emerging Inner-City Residential Developments".

Transcript of My Place through My Eyes: A social constructionist...

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My Place through My Eyes: A social constructionist

approach to researching the relationships between

socioeconomic living contexts and physical activity.

Queensland University of Technology

Humanities Research Program

Name of Candidate: Julie-Anne Carroll (BA, Post Grad Dip,

Masters)

Principal Supervisor: Associate Professor Barbara Adkins

Associate Supervisor: Associate Professor Elizabeth Parker

2008

Additional Support: This research was supported under the Australian Research

Council's Discovery Projects funding scheme, project number DP0663854, "New

Media in the Urban Village: Mapping Communicative Ecologies and Socio-

Economic Innovation in Emerging Inner-City Residential Developments".

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My Place through My Eyes: A social constructionist approach to

researching the relationships between socioeconomic living contexts

and physical activity.

Abstract

There is a growing evidence-base in the epidemiological literature that demonstrates

significant associations between people’s living circumstances – including their place

of residence – and their health-related practices and outcomes (Leslie, 2005; Karpati,

Bassett, & McCord, 2006; Monden, Van Lenthe, & Mackenbach, 2006; Parkes &

Kearns, 2006; Cummins, Curtis, Diez-Roux, & Macintyre, 2007; Turrell, Kavanagh,

Draper, & Subramanian, 2007). However, these findings raise questions about the

ways in which living places, such as households and neighbourhoods, figure in the

pathways connecting people and health (Frolich, Potvin, Chabot, & Corin, 2002;

Giles-Corti, 2006; Brown et al, 2006; Diez Roux, 2007). This thesis addressed these

questions via a mixed methods investigation of the patterns and processes

connecting people, place, and their propensity to be physically active. Specifically,

the research in this thesis examines a group of lower-socioeconomic residents who

had recently relocated from poorer suburbs to a new urban village with a range of

health-related resources. Importantly, the study contrasts their historical relationship

with physical activity with their reactions to, and everyday practices in, a new urban

setting designed to encourage pedestrian mobility and autonomy.

The study applies a phenomenological approach to understanding living contexts

based on Berger and Luckman’s (1966) conceptual framework in The Social

Construction of Reality. This framework enables a questioning of the concept of

context itself, and a treatment of it beyond environmental factors to the processes via

which experiences and interactions are made meaningful. This approach makes

reference to people’s histories, habituations, and dispositions in an exploration

between social contexts and human behaviour. This framework for thinking about

context is used to generate an empirical focus on the ways in which this residential

group interacts with various living contexts over time to create a particular

construction of physical activity in their lives. A methodological approach suited to

this thinking was found in Charmaz’s (1996; 2001; 2006) adoption of a social

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constructionist approach to grounded theory. This approach enabled a focus on

people’s own constructions and versions of their experiences through a rigorous

inductive method, which provided a systematic strategy for identifying patterns in

the data.

The findings of the study point to factors such as ‘childhood abuse and neglect’,

‘early homelessness’, ‘fear and mistrust’, ‘staying indoors and keeping to yourself’,

‘conflict and violence’, and ‘feeling fat and ugly’ as contributors to an ongoing core

category of ‘identity management’, which mediates the relationship between

participants’ living contexts and their physical activity levels. It identifies barriers at

the individual, neighbourhood, and broader ecological levels that prevent this

residential group from being more physically active, and which contribute to the

ways in which they think about, or conceptualise, this health-related behaviour in

relationship to their identity and sense of place – both geographic and societal. The

challenges of living well and staying active in poorer neighbourhoods and in places

where poverty is concentrated were highlighted in detail by participants. Participants’

reactions to the new urban neighbourhood, and the depth of their engagement with

the resources present, are revealed in the context of their previous life-experiences

with both living places and physical activity. Moreover, an understanding of context

as participants’ psychological constructions of various social and living situations

based on prior experience, attitudes, and beliefs was formulated with implications for

how the relationship between socioeconomic contextual effects on health are studied

in the future. More detailed findings are presented in three published papers with

implications for health promotion, urban design, and health inequalities research.

This thesis makes a substantive, conceptual, and methodological contribution to

future research efforts interested in how physical activity is conceptualised and

constructed within lower socioeconomic living contexts, and why this is. The data

that was collected and analysed for this PhD generates knowledge about the

psychosocial processes and mechanisms behind the patterns observed in

epidemiological research regarding socioeconomic health inequalities. Further, it

highlights the ways in which lower socioeconomic living contexts tend to shape

dispositions, attitudes, and lifestyles, ultimately resulting in worse health and life

chances for those who occupy them.

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Key words: socioeconomic; contexts; physical activity; urban; social

constructionism; grounded theory

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Table of Contents

Table of Contents................................................................................... v

Tables, Figures, Images, and Graphs .................................................. x

Appendices ............................................................................................ xi

Statement of Original Authorship ..................................................... xii

Acknowledgements............................................................................. xiii

List of Works from this Thesis Accepted for Presentation &

Publication .......................................................................................... xiii

Chapter One: Introduction and Overview of the Thesis................. 20

1. Introduction to the Topic ...................................................................................... 20

1.2 Overview of the Thesis Chapters ....................................................................... 23

Chapter Two: The Literature Review ............................................... 32

2.1 Notes on the Methodology of the Literature Review......................................... 32

2.2 Introduction: The Effects of Living Contexts on the Social Functioning,

Health, and Well-being of Residents........................................................................ 33

2.3 Public Health Perspectives on How Socioeconomic Living Contexts affect

Health Outcomes: The Challenge of Measuring and Conceptualising the

Characteristics of a Place that Determine Well-Being. ............................................ 35

2.4 Physical, Social, and Socioeconomic Characteristics of Living Contexts that

Correlate Significantly with Health-Related Behaviours......................................... 48

2.5 A Review of the Urban Planning and Design Literature that has Investigated

Residents’ Psychological, Social, and Behavioural Responses to their Living

Contexts. .................................................................................................................. 56

2.6 Drawing Conclusions ......................................................................................... 73

2.7 The Research Questions ..................................................................................... 77

Chapter Three: Theoretical Framework of the Thesis.................... 78

3.1 Human Living Contexts as Social ‘Determinants’ of Patterns in Behaviour..... 78

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3.2 The Social Construction of Reality .................................................................... 80

3.3 Application of the Conceptual Framework to the Thesis: Asking New

Questions, Exploring New Ground. ......................................................................... 83

Chapter Four: Methodology .............................................................. 85

4.1 Introduction ........................................................................................................ 85

4.2 Why an Inductive Theory-Building Approach? ................................................. 86

4.3 A Social Constructionist Approach to Grounded Theory................................... 89

4.4 A Case Study: The Kelvin Grove Urban Village (KGUV) as a Locale for

Undertaking the Research. ....................................................................................... 92

4.5 Validity and Reliability ...................................................................................... 97

4.5.1 Validity ............................................................................................................ 97

4.5.2 Reliability........................................................................................................ 98

4.6 Data Collection and Analysis ............................................................................. 99

4.6.1 QUT Ethical and Developer Approval ............................................................ 99

4.6.2 Participant Recruitment................................................................................. 100

4.6.3 Reflection on the Role of the Researcher...................................................... 102

4.6.4 Phase One: Survey on Physical Activity....................................................... 102

4.6.5 Phase Two: ‘The Blog’ – Online Qualitative Data Collection ...................... 104

4.6.6 Analysis of the Online Qualitative Data........................................................ 106

4.6.7 Phase Three: In-depth Interviews with BHC Residents (Face-to-Face Data

Collection).............................................................................................................. 108

4.6.8 Phase Four: Community Focus Group.......................................................... 110

4.6.9 Analysis of the Face-to-Face (Interview and Focus Group) Qualitative

Data .........................................................................................................................111

4.7 Conclusion ....................................................................................................... 113

Introduction to the Published Papers...............................................115

Statement of Contribution of Co-Authors .......................................119

Chapter Five: Published Paper One................................................ 120

5.1 Abstract ............................................................................................................ 120

5.2 Rationale and Background: Socioeconomic Inequalities in Physical Activity

Rates and Responses to Population Health Communication. ................................ 121

5.3 The Media Debate: Where should we be Promoting Physical Activity? ......... 124

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5.4 Applying Communication Theory to the Problem: Can a social

constructionist perspective help? ........................................................................... 125

5.5 The ‘Blog’ as a Research Tool ......................................................................... 128

5.6 ICT Access and Use for Lower-Socioeconomic Study Participants ................ 129

5.7 Data Collection Method: ‘The Blogging Experience’ ..................................... 129

5.8 Sample of Bloggers .......................................................................................... 129

5.9 Procedure.......................................................................................................... 130

5.10 Data Analysis ................................................................................................. 130

5.11 Findings and Discussion: What are the factors influencing physical activity

levels in lower socioeconomic living environments? ............................................ 131

5.11.1 Structural Realities and Everyday Decisions about Physical Activity ........ 133

5.11.2 Aesthetic and Proximal Social Neighbourhood Influences......................... 134

5.11.3 Local Relevance and Medium of Delivery ................................................. 135

5.11.4 Message Source and Credibility.................................................................. 136

5.11.5 Tastes and Preferences................................................................................. 137

5.11.6 Community ‘Ownership’ and Participation: The Blog as a Tool for

Sharing Stories and Promoting Health at a ‘Grass Roots’ Level ........................... 137

5.12 Final Comments and Implications for Future Communication Efforts on

Physical Activity among Urban Population Groups. ............................................. 138

Statement of Contribution of Co-Authors ...................................... 140

Chapter Six: Published Paper Two.................................................. 141

6.1 Abstract ............................................................................................................ 141

6.2 Introduction ...................................................................................................... 142

6.3 Rationale and Background ............................................................................... 143

6.4 Case Study: What is the Kelvin Grove Urban Village and how does it allow

us to address research questions about urban design and health?.......................... 148

6.5 Methodology .................................................................................................... 155

Study Participants and Data Collection Methods: ................................................. 155

6.6 Key Findings .................................................................................................... 156

Community Capacity-Building and Recreational Activities.................................. 164

6.7 Discussion, Conclusions, and Future Implications .......................................... 164

Statement of Contribution of Co-Authors ...................................... 167

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Chapter Seven: Published Paper Three.......................................... 168

7.1 Abstract ............................................................................................................ 168

7.2 Introduction ...................................................................................................... 169

7.3 Re-Thinking Context: A Theoretical Point of Departure ................................. 170

7.4 Methodological Design .................................................................................... 171

7.5 Location of the Study: The Kelvin Grove Urban Village (KGUV) ................. 173

7.6 Study Participants............................................................................................. 174

7.7 The Researchers ............................................................................................... 175

7.8 Entry into the Field .......................................................................................... 175

7.9 Ethical Clearance ............................................................................................. 176

7.10 Data Sources................................................................................................... 176

7.10.1 Online Blog Entries..................................................................................... 176

7.10.2 Interviews.................................................................................................... 178

7.10.3 Outdoor Community Focus Group ............................................................. 178

7.11 Analysis: A Social Constructionist Approach................................................. 179

7.12 Findings: Key Conceptual Categories Mediating Poor Contexts and Low

Physical Activity Levels......................................................................................... 181

7.12.1 On being ‘Flogged up Something Fierce’: Conditions in Childhood as

Catalysts for Patterns in Later Life ........................................................................ 182

7.12.2 ‘Running Away: A Strategy for Surviving and Starting Again in Hostile

Environments ......................................................................................................... 185

7.12.3 ‘Sleeping with One Eye Open’: Living in Poor Neighbourhood Contexts

as Young Adults with Children .............................................................................. 186

7.12.4 ‘You’re Just Fat’: Other Intervening Social Interactions and Influences

on Body Image and Physical Activity.................................................................... 188

7.12.5 ‘Exercise as a Dream’: The consequences of life-course contextual

processes on the negative social construction of physical activity within this

group. ..................................................................................................................... 189

7.13 Reflections on Methodological Limitations................................................... 192

7.14 Discussion and Conclusion ............................................................................ 192

Chapter Eight: Contribution of the Thesis to Knowledge ............ 197

8.1 Were the Research Questions Answered? ........................................................ 197

8.2 Using Social Constructionism: Reflecting on the Conceptual and

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Methodological Contribution................................................................................. 199

8.3 What Did a Social Constructionist Grounded Theory Approach Reveal

About the Context of the Lower-Socioeconomic Lived Experience? ................... 201

8.4 What Did Social Constructionism Tell Us About What Physical Activity

Means in Poorer Contexts? .................................................................................... 203

8.5 Implications for Health Promotion and Communication: The Challenge of

Encouraging Behavioural Change in Poor Settings. .............................................. 205

8.6 Implications for Urban Design: What Neighbourhood Traits Work Well for

Vulnerable Demographics? .................................................................................... 210

8.7 Implications for Health Inequalities Research: What Do We Know About the

People, Place, and Health Relationship That We Did Not Know Before?............. 213

8.8 Using the Theoretical Knowledge Built in this Thesis to Develop Effective

Research and Policy About the Relationship Between Poverty and Physical

Activity. .................................................................................................................. 216

8.9 Critical Reflections: Limitations of the Methodology and Future

Considerations........................................................................................................ 218

8.10 Conclusion ..................................................................................................... 220

REFERENCE LIST.......................................................................... 378

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Tables, Figures, Images, and Graphs

Table 1.1 Summary of Participants and Data Collection Phases ............................... 29

Figure 4.1 Inductive Theory-Building Approach....................................................... 87

Figure 4.2 Ideological Framework Behind KGUV Design ....................................... 93

Figure 4.3 A map of the geographic area in which KGUV is located is depicted

below.......................................................................................................................... 94

Figure 4.4 Master Plan ............................................................................................... 94

Table 4.1 Summary of Health-Related Resources in KGUV..................................... 95

Table 5.1 Ecological and Communicative Factors Influencing Decisions about

Physical Activity among Lower-Socioeconomic Residents in a New Urban Village.

.................................................................................................................................. 132

Figure 6.1 ‘What is KGUV a Case Of’? .................................................................. 150

Figure 6.2 Map of Geographic Area in which KGUV is located............................. 151

Figure 6.3 Master Plan ............................................................................................. 151

Table 6.1 Health Related Resources at KGUV ........................................................ 153

Table 6.2 Participants and Data Collection Phases .................................................. 156

Table 7.1 Summary of Participants and Data Collection Phases ............................. 174

Figure 7.1 Conceptual categories and core category emerging from a social

constructionist grounded theory study into the relationships between poor living

contexts and lower physical activity levels.............................................................. 182

Table 8.1 Aspects of Urban Design important for Healthy Living .......................... 212

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Appendices

APPENDIX A: QUT Ethics and KGUV Research Committee Approval................ 222

APPENDIX B: Information and Consent Forms ..................................................... 223

APPENDIX C: The Physical Activity Survey ......................................................... 234

APPENDIX D: The Blog ......................................................................................... 235

APPENDIX E: Interview Schedules and Transcripts .............................................. 295

APPENDIX F: Community Focus Group Schedule and Transcript ........................ 365

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Statement of Original Authorship

The work contained in this thesis has not been previously submitted to

meet requirements for an award at this or any other higher education

institution. To the best my knowledge and belief, the thesis contains no

material previously published or written by another person except where

due reference is made.”

Signature:

Date: 17/08/08

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Acknowledgements

There really are many, many people to thank for their support during my PhD

journey. Whether they simply supported the crazy notion of undertaking a doctoral

degree while having and raising three young children, or whether they supported me

in practice, by listening to my woes and fears, encouraging me to keep going, and

most importantly, babysitting… I owe them all a very big THANK YOU.

Thank you firstly, to Associate Professor Gavin Turrell, my first Principal Supervisor,

with whom I had many exciting and interesting discussions about the ideas and

possibilities of doing a PhD on the topic of health inequalities in the West. We spent

many, many hours thinking of angles and ideas, and arguing over methodological

approaches to this fascinating topic. I enjoyed this old school approach to academia:

spending hours discussing ideas over coffee. I formulated many of my ideas and

critical arguments during this time, and so I thank you Gavin, for the investment of

your time, and for the inspiration you gave me to do this thesis in the first place.

I extend my deepest gratitude to my next Principal Supervisor, Associate Professor

Barbara Adkins, who took me on as a student when my confidence was low and I

was plagued with self-doubt. Barbara is an exceptional person and supervisor – for

whom nothing is too much trouble, too complex, or too challenging. Whether you go

to Barbara with a conceptual, theoretical, or every day life problem (I have no

babysitter today, etc ;-) she quickly distils it down, and finds a practical way to work

through or around the problem. Nothing is too much of a big deal for Barbara,

everything can be handled calmly and intelligently, and she listens to you as though

you are the only person in the world during supervisor/student meetings. I thank

Barbara for her no-nonsense approach to dealing with bureaucracy, for sharing her

theoretical genius with me as I tried to fathom my way through my methodology and

analysis, for teaching me what qualitative research is all about, and for her non-

judgemental approach to life and those around her. I feel honoured to have met you

and worked with you Barbara, and am sure we shall continue to work together in the

future. (I must also thank my old mate Glenn Draper for suggesting I go to Barbara

when things got challenging. Thanks Glennie!)

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I also thank Associate Professor Elizabeth Parker and Dr Marcus Foth, both of whom

provided me with much needed support and guidance in other aspects of the PhD

journey. Elizabeth was always there for me, whether I needed to discuss the thesis or

my personal life, and listened to, and supported me throughout. Elizabeth is a warm

and exciting person who is always buzzing with ideas and energy – and a wicked

sense of humour – and I have felt guided and protected by her during the full length

of my PhD. Thank you Elizabeth for your pragmatism, your organisation, your direct

approach, and your friendship. I know we will stay in touch for the rest of our lives. I

must also bow down to Marcus, who already knows how highly I think of him and

adore him! But I shall say it again – thank you Marcus for your endless emails and

encouragement and inspiration and for keeping me on my toes and in-the-know

about presenting at conferences and publishing. I loved writing with you, and share

your outlook about taking every opportunity and giving it all you have. It is a

brilliant approach to life and work. You rock.

Thanks also to Professor Michael Dunne for being on my panel and being an eternal

inspiration to me as a brilliant lecturer and researcher.

I will now thank my beautiful and much loved friends for their support during the

times that I felt this thing was just never going to happen for me. In no particular

order of importance or love, I thank Siro and Ridgie for being there for me forever

and ever, and to Lizzie Macquire ‘The Amazing’ who always made me drink and

laugh a lot during my PhD – thanks mate! Thanks to Jody, for keeping it real, and

doing things like taking my Woodford tent down from around me at 8am and

reminding me that there is always real life to get back to ☺ I must thank Cassandra

Jones – a most eccentric and fabulous individual - with whom I shared a kindred

connection, a million emails, and a passion for ciggies, wine, and Leonard Cohen.

Thanks for lifting me up in those emails Cass, time and time again, no matter how

knocked down I was feeling. Thanks to Michelle Reynolds – my brilliant, non-

judgemental and very funny mate with whom I had many much needed drinks and

chats at the Normanby – mate let’s kept that habit up for years to come! Thanks to

Jamie Reynolds also for putting up with me while I raved about how hard everything

was to his good wife, while sitting on his couch drinking all his wine ;-) Thanks to

Dr Elisabeth Winkler – I have always been honoured to have conversations with you,

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m’dear – your intellect is scary and I love it! Let us stay in touch and have clever

conversations for years to come! Thank you for your kindness too, towards myself,

Ben and the kids. You always made me feel OK, even when I was broke. Speaking of

which – thanks to James Cole and Kerry Vinall, for spotting us with short term food

loans when we needed them… you saved us many times, guys – I love you both

forever for that. Make sure I cook you heaps of good dinners in future as some kind

of interest for your support. I look forward to both your PhD graduation ceremonies

and many happy camping trips to Woodford! Thank you to Sir Rob Mann, who made

me feel at home in London and like a Princess in Paris – bless you, Rob for the best

junket ever. I will never forget your kind and generous spirit during the time I

presented at Cambridge University in the UK, and was freaking out about that pretty

much the whole time I was there. Other two important groups I thank – are firstly my

neighbours, who are just the best neighbours ever. Thanks for making Miskin Street

an awesome hippy commune that I love living in – for all those emergency coffees

and ciggies and dunny rolls when stress levels were high! And secondly, I thank the

First Wives Club – Alley Cat, Maree, and Michelle – for the bonding, the

understanding, and the healing. Hats off ladies! It’s to infinity and beyond for all of

us now……..!

I would like to also thank the Collerson, Alcorn, Lowe, Pearse, Stevens, and

Domocol contingent for all their love, support, and practical help. Most especially to

Jane, Jon, and Alex for helping me with babysitting, and to Kate for editing my thesis

so beautifully for me when I was too exhausted to look at it anymore! Thanks to

Louise, Devon, and Fiona for their generous and very fun hospitality in Santa Cruz

while I was presenting in San Fran, and thanks to Nikki for letting me bend her cyber

ear when I needed to. Much love and thanks to this second family that I have happily

adopted through Ben.

And finally, there really are not going to be words that allow me to adequately thank

Ben, Charlotte, Oliver, Annabelle, Mum, Dad, Jay and Fiona. I really am stuck on

what to say here, because I am closer to you all than anyone else in the world, I see

you all the time because you are always bloody there for me (!), I tell you all

everything about everything all the time, and all this tells me how amazingly present

and loving you are in my life. Your support during this challenging and exciting

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journey has been relentless, immense, and unfaltering. I hope that I can provide the

kind of love and support you have shown me during this time for many years to

come, and that the good karma comes back to you double-fold!

I do, however, want to specifically say thanks to Ben for loving me, often silently,

patiently, generously – and above all loyally – we make a very good match in that

way… god knows we couldn’t have two people like me in a relationship! So thanks

for being my eternal ‘opposite’, the yin to my yang, and being all I ever needed you

to be to help me through this thesis.

And finally to my Mother and Father – Mum for teaching me practicality,

organisation, prioritising, simplifying, empathy, generosity, creativity, the Zen art of

cleaning, and above all charm, and the art of persuasion ;-), and Dad for teaching me

to argue, defend, critique, be political, advocate, lead, take initiative, get angry about

things that are unfair, and for teaching me to be academically minded. I thank you

both, my parents, for everything that I am, and everything that I have accomplished.

Oh, and I nearly forgot – thanks to Sauvignon Blanc, without which much of this

thesis would never have been written, and much of the editing would not have been

required!

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List of Works from this Thesis Accepted for Presentation &

Publication

Conferences

Carroll, J.-A., Adkins, B., Parker, E., & Foth, M. (2007, March 20-21). The Effects of a New

Urban Context on Health: An online investigation of into the relationships between

neighbourhood design and physical activity levels of lower socioeconomic residents. Poster

presented at the Third National Conference on Obesity and Health, Manchester, UK.

Carroll, J.-A., Adkins, B., Parker, E., & Foth, M. (2007, Sep 6-8). The Kelvin Grove Urban

Village: What aspects of design are important for connecting people, place, and health? Peer-

reviewed paper presented at the International Urban Design Conference, Gold Coast, QLD.

http://eprints.qut.edu.au/archive/00009843/

Carroll, J.-A., Adkins, B., & Parker, E. (2007, May 24-28). 'Blogging about Jogging': Digital

stories about physical activity from residents in a new urban environment with implications

for future content and media choices in population health communication. Peer-reviewed

paper presented at the 57th Annual Conference of the International Communication

Association (ICA), San Francisco, CA. http://eprints.qut.edu.au/archive/00006317/

Carroll, J.-A., Adkins, B., & Parker, E. (2006, July 8-14). The Effects of a New Urban

Context on Health: A study of the ecological processes connecting people, place, and

physical activity. Invited presentation at the Mixed Methods Conference, Cambridge

University, UK.

Book Chapters

Carroll, J.-A., Foth, M., & Adkins, B. (2008). Traversing urban social spaces: How online

research helps unveil offline practice. In J. Hunsinger, M. Allen & L. Klastrup (Eds.),

International Handbook of Internet Research. Heidelberg, Germany: Springer.

http://eprints.qut.edu.au/archive/00013350/

Journal Articles

Carroll, J., Adkins, B., Parker, E., Foth, M., Jamali, S (2008). My Place through My Eyes: A

social constructionist approach to researching the relationships between socioeconomic

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living contexts and physical activity, The International Journal of Qualitative Studies in

Health and Well-Being, In Press

Media Coverage of the PhD Findings

Science Alert Australia and New Zealand

‘Health Promotion Targets Advantaged’ http://www.sciencealert.com.au/news/20081106-17470.html

Australia Network News

‘Australia Researcher Suggests New Approach to Obesity’ http://australianetwork.com/news/stories/asiapacific_stories_2270584.htm

ABC News

‘Healthy Living Campaigns Patronising: Study’ http://www.abc.net.au/news/stories/2008/06/10/2270459.htm

Queensland University of Technology (QUT) E-News

‘One Size Doesn’t Fit All in Health Promotion’ http://www.news.qut.edu.au/cgi-

bin/WebObjects/News.woa/wa/goNewsPage?newsEventID=17497

India E-News

‘Health Campaigns Lost on the Poor’ http://www.indiaenews.com/australia/20080611/124275.htm

Thaindian News

‘Health Campaigns Lost on the Poor’ http://www.thaindian.com/newsportal/world-news/health-campaigns-lost-on-

the-poor_10059055.html

Sunshine Coast Sunday

Full page article ‘Class Barrier to Fitness’

Workout UK Magazine

‘Health Campaigns too Patronising’ http://dementia.uow.edu.au/activities/guest-lectures.html

Triple J News, 10th

June 2008

A Queensland researcher thinks poorer people aren't getting the message

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about living a healthier lifestyle and there needs to be smarter promotion. Interviewees: Julie-Anne Carroll, University of Technology, Queensland Duration: 0.29 Summary ID: S00030985582 This program or part thereof is syndicated to the following 6 station(s):- Triple J (Perth), Triple J (Melbourne), Triple J (Brisbane), Triple J (Adelaide), Triple J (Hobart), Triple J (Darwin) © Media Monitors Radio National, ‘Australia Talks’, Paul Barclay, 9

th June 2008-07-28

PhD Student Julie-Anne Carroll joins the panel to discuss the Kelvin

Grove Urban Village, an inner city residential development based around the QLD University of Technology campus. Interviewees: Caroline Stalker, Director, Architectus Brisbane; Julianne Caroll, PhD Student, Humanities Research Program, QLD University of Technology; Uras* Crest, urban designer and architect Duration: 7.46 Summary ID: C00030973544 This program or part thereof is syndicated to the following 8 station(s):- Radio National (Sydney), Radio National (Melbourne), Radio National (Brisbane), Radio National (Perth), Radio National (Hobart), Radio National (Adelaide), Radio National (Darwin), Radio National (Newcastle) © Media Monitors

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Chapter One

Introduction and Overview of the Thesis

1. Introduction to the Topic

This thesis calls into question the concept of ‘context’ as it is currently

conceptualised or measured in epidemiological studies examining relationships

between people, place, and health, and proposes a social constructionist approach to

exploring connections between living environments and health-behavioural trends. It

shifts the emphasis from measuring living contexts – at the household or

neighbourhood level - to investigating them as meaningful social places wherein

behavioural trends and lifestyle patterns become clustered over time due to ongoing,

and largely unknown, dynamics within these contexts. To test the potential

methodological contribution of a social constructionist approach to conceptualising

and studying relationships between living contexts and the specific health-related

behaviour of physical activity, a new urban locale was identified as one that typified

the relationships of interest in this study. An intensive study was conducted of a

group of lower socioeconomic residents who had recently moved into a new urban

village designed to increase residents’ physical activity levels. The study makes a

point of departure from the cross-sectional ‘snapshots’ of the links between

households, neighbourhoods, and health provided in the epidemiological literature, to

a study that captures the contextual interactions and processes that go on over time;

tracking people as they traverse through poor living environments, to produce

patterns in health practices and outcomes.

This thesis makes the overarching case that it is one thing to observe a human social

context, its characteristics, its occupants, and people’s behaviour there, and another

to set about trying to understand how and why these fit or operate together in the

orders and patterns in which they appear. In a philosophical and empirical sense,

these two tasks are highly compatible as a means of generating knowledge about the

patterns and processes that link human contexts to health outcomes of interest.

However, research looking at how socioeconomic living contexts influence health

behaviours and outcomes has created a methodological and evidence-based focus on

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the former phase of contextual analysis: observation. That is, sophisticated statistical

instruments are currently employed to find out which aspects of these contexts

appear to be most salient for health, and which factors in these environments depict

the most statistically significant relationships to outcomes of interest. Thus, this

thesis makes a philosophical and empirical shift to create an emphasis on the latter

phase of contextual analysis to find out why these patterns might be occurring, and to

tap into the psychosocial processes and interactions that give rise to behavioural

trends along a socioeconomic gradient. I argue that, firstly, a more competent

conceptualisation of contexts as propagators of trends in health-related behaviours

along a socioeconomic gradient is needed and, secondly, that a greater emphasis on

qualitative research methods is required in order to establish a competent and

insightful analysis of population trends in health – with the view to designing and

implementing more effective intervention programs in the future.

This thesis emphasises that there are inextricable links between how one thinks about

‘context’ and defines it, and one’s approach to studying the human practices within it.

An important paper devoted entirely to the discussion of context across history and

disciplines by Burke (2002) highlights the different ways in which context has been

discussed over time, and how its definition in a particular context reflects the

underlying political, religious, or cultural persuasions there. As Burke (2002) states

‘interdisciplinary discussions of the problems raised by the notion of context are all

too rare’ (p.164). He argues that a greater understanding of ‘context in context’ is

needed to generate a more profound and interdisciplinary understanding of its

evolution and emphasis across different geographical, institutional, and conceptual

spaces. In keeping with this approach, this thesis describes a journey through a

conceptual and methodological shift from the epidemiological ways of thinking

about and investigating socioeconomic contexts for their power to influence health.

The process moves from a conceptualisation of contexts as static and deterministic to

organic, dynamic, and socially produced by the humans who inhabit them, with

consequences for their health. It begins by taking note of the evidence outlined in

social epidemiological research that characteristics of households and

neighbourhoods are often strongly linked with trends in health behaviours and

outcomes, and makes the case for an intensive study to unearth the micro-level

processes that produce these patterns. With the key research goal of finding out why

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these contextual or group-bound patterns emerge, a study was designed to ascertain a

subjective viewpoint from people from lower socioeconomic groups about how their

households and neighbourhoods have influenced their lifestyles and their health, with

a particular focus on how physically active they were likely to be.

While much of the literature on health inequalities is concerned with establishing

epidemiological patterns and trends to make the case that unequal economics results

in unequal health, this thesis is interested in addressing the question of how these

trends arise, and unravelling the complex social and cultural landscapes on which

such lifestyles and life and health trends are constructed. Further, I aim to discover

how they are propagated from generation to generation within particular geographic

areas. While it is indisputable that poverty has harsh outcomes for population health

and well-being, there is room in current research efforts to find out how, in Western

contexts, ‘relative’ poverty or inequality creates significant lifestyle differences with

implications for health. It is important to be able to understand what economic

inequality means as an everyday lived experience – or how poverty translates into

lifestyle – in order to understand why such differences in lifestyle and health-related

behaviours emerge. This thesis tackles the overarching philosophical question of

‘what is it about living in poorer neighbourhoods or areas that creates particular

lifestyle patterns that damage or harm health and life chances?’ If researchers are

able to address this question effectively and more comprehensively in future

empirical efforts, the implications for public health are promising.

If empirical research can point to factors and processes mediating the relationships

between poor living contexts and less healthy lifestyles – and thus poorer health

overall – a more sound and convincing argument can be made to redress social and

economic inequalities at a macro or policy level by providing concrete answers about

what is likely to make a difference from a health perspective in these environments.

That is, the politically tenuous ground wherein paradoxical relationships between

poverty and health-risk factors – such as obesity, cigarette smoking, and alcohol

abuse – are identified, needs to be more effectively unearthed to provide insights

about how these relationships emerge in order to elicit a response that is both

effective and appropriate within these settings. Currently, the purely economic

argument to resolve health inequalities is vulnerable to counter-points highlighting

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the presence of human agency and individual resilience in being able to overcome

difficult living situations as opposed to engaging in self-destructive behaviours

within them. Further, and importantly in light of these challenges, health promotion

and communication advocating behavioural change within these target demographics

tends to be unsuccessful for the most part, as lower socioeconomic groups continue

to be less responsive to public campaigns pushing for behavioural and lifestyle

changes with benefits for health (Finlay & Falkner, 2005; Bauman et al, 2006;

Laitakari, 1998). In addition to the health sectors, urban design research also faces

the challenge of trying to respond to the community and housing needs of poorer

residential groups in ways that are healthy and sustainable. Thus, a more in-depth

examination of the micro-processes sustaining the relationships between poorer

people, poorer places, and poorer health would arguably lead to a more appropriate

and well-matched political, economic, and communicative response within these

complex living contexts on a number of different fronts.

1.2 Overview of the Thesis Chapters

Chapter Two, the literature review of this thesis, reflects on the two disciplines of

health inequalities and urban design to make note of common interests, as well as

differences, in methodological approaches between these fields, fields which are both

concerned with how people relate to, and are affected by, the places they inhabit. It

identifies the different ways these disciplines evaluate how cities and

neighbourhoods affect people’s quality of life and health, and draws out current and

common gaps in knowledge in both fields. It begins with a premise established in the

social epidemiology literature that, in Western countries, people who inhabit poorer

places and living contexts are more likely to suffer from a range of illnesses and

diseases, and tend to experience premature or earlier mortality rates than their more

well-off counterparts. Further, these patterns are primarily explained by the tendency

for higher socioeconomic groups to engage in healthier behaviours and lifestyles, and

to be less exposed to a range of risk factors associated with poor health than people

who comprise less well-off demographics (Slater et al, 1998; Williams et al, 2000;

Dovey et al, 2001; le Claire, 2001; McIntyre, Ellaway, & Cummins, 2002; Reidpath,

2003; Moyses et al, 2004; Leslie, 2005; Tucker et al, 2005; Karpati, Bassett, &

McCord, 2006; Monden, Van Lenthe, & Mackenbach, 2006; Parkes & Kearns, 2006;

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Cummins, Curtis, Diez-Roux, & Macintyre, 2007; Turrell, Kavanagh, Draper, &

Subramanian, 2007). Whether socioeconomic position is measured at the individual

level, referred to in this body of literature as a compositional measure, or at a

contextual level, that is by family, household, or living area, empirical research

shows that lower socioeconomic individuals and groups are less likely to eat the

recommended amounts of fruit and vegetables, take the recommended levels of

physical activity (PA), drink alcohol within safe limits, or not smoke cigarettes than

higher socioeconomic groups (Kamphuis 2006; Selstrom, 2007). While it is evident

that poverty contributes to poorer health and well-being via a range of lifestyle

choices and factors, what is not properly understood is how this connection has

evolved, and how lower socioeconomic contexts have come to hold ‘deterministic

powers’ in relation to population behavioural and consumption patterns.

Meanwhile, in urban planning and design literature, an emerging interest in

collaborative efforts with researchers concerned with the relationships between

health and place is growing. As noted by Jackson (2003), ‘while causal chains are

generally complex and not always completely understood, sufficient evidence exists

to reveal urban design as a powerful tool improving human condition’ (p. 191). The

urban design literature is less concerned with population health per se, and more

concerned with quality of life, or residential satisfaction, in relation to how people

respond to buildings, architecture, landscaping, and use of public and private space in

cities and neighbourhoods. The urban design literature concludes that what is

currently most in demand by urban populations, and yet what is most difficult to

deliver, includes the ephemeral qualities of community (Gleeson, 1994), diversity

(Luymes, 1997), participation (Al-Hathloul, 2004), sustainability (Van den

Dobbelstein & de Wilde, 2004), identity (Oktay, 2002; Teo & Huang, 1996), culture

and history (Antrop, 2005). The challenge put to designers to deliver urban

communities with these qualities within tightly bound spatial and economic

efficiencies points to the need for research into how to make these goals more

feasible or attainable.

The concerns facing urban designers and researchers are directly relevant to health

researchers wanting to know which aspects of place influence people’s experiences

and lifestyles there. The fields are highly relevant to one another in light of the

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potential progress that could be made via a dialectical interchange of ideas in both

substantive findings and methodological designs initiated in each discipline. In

particular, this literature review makes note of the direct and subjective accounts of

the people-place relationship put forward in the planning literature, in contrast with

the health literature seeking to establish significant correlations between place traits

and human behaviour and health as a means of finding out what matters in a place

from a public health perspective. While both disciplines have contributed greatly to

our knowledge regarding how people relate to, live in, and respond to places, both

areas still face steep conceptual and methodological challenges. Specifically, the

health inequalities literature is still struggling to ascertain a philosophical grasp on

living contexts as phenomena that produce patterns in health, while urban design

literature is still striving to carve out a clear ‘methodological identity’ for itself in the

field. It was from these substantive and conceptual gaps in the literature review that

the research questions were designed. The questions point to the need for a new

theoretical paradigm in relation to thinking about living contexts as dynamic social

spheres that influence health-related behaviours, and a methodology suited to

capturing the interactions and relationships that produce and sustain the patterns we

are so often able to observe within them.

Chapter Three of this thesis brings together the research questions raised in the social

epidemiological literature regarding how health inequality trends across places are

contextually influenced or produced, with Berger and Luckman’s (1966)

philosophical framework which focuses on the processes via which groups of

humans socially construct language, meanings, and behavioural norms in situ. This

conceptual framework emphasises the role of time, agency, context, and subjectivity

in how particular behavioural patterns arise in particular social settings. Berger and

Luckman offer a contextual, rather than a universal framework for thinking about

and analysing patterns in human behaviour. In doing this, they illuminate contexts as

powerful proponents of human behaviour, and theorise how norms and behavioural

patterns develop within them. For this reason, I propose that their work is directly

suited to studying and analysing how living contexts work to give rise to particular

behavioural and lifestyle profiles.

Chapter Four outlines the methodological approach of this thesis, including the

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study design, data collection and analysis. It describes both the quantitative and

qualitative methods used to collect and analyse the data contributing to the findings

in this thesis.

The chapter also describes how this conceptualisation of human behavioural patterns

in households and neighbourhoods as socially constructed via the interaction and

communication of the inhabitants was coupled here with the qualitative data

collection and analysis techniques of the social constructionist grounded theory put

forward by Charmaz (2001; 2006), and practised and acknowledged by others (Lesch

& Kruger, 2005; Hallberg, 2006). Charmaz has taken a divergent – and yet

increasingly accepted – means of employing a grounded theory approach, and

acknowledges the need for flexible guidelines, ‘not methodological rules, recipes and

requirements’ (p. 20). She argues that researchers bring their own histories, theories,

values and ideas to the process of generating theory from data. Thus, consideration

must be given to both the researchers’ and participants’ backgrounds when data is

being collected, selected, and analysed. A reflexive, interpretive approach to the data

must be taken if there is an ongoing understanding of it being socially produced

between the researcher and the participant.

In light of the conceptualisation of behaviour in context by Berger and Luckman, and

the principles of Charmaz’s methodological framework, I sought to gain an insider’s

perspective or subjective account of how lower socioeconomic residential groups

perceive, understand and rationalise their responses to a particular living context,

while simultaneously recognising the dialectical construction of data between the

researcher and the participant. I could not find another study that took a social

constructionist grounded theory approach to researching poorer living contexts for

their capacity to influence healthy lifestyles, however research regarding attitudes

and beliefs in relation to sexual practices among a group at risk of HIV using this

methodology has been published (Lesch & Kruger, 2005).

This theoretical framework and mixed methods study design was conducted the

residential population living within the Brisbane Housing Company (BHC) – or

‘affordable housing’ units – within the Kelvin Grove Urban Village (KGUV;

www.kgurbanvillage.com.au) to gain a better understanding of the socioeconomic

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contextualisation of physical activity. KGUV is an AUD 800 million, medium-

density, mixed-tenure, planned community on 16 hectares situated two kilometres

from Brisbane’s Central Business District (CBD) and comprised of over 1000

residential apartments. It is located adjacent to the Queensland University of

Technology’s (QUT) Kelvin Grove Campus, as well as the La Boite Theatre. The

four blocks of over 200 BHC apartments are situated within the Village, and

accommodate tenants who qualify for government-subsidised housing. The

apartments house families, couples, and single people who are selected based on

having relatively low incomes. The apartments are not, however, managed by BHC,

and tenants liaise with a private rental company regarding payments and maintenance

while living there.

Further, KGUV was chosen as a case study as it was designed on the principles of

New Urbanism. These principles focus on providing heterogeneous, diverse

communities with green spaces, wide, even walking pathways and bikeways to

increase residential mobility. It aims to decrease vehicle use with the overall goal of

creating more sustainable communities. New Urbanism uses a mixed land-use

approach that ensures that a number of working, recreational, and shopping facilities

are within walking distance to peoples’ places of residence. Overall, KGUV was

based on principles encouraging an engagement with the local neighbourhood to

increase physical activity levels, while reducing the impact of medium-density urban

populations on the environment.

Photographs of KGUV and the BHC apartments are depicted below:

Musk Avenue Apartments – Brisbane Housing Company (BHC)

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McCaskie Park, KGUV BBQ Social Area, KGUV

Ramsgate Residences, BHC Creative Industries Precinct, QUT.

The BHC residents living within the KGUV were chosen due the fact that they

occupied four apartment blocks housing only those who qualified for emergency

accommodation, or who had been on government housing waiting-lists. This

provided a lower-socioeconomic living context for investigation, which, as outlined

in the literature review has been established as exerting powerful ‘contextual effects’

over the health-related behaviours of those who occupy them. The BHC residents

were categorised as ‘lower socioeconomic’ via both housing type and income, with

only those residents earning less than AUD 25 000 per year qualifying for entry into

this housing.

The study took on a mixed methods study design in order to systematically address

the research questions rising out of the literature review of this thesis. Firstly, a

survey was developed and disseminated throughout the Village to determine the

practices of physical activity amongst people living in this new urban environment.

This quantitative approach was taken in order to firstly, determine differences in

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activities in residents since arriving in the Village, and secondly, to identify any

differences between socioeconomic groups (as defined by housing type) living there.

The first phase involved a gathering a baseline or descriptive data via the

dissemination of a survey on the physical activity patterns of all KGUV residents.

The survey findings indicated that all residents had increased their physical activity

levels since moving to the Village, and that those living in the Brisbane Housing

Company (BHC) apartments – the lower socioeconomic residential group – were

engaging in less physical activity than their more well-off residential counterparts,

despite small increases in activity since moving to the Village. This was followed by

two phases of qualitative research, including online and face-to-face data collection

techniques. Both online and face-to-face qualitative techniques were used to extract

more detailed explanations regarding these initial trends. A summary of the

participants and the data collection techniques I employed are summarised in Table

1.1 below:

Table 1.1 Summary of Participants and Data Collection Phases

Research

Phase

Participants

Recruitment

Strategy

Data Collection Techniques

One

(Quant.)

105 Mail-out to KGUV

residents

Survey on Physical Activity: A pilot

study (N=30) followed by a mail-out to

KGUV population (600 apartments) was

conducted to gauge patterns of physical

activity amongst residents

Two

(Qual. Online)

16 Telephone contact

with those who

agreed to

participate in

further research on

the survey

Blogging: An online mechanism known

as a ‘blog’ was appropriated as a means

where residents wrote answers, stories,

and opinions about KGUV in relation to

healthy lifestyles. There were 214

responses posted on the blog in total.

Blog address:

http://theeffectsofanewurbancontexton

health.blogspot.com/

Three

(Qual. Face-

to-Face)

8 Invitation in the

mail to participate

in research

interviews for

financial incentive

Face-to-Face Interviews: 1-2 hours

in-depth interviews were conducted

with BHC residents in their apartments

about how their living contexts affect

their lifestyles and health.

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Four

(Qual. Face-

to-Face)

6 Invitation in the

mail to community

BBQ and focus

group

Community Focus Group: Informal,

opportunistic interviewing and

observation notes were taken from BBQ

in local park organized by the

researcher for BHC residents.

Prior to presenting my analysis of the data and findings in Chapters Five, Six, and

Seven, I provide a brief introduction to, and overview of, the published papers. This

short description summarises the findings and illustrates how they answer the

research questions and collectively contribute to the building of the thesis. Chapters

Five, Six and Seven of this thesis by publication outline the systematic production of

findings that evolved as a result of the data collection and analysis in this urban case-

study. The findings reveal what a social constructionist approach to grounded theory

produced in a study investigating the processes connecting people, place, and

physical activity. Each chapter reporting on the findings of the research contains one

published paper reporting on the findings from a selection of the overall data

collected as part of this thesis by publication.

Finally, Chapter Eight reiterates more broadly how the contribution profiled in each

published paper addresses the research questions in Chapter Two, and builds to

generate a thesis about future issues for researching and understanding the

relationships between people, place, and health. The selection of this particular urban

case and the residential group within it reveals findings that point to the need for

further studies that take account of the importance of ascertaining a situated

understanding of health-related behaviours. The findings showed that while

characteristics within the neighbourhood environment are important, and that a

pleasing aesthetic, green spaces, and feeling safe are crucial for enhancing activity

levels, other contextual effects over time within this group of participants contributed

to a negative construction of physical activity as a concept; and that this greatly

inhibited their propensity to engage with the resources available. The histories and

past stories of this group revealed how childhood living environments and

experiences in poor, harsh neighbourhoods made physical activity both a low

priority, and something they were fearful to engage in fully. These previous

contextual influences ensured that inactive lifestyles became a norm amongst this

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group via a cycle of gaining weight through feelings of low-self esteem and poor

body image, and thus feeling too self-conscious to exercise in public. Further, the

psychosocial dynamics that connect or disconnect poorer people to each other and to

healthier lifestyles are explained in the data produced in this research. The data also

illustrates the importance of pleasing aesthetics and socioeconomic heterogeneity in

the pathways to positive changes to lifestyle and health. The complex interplay of

processes that constitute the findings of this thesis provides a rich and in-depth

description of the everyday lived experiences within poor households and

neighbourhoods with implications for health promotion, urban design and future

health inequalities research.

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Chapter Two

The Literature Review

2.1 Notes on the Methodology of the Literature Review

This literature review has been generated from exemplary and key articles within the

health and urban planning bodies of research that have paid particular attention to

finding out how the different characteristics of urban contexts impact on the health

and well-being of resident populations. It provides a review and critical analysis of

the aspects of context that have been highlighted as salient in influencing urban

residential health-behaviours, and the methodologies employed to detect and

understand the relationships between these factors.

The review has been divided into the following sections:

• Introduction: The Effects of Living Contexts on the Social Functioning,

Health, and Well-being of Residents.

• Public Health Perspectives on how Socioeconomic Living Contexts Affects

Health Outcomes: The challenge of measuring and conceptualising the

characteristics of a place that determine well-being.

• Physical, Social, and Socioeconomic Characteristics of Living Contexts that

Correlate Significantly with Health-Related Behaviours.

• A Review of the Urban Planning and Design Literature that has Investigated

Residents’ Psychological, Social, and Behavioural Responses to their Living

Contexts.

• Drawing Conclusions: Towards an interdisciplinary approach to researching

the impact of urban planning on the health-related behaviours of residential

populations.

• Identifying Gaps in the Literature: What are the questions that need to be

addressed in order to progress knowledge about the relationships between

people, place, and health?

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2.2 Introduction: The Effects of Living Contexts on the Social

Functioning, Health, and Well-being of Residents.

Current research and thinking regarding the impact of place on the health and well-

being of a population are being derived from a highly diverse range of academic

disciplines, with different goals and objectives at their core (Caughy, O’Campo, &

Patterson, 2001; McIntyre, Ellaway, & Cummins, 2002; Birrell et al, 2002; Jackson,

2003; Cummins et al, 2004, Waters, 2004; Vogt, 2004; Gleeson, 2004; Macintyre,

McKay, & Ellaway, 2005; Macintyre, 2005; Coen, & Ross, 2006; Monden, Van

Lenthe, & Mackenbach, 2006; Karpati, Bassett, & McCord, 2006; Parkes & Kearns,

2006; Carver, Timperio & Crawford, 2007; Turrell, Kavanagh, Draper, &

Subramanian, 2007; Cummins, Curtis, Diez-Roux, & Macintyre, 2007; McCormack,

Giles-Corti & Bulsara, 2007; Giles-Corti, Knuiman, Timperio, Van Niel, Pikora,

Bull, Shilton & Bulsara, 2007). This literature review will focus primarily on the

research in the fields of public health and urban design that examines the impact of

urban neighbourhood characteristics on the quality of life, satisfaction, lifestyles and

health of residential populations, and the different methodological frameworks they

employ to achieve this. These frameworks relate directly to the core business of both

urban design and public health, and act as empirical tools that allow researchers to

focus on particular challenges identified in the respective bodies of literature. For

example, while city councils and planners are faced with the challenge of designing

and implementing urban environments and infrastructure that both meet the needs of

specific sub-populations while still benefiting the community or region as a whole

(Waters, 2004; Kearney, 2006; Kowaltowski, da Silva, Pina, Labaki, Ruschel &de

Carvalho Moreira, 2006; Erdogen, Akyol Ataman & Dokmeci, 2007 ), public health

researchers focus on locating the best methods by which the characteristics of a place

that are likely to determine population health outcomes can be measured or

conceptualised (Caughy, O’Campo & Patterson, 2001; Diez-Roux, 2002; McIntyre,

2002; Hou & Myles, 2005; Nicotera, 2007). To do this, urban design research has

focussed primarily on assessing the effects of infrastructure on the quality of

community relations and the social functioning of residents, whereas public health

literature has been primarily interested in unpacking the environmental,

socioeconomic, and geographical characteristics of a place that determine health, and

more importantly, health inequalities between regions. However, both have

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ultimately remained focussed on investigating a range of complex physical and social

factors that contribute to the relationship between place and human functioning and

well-being.

Due to the interdisciplinary nature of this thesis, the perspective and priorities of

researchers from both public health and urban planning will be reviewed in terms of

their concerns for ways in which urban places affect the quality of life and health of

residential populations. The differences in the ways in which outcomes are prioritised

and goals are pursued by each discipline will be noted, and differences in

methodological approaches discussed. This review has been generated by seeking

articles that have a core concern with evaluating the impact of urban place

‘ingredients’ on the psychological, social, and health effects of the people who live

there. That is, the ultimately mysterious and little understood concept of urban ‘place

effects’ on people’s health-related behaviour and outcomes is what will be at the

centre of this review. Via this review, questions were able to be developed that

redressed gaps in the literature regarding psychological and social processes people

engage in as a means of assessing the characteristics of their urban living contexts,

and deciding what they will do there. Specifically, the review is interested in the

ecological processes that guide people towards or away from, behaviours that are

likely to affect their health.

This review aims firstly, to examine the literature that focuses on the relationships

that have established between qualities and characteristics of living places and health

outcomes. Secondly, it will review studies that have researched the physical, social,

and economic characteristics of an area that appear to be strongly related to health-

related behaviours and lifestyles of particular residential populations. And thirdly, it

turns to the body of literature concerned with assessing the impact of urban planning

and built environment of the formation and sustainability of functional and healthy

social relations and psychological well-being within and across communities, and in

particular, how these outcomes can be managed in new urban environments. The

primary goal of the review is to generate an interdisciplinary summary of the key

challenges faced within these research disciplines and locate specific research

questions that stand out as unanswered in literature that examines how both the

physical characteristics and socioeconomic demographics of urban places hold the

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capacity to affect the health-related behaviour and well-being of its residents. While

the key outcome of interest is health, some of the psychological and social variables

that have been researched by urban designers as desired outcomes will be of interest

as they have been shown in other areas of health research to be important factors for

improving well-being.

2.3 Public Health Perspectives on How Socioeconomic Living

Contexts affect Health Outcomes: The Challenge of Measuring and

Conceptualising the Characteristics of a Place that Determine Well-

Being.

A great portion of public health literature is underpinned by a concern for social and

economic inequalities – both within and between countries – and the impact this has

on the health of individuals, communities, and entire populations (Marmot, 2006).

Specifically, a large body of research has been devoted to the study of how the

socioeconomic position of living areas or contexts ‘determine’ health-behaviours and

outcomes (Slater et al, 1998; Williams et al, 2000; Dovey et al, 2001; le Claire, 2001;

McIntyre, Ellaway, & Cummins, 2002; Reidpath, 2003; Moyses et al, 2004; Leslie,

2005; Tucker et al, 2005; Karpati, Bassett, & McCord, 2006; Monden, Van Lenthe, &

Mackenbach, 2006; Parkes & Kearns, 2006; Cummins, Curtis, Diez-Roux, &

Macintyre, 2007; Turrell, Kavanagh, Draper, & Subramanian, 2007). This body of

literature has evolved around two broad central themes: the first being a pursuit to

define and refine methods for measuring the physical, social, and economic

characteristics under which area comes to affect population health; and secondly, to

determine how these measurements operationalise to produce inequalities in health.

These two key challenges sit in light of the evidence showing that while geographical

factors such at latitude, and environmental factors such as pollution and other

hazards have been found to contribute to population health (Bush et al, 2002; Hanna,

2005; Downey & Willigen, 2005; Ahamed et al, 2005), there is overwhelming

evidence that, in Western contexts, differences in health by area correlate

significantly and repeatedly with socioeconomic differences (Macintyre, 2002;

Turrell, 2003; Lenthe et al, 2005; Breeze, Jones, Wilkinson, Bulpitt, Grundy, Latif &

Fletcher, 2005; Hill, Ross, & Angel, 2005; Wright, Kessler & Barrett, 2007; Galea,

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Ahern, Nandi, Tracy, Beard & Vlahov, 2007). Health inequalities research has been

able to provide convincing evidence that the socioeconomic position of the area is a

reliable determinant of health outcomes, with poorer and more disadvantaged

communities being increasingly likely to endure worse health and well-being

(Karvonen, 1997; Dunn et al, 2000; Kruger, Reischl & Gee, 2007). The

socioeconomic characteristics of a person’s place of residence that have been shown

to matter from a health perspective, include housing quality, type, and tenure, as well

as overcrowding (Ellaway et al 1996; Waters, 2001; Jacobs, 2006). Further, the

income, employment, and educational levels of residents (both co-dwellers and

neighbours), as well as the socioeconomic measure given to an area, as calculated by

such measures as Accessibility/Remoteness Index of Australia (ARIA) and the

Socioeconomic Index for Areas (SEIFA) have also been identified as salient

determinants of the health and well-being of residents (Finch & Boufous, 2008).

More recently, variables relating to the perceived socioeconomic position of an area,

such as reputation and stigma, have also been identified as salient variables

mediating the place/health relationship (Sooman et al, 1995; Gregory et al; 1996;

Bush et al, 2001).

A large body of research has evolved in response to the inherently complex empirical

relationships that have been established between poorer health and lower

socioeconomic urban contexts, dedicated to understanding how the socioeconomic

status of an area might best and most accurately be measured (Turrell et al, 2004;

Mitchell et al, 2000; Hou & Myles, 2005; Sleigh et al, 2005; Zenk, Schulz, Mentz,

House, Gravlee, Miranda, Miller & Kannan, 2007; Nicotera, 2007). The aim of this

research is to be able to locate some of the descriptive characteristics of the residents

that are most likely to act as reliable predictors of the levels of health and well-being

within that community or social context. There are a number of instruments that have

been devised as observational checklists for describing neighbourhoods, such as the

SPACES instrument developed by Pikora (2004) in Western Australia, and earlier,

more theoretically driven measures (Caughy, O’Campo & Patterson, 2001), as well

as more recent efforts to strengthen methods to evaluate reliability, instrument

content and design, observer training and data collection in measuring a range of

neighbourhood qualities (Zenk et al, 2007). The much-used ‘multi-level’ approach to

detecting which measures are operating at individual, household, neighbourhood,

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and area levels to produce particular health outcomes has been heralded for its ability

to ‘link the traditionally distinct ecological and individual-level studies and to

overcome the limitations inherent in focusing only at one level’ (Diez-Roux, 2000).

While this approach has allowed an increasingly sophisticated means for locating the

levels at which socioeconomic attributes combine to affect health outcomes (Hou &

Myles, 2005), there is an acknowledgement of the limitations of such cross-sectional,

statistical devices in their capacity to reveal what psychological, social, and

behavioural variables lie in the ‘unspecified black box of somewhat mystical

influences on health which remain after investigators have controlled for a range of

individual and place characteristics’ (Macintyre, 2002). As Diez-Roux (2002) notes,

‘Like other statistical methods, multilevel analysis will help describe, summarize,

and quantify patterns present in the data, but it will not explain these patterns.’ (p.

18). A recent comprehensive review of inter-disciplinary ways of measuring,

describing, and analysing neighbourhoods was conducted by Nicotera (2007), noting

the need for a combination of quantitative and qualitative data collection instruments

including artworks and photography, and potentially the stories from the voices of

children who live there. She concludes that ‘such bridges offer opportunities to

develop interventions that are viable for creating lasting change’ (p. 26).

The challenge in employing the multi-level approach is also highlighted by the

myriad of different and contradictory findings regarding the impact of the

socioeconomic position of individuals and their neighbourhoods on health (Slogget

& Joshi, 1998; Duncan et al, 1995). While research generally supports the

relationship between disadvantage at the individual and area level and poorer health

outcomes, once these are further dissected, complications arise in terms of drawing

conclusions regarding how these effects operationalise in some contexts and not

others. For example, findings by Hou and Myles (2005) demonstrate firstly, the

highly refined abilities of multi-level models in locating the effects of socioeconomic

position on health, and secondly, the perplexing nature of how these factors are

triggered into effect in some contexts and not in others. Specifically, they found that

an individual’s self-reported health rating is likely to improve if they live in a more

affluent area, but where inequality in the area is most significant, that this effect

begins to reverse. They also found that contextual aspects of the area were more

likely to determine health than the compositional characteristics of the individuals

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who live there (p. 1559).

While further sharpening of such statistical instruments may indeed reveal more

specific detail about the compositional aspects of place that both procure and protect

against ill health and poor well-being, there is also a call in the literature for different

ways of conceptualising the context-effects of area on health in a bid to understand

how this phenomenon works at a psychological, social, and behavioural level. As

Macintyre (2002) stipulates, ‘the whole body of research is marred by weak

theoretical accounts of how and why the characteristics of an area might exert an

influence on the health of its resident population’ (p. 68). Increasingly, however,

researchers are turning to elements of social and cultural theories in an attempt to

bridge some of the knowledge gaps regarding how the lower socioeconomic position

of an area translates into dysfunctional or unhealthy behaviour. Markowitz (2001)

noted that efforts to understand area effects on health had been ‘hampered by lack of

appropriate data and model specification’ and responded by employing aspects of

cultural theory to test residents’ ‘attitudes’ and the concept of ‘social disorganisation’

as a means of unpacking how lower socioeconomic contexts lead to increases in

violent behaviour. He used survey techniques and an ethnographical approach to

determine the causal structure of cultural theories that highlight how the lower

socioeconomic position of residents leads to more violent neighbourhoods. He

concludes that ‘economic deficits lead to sensitivity, or concern with one’s status,

especially among peers and neighbours…. in the absence of conventional economic

opportunities, attitudes that facilitate violence become accentuated’ (p. 152). Such

research assists in developing insights regarding how the socioeconomic position of

an area operates or ‘plays out’ as a determinant of health behaviours and outcomes.

McLaren et al (2004) sought to test more unconventional aspects of area that might

determine how the health of resident populations is affected. They began their

research with the intent of trying to decipher how it is that ‘living in a poor area

appears to have an effect on health that is separate from the effect of being poor

oneself’ (p. 1). They chose to focus their research on the ‘reputation’ of the

community, based on the hypothesis that this may influence the morale, self-esteem,

and health outcomes of residents due to the fact that ‘the way in which one is

perceived by others is important for well-being’ (p. 2). The methodological aim of

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the study was to develop a quantitative mechanism that could test context factors and

be developed for use in multi-level research on area and health. They analysed print

media that reported on the area and found that ‘social identities of places are

reflected in and projected by the media’ (p.6). The authors advised that while this

progresses the potential usefulness of multi-level approaches, a semiotic or discourse

analysis on reputation is needed to further develop criterion validity. Additionally,

that there is a need to compare media reports with actual characteristics of an area to

find out whether the media is capable of generating artificial negativity about an area

that did not reflect the physical or economic reality of the place.

Further to this work, Cummins et al (2005) conducted a study in an attempt to

identify what types of data might be useful, and more importantly to illustrate that

this data was not currently available from primary sources, in an effort to progress

findings regarding the capacity of urban contexts to determine health. They

combined theory from the urban planning literature with Maslow’s hierarchy (1968)

to gather some ‘front up’ ideas about what researchers might need to know about

area to understand how it affects health. The potential usefulness of such a hierarchy

lies in that variables that are most likely to be able to affect health behaviours and

outcomes were selected as means by which further research focussing on particular

health issues, such as obesity, could be investigated. For example, in this instance,

pathways, parks, (walk-ability), and access to healthy eating options might be

isolated and investigated within the area of interest. The authors also developed what

they termed a variable ‘wish-list’ regarding social capital and transport – and

compiled a table that compared what they were able to find from primary sources

with what they really needed to know about an area to assess its impact on health (p.

258). This initiative might complement efforts to understand socioeconomic

determinants of health by comparing areas with high and low socioeconomic ratings

for the presence of the variables that have been identified here as being likely to

affect health.

Despite differences in the focus and employment of measures, many empirical efforts

have shown that the characteristics of a neighbourhood, but socioeconomic context

in particular, are significantly linked to a range of diverse health outcomes, including

self-reported health (Parkes & Kearns, 2006), traffic-related stress and general health

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(Song et al, 2007), lowered life expectancies, lung cancer and ischemic heart disease

(Coen & Ross, 2006), obesity (Boehmer et al, 2007; Miles, Panton, Jang & Haymes,

2007), accidents (Jacobs, 2006) and knee-replacement recovery (Wright et al, 2007).

The specific neighbourhood characteristics identified in these studies as contributing

to a diverse range of health and well-being outcomes included social support,

community engagement, social disorganisation, physical environment, facilities and

services, traffic congestion, quality of housing, maintenance, aesthetics, and land-use

respectively. Poverty, or lower socioeconomic position, was also located as a key

factor in this research contributing to experience of the neighbourhood and poor

health, as was gender, with Parkes and Kearns (2006) finding that different social

subgroups respond to the same neighbourhoods, or neighbourhoods with similar

qualities, in different ways. This demonstrates the importance of an empirical focus

on the match between a particular demographic and the nature of their living

environment, as well the need for subjective reports from residents who may have a

unique perspective of their context depending on their specific circumstances or

needs. The salience of subjective measures and contingency factors in the ‘who’ and

‘where’ under investigation is illustrated in a study by Kruger et al (2007) who found

that while neighbourhood deterioration was association with poor mental health, this

relationship depended on, or was mediated by a number of social and psychological

factors. For example, residential deterioration was mediated by social contact, social

capital, and fear of crime, while commercial deterioration was mediated only by fear

of crime.

There is also a large body of research showing that poverty – especially in Western

urban areas – contributes significantly to poor mental, as well as physical health

(Galea et al, 2007; Barnes, 2001; Breeze et al, 2004; Kruger et al, 2007; Wandersman

& Nation, 1998; Hill et al, 2005). An earlier paper from the discipline of psychology

identified social organisation, sub-cultural influence, and psychological stressors in

the neighbourhood as key factors influencing mental health outcomes (Wandersman

& Nation, 1998). In more recent, work Galea et al (2007) found that the incidence of

depression was significantly related to the socioeconomic position of a person’s

neighbourhood, independent of individual socioeconomic or other individual

covariates. Further research is needed to unpack the links between a poor context and

poor mental health, and the types of features within a poor neighbourhood that

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detract from psychological well-being. Interestingly, Barnes (2001) found that

although living a poor area affected women’s health negatively, receiving regular

welfare benefits actually counter-acted negative attitudes, with recipients of

consistent payments faring better psychologically than their counterparts who did not

receive welfare. This points to the importance of structural relief for those

experiencing poverty at the individual and contextual levels. Research that looked at

how older people fare in poor communities by Breeze and colleagues (2005) showed

that their reported quality of life (QOL) – a concept directly linked to mental health -

was worse than older people living in more well-off neighbourhoods, and that this

could not be explained by differences in physical health. Feelings of safety, and the

lack of a reliable police presence were reported as the factors explaining this

difference in results. A comprehensive study by Hill et al (2005) found that people

from disadvantaged areas were constantly exposed to chronic stressors in the form of

crime, trouble, harassment, and other signs of disorder and decay, and that over time,

this is more likely to lead to psychological and physiological distress that affects

health. Further research is needed into the effects of the every day witnessing of

specific behaviours and aesthetics that are often the properties of poor

neighbourhoods on residential well-being.

While structural and economic factors have been shown to be important in the

relationship between health and place, the presence of certain psychological and

social factors have also been shown to correlate significantly with residential health

in urban neighbourhoods (Cho et al, 2005; Stafford, 2005; Cohen, Inagami & Finch,

2006; Wood, Shannon, Bulsara, Pikora, McCormack & Giles-Corti, 2007; Chiu &

West, 2007; ) In particular, the variables that have been grouped together under the

concept of ‘social capital’ have featured as one of the core means of both

understanding and addressing how a community functions in a sense that enhances

the health and well-being of its residents (Lindstrom, 1995; Hawe et al, 2000; Cattell,

2001; Altschuler, Somkin & Adler, 2004; Prentice, 2005; Carpiano, 2006; Araya,

Dunstan, Playle, Thomas, Palmer & Lewis, 2006; Lindström, Lindström,

Moghaddassi & Merlo, 2006). In their much sourced paper, Hawe and Shiell (2000)

have provided a summary of what social capital is – the relational, material, and

political aspects- and how it holds the potential to allow epidemiological research

into health inequalities to attach itself to social theories and hypotheses that can help

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in understanding how contextual aspects of socioeconomic position impact on the

health of populations. They also note that the political aspect of social capital has

been under recognised and requires further investigation, and that, at that historical

point in the literature, they perceived that the concepts underpinning it had been

inadequately captured in investigations on its impact on health.

Although findings from Tasmania by Turrell et al (2004) show that social capital as

measured by public and private trust, social trust, neighbourhood integration, safety

and isolation did not correlate significantly with mortality rates in the area, this does

not mean that quality of life, or health by other definitions is not improved as a result

of the presence of this variable, and to this end, social capital may well retain its

usefulness as a tool for improving quality of life, rather than length. The limitations

of the effects of social capital on health have been acknowledged by Cattell (2001),

who reminds that ‘despite the capacity of social capital to buffer its harsher effects,

the concept is not wholly adequate for explaining the deleterious effects of poverty

on health and well-being’ (p. 1501). While there is little doubt that the incidence of

morbidity and mortality is increased in areas of socioeconomic disadvantage, the

challenge remains to unearth the pathways via which this phenomenon occurs. While

social capital was found here not to have a significant effect, perhaps elements of

social capital that are more obviously or directly associated with health behaviours,

such as community sporting memberships, walking groups, and collective attendance

to removing litter and environmental hazards, may reveal further insights regarding

how health behavioural profiles and outcomes differ.

Drukker et al (2003) found in a study in the Netherlands that one of the key reasons

that social capital tends to be higher in higher socioeconomic areas is that it appears

to emerge from residential stability, which is more likely to be present in areas when

tenure and home ownership is higher (p. 835). They found also that neighbourhoods

that experience residential stability tend to be more cohesive and safer than those

with high levels of instability. However, more recently, Drukker et al (2005) followed

up on results by Ross et al (2000), that showed that in the U.S., stable

neighbourhoods and socioeconomic deprivation correlated significantly with

psychological distress, whereas in unstable areas no effect was found between these

variables; thus implying a type of positive effect of instability on people in

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disadvantaged situations. The authors proposed that ‘stability in poor

neighbourhoods is perceived by residents as tantamount to being trapped and

powerless in a dangerous and frightening place’ (p. 122). Drukker et al’s study on the

same phenomenon showed that for the outcomes of health-related quality of life,

perceived health, perceived mental health, vitality, mental health, and life satisfaction

instability appeared to alleviate the effects of socioeconomic disadvantage.

Additionally, Prentice (2005) found that the socioeconomic composition of

individuals living in a neighbourhood was less able to explain differences in health

outcomes and use of primary care services than the aspects of the living contexts

identified in this study as being i) neighborhood information networks, (ii)

neighborhood health behavior norms, (iii) neighborhood social capital and

(iv)neighborhood healthcare resources. They noted that social capital and healthcare

resources significantly predict an individual's primary care access. Since differences

in primary care access may explain individual-level health disparities between

neighborhoods, policies designed to improve primary care access must account for

both individual and neighborhood effects.

These findings have important implications for those designing and producing

housing for disadvantaged people, as well as for those who battle with the transient

and unstable residential habits of some lower-socioeconomic groups. Geographical

mobility may be a key psychological tool that serves to entertain notions of freedom

and autonomy; and one that needs to be considered when designing and generating

living areas for people who are socioeconomically deprived. Perhaps this desire for

mobility could be satiated by addressing the amount of public space, walkable areas,

and number of low-cost recreational options available to people who otherwise feel

trapped or limited by either their own poverty, or the poverty of the area.

Other researchers have focussed on specific features of disadvantage that may

contribute to the experience of living in particular areas and how this impacts on

their well-being. Cattell (2001) examined the variable of ‘exclusion’ as one that

might be central to the apparently causal relationship between poverty and health.

She noted that exclusion was something more likely to be experienced by poorer

communities whose relationship with their own low social status and their area

become compacted over time in a sense that causes them to feel isolated from the

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broader community. Cattell argues that exclusion ultimately affects social networks,

which have been located as important mechanisms for improving health and well-

being. Siegrist (2000) proposed a more detailed framework for how poverty,

exclusion and health are linked by discussing the distinct absences of fulfilling roles

for those living in disadvantaged contexts. He states that ‘loss of core social roles…

impair personal self-regulation and trigger a state of ‘social reward deficiency’ (p.

1283). He goes on to describe more specifically how these psychosocial conditions

might lead to stress-relieving, addictive, health-damaging behaviour.

In an Australian study, Wood et al (2007) found that the built environment played a

small but significant role in increasing social capital and being associated with

increased levels of walking in neighbourhoods. The key aspect of built design

contributing to this was the number and perceived adequacy of a variety of

destinations. Additionally, the researchers found that high levels of neighbourhood

upkeep and maintenance were associated with increased levels of perceived safety

and social capital. Further research is needed to explore both the links between

poverty and neighbourhood design and aesthetics, and the psychological and

emotional effects these aspects of living environments have on health behaviours

and outcomes.

Cohen, Inagami & Finch (2006) found in Los Angeles that ‘collective efficacy’ – a

measure of social capital - was associated with particular features of the urban

environment that could be expected to have direct connection to health outcomes.

They challenged usual assumptions about direct causality between different measures

of neighbourhoods, noting that ‘collective efficacy is frequently considered a

“cause”, but we hypothesized that environmental features might be the foundation

for or the etiology of personal reports of neighborhood collective efficacy’ (p. 1).

They went on to find that parks were associated with high self-efficacy, while a high

number of liquor stores were associated with low self-efficacy in neighbourhoods,

concluding with the insights that ‘certain environmental features may set the stage

for neighborhood social interactions, thus serving as a foundation for underlying

health and well-being. Altering these environmental features may have greater than

expected impact on health’ (p. 1).

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A further study on the experience of place by older women by Young et al (2004)

looked at the effects of a sense of belonging on more specific physical and

psychological health outcomes and found that two variables in particular formed

reliable correlates of these measures; a sense of neighbourhood and feelings of

safety. They offer these factors as ‘valid measures of aspects of the social

environment of older women’ (p. 2627). However, more detailed investigations,

arguably of a qualitative nature, might be needed to reveal how such aspects lead to

differences in health.

Such empirical and theoretical developments demonstrate that the most productive

insights into the area effects on health are necessarily gained by examining how a

place influences people’s tendencies to behave in ways that affect and determine

health outcomes. Additionally, it points to a distinction that is not often made in this

area of the literature: that the studies which are interested in the effects of contextual

factors on mental health, including self-rated health, are primarily concerned with

quality of life and social functioning, and perhaps need to be conceptualised as being

categorically different from studies that are specifically concerned with how these

factors determine the health-behaviours and morbidity and mortality rates of

residents. However, their ultimate compatibility as a means for determining how well

people are likely to be in any particular place is unquestioned.

How residents perceive their neighbourhood has also proven to be significantly

linked with self-rated health and emotional status among adult Koreans (Cho et al,

2005). Cho and colleagues found that perceptions of neighbourhood, as categorised

and tested by overall neighbourhood satisfaction, the security of the neighbourhood

and the perceived quality of their relationship with their neighbours affected how

well they perceived themselves to be, as well as how happy or emotionally well they

felt overall. Stafford et al (2005) looked at self-rated health differences between men

and women and examined a number of contextual variables as well as socioeconomic

measures to achieve this. Interestingly, they found that each of the contextual

domains was associated more strongly with self-rated health than any of the

socioeconomic measures used. Additionally, this effect was stronger among the

female group, implying that aspects of a place might be especially salient for women

in terms of how they feel about their own health and well-being. The variables that

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were found to generate this effect included trust, integration into a wider society, left-

wing political climate, physical quality of the residential environment and

unemployment rate (p. 1681).

However, while such outcome variables lean more towards quality of life than health,

the potential of such psychosocial variables to determine health behaviours, and

ultimately health outcomes remains of paramount importance when attempting to

locate factors that mediate the structural characteristics of place and health outcomes.

Interestingly, the urban planning literature has used the approach of asking

participants whether particular place-traits elicit positive perceptions of people’s own

neighbourhoods, while health research has tested for the significant co-presence of

particular psychosocial variables such as positive perception of place and other

measures of health. It is evident that more direct questioning is needed to determine

which characteristics of a place make residents more likely to lead healthy lives

there.

Cross-sectional endeavours that continue to seek more refined and sophisticated

methods of measuring the compositional levels at which disadvantage affects life and

health chances will no doubt continue to provide data on the correlates of good

health outcomes in the Australian population. However, what they continue to

struggle with, is generating insight into how factors such as the overcrowding, tenure,

income levels, education levels, and employment status of residents makes them

more or less likely to become ill or die prematurely. Even more perplexing, how can

the properties of an area function to buffer or worsen the health of individuals as a

more powerful determinant than their own socioeconomic position? That is, the need

to develop methodologies that allow place and socioeconomic context to be

conceptualised and investigated as a phenomenon that somehow produces

psychological, social and, most importantly, behavioural differences between people

that ultimately affect health is vital in gaining insights on how best to group or ‘un-

group’ those in the lower end of the socioeconomic spectrum who require specific

housing needs, as well as what types of neighbourhood characteristics will provide

them with improved health and life chances. Research is needed that investigates

how the physical urban environment impacts on the social and cultural mechanisms

that work together to enhance healthier behaviours and lifestyles in particular

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socioeconomic contexts and communities. A new and more sophisticated method for

conceptualising and empirically testing the effects of place on health would provide a

timely and useful point of departure from the vast body of knowledge provided by

cross-sectional, multilevel research that reliably informs us that the lower the

socioeconomic position of an area and its residents, the poorer the health behaviours

and outcomes of those who live there are likely to be.

Additionally, research needs to be more specific about its intentions for improving

the lives of socioeconomically disadvantaged groups, and more earnest in its

attempts to find mechanisms that improve both happiness and health. If being

residentially unstable, ‘socially dysfunctional’, and engaging in high-risk health

behaviours improves the happiness of poorer people and communities, the goal of

changing behaviour becomes increasingly difficult as a sense of self and happiness

are couched within such consumption profiles. If they cease smoking cigarettes,

become more socially ‘functional’ in their behaviour, and achieve residential stability

while reporting less psychological satisfaction and well-being, is this goal then

achieved from a public health perspective? While structural researchers investigating

the health divide have used dysfunctional behaviour as evidence for the ill-effects of

poverty on people, there remain other aspects of life that are equally devastated by

deprivation, and perhaps focusing on how people can feel good about who they are

and where they live might be a more sympathetic and realistic starting point for the

long journey to permanent lifestyle and behavioural change.

Finally, much of the statistical research in this area of study makes assumptions

about the direction of the relationship between place characteristics and observable

health outcomes, and in doing this, assumes a passivity or lack of agency among

residents wherein place is the actor that affects how well they are likely to be able to

be. However, research is needed that questions these assumptions, and asks whether

people ultimately dictate the health of a place by basing their decisions regarding

where they want to live on what they want to do. The question of whether or not

people consciously choose places – or move to or away from them upon such

realisations – based on tastes, preferences, consumption patterns and lifestyle would

reveal much about what epidemiological research unearths as ‘place effects on

health’. That is, a more open-ended exploration of the direction of the relationship

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between health and place would allow critical developments in the pursuit to identify

the area variables that most prominently affect the well-being of residents.

2.4 Physical, Social, and Socioeconomic Characteristics of Living

Contexts that Correlate Significantly with Health-Related

Behaviours.

The previous section of this review has outlined the many ways in which area effects

on health outcomes have been conceptualised and empirically tested.The variables of

socioeconomic status, reputation, stigma, social capital, social cohesion, belonging,

stability, and security or safety within a particular area were all found to have an

impact on health outcomes – either directly on physical health, or on self-reported

wellness and psychological or emotional states. However, due to a well-established

connection in the literature showing that health-related behaviours tend to be strong

generators of patterns in health outcomes, this thesis is specifically interested in how

the physical and social characteristics of urban contexts tend to be related not only to

the health outcomes of people living there, but patterns in their health-behaviours and

lifestyles. In particular, this thesis aims to question how ‘area’ generates a

relationship between lower socioeconomic groups and poorer health via trends

towards less healthy lifestyles in terms of broader patterns of activity and

consumption. The way in which behavioural profiles and lifestyles shift when the

variables attributable to place do, begs the research question of ‘why?’. What are the

mechanisms at play and how do they work together to influence health-related

behaviour as well as broader patterns of consumption, recreation, and lifestyle of the

people who live there?

While this project is ultimately interested in the health-related aspects of this

relationship, the primary aim of the work is to develop theory and a new set of

variables that can be grouped together or conceptualised to further explore and

empirically test the effects of urban places on people’s reported experiences of living

there and what they do (and consume) on a daily basis. Researchers in this section of

the review have focussed on area determinants of health-related behaviour, and while

some of these studies look at behaviours known to directly affect health, such as

physical exercise and drug use, others have investigated behaviours that are related to

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the broader social health and well-being of a community, such as degree of

participation in community events, and levels of crime, graffiti, and violent

behaviour (Buchecker, 2003; Feigelman, 2000). Therefore, the next section

reviewing the literature will examine the work that has examined how the physical,

social, and economic characteristics of various places have been found to affect the

types of activities residents are likely to engage in. Again, there is a need to

emphasise that the literature addressing this question stems from a multitude of

disciplines and contains different research goals at their core.

From a preventative medical perspective, the urban environment has emerged in the

research as a salient determinant of the amount of physical activity residents

reportedly engage in via subjective and objective measures of walking, jogging, and

use of public space for exercise (Hess, 1999; Berrigan et al, 2002; Brownson et al,

2004; Duncan et al, 2005; Titze, 2005; Bedimo-Rung et al, 2005; Giles-Corti et al,

2005; Kloek, van Lenthe, van Nierop, Koelen & Mackenbach, 2005; Roemmich et al

2006; Hillsdon, Panter, Foster, and Jones, 2006; Abildso, Zizzi, Abildso, Steele &

Gordon, 2007; McCormack, Giles-Corti & Bulsara, 2007). Generally, this topic has

focused on the individual, social, and physical aspects of environment, and how they

work – both separately and together – to influence behaviour. While many of these

studies consider the individual-behavioural perspective along with contextual factors,

it is argued here that a large body of research into health behaviour and health

promotion has already examined the reasons why some individuals are more likely to

be motivated to pursue healthier behaviours than others, and that the effects of a

variable like ‘place’ on health require a more ecological perspective. That is, the yet

‘uncaptured’ capacity of a place to determine health via the social, economic, and

environmental mix of its residents and its features necessitates an examination of

context that allows these ingredients to be tested both separately and together for

their effects on lifestyle and well-being. In a recent review of the concepts and

evidence of the relationships between the social environments of neighbourhoods

and physical activity, McNeill, Kreuter, and Subramanian (2006) identified five key

factors mediating neighbourhoods and the health-related behaviour of physical

activity, including social support and social networks, socioeconomic position and

income inequality, racial discrimination, and social cohesion and social capital. They

concluded that ‘the specificity of terminology and methods in social environmental

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research on health will enable a more systematic inquiry and accelerate the rate of

scientific discovery in this important area’ (p, 1011). Future research methodologies

that investigate the way in which these social concepts operationalise and interact

with the physical environment to influence behaviours that affect health will also

inform more practical responses from urban designers and community-based

interventions.

Studies that investigated the impact of the physical and aesthetic features of urban

neighbourhoods in their capacity to affect behaviours such as jogging and leisure-

running, have found that having an aesthetically pleasing neighbourhood (Titze,

2005), access to recreational facilities (Hoehner et al, 2005), park features (Bedimo-

Rung et al, 2005), destination proximity and mix ( Cerin, Leslie, du Toit, Owen, &

Frank 2006; McCormack, Giles-Corti & Bulsara, 2007) and access to green areas

(Jackson, 2003) are all likely to affect the amount of physical activity reported by

residents. Giles-Corti et al (2005) found access to attractive public open spaces to be

associated with higher levels of walking in a community, and more recently,

McCormack et al (2007) found that proximity and a mix of destinations was

associated with increased amounts of walking for transport, but not walking for

recreation or physical activity. Further, Hoehner et al (2005) found physical activity

for transportation and recreational purposes were significantly related to objective

measures of the environment characteristics including the number attractive features

and physically active people in the neighbourhood as well as perceived access to

recreational facilities (p. 105), while Cerin et al (2006) found that access to

destinations were positively associated with walking, and that these were contingent

upon socio-demographic factors and types of destinations, with workplace proximity

greatly contributing to working to work. And Owen et al (2004) found that the

aesthetic attributes, convenience of facilities, and accessibility of destinations all

appeared to contribute to walking for all purposes. Such findings generally follow

with recommendations regarding changes to the physical environment of an area in

accordance with the contributing variables. However, such measures are not always

objectively assessed or processed by residents. Thus, one of the core issues in this

research is the impact of perceived versus objective measures of the physical

neighbourhood as predictors of the utilisation of public space and pathways for

exercise (Hoehner et al, 2005).

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Leslie et al (2005) compared objective and subjective measures of place and found

that perceived levels of density, access, diversity and street-connectivity were higher

in high-walkable neighbourhoods as assessed by Geographic Information System

(GIS) databases. Hillsdon et al (2006) also used GIS measures to assess a

relationship between the distance to and size and quality of green spaces and physical

activity in middle-age residents in different areas and found no significant

relationships between these variables. They found a converse relationship between

access to green areas and physical activity levels, which raises a number of questions

about how these factors are measured and conceptualised in such research. It also

sheds light on the weakness of the relationship between objective measures of

neighbourhood and health-related behaviours, where one cannot assume that access

will result in engagement. Interestingly, Kirtland et al (2003) infer from their

findings that behaviour of the individuals living in an area and the physical attributes

of that area, such as distance and access, affected how a place is perceived by

residents. They proposed a number of reasons for the lack of agreement between real

and perceived measures of an area and behaviour, including that ‘objective

neighbourhood data and perceptions of neighbourhood do not match because people

judge the environment according to their own desires and expectations’ (p. 329). This

raises the important point regarding the direction of these effects on each other and

on people’s health-related behaviour. As noted at the end of the previous section of

this review, cross-sectional studies that find correlations between real and perceived

characteristics of a place and human behaviour and health are not able to imply

causality. They can, however, deduce whether or not specific variables relating to

place appear to contribute to the behaviours of residents by matching the presence of

certain factors with the presence of certain behaviours. However, whether or not

behaviour determines perception or whether perception determines behaviour, and

how this relates to what is actually there in a causal sense, is relatively unknown.

Roemmich et al (2006) found, using accelerometers and measures of the

neighbourhood in New York, that a greater distance between homes and increased

amounts of green areas correlate with a greater propensity to be active. However,

there are many other potential economic and social factors at play in explaining these

findings; in particular that it is likely that increased spacing between houses is

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more common in more well-off areas, and children who are richer are more likely to

be more active, and less likely to be overweight. Further, Hillsdon (2007) found that

in the UK the availability of physical activity facilities declines with level of

deprivation. Interestingly, however, an Australian study found no differences in the

amount of open green-spaces available for active play between higher and lower

socioeconomic areas (Giles-Corti et al, 2006), even though in Australia, physical

activity levels are reportedly higher amongst wealthier people, while obesity rates are

higher amongst poorer people (Department of Health and Ageing, 2004). When

viewed in combination these studies all pose interesting questions about the complex

and little-understood relationships between place, wealth, and health.

The physical attributes of an urban environment have provided a ‘common-sense’

base to the research on place effects on the physical activity of residents; however,

research has also shown that the social characteristics of a place also play a role in

the overt levels of this behaviour. The issue of perceived safety has emerged as a

strong correlate of whether or not residents will use public space to exercise

(Kirtland et al, 2003). Further, a study by Chandola (2001) found that perceived

levels of neighbourhood safety contributed over and above socioeconomic and

behavioural factors to self-reported health in the UK. They concluded that this social

characteristic may be a key mechanism for understanding area-differences in health-

related behaviours. In addition, Giles-Corti et al (2002) found in their study on the

environmental and individual determinants of physical activity that individual and

social factors appear to be more important in determining activity levels than

physical ones, and that while ‘access to a supportive physical environment is

necessary, it may be insufficient to increase recommended levels of physical activity

in the community’ (p. 1793). Social variables that were tested in this study include

club membership and likelihood of partner and other significant relations engaging in

physical activity. Such findings point to the potential salience of social influence on

health behaviours, and need to be considered in future research into the impact of

contexts on behaviour. Fuzhong et al (2005) found that the social environment was

important in affecting health behaviours via networking and the development of

relations where levels of physical activity are observed in others. Interestingly, many

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of the studies that investigated the relationship between urban contexts and physical

activity did not consider socioeconomic position – either of individuals or the area -

among their variables, which is surprising given that it has been established as a

factor that correlates significantly with a variety of behaviours that affect health

outcomes. Although it might seem that the low cost of walking and exercising in

public spaces would deem it insignificant, the empirically significant relationship

between factors such as low-income and decreased rates of physical activity among

Australian adults (ABS, 2003) point to a relationship worth investigating more

deeply in order to understand how this effect is produced.

A more recent qualitative study that looked at the role of perception in lower

socioeconomic living contexts in shaping a range of health-related behaviours

(Kamphuis 2006) found that participants reported the behaviours of spouses and

friends to be paramount in influencing their own health-related behaviours. This

research points to the importance of investigating the social components and

processes inherent within measurable aspects of the physical and economic

environments and neighbourhood as being likely to ‘cause’ particular health-related

patterns or profiles. Specifically, these focus groups held in the Netherlands found

poor neighbourhood aesthetics, safety concerns, and poor access to facilities as being

important for physical activity, while price concerns were raised by lower

socioeconomic participants in relation to their consumption of fruit and vegetables.

In relation to other health-related behaviours, such as cigarette smoking, an earlier

study by Picket et al (2002) found that the class-context of an area contributed more

significantly to the likelihood of women to smoke during their first trimester than the

socioeconomic position of the woman herself. More recently, Selstrom (2007) found

that the chances of women smoking during pregnancy were doubled in poorer

neighbourhoods, and conclude that increased maternal education and intervention is

needed in these areas. While their findings are interesting, it is likely to be more

useful to conduct qualitative investigations into the relationship between poor

mothers and their smoking habits prior to assuming that they need to be educated

about the health-risks. Such research would assist in progressing our understanding

about the phenomenon of poor health behaviours being so deeply embedded in poor

social contexts. These findings sit comfortably with findings on the social effects of

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an area on health-behaviours, and once again raise the need to investigate how

context exerts influence via the behaviours of others living in close proximity.

Additionally, how the lived experiences of people dwelling in areas with different

measures of status attached to them are affected or guided by norms for health-

related behaviour needs to be further examined.

A qualitative study by Poland (2000) found that social interaction determined much

of the norms and moral attachments to smoking behaviour among residents. He

found ‘interpretation’ of what it means to be considerate as a function of social class

distinction played an important role on how decisions regarding smoking in public

were made. He employed Bourdieu’s analysis of class struggle for social distinction

as an instrument for interpreting the findings. Increasing attention has been given to

the theoretical relevance of Bourdieu by Gattrell et al (2002) & Carpiano (2006) due

to Bourdieu’s attention to examining how statistical relationships are produced in

every day practice and propagated in social class systems through both agency and

social (rein)forces. However, not many studies that investigate urban places and

health-behaviour have utilised philosophical concepts and theories to understand how

highly specific aspects of place and health come to correlate. Frolich et al (2002)

noted the absence of theoretical application to the interpretation of multi-level

findings, as well as the presence of assumptions regarding the direction of the

relationship between ‘higher’ (contextual) and ‘lower’ (compositional) contributions

to health. They claim that the current thinking that conceptualises the impact of

higher on lower variables needs to be re-examined for possible recursive effects, and

that a focus on theory and meaning of how these factors are experienced might allow

further insight into the direction of the relationship between people, place, and

behaviour. They state that ‘higher level effects may be produced by people’s

characteristics at lower levels, which in turn may be reinforced by these same higher-

level effects’ (p. 12). This thesis will be focussed on investigating and

conceptualising the mechanisms via which this recursive pattern operates to better

understand how place affects people and people affect place with consequences for

the health of both, with a theoretical diagnosis of ‘context’ outlined in Chapter Three.

A study into the impact of built urban environments on the likelihood of accidental

drug overdose found that deterioration of the built environment, and in particular the

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external features of buildings in an area correlated significantly with this cause of

mortality (Hembree et al, 2005). While the authors referred to this independent

variable as a ‘determinant’ of this particular observed behaviour, the way in which

deteriorating building condition influences people not to intervene or support people

in overdose situations is not explored. Hembree et al proposed that disinvestment in

social resources, psychosocial stressors and differences in responses to witnessed

over-doses may explain the observed effects (p. 147). However these are not proven

to be the causes in this particular study. Such studies highlight the need for greater

research into how the physical environment is perceived and experienced by

residents in ways that ultimately affect behaviour, and the need for interdisciplinary

efforts between researchers from different health perspectives about the role of

neighbourhoods in predicting and affecting these outcomes.

Studies into other health-related behaviour in urban populations, including levels of

violence, have found that where this social problem is prominent there is an

increased chance of young people’s involvement in it as victims, witnesses and

perpetrators (Feigelman, 2000). They found that by becoming involved, even

peripherally, in problematic behaviours, young people increased their chances of

participation in violence. These findings are of interest in that they highlight the

important role of social factors, and how they operate in ways that increase risk. The

social context of behaviour in urban areas requires increased attention in the future

research that seeks to understand how urban contexts influence those who live there

at behavioural level.

Work that identifies particular physical, social and economic place-traits that

correlate significantly with human behaviours that are of interest or concern from a

health perspective plays a role in advising planners and health practitioners about

what matters in a place in terms of well-being. However, more research is needed

that addresses the processes that mediate these empirical relationships. If more was

understood about the psychological and social impact of planning and design and the

socioeconomic position of residents on the health-related behaviours exhibited within

urban communities, a more detailed and convincing - and certainly a more social, as

opposed to individual-based - argument could be made when informing policy-

makers of the salience of economics, housing, and urban design in determining

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population health outcomes. Further, more would be known about the ways in which

urban planning and design can act in a preventative sense against illness and disease

caused by the high-risk behaviours exhibited at higher rates within more

socioeconomically disadvantaged areas.

2.5 A Review of the Urban Planning and Design Literature that has

Investigated Residents’ Psychological, Social, and Behavioural

Responses to their Living Contexts.

Since post-WWII in Australia, housing and urban development has rapidly changed

in its approach to design, function, and degree of community participation, especially

in terms of the declining tendency to rely on collective efforts to create and build

public places and spaces for every day living and working (Gleeson, 2004). Thus,

this weighing up of compact efficiency with social sustainability has become a key

focal point for both planners and researchers concerned with the impact of design on

the well-being and functioning of neighbourhoods and communities, both in

Australia and around the world (Luymes, 1997; Vogt et al, 2004; Fang, 2006; Kato,

2006; Goebel, 2007; Braubach, 2007). This section of the review will examine

research that has looked at aspects of urban planning and design that have emerged

as influential in their capacity to affect residents’ psychological and social responses

to a place that either enhance or detract from their attachment to the place and their

overall satisfaction with living there and how this relates to overall well-being.

Further, it will discuss the increasing pressure on urban planners to be able to

incorporate, or at least consider, social and affective aspects of design when

implementing and building master planned communities, which have become a

rapidly increasing lifestyle trend in Western contexts.

In a comprehensive review of the literature that examined the relationship of urban

design to human health, Jackson (2003) concluded that ‘while causal chains are

generally complex and not always completely understood, sufficient evidence exists

to reveal urban design as a powerful tool for improving human condition’ (p. 191).

She looked at the impact of design on three spatial scales: physical health, mental

health, and social and cultural vibrancy, and drew the key conclusions that greenery

and ‘access to it physically and visually’ is vital for health as it enhances civic life

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and levels of physical activity in compact areas. Further, she concluded that cultural

and business relationships need to be cultivated within urban infrastructure by using

social and technical networks that reduce dependence on automobiles. She

emphasised a need for increased communication between the disciplines of design

and health in order to achieve a more collaborative and informed effort to generating

healthy and socially sustainable urban communities, saying ‘further research is

needed to strengthen the associations between design and health’ (p. 190).

In an article by Scopelliti and Giuliani (2004), the importance of the dynamic social

characteristics of urban places, and how people respond to them, were shown to be

an important predictor of how people rate the quality of the time they spend there.

This study highlighted the need to focus on place as ‘experience’, as well as

‘environment’, and concluded from participant interviews that affective and social

dimensions of a place are salient contributors to well-being. These researchers found

that the way in which the physical and social characteristics of a place interact are

more important than the separate factors said to typify the place, in terms of

contributing to the restorative effects on people who go there. Importantly, they

emphasised the affective dimensions of a positive experience, with particular

reference to both relaxation and excitement (p. 431). Such findings provide both

planners and health researchers with insights into the importance of the task of urban

design as the creating of a product or outcome that needs to ‘come alive’ on

completion and fulfil particular social and affective human requirements or demands.

Further, it highlights the dynamic relationship people have to place, and the

consequent need to study place variables as ones that are ultimately not static, but

that are given life and meaning and movement by the people who go there and the

ways in which they respond to it and each other. What remains challenging, however,

is for urban designers to find out what physical traits trigger positive interactions,

and for health researchers to locate both the physical traits and types of interactions

that improve well-being.

While public health research into the effects of place on health are less concerned

with general quality of life, broader urban literature has spent much time on how this

can be accomplished through design, with debates over the use of subjective and

objective measures at the core of these research efforts. Marans (2003) produced a

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paper that discussed the ways in which quality of life was used to evaluate

environmental quality in the Detroit Area Study (DAS, 2001), with particular

reference to the use of both objective and subjective measures of place. He noted that

quality of life could not be examined using a single measure, and that a number of

different perspectives were needed to truly reflect this variable. Also, Marans

concluded that quality is experienced and reported as a highly subjective notion and

does not reflect the material or economic reality of a place. He states that ‘rather, it is

the meaning of those conditions to the occupants’ (p. 75). This is an important

consideration for researchers investigating how the physical traits of urban contexts

determine health outcomes and behaviour in that, often, the subjective interpretation

of the material structures are not considered in this research as one of the key

mechanisms driving the observed behavioural patterns.

The way in which residential satisfaction is measured as a means of assessing the

functioning and well-being amongst urban populations is debated in the literature,

however, there is a general agreement that asking people about their satisfaction with

their housing or neighbourhood is a valid way to gain feedback for future

developments (Lueng Ng, 2005; Kowaltowski et al, 2006; Kearney, 2006; Adriaanse,

2007; Braubach, 2007). The latest research from the WHO large analysis and review

of European housing and health status (LARES) study showed that the key indicators

for residential satisfaction were lack of noise, recreational areas, low perception of

fear, and well-maintained neighbourhoods (Braubach, 2007). Interestingly, the key

correlations were between sleep disturbance and noise exposure, lack of recreational

areas and the perception of fear, while depression was related to both noise exposure

and safety perceptions. Based on the findings from the Housing Demand Survey

(HDS) in the Netherlands, a new residential satisfaction measure has been devised by

Adriaanse (2007), who found that the most significant factor indicating residential

satisfaction was ‘residential social climate’. The inter-relationships between

indicators such as these and perceived fear and availability of green space require

further research.Other research into the relationship between quality of life and

residential satisfaction in Hong Kong found type, size, age of home and period of

occupancy to be significantly related to satisfaction, as well as university attendance

(Leung Ng, 2005), with university students being more satisfied than other residents

with their dwellings in a high-density urban environment. These findings point to the

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need for a good match between demographics, lifestyle and design. In a low-income

public housing project in the region of Campinas, Brazil researchers found that

economic factors such as housing affordability and utility bills are related to

neighbourhood satisfaction, but that community spirit in this area was high and sense

of identity strong and positive, and that these social factors were ‘self-built’ by

residents who live in a low-infrastructure area (Kowaltowski et al, 2006). They also

found that these poorer residents prefer houses to units, and this may be linked to the

fact that poorer people tend to have higher numbers of people – including children

and older family members – in their care. And a review of a ‘cluster housing’

development in the US found that nearness to green spaces was not as important for

residential satisfaction as opportunity to visit nearby shared spaces and views of

nature from home (Kearney, 2006). These findings emphasise the need for a ‘good

fit’ between people’s individual needs and a community-level approach or response

from urban designers or neighbourhoods.

Research in Edirne, Turkey (2007) found that there are three vital components to

assessing quality of life and happiness amongst residents with where they live, and

these are the individual characteristics and demographics, a description or measure of

the characteristics of a place, and reported residential satisfaction. They argue this

provides a useful framework for rectifying places with design problems and creating

more positive and successful neighbourhoods in the future. The need for these robust

measures can be seen in an earlier study in this region that explored perceived quality

of place by residents in the third-world urban setting of Istanbul (Turkoglu, 1997)

which found that a significant difference between how people living in the same

urban residential area rated a number of independent variables about the place,

depending on the quality of their own dwelling type. For the variables of physical

condition of dwelling, access to shops and services, recreational and educational

services, social problems, and climatic control, squatters rated all of these aspects of

the place less highly than residents of legal dwellings. Such research highlights the

importance of personal circumstance for how a place is perceived and experienced,

and poses interesting questions for further research into the need to address the

physical living conditions of disadvantaged people in order to improve their lived

experiences in socioeconomically heterogeneous urban settings. Further, the variable

of ‘perceived quality of own dwelling’ may be a useful measurement device for

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health researchers interested in understanding the relationship between poverty,

place, and well-being, and further, those wanting to study poverty as a meaningful,

lived experience that has a highly aesthetic and socially comparative component.

Building on the other studies described in this section, it appears that subjective

experience, meaning, and social and cultural networks are key factors that affect the

quality of life reported by residents.

One key psychosocial goal of urban planners that emerged from the literature is to be

able to instil in residents a positive sense of place identity (Wester-Herber, 2004; Teo

& Hung, 1996; Popke & Ballard, 2003; Popay, 2003; Lemanski, 2006, Goebel,

2007). While social networks and functioning are highly valued as behavioural and

communicative outputs, the psychological attachment people forge with the place in

which they live is considered by designers to be both vital, and on occasions,

ellusive. In a review of an award-winning, high-rise, high-density township in

Singapore, Seik (2001) evaluated a planning strategy that considered land-use as well

as elements of design that focussed on creative ways of constructing resources, such

as car-parks and high-rise living areas, and found these considerations to have a

positive effect on efficiency of use of resources and efficient movement of people. It

also claims to have found that the creative design resulted in an ‘aesthetically

pleasing visual identity’ (p. 33). However, it is noted here that this finding was not

actually based on specific measures or scales of identity, and the only element of this

study that reviewed resident opinion of the place was a five-item survey that

examined satisfaction with design, recognition of neighbours, and general feelings of

safety – which were then interpreted as measures of identity. However, there are

other examples in the literature that have examined identity more specifically as one

of the key mechanisms via which places are experienced, interpreted and

experienced.

In a comprehensive coverage of a critique of the loss of identity in the planning and

development of new urban landscapes, Oktay (2002) comments that ‘…buildings are

designed with little concern for their relationship to each other…spaces left between

them have become undefined, undesirable, useless, and unliveable’ (p. 261). She

emphasises identity as one of the ‘social components of design’ and an element of

planning that surpasses the quantitative aspects of buildings and neighbourhoods to

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allow the place to have meaning; the context to evoke belonging. She reinforces the

importance of participation and collective experience as vital elements of successful

design, and advocates the need for a deeper consideration of the kinds of affective,

social, and communicative networks a place is likely to be able to accommodate.

Oktay cites districts, public spaces, and streets as key physical components of the

psychological identities people will construct between themselves and place while

living and working there. Her conclusion is that these aspects are therefore worth the

higher financial investments required to maximise their ability to positively reflect

this processing and constructing of the self in place. In this conclusion, she states that

public urban places determine quality of life, as well as reflecting the culture, the

times, and the well-being of residents – and recommends that ‘we should start to

measure the city by analysing them’ (p. 270).

Such a perspective highlights the need for a departure from the epidemiological

nature of the methodologies typically investigating urban places and health, which

exalt the notion of ‘measurement’ as a means for determining traits of a context that

affect well-being. What is needed, according to this alternate perspective, is a

theoretical lens that would allow the relationship between people and place to be

analysed for meaning, symbolism and reflection of self. Such conceptualisations of

people in place and their responses to urban environments as mirrors that shape the

self via interactions with both the place itself and the people who live there, would

provide a particularly salient paradigm for future studies into how the lower

socioeconomic position of a place determines poorer health, as it is in such contexts

that this image is likely to be less flattering. Further, these sorts of frameworks for

thinking about what influences people’s responses to a place provide a visual or

aesthetic component that is often omitted from more numerically derived

categorisations of status, which are, in the health literature, increasingly valued with

their ability to be measured.

In an evaluation and critique of The Housing Development Board’s (HDB) efforts to

bring a greater sense of variety to the monotony of the skylines and blocks of public

housing in Singapore, Teo and Huang (1996) investigated the effects of using

artwork and motifs on each estate as a means of generating a sense of identity for

residents and creating a sense of belonging to the place. Additionally, physical

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infrastructure, such as courtyards, walkways, and pavilions were created as a means

via which people could increase their interactions and get to know each other better.

Teo and Hung found that while the goal of creating a sense of individual identity

between residents had been successfully created, a sense of belonging had not. In a

methodology that questioned residents directly about the effects of the paintwork on

their sense of identity and belonging to the place, they did not find that a strong sense

of community had been created via these developments in the physical appearance

and design. While this study points to the fact that specific changes to physical

infrastructure are insufficient as a means of generating psychological and social

catalysts that increase people’s sense of attachment to a place, it is noted here that the

approach may have been too simplistic at the outset in terms of wanting to alter

community consciousness by changing the colour of the buildings. Further, aiming

for both increasing the individual identities of the buildings while at the same time

hoping for increased connectivity between them may have been at odds from the

outset. The results that show that identity was achieved while belonging was not

seem less surprising when the initial goals and strategies are placed together in this

comparative sense. Further, it highlights the complexity of achieving a sense of

place-attachment as something that cannot necessarily be generated by altering the

physical or architectural aspects of design alone.

In a bleak and despairing account of modern day South Africa, the urban city of

Durban provided the case study for Popke and Ballard (2004) to explore the impact

of negative place-identity on residents. They employed a methodology that examined

ways in which the media handles this rapidly changing and apparently deteriorating

city. This qualitative study found three central themes that capture the contemporary

identity of the city namely, ‘chaos, congestion and pollution’ (p. 99). They

interviewed local residents and analysed the ways in which the place is described,

revealing what they refer to as ‘more deeply seated cultural anxieties, which have

been brought to the fore in the context of South Africa’s transition’ (p. 99). While this

particular case is fraught with political and historical complexities that make the

place-effects arguably unique, the observations concerning the changing nature of the

society on how residents use and interpret space are relevant to researchers interested

in the impact of more macro societal changes in urban places on the social

functioning of people. Durban is marked by the major cultural shift from being a

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‘whites’ only territory during apartheid years, to becoming ‘the home of a multi-

racial population, and has been transformed by new forms of economic interaction,

social affiliation and cultural meaning’ (p. 102). These changes have reportedly had

profound effects on the affective and social bond people have with the place, and

further, on the psychological processing or ‘organising’ of the activities and

behaviours of fellow residents. In graphic accounts of what participants viewed as

non-acceptable conduct, activities are described as follows:

‘…extremely obese women suckling their offspring, multi men displaying their

wares of various sorts emitting a putrefying stench everywhere…’

And ‘ You’ve got a whole nation living in Umgeni Road that are washing, cleaning,

cooking, going to the toilet… the infestation, the germs, the stench –they are living

there.’ (p. 106).

A more recent empirical account of the challenges in South Africa on the housing

front by Goebel (2007) shows that there are ongoing barriers present to the provision

of sustainable low-cost housing , such as macro-economic conditions, lingering

legacies of racial and class divisions coupled with rapid urban growth. These have

implications for an ongoing cycle of depression, violence, poverty and ill-health in

this area. While a new policy that has been named Breaking New Ground, which is

encouraging inter-departmental co-operation within the government and with key

private and public stakeholders has shown some success – allowing people to live

near transport routes and economic opportunities with clean, safe water – the

situation overall shows little sign of abating. These economic, social and design

challenges pose great difficulty to the people living there in terms of their well-being

and everyday lived experiences, and often lead to frustration, conflict, and open

political struggle as they view and experience ongoing forced evictions and

instability. Further to this, Lemanski (2005) conducted evaluative research on

Westlake, a development in a wealthy area in Cape Town, where new residents had

been afforded government housing there in lieu of their previous dwellings which

were demolished to make way for mixed-use land developments. She found that

integration between new and established residents was difficult and slow to evolve,

but attributed this more to socio-historical issues linked to place, history and identity,

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rather than race relations per se. She concludes that ‘…for while residents of low-

cost housing development are drawn from all over the city and thus have no socio-

historic affiliation to their new space, black residents moving into middle-class

suburbs do not have an equal sense of ‘belonging’ to the cultural space as their

‘white’ neighbours and thus are constantly striving to fit into white spaces rather than

experience an equal ‘right’ to shared cultural space’ (p 432). Such findings highlight

the importance of capturing the ways in which residents experience place at the

micro-level, and view and interpret the behaviours of other residents as vital

components in how they process their sense of peace and belonging where they live.

These methodological approaches and descriptive reports are likely to be helpful in

the field of research that looks specifically at place effects on health-related

behaviours, as little has been done to capture the ways in which the activities of other

residents characterise general perceptions of a place, and further influence the overall

lived experience, identities, and behaviours of those who dwell there.

In further work that illustrates the importance of both restoring and creating

community identity, Al-Hathloul et al (1999) addressed the two major challenges

facing urban planners: 1) What is community identity? 2) How can it be created in a

new community? They conducted an in-depth analysis on the case-study of a small

town, Al-badai, in the Riyadh region to examine the components of the place that

helped retain, or were at least conducive to, community identity. They concluded

with a definition of community identity as ‘a reflection of national, ethnic and

cultural identities’ (p. 217), and located the variables of road networks, presence of a

city centre, landscape architecture, systems of walkways, pathways, and plazas as

well as the character of public buildings as those most effective in building identity.

However, they do warn that, with reference to the last point in particular, that it is not

simply a case of copying architecture to retain a sense of cultural or place identity,

but that ‘we need to pay more attention to the real tradition of places, the deep

structure’ of the social fabric in order to effectively (re)create a true reflection of the

values and ideals of the residents who will, or do already, live there (p. 201). Antrop

(2005) studied this specific issue in the context of what he referred to as ‘changing

cultural landscapes’ and concluded that the complex way in which people perceive

their environment and the symbolic meanings it holds for them are central in

planning sustainable urban futures. He puts forward the idea that people require

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‘legible’ components in a place that can be read as points of identity and meaning,

and that the management of landscapes must work with this view in mind.

The reasons why such effort into creating and sustaining place-identity should be

made at all has been researched and described by Chadirji (1984) who summarised

the following social phenomena as being those that underpin people’s need for a

sense of place that reflects a positive sense of self:

• Politics and ideology

• Need for a sense of belonging

• Resistance to change and preference for continuity

• A need for cultural variety, as opposed to the increasingly homogenous

designs being produced

• Pride in national, racial, ethnic, or other social identities.

These complex social, psychological and affective variables combine to generate a

steep challenge for urban planners who often work within economical and spatial

constraints and without the substantial research investments that are required to allow

the historical and cultural intricacies of the place to be unearthed, described, and

consequently restored. Such research also raises the question of whose responsibility

it ultimately is to generate and sustain such elusive qualities, and within whose range

of capabilities they lie. Further, and in strong agreement with many other researchers

investigating the social aspects of urban planning, Al-Hathloul et al (1999) advocated

in their conclusion for more research into how residents can be allowed to play an

increasingly participative role in the urban planning process as a fundamental

component in creating a strong sense of identity with the community.

Literature in both the public health and environmental science disciplines has noted

an important relationship in urban contexts between people’s sense of connection

with, and identity in a place, when high-risk land-use ventures are either possible or

present (Bush et al, 2002; Hanna, 2005; Downey & Willigen, 2005). Wester-Herber

(2004) argued that while many high-risk industrial changes or developments are

researched for their effect on the real or perceived health of the residential

population, increased emphasis is needed on the role these ventures play in

destroying people’s connection or positive feelings about the place. She notes that

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‘identity can be affected in a negative way if changes are made to a landscape by the

introduction of a high-risk and stigmatised industrial venture’ (p. 109). While Wester-

Herber focused on changes in landscape as a means of jeopardising place-identity,

Bush et al (2001) drew on Goffman’s writing on stigma to examine how public

perceptions to air-pollution in a highly industrialised town affected people’s views of

the place. These researchers did not seek to investigate place-identity from the outset,

but found it to emerge as a ‘complex, multiple and re-enforcing concept’ via their

grounded theory methodology. Downey and Willigen (2005) also found that

industrial activity has negative effects on people living in poorer neighbourhoods,

and that poorer neighbourhoods are more likely to be exposed to pollution. They

concluded that it exacerbates ‘feelings of neighbourhood disorder and personal

powerlessness’ in lower socioeconomic communities (p. 289). However, these

researchers were examining the effects of environmental hazards on a poor

neighbourhood, whereas Hanna (2005) found that pollution does not decrease

housing prices or have negative effects if the area is not poor. These findings

highlight the salient effects of poverty in neighbourhoods, and indicate a need for

future research that considers the subjective, psychological response of people to

their place of residence and their overall health and well-being. Further, researchers

in urban planning and environmental health have made the point that while public

health as a discipline has moved away from the environment and onto individual

behaviour as a source or focus of avoidable illness, there remains a need for

collaborative efforts between those interested in health outcomes and those interested

in quality of life and environment (Augustinus et al, 2003). And more recently,

Picket et al (2004) have called for the employment of the metaphor of ‘resilient

cities’ as a focal point via which urban planning and the social sciences can share the

goal of maintaining quality of life and health of residents by striving to create cities

that become systems that are able to ‘adjust in the face of changing conditions’ (p.

381.)

Recent changes to urban environments as a result of a focus on the need to create

economical living spaces has led to research that evaluates people’s usage of public

spaces – to improve both life and health – in both the health and urban planning

disciplines to optimise new ways in which spaces can be created and features

developed to achieve these goals. A recent qualitative study in Melbourne, Australia,

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explored the ways in which both physical and social urban characteristics contributed

to the children’s use of different urban spaces for active free-play (Veitch, 2005).

Veitch found that urban design factors such as the quality of parks and playgrounds,

and social factors, such as children’s attitudes to active free-play were important

themes in how decisions were made about how to use these public spaces. It is noted

here that the children were not asked about their attitude to the place, or the appeal of

the urban design features in place, but rather, questions focussed primarily on the

health-related behaviour itself. This appears to be a common trend in the health/place

literature, and one of the emergent benefits of an interdisciplinary approach to this

area of study would be the methodological emphasis on people’s response to place

employed by urban planners as a means of assessing this process as reliable and

salient psychological mechanism linking place and the types of behaviours that are

observed there. An earlier article by health researchers discussed children’s activity

in, and use of, public space, and advocated for an emphasis to be placed on

environmental change as a means of increasing usability and safety of public places,

rather than targeting the behaviour of children to fit into a static environment.

However, no mention was made of how children evaluate, interpret, and respond to

what is available, or of asking children what they would like to be made available in

the future, as a means of making the most user-friendly changes possible. In a review

of the ‘Streets that Work’ program in Seattle, Antupit et al (1996) found that both a

proactive and ‘retrofit’ approach is required when designing with the aim of

increasing activity within public spaces, with planners needing to anticipate, and

respond to, use of pathways by residents for walking as opposed to relying on a

vehicle. These studies highlight the subtle, yet important differences between urban

planning and health literature wherein the former views residents as having higher

levels of agency, and seeks to increase participation in the processes of both research

and practice, whereas the health literature has leant towards a more deterministic

view of the effects a place has on what is viewed as a somewhat passive population.

In more recent work on the ways in which children engage with their urban

neighbourhoods and living environments in ways that affect their health, researchers

have focussed on the psychological relationships parents and their children have with

place in relation to safety, play, and how much physical activity they are able to get

done (Min & Lee, 2006; Roemich, Epstein, Raja, Yin, Robinson, & Winiewicz,

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2006; Weir, Etelson & Brand, 2006; Carver, Timperio & Crawford, 2007). A

qualitative, observational study of 91 children living in a high-rise, high density

planned neighbourhood of 5277 families in South Korea showed that children are

more attached to, and show greater affinity for places that support the behaviours

they are interested in engaging in, and places that allow them to interact with other

children (Min & Lee, 2006). The provision of open play areas in high-density living

is important for children to develop a sense of their own safe territories and

belonging in a neighbourhood, and allows them to form social attachments and

engage in ongoing games, rather than experiences short-lived and transient

interactions that do not allow a meaningful attachment to people or place to develop.

Carver, Timperio & Crawford (2007) also researched safety – both real and

perceived – amongst children and their parents living in Australia in relation to the

amount of time they spend outdoors playing. They found safety and the concept of

‘stranger-danger’ to be a major factor impacting on the amount of play children did

in their local environments. This research is supported by Weir et al (2006) who

found that inner city parents in New York have high levels of anxiety about letting

their children play outdoors and about neighbourhood safety, which may be simply

congruent with the nature of the living context. The challenge of making

neighbourhoods safe, and having residents feel safe within them is vital from an

urban design and public health perspective if people are to enjoy a higher quality of

life in residential areas and to engage with these areas in ways that increase health

and combat rising epidemics of overweight and obesity.

Much research has recognised the role of danger and fear levels – both real and

perceived in mediating the relationship between a residential population and the

depth of its engagement with the neighbourhood (Roh & Oliver, 2005; Rosenfeld,

Richman, Bowen & Wynns, 2006; Ferguson & Mindel, 2007; Waiker & Hiller,

2007). Rosenfeld et al (2006) found that exposure to, or witnessing of violence in the

local neighbourhood affected school attendance and satisfaction, but not grades, of

high-school children in the U.S, however, it was not clear from the study whether the

area was relatively poor, and whether other factors relating to poverty were present.

Ferguson and Mindell (2007) found social capital to be a key factor in alleviating

feelings of fear in a New York neighbourhood, with characteristics such as a high

police presence, social support networks, and neighbourhood satisfaction correlating

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significantly with decreased sense of fear. Interestingly, Roh and Oliver (2005) found

the mediating variable of police presence to be a key connection between high-

danger neighbourhoods and feelings of vulnerability, with a police-presence reducing

fear where perceived personal vulnerability was high. Further, Waiker and Hiller

(2007) found that trusting, reciprocal relationships between older women and their

neighbours aided their ability to live effectively in the community and positively

impacted on their health.

One of the leading researchers in the urban planning literature has noted in his paper

on the challenge of planning neighbourhoods in a changing world, that the ideal of

incorporating public responses to a place, as well as intricate social and cultural

needs, into urban design is becoming increasingly difficult (Saleh, 2004). He states

that these goals are now ‘restricted between retaining traditions of architecture,

urban design and planning with the necessary social, economic, and technological

changes in urban formation, mainly the vernacular and the modern’ (p. 625). He goes

on to critique some of what he sees as limitations within the ‘new urban’

philosophies. While he acknowledges the importance of the goal of community,

which is at the heart of new urbanism in Western contexts, he advocates for a New

Vernacularism, which has been specifically designed as an ideological framework for

generating communities that are compatible with Islamic principles. For example, in

this context, spaces would be made for women that are both private and separate in

some parts from the rest of the community. While such design considerations may

not be viewed as important in new urban Western places, the integration of religion,

ideology, and politics of a living area into urban infrastructure remains a desirable

goal for those seeking to maintain high levels of place-identity and quality of life for

residents.

As one of the researchers particularly concerned with the psychosocial and affective

aspects of design and construction in urban living spaces, Gleeson (2004) has called

explicitly for a deeper consideration for how the ‘hard-wiring’ of urban infrastructure

impacts on social development in communities where those communities have no

prior stake in the process of building the settlements. This challenge has been

recognised as one that firstly, demands a re-thinking or ‘deprogramming’ of the way

in which infrastructure and lifestyles are currently generated and pre-packaged as

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ready-made community commodities for sale; and secondly, it places an inquiry

around the types of mechanisms that might be required or employed in a catalytic

sense to elicit involvement by community members in terms of how their physical

worlds are shaped and experienced.

There has been a noted decline in participation in urban residential developments -

especially in the case of the increasing trend towards developing community

enclaves for narrowly defined target groups with highly specified needs, such as

those seeking retirement, security, affordability, and even ‘childless’ environments.

Gleeson (2004) argues that this has resulted in an industrial and service-based

response to the demand for prêt-a-port lifestyles in Western contexts with stipulations

in place about who might, and might not, qualify for inclusion in these communities

and realms of space. Thus, while there is now a means of purchasing ready-built

lifestyle packages on demand – a process that reduces people participation to a point

– there is simultaneously in this process a means of purchasing exclusivity (or

isolation); a process that reduces diversity. As Gleeson notes, diversity is a factor that

is often consciously omitted from these design equations, as sub-populations are

catered for, and development is generated around demands for highly specific (and

occasionally acute) living needs. In the broader international context, this has meant

that people move to planned areas that suit their needs, such as the Portuguese

communities that have flocked to Mississuaga, in Toronto, Canada to live in single

family households in what they perceive to be ‘good neighbourhoods’, and in doing

so, new Portuguese homelands have been created in the suburbs detracting from the

design goal to create diversity and contact between a range of ethnic groups

(Teixeira, 2007). In China, Fang (2005) found that while in the West there is an

assumption that high residential dissatisfaction leads to high residential mobility, and

that taste and preference dictate where communities form and how they respond to

pre-packaged developments, in China survey research on four redeveloped

neighbourhoods showed great dissatisfaction with living in these replanned

communities, with residents feeling that they had little chance of moving elsewhere.

This sheds light on the importance of considering the broader economic and cultural

influences on the shape, nature, and level of satisfaction in planned communities.

Meanwhile in Australia, although neighbourhood communities might be classified as

culturally and socioeconomically heterogeneous, there is an increasing focus by

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urban policy makers to consider the challenge of maintaining a balance between

rapidly diminishing urban spaces and the demand for economic efficiency with what

Gleeson terms the incessant ‘yearning’ (p. 315 ) to maintain healthy, diverse social

relationships and communities.

In a critical review of the marketing rhetoric surrounding the increasing trend

towards master-planned ‘enclave communities’, Luymes (1997) has noted that

research investigating the social role of such ventures have, on occasion, found them

to be symbols of ‘paranoia, self-interest, and elitism’ (p. 192). Further, after

examining the advertisements for such communities in a number of Canadian media

sources, he found that their promises of ‘privacy, security, image, prestige, and a

sense of community’ (p. 194) were only found in the research to deliver on the points

of privacy and image, and were in fact, located as components contributing to the

breakdown of civic public life. He concludes by raising the question of whether these

gated suburbias should be regarded as a ‘healthy’ or benign cancer spreading through

an unhealthy body, or whether they present a decaying effect to otherwise vibrant,

diverse, and unpredictable cities. Vasquez (2006) wrote a critical review of the

rhetoric or built narrative surrounding New Urban planned communities that it was

not so much the design principles of New Urbanism, but the rhetoric in which it was

shrouded that was driving its positive reception and success in the U.S. New

Urbanism has been defined by Steuteville (2004) as ‘a reaction to sprawl… based on

principles of planning and architecture that work together to create human-scale,

walkable communities. The New Urbanism includes traditional architects and those

with modernist sensibilities. All, however, believe in the power and ability of

traditional neighbourhoods to restore functional, sustainable communities.’ (p.1)

However, empirical research into the design principles of New Urbanism has

revealed positive health effects within these neighbourhoods. Researchers have

found that while there was no significant difference overall in the amount of physical

activity achieved between the residents of these neighbourhoods and those in

conventional neighbourhoods, New Urban residents were using their neighbourhoods

much more for walking to get to various destinations, and achieving high levels of

physical activity within their immediate living environments (Rodriguez, Khattak,

Evenson, 2006). The implications of this type of neighbourhood design for

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populations who are less likely to pursue deliberate exercise may hold important

implications from a population health perspective. Meanwhile, the success of key

New Urban developments in Middleton Hills and Michigan in the U.S are still under

evaluation and debate (Lydon, 2005; Michigan Land Use Institute, 2007).

While enclave and master planned communities are facing a sizeable amount of

criticism for their struggle to create community, a new urban phenomenon generally

referred to as ‘clusters’ that are central to the New Economy have been heralded for

their impact both on urban theory and the social and economic experience of those

living among them. Characterised by high levels of creativity, technology, and

diversity, such communities are increasing in Western contexts in their popularity

and demand, from both profit and pleasure-seekers (Porta, 1999; McCann, 2002;

Hutton, 2004; Kato, 2006). Hutton reports on fieldwork conducted on such new

industry clusters in London, San Francisco, Vancouver and Singapore, and notes that

the location and nature of these new economy industries in close proximity to one

another in urban environments, is having a profound impact both on urban theory

and on the socioeconomic changes and outcomes for workers and residents in these

areas. While much of this ‘new urban reality’ has been conceptualised by Florida

(2002) – Hutton makes the point that the physical and economic, as well as the

theoretical aspects of these changes will need to be taken into account by urban

planners in the near future. Among the benefits of this new economic direction,

Hutton includes improved wealth for individuals, retention of heritage buildings,

increased vitality, and the emergence of cultural and knowledge-based sectors (p.

106). Evidence to support some of the success stories emerging from evaluations of

planned communities following the concept of ‘new towns’ in America that attempt

ambitious plans for social diversity and integration are documented in research by

Kato (2006). New towns use larger amounts of land and space, and focus on mixed

land-use in their planned design, and have been shown to enjoy a greater success of

diversity and integration between different social residential groups than other

master-planned or conventional neighbourhoods.

Such rapid changes in how urban design is evolving – both in theory and practice –

means that researchers will need to increase their effectiveness at developing

methodological instruments that are best able to capture the effect these changes are

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having on residential populations, and moreover, the ways in which people are

driving and responding to the changes via their demands for particular types of

lifestyles or experiences. In a recent article that reflects on the methodologies that

have been employed to date within the urban planning literature, an interesting point

is made by Pinson (2004), who admits having a reticence about the drive towards the

integration of this discipline with other research areas whose interests depend on the

future directions of urban planning. His reason is that he does not feel that urban

planning has been allowed to develop fully from a methodological perspective, and

therefore would be unlikely to offer advice on aspects of itself that it is not yet sure

of. Specifically, he warns that ‘urban planning may forget to formulate an inventory

to build its own theoretical and practical assets’ (p. 503). This review is mindful of

the evolving nature of this discipline, however it strongly emphasises the common

interests between health researchers and urban planners. It makes the case that

researching to bring about policy changes that will result in greater equalities in

health must necessarily go beyond health into other areas that are able to effect major

change in the quality of life, health, and life chances of vulnerable populations. Thus,

an interdisciplinary approach between health and urban planning to generate a case

for change is crucial.

2.6 Drawing Conclusions

This literature review outlined an epidemiological focus on the factors that influence

health behaviours in place, while the urban design literature was proposed as a means

of complementing this literature. This is because urban design as a discipline requires

an understanding of the relationships between place and human behaviour as

reflexive; and in order to inform design, the research usually takes an intensive

approach. That is that, in order to inform design in situ, studies are conducted on

reflexive person/environment relationships. Thus, this study lies at the intersection of

the concerns of epidemiology regarding the factors and causal processes pertaining to

health-related behaviours, and the theoretical and methodological approaches

embraced by urban design. Specifically, the study takes on an in situ, intensive focus

on a sample of urban life and embraces a conceptualisation of behaviour as

reflexively constructed between people and place. This approach will be brought to

bear on the health-related behaviour of physical activity, as place and space are

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integral to this activity.

What has been noted in reviewing the urban planning and design literature is the

substantive and methodological ways in which it both connects with, and builds on,

work being done in the health inequalities literature concerned with health and place.

The concerns in the two disciplines are fundamentally very similar however the

urban planning research tends to display a more direct methodological approach, in

that it seeks to unearth subjective accounts of the people-place experience in order to

evaluate their current experiences there, and to guide the kinds of changes that are

needed, if any. It pays close attention to the nuanced, situated and highly sensitive

relationships between what is in a place and how people interpret it, respond to it,

and engage it in. On the other hand, the health and place literature primarily seeks to

locate statistically significant relationships between people and place variables in

order to clearly depict trends between place and health. This raises crucial questions

about the detailed nature and direction of these relationships. These differences in

approach are underpinned by differences in the kinds of research questions that are

being asked in each discipline. For example, in urban design literature a question

such as ‘Do you use this playground for recreational activities?’ might be asked,

whereas health inequalities literature tends to ask ‘Does the presence of this

playground correlate significantly with the amount of recreational activity the

population living there reports doing?’ In essence, the health inequalities research

literature concerned specifically with health-place relationships have prioritised

objective accounts of households and neighbourhoods as they pertain to health

outcomes of interest. These descriptive accounts of the aspects of living contexts that

pertain to health create a convincing evidence-base that factors within context, such

as the socioeconomic position of the area and the people who live there, or the

presence of physical features or resources, are powerful predictors of the kinds of

health-behaviours and outcomes we can expect to find there. The urban design

literature seeks rather to capture the responsiveness or otherwise of people to aspects

of places; to find out how aesthetics, uses of space, resources, architecture,

landscaping influence the ways in which people respond to, or connect with places.

Both bodies of literature are also interested in how the less tangible aspects of place,

such as identity, history, culture, community, and social networks and capital are

generated in places over time, and how they mediate relationships between people

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and place.

This thesis draws on the reflective and evaluative approaches taken within the urban

design literature and applies them to gaps in knowledge raised in the public health

literature regarding what the social processes and interactions are within poorer

living contexts that create barriers to healthier living. It does not seek to highlight a

tension between objective versus subjective approaches within empirical efforts in

social science or public health, nor to generate a quantitative versus qualitative

argument: but rather to highlight the compatibility and validity of both approaches to

gaining a deeper understandings of how the places in which people live influence

both the quality of their lives and their health. Further, aside from factors or measures

within living contexts being important for health, what are the perceptions of the

people who occupy them about what influences how they live there? That is, the

literature review revealed the need for research that asks what health, and in

particular the health-behaviour of physical activity, means within lower

socioeconomic living environments. How is it ‘treated’ there as a concept and as a

practice? What are the interactions and social processes that have contributed to

how it is conceptualised there over time? What are the everyday lived experiences

that account for its particular position within that context? What goes on in lower

socioeconomic contexts on an every day basis to preclude health? Thus, the need to

gain a subjective account of lower socioeconomic living contexts to establish the

meaning of physical activity there was identified, and research questions were

developed around achieving this aim. By that, I mean that questions were developed

to gain an insight – according to residents themselves- about the relationships

between their perceptions of physical activity, their own practices of physical

activity, and aspects of their past and current households and neighbourhoods

influencing this.

Guided by the methodological emphasis in the urban design literature to gain an

insider’s nuanced perspective of the ways in which they relate to, and interact with

the places they inhabit, and to draw out the meanings they attribute – not only to the

characteristics of that place – but to how they see themselves as being there, the need

to focus on a particular urban locale was apparent. Thus, an urban environment that

encapsulated the qualities of diversity, socioeconomic heterogeneity, and having a

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number of resources available to improve the health and physical activity of its

residents was chosen as a locale to investigate questions rising out of the literature

review. This way, the questions rising out of the epidemiological literature about how

to effectively conceptualise, understand, and study living ‘places’ as social contexts

that produce particular health outcomes could be addressed in situ. That is, an

intensive study of the responses and adaptations of newly arrived lower

socioeconomic residents (as measured by housing type and income) to a new urban

environment designed to increase physical activity levels was proposed to address

the research questions identified in this review. Because the urban environment that

was chosen to address the research questions was designed to promote pedestrian

mobility and autonomy and thus increase physical activity, it seemed logical and

useful to focus on physical activity as the core health-behaviour of interest in this

study.

The health-related behaviour of physical activity was chosen for three other primary

reasons. Firstly, research shows that obesity and related illnesses are on the rise in

western countries such as Australia, with a need for increased success in health

promotion campaigns targeting sedentary lifestyles (Chan, Ryan, & Tudor-Locke,

2004; Spinks, Macpherson, Bain, & McClure, 2006; Mummery, Schofield, Steele,

Eakin, & Brown, 2005; Department of Health and Ageing, 2004). Secondly,

epidemiological research shows that poorer populations are less likely to engage in

physical activity levels likely to have beneficial health effects than their more well-

off counterparts, and that contextual measures of socioeconomic position, such as

household or neighbourhood are more reliable predictors of this phenomenon than

individual measures of socioeconomic position (Lindstrom, Hanson, Ostergren,

2001; Romero, 2005; Jacoby, Goldstein, Lopez, Nunez, and Lopez, 2003; Karvonen

& Rimpela, 1997; Giles-Corti & Donovan, 2001). Thirdly, research has shown that

even in neighbourhoods where facilities to engage in physical activity are present

and superior to surrounding suburbs, poorer residential groups are less likely to

engage with them as a means of pursuing healthier lifestyles (Giles-Corti, 2003). As

such, the following research questions were generated:

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2.7 The Research Questions

• What are the patterns of physical activity amongst a lower socioeconomic

residential group living in a new urban environment?

• What does a lower socioeconomic residential group report as being the

obstacles (tangible and intangible) within their living contexts – both past and

present – that have made the pursuit of physical activity a lower priority, or

difficult to achieve?

• What happens to messages promoting the increase of physical activity

amongst a lower socioeconomic residential group?

• Which aspects of households and neighbourhoods does a lower

socioeconomic residential group report as being able to alleviate or

exacerbate barriers to leading more active lifestyles?

• How do the inhabitants of a lower socioeconomic housing group describe the

relationships between their attitudes, beliefs, and practices in relation to

physical activity and their place of residence?

• What are the everyday interactions and processes that mediate the

relationships between a lower socioeconomic residential group, their place of

residence, and their propensity to be physically active?

• How is physical activity as a concept ‘treated’ or socially constructed within a

lower socioeconomic residential group over time? What are the processes that

have contributed to this construction or perception of it over the course of

their lives?

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Chapter Three

Theoretical Framework of the Thesis

3.1 Human Living Contexts as Social ‘Determinants’ of Patterns in

Behaviour

Questions were drawn out of gaps in the literature regarding the reasons for different

patterns in health-related behaviours by different social demographics, and across

different living contexts. Research repeatedly shows that contexts matter in their

capacity to generate particular population behavioural profiles, depending on

whether particular people-place traits are present or absent. However, this thesis

addresses the question of why people who live in poorer areas are less likely to

engage in recommended levels of physical activity – even when the facilities or

resources to achieve this are present. Thus, in line with the research questions

identified in Chapter Two, this thesis employed a conceptual framework for thinking

about these patterns that highlights not only the significance or strength of the

variable relationships to one another, but the overall meaningful explanation as to

why this is. That is, this thesis aims to develop a theoretical understanding of how

poorer living contexts operate to produce less healthy and active lifestyles, and to

draw out the most pertinent experiences, interactions, and processes that shape

people’s relationships and attitudes to physical activity.

This raises the question of how ‘context’ itself, as a concept, is being thought about

in this context. An article by Burke (2002), which devotes itself entirely to the

concept of context as it is understood and studied across disciplines, makes the point

that ‘interdisciplinary discussions of the problems raised by the notion of context are

all too rare’ (p. 164). The task of this thesis involves an emphasis on this recognition:

that context is not thought about, discussed or studied in necessarily the same way

across disciplines, and to make a critical point about how epidemiological

methodologies treat ‘context’ in order to understand how it works to affect health

behaviours and outcomes. However, to make this criticism effectively, a new

philosophical lens for thinking about residential or living contexts as they influence

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health is needed, and the provision of a new framework needs to be shown to work –

both conceptually and methodologically – if it is to be deemed useful for studying

the relationships between socioeconomic contexts and health behaviours in the

future.

As noted in the literature review, population-level data reporting on factors within

living environments that correspond significantly with health behaviours of interest

have described these statistical relationships as contextual effects on health. These

have been contrasted with what are described as compositional effects – that is,

measures or descriptive characteristics of the individuals that occupy an area that

have a significant relationship to health behaviours or outcomes. The different ways

in which measures of place and measures of people have been discussed as they

relate to health has led to the debate about whether it is composition or context that

matters more in relation to health – whether it is people or place that should be

addressed. In other words, should we be targeting poor people or places as a means

of redressing current health inequalities?

The research questions that are being asked in this thesis, however, demand a

theorisation of context that dilutes this tension by creating a shift towards a

methodology aimed at unravelling insiders’ perspectives on how their own

circumstances, as well as their household and broader living environments, shape

their propensity to be physically active. I argue that this dichotomy is essentially a

false one, brought about by methodologies that can either measure aspects of the

environment, or traits of the people, and which cannot capture the processes and

dynamics between these that shape the people, place, and health connection. To

access these insights, ‘context’ is conceived of here as being comprised of not only

compositional or contextual factors, but also the interactions and forces that connect

them to one another in an ordered and meaningful way. That is, that it is made up of

people’s backgrounds, circumstances, and dispositions on the one hand, and the

social spaces they inhabit and interact with on the other. This thesis draws a

conceptualisation of context as the psychosocially constructed lenses through which

human beings perceive, interact with, and respond to particular settings. This dilutes

conceptual tensions between people and place, by conceiving of contexts as the

subjectively constructed dimensions of various social settings, and moving to address

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questions such as ‘What does this living context mean to you?’ and ‘What does

physical activity mean to you in the context of your life or lived experiences?’.

A socially theorised view of context takes into account that while people are free to

exercise agency in a social setting – according to their subjective beliefs or

expectations about what is appropriate there – contexts are also powerful in exerting

social forces on those who occupy them, or pass through them. This view of context

as socially co-operative and yet fundamentally subjectively constructed and

perceived via a number of complex psychological and social processes, shifts the

methodological emphasis from a focus on measurement to a focus on meaning. As

such, questions such as ‘What is the context of the lower-socioeconomic lived

experience?’ and ‘What is it like to be poor, to live in a poor neighbourhood, and

how does this influence one’s physical activity levels?’ are able to be addressed.

These types of questions and a socially theorised view of context constituted the

framework for the methodological design which was employed to retrieve subjective

accounts of life in an urban context, and the psychosocial processes and interactions

through which different lifestyles and realities are produced and sustained there.

3.2 The Social Construction of Reality

In line with this holistic, socially situated conceptualisation of context, the 1966

work of Berger and Luckman, entitled The Social Construction of Reality: A Treatise

in the Sociology of Knowledge, was employed to guide a methodology aimed at

retrieving the social and psychological processes linking people, place, and physical

activity. This early, seminal work, which viewed human behaviour to be contextually

determined and socially constructed, was implemented here to study the reasons for

reportedly lower physical activity levels within lower socioeconomic living contexts.

In a broad sense, social constructionism views behavioural patterns that evolve over

time to be a product of a collective acceptance within social contexts that ‘this is how

things are’ or an internal logic that ‘this is the way things are done’. That is, what

human beings perceive to be reality, or the only way to do things in a particular

context, are, according to this theory, produced and sustained via a combination of

individual agency and environmental social forces over time (Berger and Luckman,

1966). A social constructionist view of a context helps us ascertain not only its

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overall scope, definition, and meaning, but how behavioural interactions and orders

are decided upon and sustained within it. Thus, it is the study of the processes and

meanings that tie practices to their respective contexts that will allow us to see things

from the perspective of those who inhabit them, and to operate more effectively

within them in future.

Social constructionism was identified for the purposes of this study as a useful

conceptual tool for bringing into question how norms and status quos regarding

physical activity in poorer living contexts have developed over time. The framework

is not being used to make the case that poorer people have somehow ‘made up’ a

negative relationship to health, but rather that complex interactions, economic and

circumstantial constraints, and aspects of the environment particular to this

demographic have interacted over time to construct health in a poor light, or as an

unattainable goal. Importantly, it allows the researcher to take a ‘ground up’ approach

to finding out which aspects of context matter in the construction of this specific

relationship with, or version of, physical activity, by retrieving subjective accounts

from those who generate and sustain these patterns, procedures or rituals. It points to

the importance of focussing on how objective realities or an evidence-base – such as

that established in epidemiology that poorer people are less likely to engage in

recommended levels of physical activity than their more well-off counterparts – have

come into being over time.

A social constructionist standpoint takes the perspective that physical activity means

different things in different social contexts due to the interactions and processes that

have gone on there over time to generate those meanings. This does not make the

assumption that the relationship between a group of people and a particular concept

or behaviour is artificially constructed or contrived, but rather, that over time, due the

needs of the people and the nature of their living environments, phenomena take on

their salience, or otherwise, as deemed relevant by those in that situation. While a

social constructionist standpoint focuses on what different things mean in different

contexts, and thus by default emphasises the subjective nature of ‘reality’, this does

not mean that reality no longer exists, or that positivist descriptions of the health-

place relationship are invalid.

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For example, having a low income level, a low education level, or living in a poor

neighbourhood are all objective realities; however, to understand how this is

experienced and what this means in an everyday sense, subjective accounts, such as

the narratives and stories of residents, are required to shed light on this reality in a

meaningful way. Therefore, what a social constructionist approach allows this thesis

to do, is to engage with and study a group of lower socioeconomic residents living in

a new urban context to find out what physical activity means to them, and how, if at

all, their social, economic, or geographic place in society – that is, the context of

their lives – has contributed to this particular meaning and practice.

Berger and Luckman also argued that people are able to exert individual choices, and

exercise agency, but also respond to social, contextual influences. That is, while

people are able to exercise agency in a social setting, they tend to consult with the

group to negotiate the best or most appropriate way of doing things there. They

describe the processes via which people co-operate to develop the ‘best’ or the

‘normal way’ to do things in that context as habituation. They further postulated that

over time, this process of habituation causes behaviours and codes of conduct to

become institutionalised within contexts, and as such, provide a frame of reference

that allows for more automated, or economical responses from its inhabitants or

occupants. That is, little conscious thought is required about what to do there, or how

to achieve basic goals there. As a result of these processes, conceptual frameworks or

‘social lenses’ are developed via which people perceive and interpret the behaviour

of others within the contexts they enter over time. Berger and Luckman referred to

the perspectives, attitudes, and dispositions that people carry with them as a result of

the shared experiences that have shaped their outlooks as historicity.

I relate this theorisation of human behaviour in context to what epidemiology tells

us: that particular characteristics of social and living contexts appear to be influential

in relation to the health-behaviours of the occupants. That is, contexts matter in

relation to lifestyles and health. A social constructionist view would suggest that this

is due to the dialectical tension between human agency and the human tendency to

refer to the group for information about how to do things, or the best way of going

about something. If a social context is well-formed and powerful – that is, if the

people within it acknowledge its existence (even subconsciously) and demonstrate

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this by operating in predictable ways within it – then there is a case for investigating

how this sense of context formed, and the processes and interactions that go on there

to produce the norms and patterns evident there. The premise underpinning the

investigative approach of this thesis is that while agency is present, social forces are

powerful proponents of behaviour in different social and economic contexts. As such,

there is a need to study the social processes within contexts that have been identified

as being in need of intervention as these are fundamentally the driving forces behind

the behaviours, consumption patterns, or lifestyles able to be observed there.

Berger and Luckman also placed a question mark on how objective humans are able

to be about the behaviour of themselves and others, and noted the highly

contextualised, subjective nature of the laws that govern human conduct. They

outline that human beings produce – through a combination of agency and social

reinforcements – language, norms, and codes of conduct which they then tend to

perceive as an objective reality. Berger and Luckman refer to this as ‘humanly

produced and constructed objectivity’ (p. 2). Thus, people perceive and experience

reality in different ways, depending on their frame of reference, and other derivative

influences, such as backgrounds, cultural frameworks, and established belief

systems. This theoretical framing begs the question: are the backgrounds, cultural

frameworks and belief systems of poorer people different to richer people and does

this directly affect how active and healthy they are likely to be? If so, what are their

qualities, and how do these qualities work as barriers to better health? These kinds of

questions bring a methodological focus to the contextualised interactions and

processes that had influenced a particular residential demographic over time. I asked

‘How have these attitudes, beliefs, and behaviours in relation to physical activity

come to formulate as they have amongst this social group?’ and ‘What are the

subjective meanings attributed to physical activity in this context that contribute to

the objective reality that it is not done to levels that would benefit health?’

3.3 Application of the Conceptual Framework to the Thesis: Asking

New Questions, Exploring New Ground.

Thus, by re-conceiving context as social, dynamic, and charged with meanings,

associations, and attributions that develop via both agency and cooperation over

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time, new questions can be asked of the socioeconomic-health relationship, and new

methodologies introduced that are compatible with this approach or world view.

Such an approach moves beyond asking questions, such as ‘Is it this, or that, or

“these people” within this environment that are determining these patterns?’ to

opening up the context with the view that it is affected by both the people, their

circumstances, their needs, and the interactions of these over time, to ask ‘What goes

on in here that affects how people live with consequences for their health?’

Importantly, this shifts the focus away from assessing the context for the presence of

causal relationships between people, places, and health, to one that seeks to locate

why people respond to a situation or a place in the way that they do. And to do this,

we must ask the people themselves how they perceive their circumstances, their

households, their dwellings, their location, their neighbours and the resources present

and why they respond in particular ways to environments with particular qualities.

The urban design literature was an important factor in directing a focus in this thesis

to the emotional and psychological relationships people develop with the places they

visit or inhabit, and the re-conceptualisation of these contexts as socially created or

generated over time drove the methodological directions to seek subjective accounts

of these contexts. This indicated a way of opening up these contexts to ascertain

what meanings are attributed to what qualities in the environments which, up until

now, have been attended to in health inequalities research only with the desire to be

able to accurately ‘measure’ them. A methodological approach that acknowledged the

subjective associations and meanings human beings attribute to both artefacts in

place and human behaviours there was needed to develop a substantive and

theoretical knowledge base around which new studies, economic and social policy,

and health interventions could be based on in the future.

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Chapter Four

Methodology

4.1 Introduction

Chapter Three located and described the point of departure from conceptualising and

researching contexts as aggregates of environmental characteristics, or variables, to a

focus on the social and psychological processes and relationships that draw human

behavioural patterns within living contexts into being. Chapter Four now moves to

outline a methodological approach suited to capturing these relationships. It

progresses from the gaps identified in the literature – substantive, conceptual, and

methodological – to an innovative response to investigating the processes

underpinning the relationships between people, place, and health that have been

convincingly established in social epidemiology. To commence the task of finding

out what kinds of daily events and interactions might account for the research

situation as it currently sits in the empirical literature, and to develop a way for

thinking about these processes, a grounded theory approach was chosen for

conducting this study. Specifically, a social constructionist version of grounded

theory by Charmaz (2006) was coupled here with the Berger and Luckman (1966)

framework outlined in Chapter Three to guide data selection, collection and analysis,

and to reveal how the place and role of physical activity as a concept is moulded and

created over time within lower socioeconomic residential groups. Chapter Three

made the case that social constructionism is a useful and relevant conceptual

framework for making a point of departure from epidemiological notions of context,

which points to the need for methodologies that are able to begin exploring the

processes ‘from the ground up’. This allows us to find out what goes on – and what

has gone on in the past within poorer living contexts – to make physical activity a

relatively low priority in the lives of its occupants.

Chapter Four outlines the inductive, theory-building nature of this investigation, as

well as the emergent – as opposed to hypothesis-testing – methodological approach

used in this study. It goes on to describe the urban case study in which this research

was carried out. Because the rigour of grounded theory lies in its responsiveness to

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the situation in which the research gets done (Dick, 2007), I chose an urban setting

that bore traits pertinent to the questions being asked in this research project. The

Kelvin Grove Urban Village (KGUV) was identified as a case study with residents

from mixed socioeconomic backgrounds who are co-located within a neighbourhood

designed to increase pedestrian mobility and physical activity in the green

recreational spaces provided. This chapter goes on to describe the methods of data

collection within this research setting, including the survey and online and face-to-

face techniques used in this process. It also describes the concurrent analytical

process, the comparing and contrasting of case-data, the emergence of theoretical

categories, data triangulation, saturation, and the identification of key themes and a

core category.

4.2 Why an Inductive Theory-Building Approach?

The key aim of this study is to ascertain a detailed portrait of what life is like inside a

lower socioeconomic residential context in order to locate the daily occurrences and

interactions that go on there to shape attitudes, beliefs, perceptions and practices in

relation to physical activity. Thus, a methodology was needed to tap into the

everyday processes and interactions that gave rise to particular attitudes, beliefs,

norms, and routines around the practice of physical activity. The view that has been

detailed in Chapter Three that behavioural patterns in context are produced via

consultation and interaction with the human social world through a combination of –

often subconscious – human agency and socio-cultural forces led to the requirement

of a qualitative approach to studying this phenomenon. That is, a shift was made

from making objective measures, to taking subjective accounts; from quantitative

multi-level analyses of contextual factors, to a qualitative investigation of the

processes that pin various contextual factors together with implications for health.

According to Miles and Huberman (1994) ‘One major feature of qualitative research

methods is that they focus on naturally occurring, ordinary events in natural settings,

so that we have a strong handle on what “real life” is like’ (p. 10). Given that the

point of departure for this thesis was highlighted in Chapter Three as a move away

from testing whether variables are salient in the extent to which they mediate

socioeconomic context and physical activity, and towards an opening up of ‘context’

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for investigation and emergent theorisation, a grounded theory approach was chosen.

What I wanted to find out – beyond the ‘how many’ and ‘what’ of health-place

relationships – was ‘what is the greater social context in which these patterns occur?’

and ‘how can we gain a more proficient theoretical understanding of how these

contexts operate to affect health-behaviours?’ Thus, a deeper, more micro-level

investigation of the operations within a social context was required to investigate the

experiences, interactions and processes within lower socioeconomic households and

neighbourhoods that result in less healthy and active lifestyles. According to Glaser

(1967) a grounded theory approach should ultimately help the people in the situation

to make sense of their experience and to manage the situation better. The relevance

of this insight is clear as it relates here to developing a greater understanding of how

particular contexts and living circumstances generate barriers to healthier living, and

what needs to happen for these to be overcome or ameliorated. Figure 1 below

depicts the methodological location of this research project within the cycle proposed

by Blaikie (2000) regarding theory building and testing by researchers.

Figure 4.1 Inductive Theory-Building Approach

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There are a number of methodological approaches that are able to be employed to

capture the interactions in situ that give rise to the broader social patterns captured in

epidemiological work; however, in this phase of theory building, the techniques are

necessarily centred on the logic of induction. That is, phrases and utterances

collected in the data are analysed for the processes they represent, and the

psychological and social constructions upon which norms, habits, and routines are

built and sustained. It is the process of analytical induction – in which ever

methodological school it is located – that reveals the insights that shed light on the

‘what is going on here?’ that researchers seek to find out to explain social

phenomena, and more effectively intervene in patterns or problematic trends

identified via statistical methods. According to Katz (2001) ‘Analytic induction is a

way of building explanations in qualitative analysis by constructing and testing a set

of causal links between events, actions, etc. in one case and the iterative extension of

this to further cases’ (p. 164).

For the purposes of this research project, I sought to ascertain a more developed

knowledge about the causal links between characteristics of particular living

contexts, and the lifestyles exhibited there. So far, statistical methods have developed

insights about the aspects of these contexts that might, or might not, be important for

influencing lifestyles and health via the detection of correlations between particular

people, place, and health variables. However, a process of analytical induction via

qualitative research and analytical techniques was needed to develop a sense of the

pathways, processes, and factors mediating these relationships. That is, what are the

interactions within a particular context over time upon which attitudes, beliefs, and

norms are constructed? And what account of these living contexts in relation to the

health-related behaviour of physical activity is given by people who comprise them?

Katz (2001) goes on to explain that ‘Analytic induction is a research logic used to

collect data, develop analysis, and organize the presentation of research findings. Its

formal objective is causal explanation, a specification of the individually necessary

and jointly sufficient conditions for the emergence of some part of social life’ (p.

165). Thus, this research project conducts a qualitative, grounded theory study based

on these analytical principles, which results in various theoretical models and tables

informing the disciplines of public health, urban design, and sociology about what

aspects of living contexts are important for healthier living amongst vulnerable

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demographics.

4.3 A Social Constructionist Approach to Grounded Theory

This investigative approach was designed on the core principles of grounded theory

research originally proposed by Glaser and Strauss in the 1960s, and then revised

under an arguably less positivist framework in the 1990s by Strauss and Corbin.

Although there are many debates around these respective approaches, researchers

generally agree that they are both ‘emergent methodologies’ (Dick, 2007), and Mills,

Bonner, & Francis (2006) make the case that all variations of grounded theory exist

on a methodological spiral and reflect their methodological underpinnings’ (p. 2).

These methodological underpinnings refer to an inductive approach to data selection,

collection, and analysis. Although there are commonalities amongst these

approaches, there is a well-recognised continuum in grounded theory approaches,

from the more positivist approaches of Glaser and Strauss, to newer, more

constructivist perspectives (Hallberg, 2006). At the constructivist end of this

continuum, increasing attention is being paid to the work of Charmaz, who advocates

a social constructionist approach to grounded theory, and whose techniques were

identified as relevant to this research project due to the initiative in this study to build

theory around the question of how physical activity is socially constructed within

poorer living environments. Thus, Charmaz’s constructivist approach to grounded

theory seemed to be most fitting with this particular conceptual approach, or ‘world

view’. This is because constructivist grounded theory allows for a more flexible

methodological approach, and brings questions to the research process from the same

school of thought as the Berger and Luckman philosophy outlined in Chapter Three

of this thesis. Thus, the Berger and Luckman (1966) social constructionist

conceptualisation of how human behavioural patterns are formulated in contexts over

time was coupled here with the constructivist qualitative data collection and analysis

techniques put forward by Charmaz, and practised and acknowledged by others

(Lesch & Kruger, 2005; Hallberg, 2006).

However, it must be noted that Charmaz did not specifically advocate using the

Berger and Luckman framework. Instead, she takes a broader constructivist approach

to grounded theory, in which the subjectivity inherent within analysis and theoretical

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development is acknowledged, and reflection on the role of the researcher in the

production of data is emphasised. Charmaz has taken a divergent, and yet

increasingly accepted means of employing a grounded theory approach, which she

refers to as a social constructionist approach to grounded theory, and emphasises the

need for flexible guidelines, ‘not methodological rules, recipes and requirements’ (p.

20). Charmaz (2006) reminds us that taking a social constructionist approach to

research means acknowledging that this subjectivity applies also to the researchers,

who are only able to interpret interpretations, and construct constructions provided

by the participants. She argues that researchers bring their own histories, theories,

values, and ideas to the process of generating theory from data. Thus, consideration

must be given to both the researchers’ and participants’ backgrounds when data is

being collected, selected, and analysed. A reflexive, interpretive approach to the data

must be taken if there is an ongoing understanding of it being socially produced

between the researcher and the participant. Further, she emphasises the need to keep

returning to the study site to build on the data collection, and to constantly check,

compare, and contrast data between individual cases, to make sure that the themes

are developing in ways that reflect the experiences of those the researcher is

interested in.

The essence of Charmaz’s contribution to this methodological approach could be said

to be the acknowledgement that no theory is objectively created – without

consultation with one’s own historical, social, and cultural context. For this reason,

Charmaz could be described as a relativist, and herself says ‘Data do not provide a

window on reality. Rather, the “discovered” reality arises from the interactive

processes and its temporal, cultural, and structural contexts’ (Charmaz, 2000, p. 524).

However, Glaser openly and strongly opposes and critiques her angle on grounded

theory, and has said that ‘constructivist data, if it exists at all, is a very, very small

part of what grounded theory uses’ (Glaser, 2002, p. 1). With these strategic and

methodological tensions in mind, this research project drew on aspects of Charmaz’s

approach in conjunction with the Berger and Luckman framework, while still

adhering to the key principles of a traditional grounded theory approach in relation to

the treatment of the data. The unique methodological approach of this study is that it

is guided by the specific version of social constructionism introduced by Berger and

Luckman to build theory using a grounded theory approach. It acknowledges the

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iterative, and relatively subjective process of theory building, but is primarily

concerned with gaining insights into the perspectives of people who inhabit a poorer

living context to tell us what physical activity – as a concept and practice – means

there. It acknowledges that the data is co-produced between researcher and

participant, and thus the importance of comparing, contrasting, and returning to the

field to verify theoretical conclusions regarding emergent categories and their

properties is paramount.

Grounded theory is not usually coupled with any particular conceptual framework,

however, I wanted to build theory around a very specific aspect of context – and thus,

the Berger and Luckman framework that highlights the processes responsible for the

development of norms and routines in a context provided a useful ‘scaffolding’

around which to focus on ‘health in human social contexts’, and to develop theories

through this particular lens. In light of conceptualisation of behaviour in context by

Berger and Luckman, and the principles of Charmaz’s methodological framework, I

sought to gain an insider’s perspective or subjective account of how this group of

participants perceive, understand, and rationalise their responses to a particular living

context, while simultaneously recognising the dialectical construction of data

between the researcher and the participant. Charmaz’s approach allowed for a focus

on processes, interactions, and narratives, while the Berger and Luckman framework

focussed the analysis around the concepts of historicity, habitualisation and

habituation. These are defined as they relate to this study below:

• Historicity – the importance of examining people’s shared or common pasts

to understand how and why they exist and behave as they do in the present.

(What goes on in the past for lower socioeconomic groups that influences

their health-practices now?)

• Habituation – The processes via which people come to see things as the

norm and behave in ritualistic, routine fashions. Over time, people’s

behaviour habituates into patterns in various contexts. (What are the

processes via which particular patterns emerge?)

• Institutionalisation – This is the stage at which people see their code of

conduct or everyday practices as logical, normal, and objective – with little

reflection on other ways to do or see things. (How do they account for, or

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explain these patterns?)

Other researchers have also discussed and employed the constructivist approach to

grounded theory in health research ( McCann & Clark, 2003; Nelson & Poulin, 1997;

Noorton, 199l; Stratton 1997) however, I could not find another study that took a

social constructionist grounded theory approach to researching poorer living contexts

for their capacity to influence healthy lifestyles. I did find an article on research

regarding attitudes and beliefs in relation to sexual practices amongst a group at risk

of HIV using this methodology (Lesch & Kruger, 2005). While these authors

followed Charmaz’s (2006) approach, they made no reference to the Berger and

Luckman (1966) conceptual framework.

4.4 A Case Study: The Kelvin Grove Urban Village (KGUV) as a

Locale for Undertaking the Research.

This study investigates the residential population living within the Brisbane Housing

Company (BHC) units within the Kelvin Grove Urban Village (KGUV;

www.kgurbanvillage. com.au). KGUV is an AUD 800 million mixed-tenure, medium

density, inner urban planned community based on the design principles of ‘new

urbanism’ located approximately two kilometres from the Central Business District

(CBD) in Brisbane, Australia. It sits on approximately 16 hectares and contains

around 2000 residential properties from both the public and private sectors.

According to Steuteville (2004) ‘New urbanism is a reaction to sprawl. It is based on

principles of planning and architecture that work together to create human-scale,

walkable communities. The new urbanism includes traditional architects and those

with modernist sensibilities. All, however, believe in the power and ability of

traditional neighbourhoods to restore functional, sustainable communities’ (p. 23). A

further key feature of the new-urbanist aspirations of the development is a planning

focus on diversity and heterogeneity in housing types, land uses, and social groups

(De Villiers, 1997). KGUV has been built with the aims of achieving a vibrant,

healthy, diverse, and socially sustainable urban community that has access to a range

of cultural, health, and educational resources.

A wide range of demographics has been included in the accommodation options,

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including student accommodation, disability support options, aged accommodation,

and people living in government assisted housing via the Brisbane Housing

Company (BHC). In addition, there are apartments that have been sold on the private

market ranging in price from $310, 000 – $950, 000 AUD. This diverse range of

people live in close proximity to a range of resources including retail outlets, the

Queensland University of Technology, associated health clubs and services, libraries,

parks, wide paths and bikeways, and the well-known La Boite Theatre. The official

KGUV website can be viewed at: http://www.kgurbanvillage.com.au/.

Figure 4.2. below provides a conceptual overview and description of the key social,

educational, cultural, and health-related features of KGUV that underpin this unique

urban design.

Figure 4.2 Ideological Framework Behind KGUV Design

Figure 4.3 below outlines the geographical region occupied by the KGUV and its

proximity to Brisbane’s Central Business District (CBD), and Figure 5 shows an

aerial view of the master plan of the Village.

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Figure 4.3 A map of the geographic area in which KGUV is located is

depicted below

Source: (KGUV Innovation Implementation Report, Garred, 2007)

Figure 4.4 Master Plan

Source: Official Kelvin Grove Urban Village website

halla
This figure is not available online. Please consult the hardcopy thesis available from the QUT Library
halla
This figure is not available online. Please consult the hardcopy thesis available from the QUT Library
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http://www.kgurbanvillage.com.au/.

In addition to the characteristics and qualities within this master-planned community

that encourage mobility and physical activity, KGUV has a number of other health-

resources situated within it, or currently being built for use by researchers at QUT

and KGUV residents. The specific health-related resources that are located in KGUV

are outlined in Table 4.1 below.

Table 4.1 Summary of Health-Related Resources in KGUV

Health Resource Description Building Progress

Centre for

Physical Activity

and Health

The Centre for Physical Activity and Health will be

located alongside McCaskie Park, and will contain an

indoor pool, indoor multi-purpose courts, a

gymnasium and health clinics. The primary function

of the Centre will be for Queensland University of

Technology’s teaching purposes, however, it will be

available for use by the broader community as well.

Building near

completion

School of

Optometry

QUT’s School of Optometry offers services to the

community by students at no cost. Additionally,

glasses and contact lenses are available from the

clinic at discounted prices.

Complete

Nutrition Clinic

This QUT clinic offers nutritional assessment, dietary

advice for both weight gain and loss, diabetes,

cholesterol lowering, sports nutrition and healthy

eating.

Complete

Podiatry Clinic

QUT’s Podiatry Clinic, which is a part of the School of

Public Health, offers prescriptions and patient care.

Complete

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Network of

Pedestrian and

Bike Links

There is a planned network of bicycle links within the

Village to surrounding areas. These features have

been designed in accordance with the overall

philosophy to increase individual autonomy and

mobility, as well as improving health and well-being.

Complete

Landscaped Parks

and Open Spaces

Within the Village, are a number of green, open

spaces for social gatherings, BBQs, and exercise for

residents. The Roma Street Parkland and the Victoria

Park Golf Course are adjacent to the precinct, and

also provide opportunities for outdoor recreation and

physical activity.

Complete

Red Cross

In a recent media release

(http://www.kgurbanvillage.com.au/about/plan.shtm

) it was announced that in 2007 the Australian Red

Cross Blood Service would be locating a $70M facility

adjacent to the Institute of Health and Biomedical

Institute (IHBI) at the Kelvin Grove Urban Village.

This will provide university researchers with increased

opportunities and access to resources for conducting

biomedical and public health research. This is a

promising example of how new stakeholders will

invest interests and resources into the Village, based

on the collaborative initiatives and potential they see

the community as holding.

Construction

underway

According to Yin (2003), a case study is a single-bounded entity, studied in detail,

with a variety of methods, over an extended period, and is selected because it is

theoretically representative of the relationships to be investigated. A case study treats

something as a ‘system’ and this opens it up for examining the processes and

elements that comprise the system. The Urban Village provides a microcosm that

generates aspects of human behaviour that are of interest in an investigation

exploring the dynamics between lower socioeconomic living contexts and the

propensity to be physically active. The case study of the Urban Village enabled an

identification of the key relationships at stake in the adaptation of affordable housing

residents to a ‘healthy environment’. For the purposes of this study it provides an

opportunity to examine the adaptations of newly arrived, lower socioeconomic

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residents (affordable housing residents) to a space specifically designed to promote

physically active lifestyles and to increase pedestrian mobility, while decreasing

automobile dependence. Also, it provides an urban example of a socioeconomically

heterogeneous living environment, and given the emphasis on how socioeconomic

contexts work to produce aspects of lifestyle with implications for health, the Urban

Village was identified as an ideal ‘social laboratory’ for addressing the research

questions in this thesis. Thus, the grounded theory techniques were applied within

this context, because this particular neighbourhood site was seen as theoretically

representative of a development that encapsulates the relationships that were the

focus of this study.

4.5 Validity and Reliability

4.5.1 Validity

Theoretically, this case study allows us to propose that what we find out about this

scenario may be relevant to other similar settings and urban environments. The

knowledge produced via the investigation of this case study will be used for future

testing to see how widely the theories or key concepts are able to be applied. The

findings are valid within the case study, and cannot be generalised to other urban

environments and contexts. However, it does allow a case for producing knowledge

for testing in other populations and areas. More specifically, a rigorous analysis of

the validity of the chosen data collection instruments were assessed in the following

ways:

Survey: No studies evaluating the validity of IPAQ and AA surveys could be located

in the literature. Overall, the lower levels of PA practice reported by the lower

socioeconomic group in this survey on the original measures were duplicated and

reflected in the qualitative data produced following this initial study phase. That is,

they went on to give reasons for lowered levels of physical activity, and the

qualitative data in this study did not contradict the findings produced in this survey.

This indicates that the survey measures had a reasonably high level of face validity in

terms of people understanding what was being asked of them.Blog and Face-to-Face

Qualitative Techniques: The grounded theory analytical method of comparing and

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contrasting answers (Creswell, 1998) by both the same and different participants to

each other, and going back to participants for further interviewing and clarification if

answers are not in agreement. During the interview process, much clarification was

sought, as I both recorded and made notes on participants’ answers. Where

participants’ used terminology and words that were not transparent in their

translation, I asked them to rephrase and explain their use of terminology, eg ‘getting

flogged up somethin’ fierce’ was re-interpreted by that participant as ‘domestic

violence’, and so on.

4.5.2 Reliability

In the initial quantitative phase of the research, a survey was designed to measure the

physical activity levels of residents both before and after they moved into KGUV.

The survey consisted of both established International Physical Activity

Questionnaire (IPAQ) measures, Active Australia (AA) survey measures, (Brown,

Trost, Baumen, Mummery & Owen, 2005), as well as questions devised specifically

for the research being conducted in this particular urban setting. The IPAQ and AA

measures used in the survey addressed levels and frequency of physical activity

levels, and have been assessed for reliability to determine categories of ‘active’,

‘insufficiently active’ or ‘sedentary’ in a review of the test-retest reliability of four

population health surveys targeting physical activity patterns. They were tested using

interclass correlations for minutes on each item, as well as minutes of physical

activity overall. (Brown, Trost, Baumen, Mummery & Owen, 2005). Reliability for

all four instruments was concluded by the authors as being ‘very good’ with IPAQ

measures scoring the highest level of reliability at 79% where n=1-4.

In relation to the second phase of the research, the qualitative phase, a research

assistant was hired to code the data within the guidelines of the social constructionist

approach and in accordance with the research questions. Coding was compared and

contrasted until agreement was reached between the principal researcher, and the

research assistant about the categorisation of quotes, memos and notes into various

emerging themes. These were further checked and coded by an independent research

student who had not been involved in the study prior to this point. After this process,

clear and agreed upon categories had emerged from the transcripts for theoretical

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development.

4.6 Data Collection and Analysis

Both quantitative and qualitative data was collected to answer the research questions

outlined in this project. A survey was mailed out, and both online and face-to-face

qualitative techniques were used to collect data from the residents in the Urban

Village. Table 4.2 below outlines a summary of the participants involved and the data

collection techniques used in the overall study design. Data collection and analysis

occurred simultaneously until the research questions had been addressed via the

identification of a number of conceptual themes typifying or representing the

relationships between this particular urban demographic and their propensity to be

physically active. The collection, analytical processes, and theoretical development

are outlined in detail below.

4.6.1 QUT Ethical and Developer Approval

Ethical exemption for the study was granted by The Queensland University of

Technology (QUT) on 24th April 2006 to run the online data collection phase, and, as

the need for further investigations arose, an updated application was granted on 31st

August 2007 to conduct the in-depth interviews. Permission from the committee

over-seeing all research to be conducted in the Urban Village was approved in

writing on 29th March 2006. These are available for viewing in Appendix A of this

thesis. All participants received information sheets and signed consent forms. Copies

of these forms are in Appendix B of this thesis.

The data collection phases – including the survey, the blog, the interviews and the

focus group - did not identify any of the participants, nor did they include details

about participants beyond demographic measures, such as socioeconomic position as

measured by income and housing type. The blog participants contributed using

numbers only to identify themselves, and signed consent forms to have their

comments posted on that website. Interviews and the focus group revealed no details

about participants beyond their socioeconomic position. Participants all received

reimbursements for their time and contributions, and were informed and willing

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contributors to the research. During the research process, many participants received

assistance in terms of being linked to social and community services to help them

with counselling, childcare, and financial support.

4.6.2 Participant Recruitment

While the survey component of the data collection phases in this study targeted the

entire Urban Village population, only the residents housed in the affordable housing

– or government-supported housing options – within the Village participated in the

qualitative components of this study. Entry into this housing option is based on

income-criteria, with only low-income singles, families, and pensioners qualifying

for entry. Participants were all from disadvantaged backgrounds, on low incomes,

and clustered together in a lower socioeconomic residential context within the

broader context of the Village, thus providing an opportunity to study this group of

people, their low-income living context, and their perceptions and practices in

relation to physical activity.

Residents participating in the first phase of the data collection filled out surveys that

were mailed to their apartments, and returned them to boxes that were left in the

foyers of their apartment blocks. Following this, respondents who agreed to

participate in further research on the last page of their surveys were contacted via

telephone to contribute to the blog: the online qualitative phase. Thus, this initial

group was relatively accessible and enthusiastic to be involved with further study.

While a relatively heterogeneous mix of people within the affordable housing option

at KGUV was recruited for the blog, the following two processes of participant

recruitment for the qualitative research were refined to seek out people who were

most disadvantaged and the poorest in the group, in order to ascertain insight to

experiences in their lives that prevented them from pursuing physical activity.

Charmaz (2006) refers to theoretical sampling more as a strategy than a process, and

for our purposes, it worked well to not only develop categories that emerged in the

first phase of data collection, but to fill in gaps that became evident in early phases of

collection and analysis.

The participants in phases three and four constituted the ‘hard-to-reach’ group via

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whom we sought to tap into the processes giving rise to the evidence base depicting

low activity levels amongst poorer populations. Invitations were posted in their

mailboxes offering AU$30 per interview, and AU$10 for participation in the focus

group. The affordable housing residents responded to this offer, primarily by

contacting the researchers from the public telephones in the Village. Participants in

stages three and four were difficult to interview in the first instance as they were

initially slightly mistrusting of the researcher; few had home telephones connected;

and a number were often involved in court cases and social services, which made

their daily schedules unpredictable. However, over time a good rapport with the

residents was established, and they also benefited by receiving food parcels,

children’s clothing and referral to local welfare services.

A further six affordable housing residents participated in an outdoor focus group held

in one of the recreational areas in the Village. In addition to the grocery vouchers,

they were provided with a lunch during this interview phase. In this session the

interviewer focussed on the more notable similarities and differences that had

emerged in the initial interviews regarding the nature of the urban village

environment for pursuing physically active lifestyles, and directed the discussion

around clarifying these points. This process of theoretical sampling allowed for the

saturation of the emerging conceptual categories. The participants spent some time

negotiating their perceptions of the Village, their experiences in previous

neighbourhoods, and their propensity to physical exercise, as a group.

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4.6.3 Reflection on the Role of the Researcher

As a means of reflecting on the researcher-participant relationship, it was apparent

that I was in a higher socioeconomic bracket than the people I was interested in

interviewing for the study. The potential barriers created by the social and economic

differences between the researcher and participants needs to be acknowledged and

addressed in the research process (Lesch & Kruger, 2005). However, my background

experience in counselling and home-visiting in the area of housing provision for low-

income families helped me to develop a comfortable relationship with the

participants over the course of the data collection process. Further to this, in my own

life, I have experienced much financial hardship, having been relatively poor as a

teenager moving to a new country, and then again experiencing poverty while raising

three young children on a low income. These experiences both inspired my interest

in the topic, and provided me with empathy for the people whom I had recruited for

my study. In this sense, I found that the psychological distance I had from them was

diminished, and while this may have increased the subjectivity involved in my

pursuing this study, I also feel it offered me insights into what to ask, what kind of

conduct is approved of in these contexts, and how to develop a rapport with

participants that made them feel at ease about discussing these sensitive topics.

I found that by sharing and swapping personal stories and comparative experiences

in a few visits prior to each interview, trust was established and a sense of safety, and

the ability to be open in conversation was established. I also found that keeping the

relationship as informal as possible, and dressing casually for home-visits also

helped with making participants feel at ease and able to talk openly. I often had to re-

visit the participants if the time I arrived was unsuitable for an interview – often due

to intra-household conflict. Reflective notes were written on the constant divergence

between my research focus on physical activity, and the focus brought to the

interviews by the participants on other aspects of their lives that were salient to them

in shaping their current attitudes and beliefs in relation to health.

4.6.4 Phase One: Survey on Physical Activity

Initially, this study included a survey of the KGUV residents about their physical

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activity levels and patterns. This was meant to gauge the patterns of physical activity

amongst the residential population of KGUV prior to studying the processes that

produced them; with the latter phase being crucial as a means of generating a unique

contribution to this area of research.

The survey was developed using measures from the International Physical Activity

Questionnaire (IPAQ) , the Active Australia (AA) Survey, as well as some new

measures developed for the specific goals of this research. Both the IPAQ and the AA

measures used in the survey addressed levels and frequency of physical activity

levels and have been assessed for reliability to determine categories of ‘active’,

‘insufficiently active’ or ‘sedentary’ in a review of the test-retest reliability of four

population health surveys targeting physical activity patterns (Brown, Trost,

Baumen, Mummery & Owen, 2005). Reliability for all four instruments was

concluded by the authors as being ‘very good’ with IPAQ measures scoring the

highest level of reliability at 79% where n=104. However, additional questions were

created to expand the data collection beyond traditional measures of physical activity

for two reasons: firstly, to determine the context in which various levels were

conducted (ie the actual settings in which incidental and deliberate activity was

carried out), and secondly, to determine the specific interpretations and uses of local

resources by residents, for example, to assess whether wide pathways were used by

residents and the context in which this occurred,

A pilot study was conducted (n=30), followed by a mail-out to the entire KGUV

residential population (650 apartments). No changes were made to the survey

following the pilot study, as these participants expressed no concern regarding the

clarity or meaning of the questions, and their answers made it evident that they were

interpreting the questions in the way in which they were intended to be read and

understood, a high level of face validity was evident.

However, due to a low response rate (105 people returned their surveys out of 650

mailed out, ie 16% response rate)– attributed to the newness of the Village, and

residents going through a transition and evaluation stage – the data has not been

published and was not used in the development of the thesis overall. The n was

insufficient to determine significant differences between groups. However,

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percentages were calculated to gain a sense of physical behaviour patterns and depth

of engagement with the health-related resources across the Village for all of the

demographic or socioeconomic groups living there.

The survey is available for viewing in Appendix C of this thesis.

From this descriptive, statistical baseline, qualitative research data collection

methods were used to find out the types of social, psychological and contextual

processes that were at work to produce these early trends or indications, and to

ascertain a more in-depth view of the nature of lower socioeconomic residential

contexts as they pertain to health.

4.6.5 Phase Two: ‘The Blog’ – Online Qualitative Data Collection

Sixteen affordable housing participants self-selected for the online qualitative data

collection phase, or blog, by ticking the box on the survey saying that they would be

willing to participate in further research. A ‘blog’ is an online public forum

traditionally used by a single author for writing a diary, and is often accompanied by

photographic accounts to tell stories and share interests and viewpoints with others

(Bachnik et al, 2005, p.1). We chose this Information and Communication

Technological (ICT) medium as it offers participants the opportunity to write their

stories, opinions, and answers to the research questions in an online forum where

they are able to view the anonymous input of other members of the community, and

from where we could study their answers as a collective. Photographs of the

neighbourhood were posted, as well as questions for participants to answer, which

followed the following key themes:

• Self, Health and Space: What Moves You?

• Social and Psychological Aspects of Physical Activity

• Depth of Engagement with Neighbourhood Resources for Physical Activity

• Moving into a New Urban Environment.

• The Effects of a New Urban Context on Health

The following insertion is a sample from the blog to demonstrate its appearance on

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screen:

Social and Psychological Aspects of Physical Activity

This is the last post for questions about the Kelvin Grove Urban Village and the

amount of physical activity you do. Please write as much as you can...

1. Would you say that, in a general sense, you are aware of how much physical

activity or exercise you achieve during the day, and do you worry about it, or try to

increase the amount? Do you ever consider taking more exercise, or are you content

with how active you are?

2. If you see an ad on the TV telling people to do more physical activity, or hear a

health promotion message about it on the radio does this make you want to become

fitter? Do you ever act on these messages, or do you forget about them soon after

hearing them?

3. What types of thoughts do you have that would make you want to increase your

physical activity levels? What kinds of things play on your mind or which life events

might suddenly make you motivated to exercise?

4. If you see people out and about exercising, does this inspire you to become more

active? Do you compare yourself to others’ bodyweights in and around the area that

you live? How does this make you feel?

5. How interested would you be in being part of a social group that organised group

walks, or bicycle rides, or games in the local park? Why/why not? And would you

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like to hear about such events online, by mobile/home phone, texting, or pamphlet in

the mailbox?

posted by Julie-Anne @ 8:32 PM 73 comments

A total of 214 comments were made by participants on the blog.

Participants wrote comments, anecdotes, stories, and their opinions about each of

these topics, which sought to investigate their psychological relationship to both

physical activity and the general pursuit of health, and the quality of the KGUV

environment for allowing them to engage in various types of physical activities.

Because the participants were from a lower socioeconomic group, most did not have

access to a computer, and QUT laptops were loaned to them for use in their homes

over a period of days or weeks until their contributions were complete. Participants

were enthusiastic to learn the skills to participate in this online data collection

process, and showed great interest in the development of the blog. All posts were

anonymous, and while participants could view the contributions of others, they were

not able to identify them.

All data can be viewed at the blog site:

http://theeffectsofanewurbancontextonhealth.blogspot.com/

A full copy of the blog and all the contributions by participants are attached in

Appendix D.

4.6.6 Analysis of the Online Qualitative Data

The blog data was copied and transferred into the NVivo software program for

coding and analysis. The data collected on the blog was treated as ‘initial entry’ and

scoping data that gave an overall impression of the participants and their relationship

with their place of residence and physical activity. In line with the emphasis on

uncovering more about the nature of the contexts of a lower socioeconomic

residential group who had recently moved into a new urban village, the online

contributions of participants were scanned and distilled for themes or basic topics

that epitomised how important they saw physical activity being as part of their daily

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lives, and the extent to which they responded to and interacted with their

neighbourhoods in these early stages of moving to the Village. The blog data

provided a basic assessment of whether their relationship with a new environment,

which contains a number of specific design characteristics, was shaping their

lifestyles in ways that made them more physically active. Moreover, it addressed the

question of what were the processes and relationships at work in this living context

driving changes in lifestyle, or intervening with current attitudes, beliefs,

perceptions, and practices.

Although the participants’ responses were relatively diverse in the sense that the

barriers they saw existing in their lives that prevented them from being ideally active

were different in nature, they were still able to be grouped under themes. For

example, not being able to leave the house for reasons of physical illness, treatment

programs, anxiety or depression, were captured within the broader category of

‘physical and mental illness’. The data was analysed under three broad ‘key-

categories’ which were further divided into sub-categories with various properties,

giving further detail to the nature of the individual, neighbourhood, and broader

ecological contextual influences shaping this group’s relationship to physical activity,

and the relative importance of it in their lives. The analytical process involved a line-

by-line evaluation of the written phrases and stories to explore the interactions and

processes between their relationship with physical activity and their relationship with

their living environment. Specifically, I wanted to find out the extent to which they

felt comfortable engaging with their environment as a particular social demographic

within a mixed-tenure context. To illustrate, quotes such as ‘If I see other people

exercise I feel bad, as they are fitter and better looking than I am and I feel if people

see me exercising I will just look fat and stupid, so it quietly motivates me to better

myself but makes me feel bad…’ shed insight as to some of the tensions between

wanting to become involved in activities around them, but being held back by a lack

of confidence or low self-esteem.

Utterances such as these were transported into shared or common categories that

were identified through a process of comparing and contrasting sections of the data.

For example, focussed coding resulted in conclusions such as the participants

holding a shared belief that while health promotion around physical activity was

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largely to be mistrusted, physical activity was an important part of life that they

would like to be able to do more of. Further, a theme emerged that participants were

held back by circumstantial factors in their lives and personal beliefs that made

achieving an active and healthy lifestyle difficult. As these quotes explain:

• ‘I am unable to leave [husband] unattended even to take a quick walk around

our pathways.’

• ‘I rarely use the parks or BBQ areas because I tend not to have the time.’

• ‘I do not use the BBQ areas yet because I cannot do that because I am alone.’

• ‘The news always says that people are being attacked, so I don't go out…’

The analysis followed a relatively standard grounded theory approach, and this can

be illustrated by the following extract of coding, note-taking and memoing:

Quotes Coding Notes

‘I have also been motivated to

go for a run in the area, which I

haven’t done for years due to

illness, and have found the

pathways useful for this as they

are broad…’

Mental Illness

Inhibition

Health-Resources as

‘Intervention’

Positive aspects of KGUV

neighbourhood as respite from

condition

This was a young woman who

had been battling anxiety and

depression for many years. She

used to enjoy track and field

events in her high-school years,

however, the mental health

problems had prevented her

from having success in the

workforce or from pursuing

running, which she had

previously enjoyed.

4.6.7 Phase Three: In-depth Interviews with BHC Residents (Face-

to-Face Data Collection)

Eight affordable housing residents responded to a mailed invitation to participate in

the interviews, saying that they would be willing to be involved in this stage of the

research (a 25% response rate). These participants had not participated in the survey

or blog aspects of the research, and were unlikely to have agreed to participate

without a financial incentive (an important note for future researchers trying to

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access groups who do not self-select for research participation, but who do contribute

to trends in morbidity and mortality). This provided an opportunity to explore

individual and household relationships, as well as broader contextual neighbourhood

influences on how active participants were likely or able to be. It allowed for

questions to be asked at the individual level, and then opened up to questioning the

whole household about the factors that played into whether or not the family

achieved an active and healthy lifestyle. Individual interview schedules were drafted

around the following key areas of investigation:

• Experiences living in previous neighbourhoods – impressions and opinions

• Families of origin – how important was an active and healthy lifestyle in the

family you came from?

• Living in KGUV now – impressions, experiences, opinions

• How important is healthy living, and what do you do to keep healthy?

• What images come to mind when you think of keeping fit and healthy?

• Which health promotion campaigns can you think of that are effective?

• What are the current barriers to increasing the amount of physical activity

that you achieve, and what would you be interested in doing if there were no

barriers?

• What kinds of activities would your children be interested in doing and what

could KGUV do to improve options for parents and children keeping fit and

active?

Then questions pertaining to the role of the whole household in shaping lifestyle and

physical activity were drafted around the following key points:

• Describe a typical day

• Describe a typical weekend

• Who is keen to do more physical activity in the family?

• What are some of the things that make it difficult to do things together and

stay active?

• If someone in the family suggested doing more physical activity, would the

rest of the family be likely to follow that suggestion?

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While these core issues were addressed in each interview, participants were

conversed with about a diverse range of issues within their living situations and

contexts that affected their relationship to health, and due to the lifestyles of this

particular group, a range of health-risk behaviours such as smoking, drug and alcohol

abuse, and dietary intakes were also discussed at length. An important aspect of the

interviews is that they explored the influences of various living ecologies in each of

the participants’ pasts – including families of origin and previous neighbourhoods in

their adult lives – on their current lifestyles. Each interview with the participants and

the members of their households took between one and a half and two hours and

were transcribed and transferred into NVivo software for analysis. The interview

schedules and transcripts are available in Appendix E of this thesis.

4.6.8 Phase Four: Community Focus Group

A BBQ was held with the aim of conducting informal, opportunistic interviews with

residents to verify and clarify themes that had arisen in the blog and face-to-face

interviews. An invitation was mailed out to the residents in the affordable housing

units, and while many turned up, only six ended up participating in the recorded

focus group. A rough interview guide was used to direct the discussion with a range

of people who contributed over the course of this social event to a general

conversation about the potential of the Village to improve the health and lifestyle of

the affordable housing residents. BBQ attendees were keen to voice their opinions

about how their lives in the apartments within the Village were progressing and

affecting their health. This provided an opportunity to anonymously bring up the

themes raised in the interviews to see if there was a general consensus around them,

and to invite other perspectives and ideas to be voiced on these topics.

The outdoor focus group discussion centred on the following key questions, and is

available in Appendix F.

• Describe an ideal neighbourhood for your current family living situation

• What do you value in KGUV?

• What do you dislike?

• What makes a difference to healthy and active living in a neighbourhood?

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• What would you like to have more access to?

• How influential is the behaviour of neighbours in affecting your lifestyles and

health?

• How important is being healthy to you and your family?

The discussions were recorded, transcribed, and transferred into NVivo software for

analysis.

4.6.9 Analysis of the Face-to-Face (Interview and Focus Group)

Qualitative Data

According to Charmaz (2006), a core benefit of the social constructionist grounded

theory approach is gaining an insider perspective of the meanings behind the patterns

of behaviour that can be observed in a particular context. This approach allows a

focus on time, culture, and context; challenging the use of traditional, positivist

methods (Hallberg, 2006). In an analytical sense, I adhered to the Berger and

Luckman (1966) approach to studying human practice in context by noting the

patterns of practice there, and then exploring the social influences involved in the

construction of these over time. I explored the historicity of a particular social group

to unearth the habituation of their conceptual relationship with physical activity as it

evolved over time. We analysed the data for clues as to how this important health-

related behaviour came to be institutionalised within their living contexts as a

negative or low priority construct. Thus, concepts were built out of the stories told by

the participants about their childhoods, their teenage years, their experiences in

previous poor neighbourhoods, and their perceptions and practices around physical

activity in their current neighbourhoods at this point in their lives.

The data from the blog and the transcripts from the interviews and focus group were

transferred into NVivo software for coding and analysis. An inductive analysis fitting

with the constructionist approach that emphasises the importance of respondents’

narratives of their experiences was used (Charmaz, 2006). In line with the emphasis

Charmaz (1995) places on processes, actions, and consequences, I conducted a line-

by-line coding procedure which provided subjective, temporal accounts of how

physical activity as a concept was shaped and reinforced over time amongst these

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participants. The phrases and narratives they provided revealed how the different

social and living contexts through which they travelled had created harsh and hostile

barriers to feeling confident about both their body image and their ability to become

physically active. I also used focussed coding, which is a more directive means of

locating emerging themes and codes in the data, to identify the key processes

mediating the people, place and health relationship in this case. Charmaz (2006) uses

this focussed approach to develop the conceptual categories, which, according to

Moghaddam (2006) become the ‘building blocks’ for the theoretical development

later in the process. This focussed, or conceptual, coding involves an abstraction of

the data as it has been collected, organised, and analysed into sets of shared

phenomena underpinning the narratives (Charmaz, 2000). These analytic codes or

categories allowed me to develop a conceptualisation of the data as it was collected,

recorded, and analysed. I developed a number of conceptual codes that appeared to

underpin the collective experiences representing the evolution of the attitudes,

beliefs, and behaviours in relation to physical activity amongst that residential group.

This was followed by an exploration of how these conceptual categories relate to one

another within the context of the groups’ experiences over time. In other words,

while I could gather together key shared experiences and phenomena – such as

abuse, neglect, early homelessness, or feeling afraid in one’s neighbourhood – I then

had to explore their connectedness to one another in order to develop the theory. In

other words, how do these concepts tie together in a meaningful way and what is the

core category mediating these subsets? To do this, I developed sub-categories, for

example ‘types of abuse’, and ‘different experiences and contexts of abuse’ that tied

to this important category. The next important category of ‘leaving home early and

homelessness’ was analysed as relating to the previous category and a strategy, or

consequence of the initial conditions of early childhood abuse and neglect. The key

categories that typified their experiences of growing up poor and how these related to

one another in an almost catalytic sense were revealed in this part of the analysis.

Finally, a core category of identity management was located as the constant framing

and reframing of self against others in poor contexts; the striving of participants to

mould their identities as more palatable or less stigmatised than those around them,

with strategies to do this often failing and resulting in even more unhealthy and harsh

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living situations. Theoretical coding was used to bring together the primary

conceptual categories as they relate to the core category as a means of building

theory and insight about how contexts affect physical activity levels. This process

resulted in the production of a model for framing thinking and approaches in future

research.

In addition to the analysis conducted on the data from the blog and the interviews,

memos and observation notes were made to aid a reflection on the relationship

between the goals of the research and the things that mattered most to participants in

their living context. A consistent divergence from the topic of physical activity to

‘what matters to me here and now’ was noted, and the events and reactions of

salience to participants were categorised. Notes on the participants – such as smoking

habits, weight, age, family dynamics, and the nature and contents of the households –

were also made.

The details of these qualitative data collection phases, including the findings and the

implications are outlined in Chapters Six and Seven of this thesis in the form of

published papers:

Carroll, J., Adkins, B., Parker, E., Foth, M. (2007). The Kelvin Grove Urban Village:

What aspects of design are important for connecting people, place, and health? In:

Proceedings International Urban Design Conference: Waves of Change – Cities at

Crossroads, Jupiters Casino, Gold Coast.

Carroll, J., Adkins, B., Parker, E., Foth, M., Jamali,S (2008). My Place through My

Eyes: A social constructionist approach to researching the relationships between

socioeconomic living contexts and physical activity, The International Journal of

Qualitative Studies in Health and Well-Being, In Press.

4.7 Conclusion

This chapter has outlined the methodological framework, research design, data

collection, and analysis. As this is a thesis by publication, the data has been written

up in articles, reviewed and published as an ongoing part of this PhD research

project. The following three chapters contain three full peer-reviewed articles that

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were published from the above data collection and analysis efforts. These contain

detailed versions of the data collection, analytical phases, and key findings resulting

from the research.

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Introduction to the Published Papers

The findings from the data collection and analysis techniques outlined in Chapter

Four of this thesis are presented in the following three published papers.

The first published paper from the thesis was produced from an analysis of the online

data from the blog ‘The Effects of a New Urban Context on Health’. The paper was

internationally peer-reviewed and published in the International Communication

Association (Health Division) Conference Proceedings (2007). The paper, entitled

Blogging about Jogging: Digital stories about physical activity from residents in a

new urban environment with implications for future content and media choices in

population health communication made the case for a social constructionist grasp on

the relationship between the nature of particular living contexts and the position, or

social location, of ‘physical activity’ as a concept within them. It was argued that this

conceptual and methodological approach would result in more meaningful, and well-

matched health communication programs within these contexts – be they defined as

social, economic, geographic, or cultural.

Three key contextual or ecological factors shaping how active and healthy this

residential group were likely to be were identified in the data. Firstly, structural or

circumstantial factors in their lives, such as disability, illness, work constraints,

caring for others, and fear about living alone that prohibited them the time, autonomy

or mobility to use the resources provided for physical activity. Secondly,

characteristics of the neighbourhood such as an appealing aesthetic, positive

reputation in the media, close proximity to a reputable University, and positive

relationships with others living and working in the Village all contributed to

participants’ enthusiasm to engage with their environment in ways that would allow

them more physical activity. However, personal factors and reflections, such as self-

consciousness about exercising in public or body-image were located under the

concept of ‘social comparison’, which deterred them from being as active as they

might potentially be there. Finally, and perhaps most importantly, one of the most

powerful deterrents was the general consensus of hostility amongst the group to any

promotion of physical activity in the media. Distal media influences – whether

commercial or governmental – were treated with mistrust and suspicion by the group.

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This highlights the need for a particular approach to increasing physical activity

levels in neighbourhood or community contexts where the resources are present, but

a number of complex social and psychological processes are acting as inhibitors to

engagement. The findings point to the importance of engaging in in-depth

investigations of the social processes governing patterns in health-related trends prior

to creating and disseminating messages about health or behavioural change.

The second published paper draws on an analysis of the blog data and emerging data

from face-to-face in-depth interviews, and was published in the conference

proceedings for the International Urban Design Conference, held on the Gold Coast,

2007. The paper, entitled The Kelvin Grove Urban Village: What aspects of design

are important for connecting people, place, and health? extended the work that went

into producing the first layer of findings, by deepening both the data collection and

the analysis of contextual or ecological influences on the lifestyles and physical

activity levels of this lower socioeconomic residential group. I collected data via

face-to-face interviews, and a focus group. Staying within the social constructionist

approach, I asked participants to draw out specific aspects of design within KGUV

that they saw as contributing to, or inhibiting their physical activity levels. Questions

were open-ended and allowed participants to reflect on their new neighbourhood at

length, and to bring to the forefront what they saw as salient in this environment in

terms of their quality of life there, and their propensity to lead physically active

lifestyles.

Participants’ accounts of the Village revealed that living in close proximity to other

lower socioeconomic residents within the same apartment block was highly

detrimental to their quality of life, and generated strong barriers to engaging with the

neighbourhood to increase physical activity levels. High levels of intra and inter-

apartment conflict, a high number of police and ambulance call-outs, discarded

intravenous (IV) drug needles on the ground and the water tanks, and anti-social

behaviour amongst residents meant that the people we interviewed were reluctant to

leave their apartments, and spent a great amount of their time trying to keep safe and

manage risk. However, on the other hand, participants did report positively on the

design of the broader Village, with special mention being made to being close to the

University, close to shops, having access to parks and public transport, being close to

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the CBD, and the place’s positive reputation in the media. Two key recommendations

were made. Firstly, more sensitive considerations need to be made to mixed tenure

design being more appropriately and subtly integrated into planned communities.

Secondly, for an increased interdisciplinary co-operation between public health and

urban design, wherein designers heed findings from studies into ‘area effects on

health’ and health communicators conduct more in-depth contextual analyses of

living areas prior to the design and dissemination of information about increasing

physical activity levels there.

What was evident in this analysis was the relatively low priority status given to

physical activity in their everyday lives, and their preoccupation with other, more

immediate problems and challenges. At this stage in the research, we identified the

need for a more in-depth examination of the nature of these lower socioeconomic

contexts, and how they had influenced the participants over time to generate the

kinds of attitudes, dispositions, and indeed disregard for physical activity that we

were observing. Despite the design of KGUV to promote a physically active

lifestyle, it was apparent that the nature of the contexts these people were used to

inhabiting were more powerful than physical infrastructure in moulding health-

behavioural patterns.

Findings from the final stage of data collection and analysis are provided in an article

which has been accepted for publication on 11th August 2008 by Professor Hallberg

(Editor) following international peer review in the International Journal of

Qualitative Studies in Health and Well-Being, and is currently in press. The article is

entitled My Place through My Eyes: A social constructionist approach to researching

the relationships between socioeconomic living contexts and physical activity. This

analysis was taken from the blog data as well as interview and focus group data with

residents living in the government supported housing option within KGUV. I

continued the social constructionist grounded theory approach to data selection,

collection, and analysis to unearth firstly, what the patterns in their current attitudes,

beliefs, and practices were in relation to their likelihood to take up a physically active

lifestyle in the KGUV environment, and secondly, to reveal the interactions, social

processes and other contextual influences that had led to their particular construction

of physical activity as it stands now. Paying particular attention to Berger and

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Luckman’s (1966) text, The Social Construction of Reality, I employed the concepts

of historicity, habituation, and institutionalisation as analytical tools drawing out how

the contextual influences on these women over time that carved out their particular

relationship to the health-related behaviour of physical activity. A focus on

subjectivity, agency and time was highlighted as a key conceptual and

methodological contribution to unearthing findings not accessible via traditional

positivist methods. I followed Charmaz’s (1995; 2006) social constructionist

approach to grounded theory to reveal categories ‘being flogged up something

fierce’, ‘running away’, ‘sleeping with one eye open’, ‘you’re just fat’ and ‘exercise

as a dream’ as key contextual influences mediating socioeconomic context and

physical activity levels. A core category of ‘identity management’ was located. The

paper made a substantive, conceptual and methodological contribution to the ways in

which we understand, think about, and study the contextual relationships between

socioeconomic living environments and physical activity.

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Statement of Contribution of Co-Authors

The authors listed below have certified* that:

1. they meet the criteria for authorship in that they have participated in the conception,

execution, or interpretation, of at least that part of the publication in their field of expertise;

2. they take public responsibility for their part of the publication, except for the responsible author who accepts overall responsibility for the publication;

3. there are no other authors of the publication according to these criteria;

4. potential conflicts of interest have been disclosed to (a) granting bodies, (b) the editor or publisher of journals or other publications, and (c) the head of the responsible academic unit, and

5. they agree to the use of the publication in the student’s thesis and its publication on the

Australasian Digital Thesis database consistent with any limitations set by publisher requirements.

In the case of this chapter:

Publication title and date of publication or status: ‘Blogging about Jogging’: Digital

stories about physical activity from residents in a new urban environment with

implications for future content and media choices in population health

communication. In: Proceedings 57th Annual Conference of the International Communication Association, San Francisco, 2007.

Contributor Statement of contribution

Julie-Anne Carroll

29th July 2008

Conducted revisions, assisted with structure and the presentation and conducting of analysis and findings, sentence-level-editing and writing corrections. Presented the article at the 57

th Annual Conference of the

International Communication Association, San Francisco, 2007.

Dr Barbara Adkins

Assisted with the methodological design and the refining and application of the conceptual framework to the investigation. Made revisions to the article, and assisted with the overall structure of the article and the presentation of analysis and findings.

Associate Professor Elizabeth Parker

Conducted revisions, assisted with structure and the presentation and conducting of analysis and findings, sentence-level-editing and writing corrections.

Dr Marcus Foth

Conducted revisions, assisted with structure and presentation of analysis and findings, sentence-level-editing and writing corrections.

Principal Supervisor Confirmation I have sighted email or other correspondence from all Co-authors confirming their certifying authorship.

Dr Barbara Adkins 29th July 2008

Signature Date

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Chapter Five

Published Paper One

Title: ‘Blogging about Jogging’: Digital stories about physical activity

from residents in a new urban environment with implications for future

content and media choices in population health communication.

Authors: Carroll, Julie-Anne and Adkins, Barbara A. and Parker,

Elizabeth A.

Published: In Proceedings 57th Annual Conference of the International

Communication Association, Health Division, San Francisco, 2007.

5.1 Abstract

This paper contributes conceptually and empirically to the problem of constructing

effective health promotion communication to lower socio-economic groups about

increasing daily levels of physical activity. Epidemiological research has

demonstrated that people living in lower socioeconomic neighbourhood contexts are

less likely to engage in recommended levels of physical activity. However, the

reasons for differences in uptake across contexts remain relatively unknown and

poorly conceptualised, with poorer groups remaining less likely to respond to

interventions and communication campaigns in a sustainable way. This paper firstly

outlines a gap between our understanding of this domain from epidemiology, and the

nature of the knowledge required to construct contextually sensitive messages in

health communication around this problem. Secondly, we apply social constructionist

theory to the development of a theoretical and methodological framework for

investigating the issue, and thirdly, the paper reports on findings from an online

qualitative study which uses a ‘blog’ to record digital stories from a lower

socioeconomic group of residents living in a new urban village, Brisbane, Australia,

about their daily patterns of physical activity. The findings are discussed with

implications for media and content in future health communication efforts on this

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topic, and an analysis of the role of the ‘blog’ as both a tool for data collection and a

medium for health promotion is provided.

5.2 Rationale and Background: Socioeconomic Inequalities in

Physical Activity Rates and Responses to Population Health

Communication.

Within recent discussions on the increasing number of sedentary adults and rising

obesity rates within Western countries (Chan, Ryan, & Tudor-Locke, 2004; Spinks,

Macpherson, Bain, & McClure, 2006; Mummery, Schofield, Steele, Eakin, & Brown,

2005; Department of Health and Ageing, 2004) critical points are emerging on health

promotion’s apparent lack of integration with communication theory to achieve its

mass media goals of reducing these rates (Finlay & Faulkner, 2005; Bauman et al,

2006; Laitakari, 1998). While the media via which messages promoting physical

activity are best delivered remain under debate (Pinto et al, 2002; Spinks et al, 2006),

and within the context of mixed empirical findings (Marks et al, 2006; Glasgow et al,

2001), criticism is arising around the need for designers of population health

communication to take a less simplistic, or ‘blanket-approach’ to public message

delivery, and to adopt a more social constructivist approach to the design and

dissemination of health information or knowledge (Dahler-Larsen, 2001). Finlay and

Faulkner (2005) report in their review of mass media campaigns that ‘little in-depth

consideration [had been given to] the comprehensive media processes involved in

creating media processes and meaning’ (p. 121). They conducted a critical media

studies analysis on a systematic literature review of campaigns to increase physical

activity and concluded that there was an absence of a ‘more sophisticated

understanding of the media processes of inception, transmission, and reception’ (p.

121). They also note that with this recommendation comes the need for an increase in

the number of qualitative studies being done around the promotion of physical

activity in order to gather more knowledge about the contexts in which such

messages are sent and interpreted. Further, Bauman et al (2006) make the point that

‘most important, and most often neglected, is the formative stage of developing

effective communication messages that are relevant for the proposed target

populations’ (p.1). Thus, there is an established need for increased research within

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the area of communication and rhetorical design in terms of a creating a better match

between message content and media and target group, as well as a continued

uncertainty regarding the best means of delivery.

This need for contextually specific health communication is particularly evident in

light of the inequalities recorded in epidemiological data and research which depict

socioeconomic differences in the amount of physical activity people achieve on a

daily or weekly level (Karvonen & Rimpela, 1997;O’Loughlin et al, 1999; Giles-

Corti & Donovan, 2002).While the phenomenon of decreasing physical activity

levels and soaring obesity rates among both adults and children in developed

countries is ultimately a ‘whole- population’ public health issue, research and

statistics show significant differences within demographic subgroups of western

populations, with lower socioeconomic groups - as measured by income, education,

employment, occupation, ethnicity or area of residence - being less likely to respond

to health campaigns and messages promoting an increase in the amount of moderate

and vigorous physical activity individuals achieve on a daily or weekly basis.

Further, people living in lower socioeconomic contexts have been shown to under-

use environmental resources and facilities available to them for increasing physical

activity (Lindstrom, Hanson, Ostergren, 2001; Romero, 2005; Jacoby, Goldstein,

Lopez, Nunez, and Lopez, 2003; Karvonen & Rimpela, 1997; Giles-Corti &

Donovan, 2001). For example, a study by Giles-Corti and Donovan (2001) found that

although people living in a lower socioeconomic area had superior access to health-

related resources for physical activity, such as sidewalks and parks, they were less

likely to utilise them for exercise or the pursuit of health. They also found that

although this group walked more for transport than their wealthier counterparts (not

significantly so), they were 36% less likely to undertake vigorous physical activity.

Further, a study by Karvonen and Rimpela (1997) found that characteristics in poorer

neighbourhoods were more significantly connected with a range of higher-risk health

behaviours than individual measures of disadvantage, with adolescent girls more

likely to be physically inactive where overall unemployment levels were high, and

more likely to be active where owner-occupied housing rates were high (p. 1089).

Such empirical findings raise important questions about what needs to be considered

in the design and implementation of communication campaigns to increase urban

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population physical activity levels, such as ‘what are the psychological and social

components of a poor environment that create less healthy lifestyles?’ and ‘what do

we need to know about the reality or aesthetics of living in a less wealthy home or

neighbourhood context prior to devising rhetoric or implementing interventions

aimed at behavioural change?’.

There is general agreement within the health inequalities literature that the reasons

for which people living in different socioeconomic and geographic contexts do not

respond equally to health promotion efforts, nor why health-behaviour patterns are

clustered differently among such contexts have not yet been fully explained by

empirical efforts (Mcintyre, Ellaway, & Cummins, 2002). Research has not yet been

able to convincingly explain why higher socioeconomic groups appear to respond

more quickly and in a more sustainable way to mass communication about health-

related practices and behaviours (Picket et al, 2002; Frolich et al, 2002). And while

much research is committed to locating factors in the urban environment responsible

for low receptivity and uptake (Jacoby et al, 2003; Romero, 2005; Lindstrom, 2001;

O’Loughlin et al, 1999; Kamphuis, 2006), Giles-Corti et al (2002) found in their

study on the environmental and individual determinants of physical activity that

individual and social factors appear to be more important in determining activity

levels than factors in the physical environment. They noted that, while ‘access to a

supportive physical environment is necessary, it may be insufficient to increase

recommended levels of physical activity in the community’ (p. 1793). In a recent

paper on the people versus places debate, Giles-Corti makes the comment that

‘comprehensive interventions targeting both people and places are required to

increase physical activity’ (p. 357). Within the health communication literature on the

topic Booth et al (2006) posit that research needs to take account of the specific

qualities of a target group to ‘provide more relevant and appealing options for those

who might other-wise be missed by ‘one–size-fits-all’ physical activity promotion

strategies’ (p. 131), and although adequate recognition is being given to the need for

different cultural (O’Loughlin, Paradis, Kishchuk, Barnett, & Renaud, 1999) and age

(Burke, Beilin, Dunbar, and Kevan, 2004; Brawley, Rejeski, & King, 2003) groups in

relation to communicating about the promotion of physical activity, we argue that

similar contextual sensitivity, and attention to appropriate content and media be

given to poorer demographics.

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5.3 The Media Debate: Where should we be Promoting Physical

Activity?

While the differing attitudes, beliefs and structural realities of target groups remains

a challenge for health communicators, the most appropriate media or mode of

delivery are also researched extensively for their effectiveness in promoting physical

activity and exercise among different social groups (Marks et al, 2006; Reger et al,

2002). Recently, a discussion in the literature has emerged regarding the nature of

both the message content and media used to deliver messages about physical activity,

with much research being done to evaluate paper-based versus online formats

(Marshall, Owen, & Bauman, 2004; Pinto, Friedman, Marcus, Kelley, Tennstedt &

Gillman, 2002). For example, while Glasgow et al (2001) have found the association

between children utilising Information and Communication Technologies (ICTs) and

over-weight to be a problem, other researchers advocate the Internet as an effective

mechanism for mass message dissemination among sedentary adults, with Marcus et

al (2000) making a comprehensive argument for future considerations of interactive

modalities that might eliminate the paradox of using an inactive channel to generate

physical activity among people (p. 125).

Interestingly, however, Marks et al (2006) found that a paper-based intervention was

more effective than an Internet-based campaign aiming to increase the physical

activity levels of adolescent females in the U.S. Two groups of young women had

either online reminders or paper work books delivered to their homes, and while both

interventions yielded a significant increase in physical activity self-efficacy and

intention, the paper based intervention was the only one to see an increase in reported

levels of physical activity.

Other mass media efforts that integrated the use of the Internet in their campaigns

have found that while they are successful, they are not sustainable due to a ‘decrease

in the number of participants that use the system’ (p. 113). However, little work has

been done using more mobile technologies, such as cell phones and instant

messaging, or sms, which do not restrict people or tie them to a geographic location,

or web-based commitment that participants may be reluctant to sustain. Overall,

there is somewhat of a consensus that combinations of different media and integrated

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efforts are most likely to succeed in future, with room for further research into online

formats for getting messages and persuasion about healthy lifestyles to different

social groups. However, future efforts that plan to rely on online mechanisms for

promoting physical activity will depend greatly on the ICT access and ability of the

participants, and there is currently little research into the impact of the technological

divide on the success of Internet-based campaigns as communication vehicles to

promote healthier lifestyles. Issues of power, control, and the democratic nature of

such media remain under scrutiny as the majority of Western populations embrace

the Internet, email, chat-programs, online discussion forums and interactive games,

while sub-groups within these populations fall behind in both technological and

health aspects of modern lifestyles (Burbulus, 2006; Azari & Pick, 2004)

5.4 Applying Communication Theory to the Problem: Can a social

constructionist perspective help?

In our review of the current debates in literature regarding media and message in

health communication on physical activity, it became apparent that the problem

needed to be addressed on both these levels, and within a research paradigm that

would allow us to examine lower socioeconomic contexts conceptually and

empirically to determine what would be most likely to resonate within the lived

experiences of these groups. The need for a theoretical body that emphasised the

importance of context in understanding human behaviour and communicative

exchanges became apparent in light of our inquiry into this public health problem,

wherein people living in contexts with particular economic and social qualities are

consistently more likely to engage in a range of health-risk behaviours. While the

importance of contextual awareness and sensitivity is paramount within broader

communication theory, research, and practice (Littlejohn, 1996), with numerous

models and frameworks having been researched and developed with the purpose of

studying, analysing, and understanding human interactions and behaviours in a range

of social and cultural contexts (Berger & Luckman, 1966; Giddens, 1982; Shimanoff,

1980; Bernstein, 1971; Penman, 1992; Goffman, 1963), this emphasis is less visible

in epidemiological research. Within public health research, much of the emphasis

remains on locating population traits that can be significantly linked to particular

health behavioural profiles, with these groups being targeted with increased

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information and education about the risks of illness and death associated with that

type of lifestyle (Spinks et al, 2006; Kelly et al, 2006). The limitations inherent

within this approach are such that they are not conducive to the generation of

knowledge about a context that is likely to aid the design, production, or delivery of

successful rhetorical and persuasive tactics or campaigns.

For example, while you may be able to use epidemiological methodologies to locate

a statistically significant link between lower education and increased likelihood in

engaging in health risk behaviours, this approach is not suited to revealing the

pertinent properties or social and cultural territory of a low education that leads to

that particular lifestyle; and this is the type of knowledge that is vital in the

preparation of communication messages and media that will resonate in that context.

We argue that the current conceptual and methodological frameworks employed to

identify ‘problem demographics or areas’ are useful only up to and including that

point, and that from there, the communication discipline is more likely to be of use in

the types of thinking and techniques it could offer to study these contexts. Thus, we

do not seek to identify environmental determinants within neighbourhood contexts

that ‘produce’ various physical activity levels, but to find out more about the social

contexts and inherent contingencies around which such norms or patterns are

generated.

A range of communication theories, such as symbolic interactionism, dramatism and

narrative are all likely to be useful in studying human behaviour in context, we have

employed the closely-related family of social constructionism as both an inspiration

and a theoretical and methodological paradigm for this study. The key notion

underpinning theories of social constructionism is that much of what we experience

as reality is a product of our interactions and communications with others (Harre,

1972; Gergen, 1985). Also, that people’s perspectives and interpretations of their

contexts or worlds depend on their social realities and that while human agency is

always present, there are many social forces that shape the way we react and respond

to our immediate environments. Further, that the knowledge that we gain during our

lives is determined by the language that we use and which is used around us, and

what we understand this to mean. Most importantly, the social constructionist

perspective views all human knowledge to be contextual, and something that evolves

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across spatial and chronological events (Penman, 1992). There has been some health

research that takes a contextual view to understanding how different habits or

responses arise and form among both health practitioners and the general population

(Jordens & Little, 2004), however, most research in this area is reticent to take

account of a contingency-based approach to understanding contextual effects on

behaviour, and seeks rather to locate determining factors within the environment that

treat human agency as less salient in this process.

Thus, because the aim of our study was to investigate contexts as social locations for

generating insights into health or health-related behaviours, and how these are

constructed meaningfully within them, then the methodological research lens needs

to be magnified to capture the micro-processes that are of interest here. A

methodology that allows health behaviours within poorer urban contexts to be

studied as socially constructed, and further, to closely examine the impact of health

communication campaigns on the ears and eyes of those who appear not to be

producing the desired ‘behavioural outputs’- a qualitative approach that aimed to

capture the stories and interactions of residents within such a context - was sought. In

light of the current debates and inquiries in health communication research regarding

the potential or otherwise of online mechanisms to both research and promote health,

we decided to set up a ‘blog’ dedicated to the collection of opinions, insights,

comments, stories and explanations from people living in a low-income government

supported housing option in the Kelvin Grove Urban Village regarding the ways in

which their living environment affects their propensity to take up physical activity or

exercise for health reasons.

By doing this, we are able to address the three primary questions raised earlier in this

paper:

1. What is it about lower socioeconomic contexts that inhibit the uptake of

recommended levels of physical activity for health and well-being?

2. What is the nature of the message content that is most likely to resonate in

a meaningful way within these contexts (what are the self-evaluative and

adaptive rules?)

3. What are the best mediums or communication formats for delivering

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rhetorical and persuasive campaigns to increase daily levels of physical

activity within these contexts?

This theoretical perspective and methodological framework allowed us to study this

problem with the aim of understanding how physical activity levels and patterns are

socially constructed in situ and governed by norms, habits and practices that evolve

over time within these contexts. Observation methods and notes were also used, but

are not displayed as ‘data’ in this particular paper.

5.5 The ‘Blog’ as a Research Tool

A ‘blog’ is a form of website that is used as a type of diary, with entries made

primarily by the author of the blog. The appeal of the blog is said to be due to the

creation of a space where people can ‘express their opinions and views on different

topics without fear of censorship’ (Bachnik et al, 2005, p. 1) and blogs have been

found to ‘generate a sense of community’ among people with shared interests (Nardi

et al, 2004). Some of the many reasons for blogging include documenting one’s life,

a commentary, catharsis, a muse, and as a community forum. While blogs have

certainly been used among academic and research communities to share experiences

and processes, such as that of the PhD journey (Archives by Thread, Air-1, 2006), or

to share knowledge or resources such as the case of a blog created for learning

research methods (Giarre & Jaccheri, 2005, p 2716), we are not aware of any current

efforts that utilise the blog as a means for actual collection of data.

The blog provided a way to bring individual, online answers to research questions

together in a visually accessible community-based collection of responses. In line

with the research aims of this study, which were to ascertain the contextual processes

in a lower socioeconomic living environment contributing to physical activity levels

of residents, the blog allowed residents to respond to questions on physical activity

and photographs of their neighbourhood and housing options at their own pace, and

with as much reflection as they needed, while simultaneously being able to observe

the answers and comments made by other residents. Additionally, while not true for

all participants, most could write their answers to the questions that were posted

without interference or even the presence of a researcher, while still being able to

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read the comments of other participants. Implications for the democratic nature of

this method of data collection are discussed in further detail below.

5.6 ICT Access and Use for Lower-Socioeconomic Study Participants

The use of an online data collection mechanism raised the issue of access to

technology and the Internet, with poorer, less-educated residents less likely to have

access to both. Therefore, we provided those participants with no access to a

computer or the Internet with Queensland University of Technology (QUT) library

laptop computers and dial-up access for a period of four hours a day in their homes,

over a period of as many days as they needed to generate their responses. Some IT

support and training was given to participants, and enthusiasm to learn was high.

5.7 Data Collection Method: ‘The Blogging Experience’

5.8 Sample of Bloggers

Following on from the results of a pilot survey on the physical activity patterns and

habits of residents from different demographics within a new urban environment,

‘The Kelvin Grove Urban Village’ (KGUV) in Brisbane, Australia

(http://www.kgurbanvillage.com.au/), a sample of 16 residents from the public

housing group, Brisbane Housing Company (BHC), were chosen to participate in a

qualitative study using a ‘blog’. The participants were chosen in that they represented

residents living within a lower socioeconomic context. Within that sampling

framework however, criterion sampling was used to identify people who represented

a broad range of the characteristics within that demographic. Participants’ ages

ranged from 19 to 77 years, they had an income of less than $25, 000 per annum per

household, and in addition, the following characteristics were present among the 10

residents (these were ascertained from the survey):

• diagnosis of anxiety and depression

• diagnosis of cancer

• wheelchair bound

• mild acquired brain injury

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• Being a full-time carer

• non-English speaking background

• Lone parent

5.9 Procedure

Participants contributed to a ‘blog’ by addressing questions posted by the researchers

about their relationship between their living environments, health promotion

influences, and their physical activity levels over a four-week period. The blog was

divided up by posts into four themes:

1. Moving into a New Urban Environment

2. Depth of Engagement with Neighbourhood Resources

3. The Social and Psychological Aspects of Physical Activity

4. Self, Health and Space: What moves you?

While themes 1-3 asked specific questions about how the built environment and

social and communicative processes influencing how active their lifestyles are, the

fourth post offered a space for free comments, opinions, stories, and networking

opportunities about their relationship with their neighbourhood and what ecological

influences would be likely to increase their physical activity levels.

The blog containing the data as written in by study participants can be found at:

http://theeffectsofanewurbancontextonhealth.blogspot.com/

5.10 Data Analysis

The comments and stories posted on the ‘blog’ by study participants were copied into

the NVivo 7 software for analysis. A thematic analysis was conducted to ascertain

emerging concepts that appeared in a repeated format within different stories,

explanations or accounts of the reasons for differing physical activity levels. Blog

entries were read in their entirety, and while already themed according to questions

by categories, sub-themes and topics were identified and coded into points of

potential significance for people designing mass or targeted communication aimed at

increasing physical activity levels among lower socioeconomic demographics.

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5.11 Findings and Discussion: What are the factors influencing

physical activity levels in lower socioeconomic living environments?

As a means of drawing data about many aspects of neighbourhood contexts, as well

as reactions to the communication campaigns and messages that reach these contexts,

answers were sought around a range of place-based, as well as media and

promotional influences on physical activity in the urban environment. Table 1 below

has been drawn up to broadly illustrate the themes and sub-themes that emerged

regarding these influences on physical activity levels, and is discussed in further

detail with illustrative quotes from the data provided to demonstrate how participants

expressed their views on these issues. We propose that Table 1 represents a type of

‘checklist’ or list of factors to consider when communicating with residents living in

a lower-socioeconomic context, rather than a list of variables that are likely to

‘determine’ physical activity in these settings. It is based on the pertinent ecological

and communicative factors raised in the digital stories written by residents. Further, it

captures the importance of a shift from a ‘top-down’ approach to communicating

with lower socioeconomic groups on health, to a mediation of health knowledge and

initiatives in context.

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Table 5.1 Ecological and Communicative Factors Influencing Decisions about Physical Activity among Lower-

Socioeconomic Residents in a New Urban Village.

Structural

Realities/

Environmental

Factors

Aesthetic

Proximal/Soci

al

Neighbourhoo

d Influences

Local

Relevance and

Media

Message

Source and

Credibility

Tastes and

Preferences

Community

Ownership and

role of ICT

Work duties

Carer roles

Disability/

Illness

Time constraints

Income

Urban design

Health resources

Safety/Lighting

Population

diversity

Body

weight/image

Neighbourhoo

d

relationships

‘Seeing others

exercise’

Social

comparison

Reputation of

place

Activities

available

Local

networks

Online

‘neighbourhoo

d’ forums

Pamphlets on

local events

Scepticism

about

Television

Health

promotion

‘overload’

Unobtrusive

nature of

message

Individual

agency and

choice

Trust in local

sources

Diversity of

activities

Range of

options

‘Lone’ vs

‘group’

exercisers

Self-

consciousness

Inclusive

environments

ICT access and

user ability

Local

dissemination

Neighbourhood

networks

‘Grassroots’

discussions,

decisions, and

initiatives

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5.11.1 Structural Realities and Everyday Decisions about Physical

Activity

In order to gain an understanding of the kind of lived reality or everyday context in

which a health communication message is ultimately delivered, it is important to

consider potential structural constraints, or factors in the environment that might

support or promote lifestyle change. For this reason, we asked participants to write

about the ecological and urban design features in their environment that either aided

or prevented them from engaging in recommended levels of activity. An interesting

aspect to this finding was the general consensus among this lower-income group that

physical activity and exercise was not something that was pursued as an extra-

curricular activity with goals about health and/or body image, but rather something

that was smuggled into everyday routines, and only increased if the nature of the

routine changed, as this comment illustrates ‘Most exercise consists of getting from A

to B. No particular thoughts influence me to increase my activity except if I'm

running late for an appointment or something similar’ while others simply integrate

it into what has to happen that day: ‘My daughter attends the local school which is

only a short walk away’ and ‘I get to walk to work and that makes me healthy.’

Some participants stated that pathways and bikeways in the vicinity influenced their

physical activity patterns in that ‘I use the paths and bikeways to get from A to B’ and

‘I find them very useful. I have also been motivated to go for a run in the area, which

I haven’t done for years due to illness, and have found the pathways useful for this as

they are broad’. However, others do not relate these aspects of urban design to

health, stating that ‘I find them to be simply a requirement of a small urban area and

not specifically built as a walkway for exercising or riding.’ However, walking for

recreation or around the neighbourhood for sight-seeing or something to do did

appear to have increased as a result of the pleasing aesthetic and clean environment

reported by participants in the following notes: ‘I like the parks surrounding the area

because they are so gorgeous and I feel comfortable and satisfied with the air. I just

walk around and sit down and with the other people resting there’ and ‘I love the

Victoria park, if you walk there at night is it wonderful sightseeing, you can see the

beautiful city.’ Walking also appeared to have increased as a result of private

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transport being unavailable to some participants, coupled with the close proximity of

public transport, as participants stated ‘It has been necessary for me to become more

physically active because of the lack of private transport. I thoroughly enjoy walking

so this has become an added bonus more than intentional.’

Other constraints within the participants’ homes, such as caring for partners, children

and older relatives was reported as being a structural constraint preventing them from

achieving the levels of physical activity they would like to, as stated by this

participant: ‘I am unable to leave [husband] unattended even to take a quick walk

around our pathways.’ Thus, for those designing the content of health

communication campaigns to increase physical activity in lower socioeconomic

target groups, the apparently low priority of it in people’s lives along with their equal

willingness to incorporate regular, brisk walking into daily routines and recreational

pursuits is useful as a guide for the types of suggestions that are made. Perhaps even

encouraging people to pursue options for respite for relatives requiring care might be

an indirect, yet highly effective means of improve both the health and quality of life

of people in these positions.

5.11.2 Aesthetic and Proximal Social Neighbourhood Influences

Local social networks and the pursuit of recreation and company among neighbours

in the government-supported housing option came through as being important in

terms of how residents felt generally about their well-being in the Village. As some

participants explained, ‘I have met some really interesting people here and have had

a great social experience’, and ‘I had no job when I came here, and I was welcomed

greatly by my neighbours and thought that was a great sign’. In addition, some of the

older people claimed that being in an environment with a diverse range of ages and

backgrounds being present were motivating factors to get ‘out and about’.

Participants noted that just by being in close proximity to others who exercised, or

seeing others enjoy themselves in the neighbourhood, was enough to motivate them,

as well as improving their perceived health, and their overall well- being, as is

demonstrated in the following quote ‘Young people keep you young’ and

‘Encouragement from other people who are doing exercise inspires me so much to

become more active’ and ‘I always think why they can do it and why can I not do it?’.

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However, an interesting counterpoint was made by one of the younger female

participants, ‘If other people excercise [sic] I feel bad, as they are fitter and better

looking than I am and I feel if people see me excercising [sic] I will just look fat and

stupid, so it quietly motivates me to better myself but makes me feel bad.’ Such

insights are vital for health communicators in showing images to poorer young

women – who are statistically more likely to be overweight – of more well-off,

thinner women engaging in physical exercise. This also has implications for health

communicators who need to advocate to urban designers and town planners to create

diversity in neighbourhoods, and to find communication techniques and strategies

that are effective as ‘growers’ of social networks that can sustain and improve local

physical activity levels, as well as providing resources that make the uptake of

physical activity less socially intimidating.

5.11.3 Local Relevance and Medium of Delivery

An interesting finding that emerged from participants’ stories on the blog, was their

interest in gaining face-to-face visits, local discussions, or even telephone calls

regarding the organising of different options or activities to improve health. As one

participant explained ‘If you don't come and talk face to face or verbally with us then

we won't go, but a home visit is much more important - person to person to talk

about these things and organise activities is better.’ Others stated that an email or

online system that either let them know of things that were going on in the area, or

which allowed them to connect up with other neighbours to organise activities such

as social walking groups would be welcomed, with a participant stating that ‘hearing

about something like Tai Chi online would be good, I do not like having what I

consider junk mail’. Most participants expressed that they had busy lives that were

filled with various duties and obligations, but that they would be receptive to

suggestions and information about what was available for them do locally, with most

agreeing that a pamphlet in the mail, or email reminder being an effect mechanism

for allowing this to happen, as another participant stated ‘E-mail is fine for more

information or pamplets [sic] in the mail’. Overall, it appeared that a message that

was targeting them personally via a proximal rather than distal, or mass media

source, and which applied to their living environment in so far as it pointed to what

avenues of physical activity could be achieved or undertaken realistically in their

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particular environment being preferred.

5.11.4 Message Source and Credibility

Participants expressed relatively uniform distaste for TV messages about increasing

levels of daily physical activity, with one participant saying that ‘I am not usually

prone to just accept because TV or papers tell me this or that will benefit my health

wise or physically’ while another commented that ‘I never act on advertising and am

not influenced by other people's comments regarding becoming "fitter"’, and further,

‘TV doesn’t sell me on anything.’ The majority of participants associate TV with a

‘hard sell’ approach to health, and were inherently sceptical about these sources.

Interestingly, one participant also doubted the credibility of such health

communication campaigns, stating that ‘I take it on onboard but I am generally

aware of my own health needs from use more reliable sources’. A concept that

dominated this area of questions was that of individual agency, with participants

expressing adamantly that their own knowledge, beliefs, and attitudes to physical

activity were sufficient in terms of what they thought they should be doing, and that

people making suggestions to them to improve these levels were somewhat of a

personal intrusion, with a participant stating that ‘I think there is too much said about

diets and exercise and I think it is only up to one’s own self to participate in looking

after your own body.’

Most felt that, despite the many structural constraints that they faced during a normal

day, they were aware of the potential health effects of any physical activity that could

be fitted into their routines, and sought to increase this at a time in their lives when

they felt that this was right or possible again, with a participant noting that ‘I feel

quite confident regarding my own judgement of how fit I am and will only increase

my activity if I wish to.’ Thus, in light of the preferences described above for more

locally based sources of suggestion and information regarding physical activity,

health communicators might consider working with individual local councils, gyms,

pools, and perhaps use local shop and library outlets to promote options in people’s

neighbourhoods for increasing their physical activity levels.

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5.11.5 Tastes and Preferences

A notable number of differences in the types of activities and events people might

like to participate in to improve their physical activity and health was evident. While

there was somewhat of a consensus on the need for more locally organised social

networks as a means for generating activities, the types of preferred activities

differed greatly. These are some of the types of suggestions that point to the many

and varied range of interests within one housing complex in this particular urban

village:

• I am very much interested to join if there are people who can organise this

kind of activity. Games in the park would be great.

• I think I would be interested in like an indoor netball team or social soccer

team or something, but not just a social walking group.

• I generally prefer to exercise alone except for Thai Chi which is pleasant to

do as a group.

• Very interested in a social group with walks etc.

• Yes I would be interested in organised walks including, for example, bird-

watching.

Implications of this from a communication perspective are that messages about

increasing physical activity levels may need to include texts and images of a diverse

range of ways that this can be achieved in order to get away from more standard

connotations of exercising such as say, jogging or playing basket ball. Also, it would

be ideal for these suggestions to be contextualised within accessible parts of urban

neighbourhoods, and not just in sporting arenas, swimming pools, or clubs, where

geography and finances are likely to create structural barriers.

5.11.6 Community ‘Ownership’ and Participation: The Blog as a

Tool for Sharing Stories and Promoting Health at a ‘Grass Roots’

Level

While the content from the answers and anecdotes posted on the ‘blog’ by

participants provided a great deal of insight into the way in which they respond to,

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and manage knowledge about the positive effects of physical activity on health, the

enthusiasm for the use of the ‘blog’ to generate their own stories, as well as read and

respond to stories from other residents, demonstrated the benefit of this type of

technological medium in creating and sustaining health at a local level. While the

maximum benefit of the blog as both a data collection tool, and a forum for

discussing ways of increasing social connectivity and physical activity at a local

level is yet to be revealed, it is still being used as a growing source of stories,

comments, and suggestions made by this group about what they would like to see

happen in their local environment. The experimentation with this type of

communication technology for gathering insight into urban contexts holds great

potential for those seeking to understand statistical trends in the people, place, and

health relationship, as well as those trying to communicate and instigate behavioural

change as a result of them.

5.12 Final Comments and Implications for Future Communication

Efforts on Physical Activity among Urban Population Groups.

We concur with current critiques of health promotion strategies that contextually-

specific communication designs are needed to combat the inequalities inherent

within this public health problem. Further, communication theories need to be more

extensively studied and explored for their suitability to guiding future research into

the reasons for differing levels of uptake among people living in different urban areas

and neighbourhoods. Such knowledge is needed in order to create a better match

between future campaigns and specific geographic or socioeconomic target groups. A

social constructionist critique of contexts would allow research to unearth what a

particular ‘health behaviour’ means within different human settings and

environments, and to gain insights into the perspectives and experiences of those

who are not engaging with current information dissemination and rhetoric designed

to influence particular behaviours. A more socially and culturally-based approach to

targeting of groups about behaviour change or uptake is needed if successful

communication is to be generated that resonates within the lived realities, beliefs,

attitudes and structural constraints of people currently being missed in whole of

population efforts. Finally, the role of ICT and options for online forums wherein a

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‘ground up’ approach to generating local networks able to organise and instigate

healthy lifestyle programs that are contextually relevant, and are considered

appropriate by to those who know their geographic and social environments best,

needs to be further investigated.

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Statement of Contribution of Co-Authors

The authors listed below have certified* that:

6. they meet the criteria for authorship in that they have participated in the conception,

execution, or interpretation, of at least that part of the publication in their field of expertise;

7. they take public responsibility for their part of the publication, except for the responsible author who accepts overall responsibility for the publication;

8. there are no other authors of the publication according to these criteria;

9. potential conflicts of interest have been disclosed to (a) granting bodies, (b) the editor or publisher of journals or other publications, and (c) the head of the responsible academic unit, and

10. they agree to the use of the publication in the student’s thesis and its publication on the Australasian Digital Thesis database consistent with any limitations set by publisher requirements.

In the case of this chapter:

Publication title and date of publication or status: The Kelvin Grove Urban Village:

What aspects of design are important for connecting people, place, and health? In Proceedings International Urban Design Conference: Waves of Change – Cities at Crossroads, Jupiters Casino, Gold Coast, 2007.

Contributor Statement of contribution

Julie-Anne Carroll

29th July 2008

Identified a gap in the literature, wrote the research questions, identified a point of departure, designed the methodology (including conceptual approach), collected the data, conducted the analysis, wrote up findings, and wrote the article. Presented the article at Waves of Change – Cities at Crossroads, Jupiters Casino, Gold Coast, 2007.

Dr Barbara Adkins

Assisted with the research questions, methodological design and the refining and application of the conceptual framework to the investigation. Made revisions to the article, and assisted with the overall structure of the article and the presentation of analysis and findings.

Associate Professor Elizabeth Parker

Conducted revisions, assisted with structure and the presentation and conducting of analysis and findings, sentence-level-editing and writing corrections.

Dr Marcus Foth

Conducted revisions, assisted with structure and presentation of analysis and findings, sentence-level-editing and writing corrections.

Principal Supervisor Confirmation I have sighted email or other correspondence from all Co-authors confirming their certifying authorship.

Dr Barbara Adkins 29th July 2008

Signature Date

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Chapter Six

Published Paper Two

Title: The Kelvin Grove Urban Village: What aspects of design are

important for connecting people, place, and health?

Authors: Carroll, Julie-Anne and Adkins, Barbara A. and Foth, Marcus

and Parker, Elizabeth A.

Published: In Proceedings International Urban Design Conference :

Waves of Change – Cities at Crossroads, Jupiters Casino, Gold Coast,

2007.

6.1 Abstract

There is an emergent trend in both urban design and health-related literature calling

for strengthened connections between these fields, with the aim of meshing social

aspects of urban design with current efforts to generate healthier lifestyles and

behavioural patterns among urban populations (Gleeson, 2004). As Jackson states,

‘while causal chains are generally complex and not always completely understood,

sufficient evidence exists to reveal urban design as a powerful tool for improving

human condition’ (p. 191). The Kelvin Grove Urban Village (KGUV) will be

discussed in this paper as a case-study for responding to this call. The underlying

design principles of KGUV, including its basis in new urbanism, social diversity, and

the availability of wide, even, pathways and green spaces identified it as an ideal

location for addressing some long-standing questions in the research about which

social and physical design features are most salient for increasing people’s propensity

to walk or engage in recommended levels of physical activity. The findings from this

interdisciplinary investigation examining the patterns and processes connecting

people, place and health are presented in this paper, and illustrate the ways in which

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different urban demographics engage with their immediate environment, in the

pursuit of social, recreational, and health-related goals. Implications rising out of

these findings are two-fold: firstly, for urban designers to heed the findings in

research examining ‘area effects’ on health, and secondly, for health communicators

to give deeper consideration to the design features of the context hosting their target

demographics prior to the design and dissemination of health promotion messages

and campaigns. This way, new urban neighbourhoods stand an increased chance of

creating environments that encourage and allow increased levels of physical activity,

and health communicators are more likely to create campaigns and interventions that

resonate within the contexts in which they are delivered and received.

6.2 Introduction

This paper firstly draws on the current bodies of research in both urban design and

public health to develop the need for a stronger empirical link between these

disciplines in light of existing evidence that points to a connection between urban

neighbourhood contexts and population health and well-being. A review of the

research in the field of urban design that indicates its salience for both real and

perceived well-being is provided, as well as evidence from research in health

demonstrating that household and neighbourhood contexts exert powerful, yet still

largely unexplained influences on human health-related behaviours. The

identification in the literature of this common concern between the disciplines

regarding which ‘ingredients’ of urban neighbourhoods make them dynamic, healthy,

and socially sustainable provided the rationale for this research investigation aimed

at developing insights into ‘what works’ for people in urban settings.

Secondly, the paper provides a description of the Kelvin Grove Urban Village

(KGUV) which is a medium-density, mixed-tenure, urban neighbourhood based on

the design principles of new urbanism, and situated in close proximity to the Central

Business District (CBD) in Brisbane, Australia as the case-study for this

investigation. It outlines the ways in which the qualities and characteristics of this

new urban context allow research into the role of urban design in mediating the

relationships between people, place, and health to be undertaken. The Village will be

discussed for its unique design qualities and its contribution to finding out more

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about the ways in which urban neighbourhoods and living contexts elicit what have

come to be known as ‘ecological effects’ on health.

Thirdly, the paper reviews methodologies and findings from qualitative investigation

of residents’ experiences within KGUV, with special emphasis on the presence of

health-related resources and a mixed-tenure demographic. Residents participated in a

number of research activities to gain insights into the ways in which the presence of

people from different social sectors, and resources such as parks, BBQs, wide

walking and bikeways and the close proximity of shops and public transport affect

how physically active they were likely to be. Research questions targeted how

residents felt about their own housing and accommodation within the Village, the

overall design of the Village, and their prior housing histories and attitudes to health

and physical activity.

Finally, the paper discusses the potential of KGUV to provide a resource for further

investigations into the relationships between people, place, and health and as a

proponent of healthier lifestyles for vulnerable demographics. In particular, the role

of design on lifestyle and health-related behaviours is highlighted, with future

implications for urban designers who are aiming to generate sustainable communities

with the potential to mediate the relationship between poorer demographics and less

healthy and fulfilling lifestyles. Also, the research aims to highlight the importance

of built design, social mix, and local resources in alleviating ghettoisation, urban

decay, and the increased likelihood of lower socioeconomic groups being highly

transient across both the private and public housing markets. It is the intention of this

study to identify links between urban design, population health, and health

communication that contain the potential to ensure that the needs of vulnerable social

groups are considered in the building and marketing of new developments, and that

health researchers effectively understand the influence of the nature of an urban

environment on the likelihood of populations to respond to community health

promotion efforts in a sustainable way.

6.3 Rationale and Background

Urban planning and design research has identified a number of key ‘ingredients’ that

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appear to be important in contributing to the overall health and quality of life for

residents living in urban areas (Jackson, 2003). These include, but are not limited to,

the following design components:

• Contours/skylines/variety of height (Al-Hathloul, 1999).

• Land-use (Wester-Herber, 2004)

• Biodiversity (Sandstrom, 2005)

• Building conditions and aesthetics (Hembree, 2005)

• Quality of own dwelling (Turkolglu, 1997)

• Public space and meeting points (Vogt & Marans, 2003)

• Greenery and green connectors (Teo & Hung, 1996)

• Identity Markers (Oktay, 2002)

• Roadworks (Foo, 2001)

These findings are important as they assist planners and designers to incorporate and

consider components that contribute to improved social functioning, satisfaction,

quality of life and health of residents. As Jackson (2003) notes ‘while causal chains

are generally complex and not always completely understood, sufficient evidence

exists to reveal urban design as a powerful tool improving human condition’ (p. 191).

Increasingly, in Western countries, master planned communities have risen in

popularity and demand, and, in the process, have introduced a range of complexities

and challenges for planners hoping to locate and include the types of features that

will generate and sustain healthy and fulfilling lifestyles for residents. Further, urban

planners and designers are currently facing the challenges involved in being able to

deliver the types of ‘communities’ being offered in the marketing rhetoric of these

prêt-a porte lifestyle packages (Luymes, 1997; Gleeson, 1994). Much criticism has

arisen regarding the ultimate inability of urban planners to match the promises

offered in the real estate brochures of these enclave communities. These criticisms

are encompassed in the following quotes by leading researchers in this area:

• ‘Image and product are concepts that are researched and packaged long

before the community even opens for sales’ (Wolford, 1993).

• ‘The theme of ‘community’ found in the marketing rhetoric is absent from the

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critical literature on enclave communities, and is indeed antithetical to the

warnings about the breakdown of civil public life’ (Luymes, 1997, p. 194).

Therefore, the challenge remains within urban planning and design to be able to

locate the social and affective aspects of design that allow thriving, dynamic, and

healthy communities to be (re)created. Further, the aim is to be able to incorporate

and coordinate the built ingredients known to benefit the well-being of residents,

such as pathways, bikeways, and green recreational areas, in a way that allows

communities to be developed, and positive social networks and functions to be

maintained.

Contemporary design literature points to the following outcomes as 'most in demand',

and simultaneously most difficult to deliver:

• Community (Gleeson, 1994)

• Diversity (Luymes, 1997)

• Participation (Al-Hathloul, 2004).

• Sustainability (Van den Dobbelstein & de Wilde, 2004)

• Identity (Oktay, 2002; Teo & Huang, 1996).

• Culture and History (Antrop, 2005).

With a contemporary focus on space and economic efficiencies and a trend towards

master planned communities, the delivery of these principles in the lived experience

of residents is very challenging from a design perspective. However, the difficulty in

delivering these outcomes is not only a problem at the level of everyday design

dilemmas. Part of the difficulty also lies in the requirement for a framework which

can capture the realities and parameters of design processes on the one hand, and the

lived experience of subsequent designed environments. The work of Henri Lefebvre

in The Production of Space is an important analytical resource in focusing on the

processes of translation of a design into residents' experiences. He distinguishes three

levels at which space is produced: Representations of space – space conceptualised

by planning, design and development professionals; Representational space – space

as it is perceived or experienced symbolically by inhabitants; and Spatial practices –

space as it is lived and the point at which the conceptualised and symbolically

represented space are appropriated in everyday contexts of residents (Lefebvre,

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1991).

Based on these analytical levels, the notion of community, for example, may figure

in 1) planning and development principles, 2) at the level of marketing and symbolic

representation of a development and 3) may be seen as present or absent in the lived

experience of residents. At each of these levels there is no guarantee that the meaning

of 'community' is translated unproblematically across these levels. In a planning

environment which is intensifying the requirement for identifying 'what works' and

'how it works' in terms of generating healthy and satisfied residents in urban areas, a

framework such as this that can accommodate the logics, understandings and

processes at stake in each of these levels of design is critical for an understanding of

the full set of processes required to deliver principles such as "community". This also

provides for research that is able to examine the processes via which a range and

combination of place characteristics combine to produce these outcomes.

The importance of research that focuses on the different levels at which space is

produced and experienced is very evident from a review of public health literature as

it pertains to urban environments. Public health research has been particularly

interested in the physical, social, and economic characteristics of urban places, as

they have been found, in various forms and examples, to affect both the health

behaviours and outcomes of the people who live there (Macintyre, 2002; Bush, 2001;

Diez-Roux, 2000; Picket, 2002; Titze, 2005; Giles-Corti, 2005). Preventative medical

perspectives have engaged in much research regarding the ways in which the built

features of urban design, such as the presence of pathways, bikeways, public

transport and green meeting spaces can contribute to the likelihood of residents being

physically active in an area (O'Loughlin, 1999; Badland, 2005; Kirtland, 2003),

while social epidemiologists and health promotion researchers have been interested

in locating 'psychosocial' attributes of a place, such as social cohesion and capital,

culture, and a sense of safety and belonging in terms of their apparent ability to

improve the health behaviours and outcomes of those who live there (Chandola,

2001; Markowitz, 2003; Feigelman, 2000; Shiell & Hawe, 2000).

In Western contexts, such as Australia, health inequalities researchers have

repeatedly shown that the socioeconomic qualities of urban places - via area or

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residential composition – comprise the most powerful variables influencing the

health behaviours that can be observed there, and the morbidity and mortality rates of

that area (Frolich, 2002; Turrell, 2003; Macintyre, 2002). Much effort has been

invested in this area of research on being able to accurately measure and define the

socioeconomic position of an area and its people in order to be able to identify the

specific ecological contexts contributing to worse health for poorer urban

populations (Ecob, 2000; Sleigh et al, 2005; Cummins et al, 2005; Macintyre, 2002).

The socioeconomic characteristics of a person’s place of residence that have been

shown to matter from a health perspective, include housing quality, type, and tenure,

as well as overcrowding (Ellaway et al 1996; Waters, 2001). Further, the income,

employment, and educational levels of residents (both co-dwellers and neighbours),

as well as the socioeconomic measure given to an area, as calculated by such

measures as Accessibility/Remoteness Index of Australia (ARIA) and the

Socioeconomic Index for Areas (SEIFA) have also been identified as salient

determinants of the health and well-being of residents. More recently, variables

relating to the perceived socioeconomic position of an area, such as reputation and

stigma, have also been identified as salient variables mediating the place/health

relationship (Sooman et al, 1995; Gregory et al; 1996; Bush et al, 2001). What is less

established, however, is how these patterns come to exist and what the motivational

linkages or barriers are between the socioeconomic position of an urban area and

what people do there in terms of their health. There are a number of interesting, and

largely unresolved, points regarding the ways in which this variable operationalises

to produce ‘health effects’ in urban areas. Some of these include:

1. The complexity of socioeconomic position as a ‘determinant’ of health:

How is it that higher-risk health behaviours become embedded in the

lifestyles of poorer social demographics?

2. The salience of socioeconomic position of an area: How do factors within

urban neighbourhoods differently affect lifestyle and health?

3. The contextual nature of socioeconomic influences: Why is it that

socioeconomic context is more powerful than individual measures of

socioeconomic position as a predictor of lifestyle and health?

Research that examines how the socioeconomic traits of urban places play out in

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every day lives of residents to produce the health-related outcomes that have been

repeatedly observed by researchers is needed to further knowledge about the ways in

which place affects people. This way, both urban planners and health researchers and

practitioners can gain insight into not only what appears to matter in terms of the co-

existence of particular traits and health outcomes, but how built resources and

residential composition can be composed and positioned in ways that generate

meanings that are interpreted and enacted by residents as healthier lifestyles. If the

pathways connecting people, place and health can be more adequately understood or

conceptualised, then changes and developments can be made in urban areas based on

the meaningful ways that people are likely to experience such efforts.

In light of this empirical research and the gaps in knowledge that currently remain

within the fields of urban design and population health, the following research

questions were developed for investigation within the Kelvin Grove Urban Village

(KGUV), which was identified as an appropriate urban case-study.

1. What are the contextual social processes that influence lifestyle and well-

being in urban neighbourhoods?

2. What aspects of design are conducive to producing healthier lifestyle

patterns, especially amongst lower socioeconomic demographics?

3. Which aspects of demographic, living context, and everyday life need to

be considered by urban designers and public health researchers working

towards decreased health inequalities and increased social sustainability?

6.4 Case Study: What is the Kelvin Grove Urban Village and how

does it allow us to address research questions about urban design

and health?

KGUV is an $800 million mixed-tenure, medium density, inner urban planned

community based on the design principles of ‘new urbanism’ and located

approximately two kilometres from the Central Business District (CBD) in Brisbane,

Australia. According to Steuteville (2004) ‘New urbanism is a reaction to sprawl. It

is based on principles of planning and architecture that work together to create

human-scale, walkable communities. The new urbanism includes traditional

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architects and those with modernist sensibilities. All, however, believe in the power

and ability of traditional neighbourhoods to restore functional, sustainable

communities’ (p 23). A further key feature of the new urbanist aspirations of the

development is a planning focus on diversity and heterogeneity in housing types,

land uses and social groups (De Villiers, 1997). KGUV has been built with the aims

of achieving a vibrant, healthy, diverse and socially sustainable urban community

that has access to a range of cultural, health, and educational resources.

While KGUV is based on new urban principles that have proven highly successful in

other international contexts (Michigan Land Use Institute, 2006; Funders Network

for Smart Growth and Liveable Communities, 2007), it is still regarded as somewhat

of a ‘social experiment’ in Australian urban design, primarily due to its complex mix

of residential groups and local resources, services, and retail options. However, it is

optimistically being coined as ‘The Smart Village’ by the State of Queensland’s

Premier, Peter Beattie due to its underlying close philosophical ties with Smart

Growth design concepts. David Manzie, Manager of Department of Housing

Portfolio Management Division states ‘The vision for the Kelvin Grove Urban

Village was for an inclusive and sustainable community where people live, learn,

work and play in one accessible and walkable neighbourhood – and all within two

kilometres of the Brisbane central business district’ (Sectorwide, p. 2).

A wide range of demographics has been included in the accommodation options

including student accommodation, disability support options, aged accommodation,

and people living in government assisted housing via the Brisbane Housing

Company (BHC). Within this latter group there is a great variation among residents

in terms of age, health, education levels, support needs, and number of children and

elderly in their care. In addition, there are apartments that have been sold on the

private market ranging in price from $310, 000 - $950, 000 AUD. This diverse range

of people live in close proximity to a range of resources including retail outlets, the

Queensland University of Technology, associated health clubs and services, libraries,

parks, wide path and bikeways, and the well-known La Boite Theatre. Figure 6.1

below provides a conceptual overview and description of the key social, educational,

cultural, and health-related features of KGUV that underpin this unique urban design.

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Figure 6.1 ‘What is KGUV a Case Of’?

KGUV covers a geographical area of approximately 16 ha, and contains around 2000

residential units. Figure 6.2 below outlines the geographical region occupied by the

KGUV and proximity to Brisbane’s central business district (CBD). Figure 6.3

shows the design plan for KGUV, and the photographs depicted below firstly show

the resources in KGUV based on new urbanism principles with special attention to

walkways and green places, as well as close proximity to cultural and educational

resources; and secondly the housing options on offer to residents.

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Figure 6.2 Map of Geographic Area in which KGUV is located

Source: (KGUV Innovation Implementation Report, Garred, 2007)

Figure 6.3 Master Plan

Source: Official Kelvin Grove Urban Village website

http://www.kgurbanvillage.com.au/.

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Photographs

Source: (KGUV Innovation Implementation Report, Garred, 2007)

Source: (KGUV Innovation Implementation Report, Garred, 2007; photographs from

the ‘blog’ http://theeffectsofanewurbancontextonhealth.blogspot.com/)

The specific health-related resources that are located in KGUV are outlined in Table

6.1 below.

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Table 6.1 Health Related Resources at KGUV

Health

Resource

Description Building

Progress

Centre for

Physical

Activity and

Health

The Centre for Physical Activity and Health will be located

alongside McCaskie Park, and will contain an indoor pool,

indoor multi-purpose courts, a gymnasium and health clinics.

The primary function of the Centre will be for QUT teaching

purposes, however, it will be available for use by the broader

community as well.

Building

near

completion

School of

Optometry

QUT’s School of Optometry offers services to the community by

students at no cost. Additionally, glasses and contact lenses

are available from the clinic at discounted prices.

Complete

Nutrition Clinic

This QUT clinic offers nutritional assessment, dietary advice for

both weight gain and loss. Diabetes, cholesterol lowering,

sports nutrition and healthy eating.

Complete

Podiatry Clinic

QUT’s Podiatry Clinic, which is a part of the School of Public

Health, offers prescriptions and patient care.

Complete

Network of

Pedestrian and

Bike Links

There is a planned network of bicycle links within the Village to

surrounding areas. These features have been designed in

accordance with the overall philosophy to increase individual

autonomy and mobility, as well as improving health and well-

being.

Complete

Landscaped

Parks and

Open Spaces

Within the Village, are be a number of green, open spaces for

social gatherings, BBQs and exercise for residents. The Roma

Street Parkland and the Victoria Park Golf Course are adjacent

Complete

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to the precinct, and also provide opportunities for outdoor

recreation and physical activity.

Red Cross

In a recent media release

(http://www.kgurbanvillage.com.au/about

/plan.shtm) it was announced that in 2007 the Australian

Red Cross Blood Service would be locating a $70M facility

adjacent to the Institute of Health and Biomedical Institute

(IHBI) at the Kelvin Grove Urban Village. This will provide

university researchers with increased opportunities and access

to resources for conducting biomedical and public health

research. This is a promising example of how new stakeholders

will invest interests and resources into the Village, based on

the collaborative initiatives and potential they see the

community as holding.

Constructio

n underway

Due to the commitment to developing resources and the basis in design principles

likely to impact on the health of residential populations, KGUV was chosen as the

case-study in which to investigate the research questions outlined above. A case

study is a single-bounded entity, studied in detail, with a variety of methods, over an

extended period, and is selected because it is theoretically representative of the

relationships to be investigated (Yin, 2003). Following this logic, the KGUV

(www.kgurbanvillage.com.au) has been identified as a planning and design strategy

reflecting a desire to achieve a higher level of integration between residential,

commercial, educational, cultural and employment activities (Healy & Birrell, 2004)

with great potential for improving residential health and well-being. In this context

KGUV represents an explanatory case study, which, according to Yin is oriented to

proposing an explanation for an already identified pattern or phenomenon. For this

purpose it is studied as a system of relationships with the key purpose of identifying

key elements and their interrelationships that are responsible for the production of

space/health relationships (Yin, 2003).

As such, KGUV was selected because it was representative of some of the key

relationships that have already been identified as at stake in existing theories

spanning urban space and health. First, as a mixed tenure development, it provided

an opportunity to study residents in subsidised housing, already theorised to be more

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vulnerable to ill-health, co-located with those from different socio-demographic

backgrounds: middle and high income earners as well as students. Further, in the

context of an inner city development co-located with educational, cultural

recreational and health facilities, it enabled a focus on the role of space, proximity

and service availability in health related practices. Third, in terms of Lefebvre's

analytical levels of spatial relationships, it allowed an understanding of the different

levels of production of space/health relationships: the planning/design representation

of those relationships, the symbolic manifestation of those relationships and

residents' perception of them, as well as the daily spatial practices in which residents

appropriate these relationships.

Thus, KGUV was seen as theoretically representative of a development that

deliberately encapsulated the relationships that are the focus of this study. For this

reason, this urban setting provided a type of 'urban social laboratory' in which to

explore people's reactions to urban places and to evaluate, from a health perspective,

whether ideas about diversity, connectivity, space and creativity are conducive to

outcomes such as improving the health and well-being of residents.

6.5 Methodology

Study Participants and Data Collection Methods:

Participants for the qualitative data collection phases were recruited via both

telephone and mailed invitation, as well as from the returned surveys from the

quantitative research conducted in the KGUV as part of this study. All participants

were current residents in KGUV. A multi-method approach was taken to capturing a

range of information types from within the case-study over the period of one year,

including surveys, online mechanisms such as the ‘blog’, interviews, workshops, and

focus groups. For the ‘blog’, in-depth interviews, and community focus group all

residents were from the Brisbane Housing Company (BHC) apartments, which is a

government-supported accommodation project. By this qualification, these

participants are all on incomes of $25 000 or less per annum, and fall into the

category of lower socioeconomic position as defined by both housing and income.

The workshop, however, included a cross-section of residents from across the

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Village.

The reason for the focus on the lower socioeconomic demographic is due to the

evidence in health research that shows that these groups are less likely to engage

with their urban neighbourhood in ways that develop their lifestyles and improve

their health and wellbeing. In addition, the salience of socioeconomic context as a

factor influencing health-related behaviours was of key interest in this study that

investigates the role of new urbanism in alleviating such effects. In line with the

theoretical contributions of Lefebvre that emphasise the need to draw on the social

practices that occupy the space under investigation as a means of understanding how

humans interact with the physical and social places they inhabit, methods were

created that tapped into BHC participants’ accounts of everyday practices and the

locales that either enabled or disabled their desires and abilities to lead more active

and healthy lifestyles.

The breakdown of participant numbers and qualitative research activities are outlined

in Table 6.2.

Table 6.2 Participants and Data Collection Phases

Participant

Numbers

Demographic

Details

Data Collection Type

16 BHC residents Blogging: An online mechanism known as a ‘blog’ was

appropriated as a means where residents wrote answers,

stories, and opinions about KGUV in relation to healthy

lifestyles. There were 214 responses posted on the blog in

total. Blog address:

http://theeffectsofanewurbancontextonhealth.blogspot.com/

8 BHC residents Individual Interviews: In-depth interviews were

conducted with lower socioec residents in their apartments

about how their living contexts affect their lifestyles and

health.

6 BHC residents

present.

Community Focus Group: Informal, opportunistic

interviewing and observation notes were taken from BBQ in

local park organized by researchers for BHC residents.

6.6 Key Findings

The data from all collection points was brought together and triangulated for analysis

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using NVivo software to address the overall research question: which aspects of

design are important for connecting people, place, and health? A content and

thematic analysis revealed the following factors and processes as being crucial in

both understanding how people, place, and health are connected, and which aspects

of neighbourhood ecologies are vital for improving residential health and well-being.

Analysis of relationships between people, place and health were guided by

Lefebvre’s attention to the three levels of understanding the ways in which urban

spaces are created and utilised, in particular, the design and planning elements, the

symbolic or rhetorically created aspects, and the everyday experiences and practices

within these dimensions.

• Overall KGUV Marketing Concept and Place Reputation

The qualitative data from the various sources of collection revealed that the

marketing rhetoric and promotional material, as well as how KGUV was portrayed in

the media and recognised by others in Brisbane affected how they felt about living

there, for example, ‘It makes us feel really good. It makes us feel poshy for once, you

know’ (BHC mother, interview) whereas she claimed that in previous

neighbourhoods ‘You feel down, you feel like you’re nothing, but now here we feel

like we’re something, you know, cause we’re in something nice. It makes us feel

good’ (BHC mother, interview). In addition, another participant stated that ‘All my

friends say oh you’re so lucky to be living there, right near the city, and it has

everything, and we are in the media, and being part of that buzz is great’ (BHC

resident, community focus group).

Not only did it affect how residents felt about living there, but also what they

perceived they would be likely to do there. Participants felt that the promotion and

reputation of KGUV as a development based on the principles of new urbanism with

attention to ‘walkability’, physical activity, and health influence how they expected

their lifestyles to take shape there. This can be demonstrated in the following

quotations:

‘I think in time KGUV will promote physical activity as it is a new concept in living

so I am looking forward to new ideas’ (BHC resident, blogging participant).

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‘KGUV appears to promote a healthier lifestyle through its advertising promotions’

(BCH resident, interview).

‘I think KGUV does promote health and wellbeing. The parks are encouraging to

have a fun activity, while the pathways are great for a run and there is a gym, more

serious fitness activities. I think it will also promote social activities and be a very

active area’ (BHC resident, blogging participant). This quote in particular highlights

the interface between physical and symbolic aspects of design and how these are

appropriated into spaces that are conducive to health.

In light of what, for the most part, are housing histories steeped in experiences of

crime, fear, violence, and poor neighbourhood reputation, both the perception of

KGUV via successful marketing packages, as well as the design principles appeared

to promote a more active and healthy lifestyle for residents, thus demonstrating the

importance of understanding the psychological and social components of design in

enhancing both perceived and actual health.

• Mixed-Land Use and Proximity to Destinations

Participants spoke frequently and at length on the benefits of having highly-regarded

and desirable destinations within walking distance from their homes. They

mentioned both established venues as well as shows and concerts that were held in

and around the CBD for both themselves and their children, for example ‘We went

and saw a show at The Con (Queensland Conservatorium of Music) and that was

great’ (BHC resident, blogging participant) and one mother told of an outing with

her four children ‘Well I took ‘em to the park, and High Five was on, and I take ‘em

to that, and the shops are closer here…Yes, the kids are more settled here. They can

go to libraries’ n that here and a park just up the road’. And further, she went on to

explain how this affects her well-being and quality of life ‘Well if they’re bored, we

just take ‘em, take ‘em out, instead of stuck here at home, and that stops me from

being a bit stressed. And that’s even better (BHC resident, interviews). Other venues

that came up repeatedly as being destinations of interest that were within walking

distance are illustrated in the following quotes:

‘South Bank and The Lyric Theatre are only 15 mins away for all the activities one

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enjoys and buses are available every 10 mins (BHC resident, blogging participant).

‘I love the Victoria park, if you walk there at night it is wonderful sightseeing, you

can see the beautiful city (BHC resident, blogging participant).

‘Roma Street Parklands are beautiful and they are just over there, so that is fantastic

to go to’ (BHC resident, community focus group).

Residents also acknowledged that the location of a bus service that is centralised with

buses frequently travelling to a broad range of destinations was an important design

component contributing to the improvement of lifestyle overall. ‘It's good in the

walking sense, even walking to the buses and there are so many bus services here -

you can get to the Bulimba ferry, Valley, city - so it's easy to walk to those things’

(BHC resident, blogging participant).

In addition to desirable, accessible locations, the close proximity of the University

and the La Boite theatre were also raised as destinations and resources that

encouraged activity and engagement with the urban neighbourhood, as one

participant illustrated

‘QUT’s coffee shop and maybe library with its computer access and maybe any

learning programmes such as writing we all will grow and at the same time learn and

also help others (BHC resident, blogging participant). Further, the interviews

highlighted how these facilities give life to social connections between the BHC

residents and other demographics that might not have otherwise met, for example,

‘And you can meet the students and talk to them. The international students have

come to visit us here’ (BHC resident, blogging participant). Another participant

stated that ‘being around the students and theatre-goers makes me feel so young and

good’ (BHC resident, interviews). An activity in the workshop highlighted the fact

that residents felt that the inclusion of social groups as a result of the mixed land-use

at KGUV such as students, theatre-goers, university staff and international visitors

was perceived as a positive contribution to their lived experiences in the

neighbourhood. Both indirect and direct benefits to lifestyle and well-being regarding

mixed land-use and walk-ability to destinations were evident in the data, and

highlight little-understood and yet potentially salient contribution of social and

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cultural resources to the improvement of people’s health in a place.

• Parks, Green Spaces and Health-Related Resources

Participants highlighted the walkways as being highly beneficial for increasing the

amount of physical activity they were likely to do, for example, ‘I use the pathways

for walking. They are better than the walkways I previously had access to, which was

a hilly area’ (BHC resident, blogging participant) and ‘the walking paths are great

and the parks are well estabished for all sorts of fun and games’ (BHC resident,

blogging participant), and further, one participant links design to motivation to a

renewed focus on fitness ‘I have also been motivated to go for a run in the area,

which I haven’t done for years due to illness, and have found the pathways useful for

this as they are broad’ (BHC resident, blogging participant).

Residents also commented positively on the number, location, and quality of parks in

KGUV for recreational, leisure, and physical activity pursuits, for example ‘On one

of our walks we visited all the parks in the area and I saw that Grey Guns park

would be ideal when small children of my friends and family come to visit as we can

take them for a walk up there and let them kick a ball around and we can sit and talk’

(BHC resident, community focus group) and ‘I usually show visitors around the

parks and often relax as the seating is excellent around the pathways and parks’ and

further ‘I like the parks surrounding the area because they are so gorgeous and I feel

comfortable and satisfied with the air’ (BHC resident, blogging participant). Another

resident commented on the combination of pathways suitable for walking and

desirable destinations for both utilitarian and health-related reasons ‘It is good for

physical activity especially walking and jogging and going sight-seeing is good

exercise. And going to the shops’ (BHC resident, blogging participant). The

psychological, social, and health benefits of wide, even pathways and well-kept

green areas were greatly emphasised in the data, with implications for improving

current neighbourhoods and considering the positive aspects of health-related

resources such as these in the design of future planned communities.

• Housing Histories and Perceived Levels of Danger and Fear in the KGUV

Neighbourhood

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The transition from previous housing and neighbourhood experiences was contrasted

in the data to current perceptions of life in KGUV, and how both lifestyle and well-

being have been affected. While not all participants were in agreement about safety

issues in KGUV, the data demonstrate the importance of perceived levels of fear and

ideas about neighbours as key in determining whether or not residents were likely to

be active there, for example ‘Absolutely I walk more here, I didn’t have parks or

pathways where I was before, and I never felt safe anyway’ (BHC resident,

interviews). Further, participants reported safety as a key factor influencing how

mobile and active their children were able to be in KGUV, for example, ‘The kids

can go out and we’re not worried about ‘em, in the last places we had to go out

check what they’re doing every five seconds, cause there are too many bad people

around’ (BHC resident, interviews). And ‘I have used the parks to play with my

grandson and enjoy the walks on the pathways as it is very safe and secure’ (BHC

resident, blogging participant). In addition, one participant stated ‘…and it’s nice and

clean here. It’s just got a clean feel’ (BHC resident, interviews).

However, some residents still feel that despite the positive aspects of a clean

environment that is aesthetically pleasing, the close congregation of lower

socioeconomic residents in the BHC apartments recreates a similar problem of fear,

based primarily on a perceived connection between demographic qualities of

residents and likelihood of crime, for example:

‘I hated going out after dark ‘cause it was pretty scary, with a high unemployment

level. Just um walking down the road, they knew you would have a few dollars on

ya, so they’d roll ya for the money for grog or smokes. Because it has a lot of people

living in the same spot it reminds me of that, so after dark you don’t go out by

yourself’ (BHC resident, interviews).

This raises questions for the designers of future planned communities about the

balance between providing health-related resources and a positive promotional

package, and the problematic nature of a mixed-tenure concept, when in fact ‘mixed’

refers to clusters of lower socioeconomic residents located adjacent to clusters of

high socioeconomic residents, rather than a random allocation or physical blending

of accommodation options. While marketing rhetoric that promotes a clean-living,

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healthy lifestyle and health-related resources are important in creating positive,

sustainable experiences for residents, social and demographic qualities of the area

contribute powerfully to this mix, and need to be considered as important in design

as the provision of material and physical resources.

• Mixed-Tenure

Participants talked at length about the problematic nature of being clustered together

in apartment-style living with people who are experiencing similar social and

economic difficulties, and how when people enduring them are placed in close

proximity, tensions arise, for example ‘Yeah and a lot of these people don’t work here

either. Like you’re meant to live in peace and harmony, but as far as that goes it went

out the window pretty much straight away’ (BHC resident, interviews) and ‘Like the

police have been here, like, in the first week we were living here, like a half a dozen

times. Yeah just through people fighting and bitching and things. And other domestic

violence incidents like 6 o clock in the morning there were people having domestics

downstairs…’ (BHC resident, interviews), while another mother commented ‘But we

were here and people were yelling out any time, doesn’t matter if its midnight, three o

clock on the morning, or whatever, and screaming, barnying, over whatever.’ Another

young mother described the following scenario:

This place, we’ve had a few hiccups along the way, we’ve had a man come in

and it’s the wrong house… with a gun. So that’s why we’ve got the dog here. But

um, someone came in with a gun, and they came into the wrong place, so…it was

a bit full on. It’s a bit like the Bronx here at the moment. Yeah. We’ve had

someone get burnt by hot water by her boyfriend, and the police rock up here like

every day.I think it’s calming down a bit now, but it’s become like pretty full on,

like that all comes with the people who are being moved here as well, like yeah,

we’re all from the same lifestyle but some of us have changed and some of us are

still there. So its difficult in that way, where they have tried to put all lower class

people in one building, where some people have moved on and some people

haven’t.’

This final comment highlights quite pointedly, the psychological detriment of

classifying housing type by demographic category in terms of restricting their

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perceived ability to ‘move on’ or make changes in their lives. Another theme that

rose during the interviews with young mothers in BHC apartments, was the problem

with a lack of disposal facilities for intravenous drug users in the buildings, with

needles being left lying around spaces where their children play. One participant

stated ‘There is a huge problem with needles, we have to pick them up and put them

in bins, and sometimes they are left next to the bins, and I’ve seen them on the water-

tanks, everywhere.’

Not only the young mothers were affected by the mix of residents in the BHC

apartments, with one middle-age couple describing their government supported

living experiences in the BHC apartments as follows: ‘Our neighbour next door - you

couldn't wish to meet a nicer couple. And the lass with the baby she is fine now that

the baby has a cot - but before she was crying a lot. The smokers drive us mad,

because they are chain smokers. And we had to call the police because a man was

throwing shoes at our louvres at 4am in the morning’ and ‘Someone started a fire in

our refuge. Someone smelt the smoke and saw the burnt paper’ (BHC residents,

blogging participants). And in this poignant comment, a young mother noted the

negative impact on quality of life of being placed in housing that is government

supported and is notably defined as such within a community ‘Yeah it’s funny, I’m a

big addiction person, and um its even like associating in the same complex as those

people then it goes OK, it’s really nice and everything, but you haven’t moved on, it’s

still housing commission’ (BHC participant, interviews). Interestingly, despite BHC

efforts to call it ‘affordable living’ and to move away from the category of ‘housing

commission’, all BHC residents referred to it as such, and spoke of it being a

drawback from the otherwise positive aspects of design at KGUV. One written

comment in a workshop activity regarding the non-BHC housing from a BHC

resident stated that people in private accommodation were ‘Rich, tall, and better than

us. They think.’ While KGUV has been described as mixed tenure, it does not break

the mould from the older style government supported living wherein people from

poorer backgrounds are confined to living together in apartments where privacy is

low and space is limited.

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Community Capacity-Building and Recreational Activities

Finally, when participants were asked about which aspects of design could be

improved and what might contribute to how active they were able to be in KGUV,

most expressed a need for community-based activities and sport and recreation

centres that were affordable, close, and child-friendly. One mother from BHC

suggested ‘Like something for the kids, more for the kids to do, instead of just a park

and them playing on the slippery slide and they get bored just swinging on swings.

We try to take balls usually, but still they need something that is going to be fun. And

somewhere where I can take them to do something where I can sit down and relax’

while another stated ‘A mothers’ group would be good, or a play group like we used

to have in West End’ and ‘Activities for the kids like sports or martial arts or

dancing’ (BHC participant, interviews). Other older residents from BHC also

expressed a desire for activities that brought them closer to other residents and got

them out of their apartments ‘A community centre with its facilities e.g. card games,

exercise programmes such as tai chi perhaps, just mingling socially perhaps’ (BHC

resident, blogging participant) while another said ‘The community hub would be

great for people to interact with others to organise some activities’ and ‘…very gentle

exercises for families with a B.B.Q afterwards would be an idea for getting to know

the residents’ (BHC residents, blogging participants). Some of the parents from BHC

spoke positively regarding previous experiences with PCYC, and the many resources

it offered to young families, ‘My daughter used to go to the PCYC cause they had

everything there for kids and she did Ju Jitsu there’ (BHC participant, interviews).

These suggestions and illustrations demonstrate a current need in KGUV for

community developers and health promotion workers from government, not-for-

profit, and research areas to generate programs and activities that can build social

capacity and improve lifestyles and health for residents in a way that contributes to a

vibrant and sustainable community.

6.7 Discussion, Conclusions, and Future Implications

At the level described by Lefebvre as representations of space – space as it is

conceived in planning and design – KGUV clearly displays an orientation to

integration between residents and village life and a commitment to the coherent co-

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location of different tenure developments. This conceptualisation was seen to

intersect in important ways with the field of health through the co-location of health

facilities, the provision of walking and recreation facilities and a design oriented to

encouraging movement and activity. These design values were experienced very

positively at symbolic level by participants. In general, the respondents were very

supportive of their inner-city location, the mixing of tenures, the availability of

services and the diversity of the village in terms of both visitors and residents. Their

descriptions of their housing careers positioned their move to KGUV as a change for

the better in terms of happiness and well-being.

However, when their responses moved to descriptions of everyday experiences of the

space, their utterances revealed a level of ambivalence and negativity. On the one

hand, descriptions of spatial practices revealed some very positive changes for the

better in their housing circumstances and well-being. The quality of the dwellings is

proving to be a positive influence on both real and perceived well-being, as is the

availability of shops and affordable, child-friendly venues, such as the proximity to

South Bank and Roma Street Parklands. Additionally, the overall absence of fear is a

great contributor to the level of engagement with local resources, especially in light

of residents' prior experiences in poorer neighbourhoods and housing histories.

However, on the other hand, interviews found that vulnerable groups perceive the

poverty, ill-health and addictions of others acutely, and see it as a reflection on

themselves when it occurs in close proximity to their living area. Therefore, while

the well-designed units, the presence of the university and the theatre and the

demographics that utilise these resources contributed to an overall improved sense of

well-being for residents, at the level of everyday experience other social aspects of

life at KGUV were experienced as more problematic.

While the Brisbane Housing Company residents were able to physically access a

range of urban resources that are usually linked with improved health and well-being,

such as parks, pathways, and bikeways, at a social level there were a range of

complex processes at work generating barriers to a greater connection between these

people and the lifestyle on offer to them at KGUV. Firstly, a mistrust of other

residents in the same demographic and perception that they were not ‘good people’

was born out of previous negative experiences living in poorer suburbs in the

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Brisbane region, thus inhibiting social activity and venturing outdoors to participate

more fully in KGUV life. Secondly, close proximity to people with social and health

problems meant that another level of symbolism about the KGUV was created

internally within the apartment blocks; with used needles, over-flowing bins, broken

toys, rummaged-through mailboxes, and even blood stains in some areas comprising

a set of semiotics not conducive to feelings of happiness and well-being. Finally, a

tension was being played out between aesthetics relating to different components of

design, between the physical and the social, and which raise important questions for

both urban designers and public health researchers. Further investigation is required

to understand the effects of social contexts on health-related behaviours in urban

environments, and greater consideration of these effects needs to be taken at a

planning level when considering co-location of different demographics and land-use.

Stronger research links are needed between health and urban design to ensure that

health promotion and intervention takes into account the power of design to

potentially mediate these effects, and for designers to acknowledge the salience of

social context and its impact on a range of goals for future planned community,

including health and sustainability.

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Statement of Contribution of Co-Authors

The authors listed below have certified* that:

1. they meet the criteria for authorship in that they have participated in the conception,

execution, or interpretation, of at least that part of the publication in their field of expertise;

2. they take public responsibility for their part of the publication, except for the responsible author who accepts overall responsibility for the publication;

3. there are no other authors of the publication according to these criteria;

4. potential conflicts of interest have been disclosed to (a) granting bodies, (b) the editor or publisher of journals or other publications, and (c) the head of the responsible academic unit, and

5. they agree to the use of the publication in the student’s thesis and its publication on the Australasian Digital Thesis database consistent with any limitations set by publisher requirements.

In the case of this chapter:

Publication title and date of publication or status: My Place through My Eyes: A

social constructionist approach to researching the relationships between

socioeconomic living contexts and physical activity In: The International Journal of Qualitative Studies in Health and Well-Being, In Press, 2008.

Contributor Statement of contribution

Julie-Anne Carroll

29th July 2008

Identified a gap in the literature, wrote the research questions, identified a point of departure, designed the methodology (including conceptual approach), collected the data, conducted the analysis, wrote up findings, and wrote the article.

Dr Barbara Adkins

Assisted with the research questions, methodological design and the refining and application of the conceptual framework to the investigation. Made revisions to the article, and assisted with the overall structure of the article and the presentation of analysis and findings.

Associate Professor Elizabeth Parker

Conducted revisions, assisted with structure and the presentation and conducting of analysis and findings, sentence-level-editing and writing corrections.

Dr Marcus Foth

Conducted revisions, assisted with structure and presentation of analysis and findings, sentence-level-editing and writing corrections.

Soad Jamali

Assisted with the sorting of data into NVivo, open and conceptual coding into key categories, editing of article.

Principal Supervisor Confirmation I have sighted email or other correspondence from all Co-authors confirming their certifying authorship.

Dr Barbara Adkins 29th July 2008

Signature Date

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Chapter Seven

Published Paper Three

Title: My Place through My Eyes: A social constructionist approach to

researching the relationships between socioeconomic living contexts and

physical activity.

Authors: Carroll, Julie-Anne, Adkins, Barbara A., Foth, M., Parker

Elizabeth A., Jamali, S.

Published: The International Journal of Qualitative Studies in Health

and Well-Being, IN PRESS, 2008.

7.1 Abstract

Empirical research has shown that household and neighbourhood characteristics are

significantly linked to particular health-behaviour profiles. Specifically, people living

in lower socioeconomic living contexts tend to be associated with less active and

healthy lifestyles. However, what is not yet fully understood is how living contexts

work to produce and sustain common or shared behavioural patterns. To address this

question, we employed Berger and Luckman’s (1966) social constructionist

conceptualisation of context to study a group of residents who had recently moved

from poorer living contexts to a mixed-tenure, inner city, new urban village equipped

with various resources promoting a physically active lifestyle. This framework was

coupled with Charmaz’s (1995; 2006) social constructionist approach to grounded

theory. An analysis of the qualitative data gave rise to the conceptual categories of

‘being flogged up something fierce’, ‘running away, ‘sleeping with one eye open,

‘you’re just fat’, and ‘exercise as a dream’ as the key contextual influences mediating

poor living contexts and low physical activity levels. A core category of ‘identity

management’ was located. The selection of this case and the findings exhibited here

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draw attention to the need for a situated understanding of how particular lifestyles

develop in socioeconomic living contexts. The insights need to be drawn from

‘insider perspectives’ in order to ensure more sensitive and effective interventions in

the future.

7.2 Introduction

Research has established that the socioeconomic position of households and

neighbourhoods is a reliable predictor of a range of health-related behaviours and

outcomes (Ioannides, & Zabel, 2007; Kavanagh, Goller, King, Jolley, Crawford &

Turrell, 2005; McCracken, 2001). However, questions remain about the internal

mechanisms, processes, and practices through which poorer living contexts produce

and sustain less healthy lifestyles than wealthier ones (Macintyre, McKay, &

Ellaway, 2005; Coen, & Ross, 2006; Monden, Van Lenthe, & Mackenbach, 2006;

Cummins, Curtis, Diez-Roux, & Macintyre, 2007; Parkes & Kearns, 2006). While

sophisticated statistical methodologies have been used to establish convincing links

between contexts and health (Diez-Roux, Kiefe, Jacobs, Haan, Jackson, Nieto,

Parton & Schulz, 2000; Hou & Myles, 2005), further qualitative studies are needed

to extend this knowledge to something beyond what statistics alone can capture. The

nature of statistical analyses places limits on the insight that can be gained about the

nature and the direction of the relationships linking poorer living contexts with

poorer health. Thus, it is important to complement the epidemiological evidence base

regarding ‘area-effects’ on health with studies that allow an intensive focus on the

situated relationships between context and practice.

Further to the lack of qualitative studies, there has been an associated lack of the

theoretical development needed to understand and conceptualise the relationships

between context and health-related behaviours. A key article by Frohlich, Potvin,

Chabot, and Corin (2002) makes special note of the lack of a useful

conceptualisation of context for the study of health-related behaviours in urban

neighbourhoods. They make the point that to study the ‘social contextuality of

meaning’, methodologies are required that situate health-related behaviours within

the context of the social relations and transactions or interactions of people’s lives by

tapping their subjective experience within their social location (p. 1402). They go on

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to refer to an article by Poland (1992) to emphasise the point that ‘not only is it a

methodological issue requiring qualitative methods, but it is also a theoretical one in

which the relationship between health-related behaviours, risk, and knowledge can

be analysed in terms of the intersection of structure (norms, codes of conduct and

institutions) and human agency (individual volition, action)’ (p. 1402). In this paper

we make the case that what is needed is a theorisation of living contexts that lends

itself to revealing the internal mechanisms that influence less healthy lifestyles, as

well as qualitative instruments for extracting and analysing the data relevant to

addressing this question. To illuminate, the main aim of the study was to gain

insights into the everyday properties and processes underlying the empirical evidence

depicting an association between lower socioeconomic living contexts and less

physically active lifestyles (Mokdad, Ford, Bowman, Dietz, Vinicor, Bales & Marks,

2003; Lindstrom, Hanson, & Ostergren, 2001). Importantly, we sought to unearth the

key occurrences within poorer contexts that result in a particular construction or

treatment of it there, and conceptualise these within a theoretical paradigm to both

guide, and be tested in, future research.

In accordance with this aim, we adopted a theorisation of ‘contexts’ from Berger and

Luckman (1966) who understand it as a reflexive relationship between people’s

backgrounds and dispositions on the one hand, and the milieu and environments they

inhabit on the other. Second, we describe the coupling of this conceptual and

philosophical shift with the social constructionist approach to grounded theory as

proposed and practised by Charmaz (2006) and others (Hjalmarson, Strandmark &

Klassbo, 2007; Lesch & Kruger, 2005). Third, we outline data collection and analysis

according to the principles that are typical of this qualitative approach. Fourth, we

discuss the identification of the key processes and social interactions within

participants’ housing and neighbourhood contexts which have affected their

propensity to lead active and healthy lifestyles and develop these into conceptual

categories. Finally, we identify a core category, and implications of these findings for

future interventions.

7.3 Re-Thinking Context: A Theoretical Point of Departure

This paper extends work oriented to capturing the relationship between living

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contexts and health practices by applying Berger and Luckman’s philosophical

framework devised in their 1966 work The Social Construction of Reality to this

empirical problem. Their conceptual framework emphasises the roles of agency,

context, and subjectivity, in how particular human behavioural patterns arise over a

period of time in particular social settings. Berger and Luckman offer a contextual,

rather than a universal framework for thinking about and analysing patterns in

human behaviour. In doing this, they illuminate contexts as powerful proponents of

human behaviour, and theorise how norms, routines, and patterns of practice develop

within them. For this reason, we propose that their work is directly suited to studying

and analysing how living contexts work to give rise to particular behavioural and

lifestyle profiles.

In Berger and Luckman’s 1966 work The Social Construction of Reality, they

proposed that people participate in social processes within a particular context over

time to decide what things mean there, and what ‘the done thing’ is amongst its

occupants. They referred to this normalisation of procedures and responses over time

as habituation, and noted that over time, these habits become institutionalised in that

context and taken for granted as ‘normal behaviour’. They further purported that the

points of reference people use for assessing how to respond to something or

somewhere and their interpretation of the behaviour of others there, depends on their

personal and shared histories and experiences. They referred to this notion as

historicity. The study applied the concepts of habituation, institutionalisation, and

historicity to the problem of researching the responses of a particular socioeconomic

group to a new urban environment, with particular attention paid to the amount of

physical activity they became involved in. In line with this social constructionist

perspective, we sought a subjective account of the world where physical activity has

a low-priority status. A temporal account of poorer social contexts, and the dialectical

tensions between human agency and social forces within them was undertaken.

7.4 Methodological Design

Due to the initiative in this study which sought to build the theory around the

question of how physical activity is socially constructed within poorer living

environments, Charmaz’s constructivist approach to grounded theory seemed to be

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most fitting with this particular conceptual approach, or ‘world view’. This is

because constructivist grounded theory allows for a more flexible methodological

approach (Mills, Bonner, Francis, 2006) and brings questions to the research process

- with consequences for method and analysis, - from the same school of thought as

the Berger and Luckman philosophy. However, it must be noted that Charmaz did not

specifically advocate using the Berger and Luckman framework, but takes a broader

constructivist approach to grounded theory, in which the subjectivity inherent within

analysis and theoretical development is acknowledged, and reflection on the role of

the researcher in the production of data emphasised. Charmaz has taken a divergent,

and yet increasingly accepted means of employing a grounded theory approach,

which she refers to as a social constructionist approach to grounded theory, and

emphasises the need for flexible guidelines, ‘not methodological rules, recipes and

requirements’ (p. 20).

Charmaz (2006) reminds that taking a social constructionist approach to research

means acknowledging that subjectivity applies also to the researchers, who are only

able to interpret interpretations, and construct constructions provided by the

participants. She argues that researchers bring their own histories, theories, values

and ideas to the process of generating theory from data. Charmaz herself says ‘Data

do not provide a window on reality. Rather, the ‘discovered’ reality arises from the

interactive processes and its temporal, cultural, and structural contexts’ (Charmaz,

2000, p. 524) Thus, consideration must be given to both the researchers’ and

participants’ backgrounds when data is being collected, selected, and analysed. A

reflexive, interpretive approach to the data must be taken if there is an ongoing

understanding of it being socially produced between the researcher and the

participant. Further, she emphasises the need to keep returning to the study site to

build concepts via the process of theoretical sampling, and to constantly compare and

contrast data between individual cases, and to reflect on the relationship between

researchers and participants as the theory is being developed.

While this study lies on the constructivist end of the Glaser-to-Charmaz approach to

grounded theory (Hallberg, 2006), the unique methodological approach of this study

is that it is guided by the specific version of social constructionism introduced by

Berger and Luckman (1966) to build new theory around the relationships between

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poor living places and poor health. It acknowledges the iterative, and relatively

subjective, process of theory building, but is primarily concerned with gaining

insights into the perspectives of people who inhabit a poorer living context to tell us

what physical activity – as a concept and practice – means there, and how this

meaning was socially constructed over time. Importantly, it aims to use a social

constructionist lens to build a theory with the capacity to hold explanatory power in

relation to what has been described by McIntyre et al (2002) as ‘a black box of

mysterious influences on health’ (p. 125). Other studies on health-behaviours using

Charmaz’s approach to grounded theory were located (Hjalmarson, Strandmark &

Klassbo, 2007; Lesch & Kruger, 2005), however these authors made no reference to

the conceptual framework of Berger and Luckman as a means of guiding the

selection, collection or analysis of the data.

7.5 Location of the Study: The Kelvin Grove Urban Village (KGUV)

This study investigated the residential population living within the four blocks of

‘affordable housing’ apartments within the Kelvin Grove Urban Village (KGUV;

www.kgurbanvillage. com.au). KGUV is an AU-$800 million mixed-tenure, medium

density, inner urban, master planned community based on the design principles of

‘new urbanism’ located approximately two kilometres from the Central Business

District (CBD) of Brisbane, Australia. It sits on approximately sixteen hectares and

contains around 2000 residential properties from both the public and private sectors.

KGUV was designed according to the principles of new urbanism, thus promoting

pedestrian mobility and activity through the provision of wide-pathways, bikeways,

parks, and green recreational spaces. The KGUV provided a microcosm that

generates aspects of human behaviour that are of interest in an investigation

exploring the dynamics between lower socioeconomic living contexts and the

propensity to be physically active. The case-study of KGUV enabled an

identification of the key relationships at stake in the adaptation of affordable housing

residents to a ‘healthy environment’. Thus, the grounded theory techniques were

applied within the KGUV context, because this particular neighbourhood site was

seen to be theoretically representative of a development that encapsulated the

relationships that were the focus of this study.

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7.6 Study Participants

Only the residents housed in the affordable housing – or government supported –

housing options within the Village participated in this study. Entry into this housing

option is based on income-criteria, with only low-income singles, families, and

pensioners qualifying for entry. They were all from disadvantaged backgrounds, on

low incomes, and clustered together in a lower socioeconomic residential context

within the broader context of the Village, thus providing an opportunity to study this

group of people, their low-income living context, and their perceptions and practices

in relation to physical activity.

While a relatively heterogeneous mix of people within the affordable housing option

at KGUV was recruited for the initial phase of data collection, the following two

processes of participant recruitment were refined to seek out people who were most

disadvantaged and the poorest in the group, in order to ascertain insight to

experiences in their lives that prevented them from pursuing physical activity.

Further, Charmaz (2006) refers to theoretical sampling more as a strategy than a

process, and for our purposes, it worked well to not only develop categories that

emerged in the first phase of data collection, but to fill in gaps that became evident in

early phases of collection and analysis. A table summarising the participants and data

collection phases is depicted below:

Table 7.1 Summary of Participants and Data Collection Phases

Participant s

Data Collection

16 Blogging: An online mechanism known as a ‘blog’ was

appropriated as a means where residents wrote answers,

stories, and opinions about KGUV in relation to healthy

lifestyles. There were 214 responses posted on the blog in

total. Blog address:

http://theeffectsofanewurbancontextonhealth.blogspot.com

/

8 Face-to-Face Interviews: 1-2 hours in-depth interviews

were conducted with BHC residents in their apartments

about how their living contexts affect their lifestyles and

health.

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6 Community Focus Group: Informal, opportunistic

interviewing and observation notes were taken from BBQ in

local park organized by researchers for BHC residents.

7.7 The Researchers

The researchers were all of a higher socioeconomic background than the participants

in the study. The potential barriers created by the social and economic differences

between the researcher and participants needs to be acknowledged and addressed in

the research process (Charmaz, 2006; Lesch & Kruger, 2005). However, the

background experience in counselling and home-visiting in the area of housing

services by the first author who conducted all the interviews helped develop a

comfortable relationship with the participants. By sharing and swapping personal

stories and comparative experiences in a few visits prior to each interview, trust was

established and a sense of safety, and the ability to be open in conversation was

established. Reflective notes were written on the constant divergence between the

researcher’s focus on physical activity, and the focus brought to the interviews by the

participants on other aspects of their lives that were salient to them in shaping their

current attitudes and beliefs in relation to health.

7.8 Entry into the Field

The first round of participants were recruited via a survey, which was distributed in

an earlier phase of this research project. Respondents returned their surveys, and

agreed to participate in further research. Thus, this initial group was relatively

accessible and enthusiastic to be involved with further study. However, the

participants in phases two and three were the ‘hard-to-reach’ group via whom we

sought to tap into the processes giving rise to the evidence base depicting low

activity levels amongst poorer populations. Invitations were posted in their

mailboxes offering AU-$30 per interview, and AU-$10 for participation in the focus

group. The affordable housing residents responded to this offer, primarily by

contacting the researchers from the public telephones in the Village. Participants in

stages two and three were difficult to interview in the first instance as they were

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initially slightly mistrusting of the researcher; few had home telephones connected;

and were often involved in court cases and social services, which made their daily

schedules unpredictable. However, over time a good rapport with the residents was

established, and they also benefited by receiving food parcels, children’s clothing and

referral to local welfare services.

7.9 Ethical Clearance

An ethics application was approved by Queensland University of Technology (QUT)

to conduct the study. Data was collected over a six month period, including the

online and face-to-face phases.

7.10 Data Sources

7.10.1 Online Blog Entries

Sixteen residents in the affordable housing option at KGUV who had agreed to

participate in further research following the completion of the survey were selected

for the online qualitative data collection phase through a web log (‘blog’). A blog is

an online public forum traditionally used by a single author for writing a diary, and is

often accompanied by photographic accounts to tell stories and share interests and

viewpoints with others (Bachnik et al., 2005, p. 1). We chose this medium as it offers

participants the opportunity to write their stories, opinions, and answers to the

research questions in an online forum where they are able to view the anonymous

input of other members of the community, and from where we could study their

answers as a collective. Photographs of the neighbourhood were posted, as well as

questions for participants to answer following these key themes:

• Self, Health and Space: What Moves You?

• Social and Psychological Aspects of Physical Activity

• Depth of Engagement with Neighbourhood Resources for Physical Activity

• Moving into a New Urban Environment.

• The Effects of a New Urban Context on Health

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The following insertion is a sample from the blog to demonstrate its appearance on

screen:

Social and Psychological Aspects of Physical Activity

This is the last post for questions about the Kelvin Grove Urban Village and the

amount of physical activity you do. Please write as much as you can...

1. Would you say that, in a general sense, you are aware of how much physical

activity or exercise you achieve during the day, and do you worry about it, or try to

increase the amount? Do you ever consider taking more exercise, or are you content

with how active you are?

2. If you see an ad on the TV telling people to do more physical activity, or hear a

health promotion message about it on the radio does this make you want to become

fitter? Do you ever act on these messages, or do you forget about them soon after

hearing them?

3. What types of thoughts do you have that would make you want to increase your

physical activity levels? What kinds of things play on your mind or which life events

might suddenly make you motivated to exercise?

4. If you see people out and about exercising, does this inspire you to become more

active? Do you compare yourself to others' bodyweights in and around the area that

you live? How does this make you feel?

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5. How interested would you be in being part of a social group that organised group

walks, or bicycle rides, or games in the local park? Why/why not? And would you

like to hear about such events online, by mobile/home phone, texting, or pamphlet in

the mailbox?

posted by Julie-Anne @ 8:32 PM 73 comments

A total of 214 comments were made by participants on the blog.

All data can be viewed at the blog site:

http://theeffectsofanewurbancontextonhealth.blogspot.com/

7.10.2 Interviews

One to two hour semi-structured, in-depth interviews with eight additional

participants allowed an exploration of previous and current households and

neighbourhoods as they related to the health and physical activity levels of

participants. Questions were open-ended, and further questioning encouraged

participants to talk at length about their previous experiences in households and

neighbourhoods. Participants were left to emphasise what they felt was important to

them, and raised topics, contextual characteristics, and past events that they recalled

as being salient in terms of how it affected their propensity to be physically active.

Notes and memos were written up both during and immediately after the interviews

were conducted and recorded.

7.10.3 Outdoor Community Focus Group

A further six affordable housing residents participated in an outdoor focus group held

in one of the recreational areas in the Village. In addition to the grocery vouchers,

they were provided with a lunch during this interview phase. In this session the

interviewer focussed on the more notable similarities and differences that had

emerged in the initial interviews regarding the nature of the urban village

environment for pursuing physically active lifestyles, and directed the discussion

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around clarifying these points. This process of theoretical sampling allowed for the

saturation of the emerging conceptual categories. The participants spent some time

negotiating their perceptions of the Village, their experiences in previous

neighbourhoods, and their propensity to physical exercise, as a group.

7.11 Analysis: A Social Constructionist Approach

According to Charmaz (2006), a core benefit of the social constructionist grounded

theory approach is gaining an insider perspective of the meanings behind the patterns

of behaviour that can be observed in a particular context. This approach allows a

focus on time, culture, and context; challenging concepts to examine using

traditional, positivist methods (Hallberg, 2006). In an analytical sense, we adhered to

the Berger and Luckman (1966) approach to studying human practice in context by

noting the patterns of practice there, and then exploring the social influences

involved in the construction of these over time. We explored the historicity of a

particular social group to unearth the habituation of their conceptual relationship

with physical activity as it evolved over time. We analysed the data for clues as to

how this important health-related behaviour came to be institutionalised within their

living contexts as a negative or low priority construct. Thus, concepts were built out

of the stories told by the participants about their childhoods, their teenage years, their

experiences in previous poor neighbourhoods, and their perceptions and practices

around physical activity in their current neighbourhoods at this point in their lives.

The data from the blog and the transcripts from the interviews and focus group were

transferred into NVivo software for coding and analysis. An inductive analysis fitting

with the constructionist approach that emphasises the importance of respondents’

narratives of their experiences was used (Charmaz, 2006). In line with the emphasis

Charmaz (1995) makes to focus on processes, actions and consequences we

conducted a line-by-line coding procedure which provided subjective, temporal

accounts of how physical activity as a concept was shaped and reinforced over time

amongst these participants. The phrases and narratives they provided revealed how

the different social and living contexts through which they travelled had ensured

harsh and hostile barriers to feeling confident about both their body image and their

ability to become physically active. We also used focussed coding, which is a more

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directive means of locating emerging themes and codes in the data, to identify the

key processes mediating the people, place and health relationship in this case.

Charmaz (2006) uses this focussed approach to develop the conceptual categories,

which, according to Moghaddam (2006) become the ‘building blocks’ for the

theoretical development later in the process. This focussed, or conceptual coding,

involves an abstraction of the data as it has been collected, organised and analysed

into sets of shared phenomena underpinning the narratives (Charmaz, 2000). These

analytic codes or categories allow us to develop a conceptualisation of the data as it

is collected, recorded, and analysed. We developed a number of conceptual codes

that appeared to underpin the collective experiences representing the evolution of the

attitudes, beliefs and behaviours in relation to physical activity amongst that

residential group.

This was followed by an exploration of how these conceptual categories relate to one

another within the context of the group’s experiences over time. In other words,

while we could gather together key shared experiences and phenomena – such as

abuse, neglect, early homelessness, or feeling afraid in one’s neighbourhood – we

then had to explore their connectedness to one another in order to develop the theory.

In other words, how do these concepts tie together in a meaningful way and what is

the core category mediating these subsets? To do this, we developed sub-categories,

for example ‘types of abuse’, and ‘different experiences and contexts of abuse’ that

tied to this important category. The next important category of ‘leaving home early

and homelessness’ was analysed as relating to the previous category and a strategy,

or consequence of the initial conditions of early childhood abuse and neglect. The

key categories that typified their experiences growing up poor and how these related

to one another in an almost catalytic sense were revealed in this part of the analysis.

Finally, a core category of identity management was located as the constant framing

and reframing of self against others in poor contexts; the striving of participants to

mould their identities as more palatable or less stigmatised than those around them,

with strategies to do this often failing and resulting in even more unhealthy and harsh

living situations. Theoretical coding was used to bring together the primary

conceptual categories as they relate to the core category as a means of building

theory and insight about how contexts affect physical activity levels. This process

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resulted in the production of a model for framing thinking and approaches in future

research.

In addition to the analysis conducted on the data from the blog and the interviews

memos and observation notes were made to aid a reflection on the relationship

between the goals of the research and the things that mattered most to participants in

their living context. A consistent divergence from the topic of physical activity to

‘what matters to me here and now’ was noted, and the events and reactions of

salience to participants were categorised. Notes on the participants, such as smoking

habits, weight, age, family dynamics, and the nature and contents of the households

were also made.

7.12 Findings: Key Conceptual Categories Mediating Poor Contexts

and Low Physical Activity Levels

A model illustrating the results of the data analysis, the emergent key conceptual

categories described above, and the core category of identity management are

provided in Figure 7.1 below. Figure 1 demonstrates the key categories that

emerged as typical of experiences within poor contexts over the life-course that

generate barriers to physical activity, as mediated by the core category of ongoing

identity management in this process. It depicts the key conceptual categories that

typified the experiences of the participants in this study from their childhood living

environments to their current circumstances and experiences. The model indicates

the catalytic chain of events that characterised the stories of all participants, and even

if the abuse or neglect came in various forms, it was an ever-present trait of their

childhood experiences. Their descriptions of their previous living contexts go some

way to explaining their current perceptions, constructions and practices of physical

activity and their experience of their body image in public spaces. The data analysis

revealed the role of ‘context’ – be it defined or measured socially, economically, or

geographically – is a powerful factor influencing people’s sense of identity and

health-related practices such as physical activity. Their sense of self, place, and

health appeared to be inextricably linked in the data, pointing to the need to intervene

on a broad front to improve self-worth and health in these contexts.

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Figure 7.1 Conceptual categories and core category emerging from a

social constructionist grounded theory study into the relationships

between poor living contexts and lower physical activity levels

The following quotes from the data demonstrate how the coding process developed,

and how the conceptual categories formed from the stories told by participants about

their previous living contexts, and their current attitudes and norms in relation to

active and healthy living in their new neighbourhood environment.

7.12.1 On being ‘Flogged up Something Fierce’: Conditions in

Childhood as Catalysts for Patterns in Later Life

An important historical theme that emerged in the data was how participants were

treated by others over the various social and living contexts they traversed

throughout their lives. Their sense of ‘self’ had been greatly damaged in the first

instance by spending their formative years in violent, neglectful, and psychologically

and emotionally damaging places. As Goulding (1999) suggests, it is important to

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ask of early scenarios that emerge in the data ‘what is happening in this data? What is

the basic socio-psychological problem?’ Each contextual scenario that participants

described revealed a process wherein their sense of self and identity was being

damaged by the various dimensions and properties of poverty. Further, their strategic

responses for managing their circumstances and their sense of self meant that they

were less able to focus on a health-related behaviour such as physical activity as a

priority. For example, we began the interviews by asking participants about the

extent to which being physical activity had been a priority in their childhood living

environments, and the answers they provided all went similarly along the following

tracks:

When you were growing up, how important was a healthy lifestyle in the family you grew up in?

Were your parents or carers encouraging you to be fit and healthy or was it not really talked about

that much.

Not really talked about. We used to bring ourselves up. My mother was a real, you know. She wasn’t a

very nice person. We brung ourselves up and looked out for each other.

So you had a lot of other things to worry about, besides health?

Yeah, well my mum used to get flogged up somethin’ fierce, so...

Can you tell me what you mean by that?

She used to get, what’s it called? Like, what do they call it on the TV? Like, domestic violence.

Oh, your mum was beaten up? By your dad?

Yeah, by my stepfathers. Not my real father, cause I didn’t know who my real father was until I was 18.

I’ve never met my father.

The relatively jarring re-orienting of the answers by participants that describe

abusive and harsh childhood households from questions that inquired about health

and physical activity, shed light on the powerful contextual influences in these early

years that directed a priority from healthy living to sheer survival. The pictures

painted for us by the participants of their roles as small, frightened child-figures in

places that were meant to be safe, but were in fact filled with fear, darkness, and

dread, go some way to answering questions about how poor contexts block pathways

to physically active and healthy lifestyles. These rich narratives tell us that sexual,

emotional, and physical abuse were powerful forces shaping their sense of self as

children, and the extent to which they were able to feel confident about their

identities and their bodies, as another story reveals:

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When you were growing up, how important was it in the family you came from, or the household

you grew up in to be healthy? Did your parents or carers emphasise this as a goal, or was it not so

important?

Um, I as a, well, growing up in my household, well there were lots of problems we faced on a daily

basis.

What kinds of problems?

My stepfather abused us, um, my mum ended up staying with him for twelve years, which we in the

end, just you know, got to the point where we were sick of it, cause we had enough. And my mum

ended up carrying on a few of his traits, and me and mum clashed a lot, so…

Right…

I did have a weight problem when I was young, but I did something about it, I went and joined Jenny

Craig and you know, and started losing weight, and you know, I dealt with it myself, because my mum

used to call me horrible names about being overweight and that didn’t help me.

Thus we can see in this example, how the combination of abuse, household stress,

and parental bullying held great implications for her perceptions of her body, her

sense of self, and her general well-being.

The pertinent properties of lower socioeconomic contexts were identified in this

study as abuse, neglect, alcoholism, violence, and parental bullying - often about

participants’ weight or body images. Thus, it became evident that poverty was as

much a property of these contexts as poor health practices were, with the

psychosocial processes such as abuse and neglect being the powerful mediating these

types of tangible ‘outcomes’. That is, the outcomes which are so often tended to in

quantitative studies are merely the identifiable results of violent processes that

diminish participants’ sense of self, and leave them with the ongoing psychological

battle of trying to improve this condition or perception in harsh and hostile contexts

that constantly threaten their ability to feel positive about who they are and what they

are capable of achieving. Abusive and neglectful early years meant that participants’

sense of self and personhood in the world remained in a constant state of risk, with

the chain-reaction effect that ensured poverty, low physical activity levels, and poor

sense of self ensued for the most part of the rest of their lives.

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7.12.2 ‘Running Away: A Strategy for Surviving and Starting Again

in Hostile Environments

In the descriptions of scenes in which abuse and neglect were the norm, participants

struggled to find ways out of the conflict via their own resources. They all reported

leaving home early, between the ages of eight and fourteen. This participant gave a

vivid account of the conditions of her childhood, and the strategies she employed to

deal with that living context:

Cause with alcoholism, I got molested by an uncle and I felt the best thing to do was to tell my

mother? And I remember the guy saying, you can tell you and she’s not going to believe you, and I told

my mum and she would not believe me and I was really just hurt in the heart. I ran away. That was it,

you know. She didn’t believe me. Although before she died, before she died she knew that I was telling

her the truth.

How old were you when this happened?

Eight years old.

Eight? And you ran away?

Eight. And I kept on running away and running away.

All participants reported running away from home as a means of escaping contexts

that were not a feasible option for them to continue inhabiting:

I ended up going into a homeless shelter…

The consequences of the strategy of escape or flight from these situations led in all of

the cases to starting a ‘new family of their own during their teen years, thus

cementing their difficulties in relation to poverty due to limited options to develop

further education, working skills or an earning capacity.

I didn’t live at home, but I ended up falling pregnant. I was a runner.

So where did you live, when you were 13, but still at school, and being a runner?

I lived with Tom. They let me run for a couple more months, but then I ended up getting bigger and

they said it would be too stressful

In year 9?

Yeah, going into Year 10. I ended up getting out of school in year 10

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Further, many turned to drugs to cope during these teenage years:

…then I ended up in rehab.

So you got into some drug use and then rehabilitate?.

Yup and haven’t been near it since I was sixteen. Nearly ten years.

7.12.3 ‘Sleeping with One Eye Open’: Living in Poor Neighbourhood

Contexts as Young Adults with Children

Participants went on to describe living in and moving through neighbourhoods that

were poor and unsafe. When we asked them to describe their relationship with these

places, what they meant to them, and how they influenced their activity levels,

participants reported high levels of danger and fear.

Before I was living in Fortitude Valley, and it was very unsafe there.

OK, and what were the dangers?

People robbing you of money, and stalking you.

And

Everythink. You can’t even walk out your backdoor…

For fear of?

For fear of the kids, they can’t ride their pushbikes ‘cause they will get bashed and robbed for ‘em. If

you’re out, after a certain time you will get rolled for shoes, your money, your wallet, different things

like that. It was just… a lot of the areas aren’t safe no more.

They describe living in fear due to the presence of a range of factors, such as

discarded intravenous drug needles and crime, but also because of the relational

dynamics that centre round intra and inter-household conflict and violence. For

example:

I always had to sleep with one eye open, you know?

Another participant told many stories of crises occurring amongst neighbours, with

police and ambulance call-outs:

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But when the neighbours at night n that are having big arguments, and a lot of the time they come and

there’s the police or the ambulance and you can see the lights when the ambulance comes, and at

times like that, I feel like I am in Once Were Warriors or something like that…

Importantly, one participant described the importance for her of needing to find a

way out of her associations with poverty, danger, fear, and stigma. Her disapproval of

being placed in government supported housing with people in similar circumstances

is clear here:

They think ‘Oh you live at that community housing place’.

And do you think it reflects on you?

Oh it does. Yeah. I think well they think I’m a drug addict just like everyone else is around here. And I

feel like ‘I’m not one of them!’ And I don’t want to be categorized into that.

And another stated:

…but you haven’t moved on, it’s still housing commission.

As a result of the nature of these living environments, belief systems, attitudes, and

norms developed around the importance of keeping to oneself and staying indoors to

manage risks and stay safe – physically and emotionally. As one participant

described her housing history:

It’s a roof over your head and you keep to yourself

While another explained her reasons for not wanting to socialise with neighbours:

That’s just a personal thing for myself because I’ve been involved and been friends with neighbours

and it doesn’t turn out a good thing.

Oh, OK?

For myself, it always turns out it always seems to be a bad thing, and I dunno whether it’s the people I

meet or whether it’s just myself, who knows? (Laughs)

As a strategy of everyday risk-management in these contexts, participants expressed

a preference for staying indoors. As one participant explained, she is not even

comfortable being seen outside of her apartment:

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I’m not out here much. I very rarely venture out onto the balcony. Susie [her daughter] will come out

here for fresh air to have her cigarettes. When you’re out here, who knows who’s watching you and

from where.

This relationship between sense of place and sense of self-being reflected in where

you live, what is there, who is there, and what goes on there appeared to be salient in

the data, with great implications for whether or not they are willing to leave their

houses and feel safe, positive, or confident about engaging with the resources in the

neighbourhood in ways that would ultimately improve their health.

7.12.4 ‘You’re Just Fat’: Other Intervening Social Interactions and

Influences on Body Image and Physical Activity

As is evident in this data, the contextual influences that shaped their relationship to

managing their weight and being physically active are complex, and are comprised of

a number of situational dynamics and environmental characteristics, which over

time, have shaped their perception, or conceptual relationship with this particular

health-related behaviour. The data reveals a psychosocial relationship between

growing up in poor environments, experiencing difficulty with body weight and

image, and a self-consciousness and general fear of others that then prohibits a

propensity to be more physically active. Our data shows a connection between the

characteristics and traits of poor households and neighbourhoods, such as violence,

neglect, abuse and other dangers, and being less active, more over-weight, and

consequently less likely to feel confident to engage in physical activity. One

participant described the kinds of social challenges that arise from being overweight

in public:

The thing that hit me the most in terms of my weight was when I went to the shopping centre just a

couple of weeks ago, and I was putting on makeup because I was going for interviews for a job and I

was with my girlfriend at the time and I said to her ‘Quick!’ cause she loves to try on all the make-up

all the time, and I said ‘Quick! I gotta go to the toilet!’ and a lady turns around and says ‘Well that’s

what happens when you are expecting!’ And I was like ‘I’m not pregnant.’ And it just hit me like a ton

of bricks, so I felt so horrible.

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Another participant described her experience when she went to visit a doctor about

trying to manage her weight.

She [doctor] just turned around to me and said ‘Lay up on the bed’ and she grabbed my stomach and

said ‘You’re just fat, you need to lose some weight, can you do that?’ It shouldn’t be like that.

These kinds of social interactions and experiences deterred this group from wanting

to be out in public too often, or from seeking assistance from health professionals to

better manage their weight. There are clearly power differentials apparent in this last

example that highlights the relationships between social status and feelings about

body image, weight and exercise. This data also sheds light on potential reasons

behind statistically proven weight differences between higher and lower

socioeconomic demographics.

7.12.5 ‘Exercise as a Dream’: The consequences of life-course

contextual processes on the negative social construction of physical

activity within this group.

Interestingly, the participants expressed the salience of the relationship between self

or body-image and their reluctance to engage publicly in physical activity for health

and fitness reasons. They felt that the people who were able to do this must have had

access to other means to looking as fit as they do, and that the participants were

outside the realm of these recreational pursuits. Consider the following extracts:

If I see other people exercise I feel bad, as they are fitter and better looking than I am and I feel if

people see me exercising I will just look fat and stupid, so it quietly motivates me to better myself but

makes me feel bad…

Or:

I think, I would love to go for a jog or a run, but I dunno… I think when I look at them [other people

running] that they’ve probably had liposuction… (laughs).

This self-consciousness seems to be contributing to a sense of ‘us’ and ‘them’ in

terms of their own physical appearance or ability versus belonging to the social

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group that constitutes the ‘fit type’.

Yeah well we’re really not a fit type like other people you see running around here and that (laughs).

While another participant has considered the potential of having community games

organised in the local parks, she did not feel that she would automatically qualify for

inclusion, as is expressed here:

Games in the park would be great. But I wonder if they would invite me…

However, it is entirely not clear who the ‘they’ in her sentence is, aside from them

having some kind of authority over the resources in relation to her requiring an

invitation to participate. Further research is needed to unpack the relationship

between the socioeconomic profile of co-located residents and their relative

willingness or confidence to engage in the local neighbourhood to create more active

lifestyles.

Primarily, participants expressed their sense of having a poor body image, or feeling

overweight as a phenomenon that was incompatible with what they perceived

physical activity to be about or associated with, as this participant explained:

My weight is a huge factor in my not wanting to exercise

There seemed to be a relationship between looking and feeling good, and being

prepared to be out and about and active, as is revealed to some extent here:

When I go into the bathroom now I don’t even want to put make-up on because I just don’t see the

point. I only go out if I have to go out.

The group generally felt that exercise was for people who had ideal body weights, or

who looked like models and other celebrities, as this participant explained:

So what kinds of images or people come to mind when you think of physical activity?

As soon as I think of exercise, I think of models.

So for you it’s mainly about body image and appearance?

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I think that that’s the time we live in now, the bigger you are, the more down you get put.

Further, participants expressed that the pursuit of physical activity for health and

fitness reasons was out of bounds for most of them, who did not perceive it as a

realistic or accessible goal in a ‘real life’ sense:

No, yeah, I would love to be fit. I walk past gyms and see fit people, and it really makes me think of

going in, joining in…

Ah yeah, really?

But as soon as I walk past it, I think it’s just a dream.

In light of their negative [dis]associations with physical activity, body image and

weight-control, we explored their relationship with media sources and health

promotion on the topic of physical activity. There was a strong agreement amongst

participants that neither commercial nor government sources of information or

promotion of physical activity were to be trusted. As these participants stated:

• No. T.V. does not sell me on anything. I think there is too much said about diets and exercise

• I am not usually prone to just accept because TV or papers tell me this or that will benefit me

health wise or physically

• I never act on advertising and am not influenced by other people's comments regarding

becoming fitter.

• Jenny Craig, or the ads where they are selling all these gym products ‘You can look like this,

just 20 minutes three times a day’ and that is just like ‘Yeah right!’

Participants did, however, say that they enjoyed watching the show “Australia’s

Biggest Loser” as they could relate to the struggles of the people in the show to

combat their obesity, and felt that these were just ordinary people like them, with

similar weight issues and inhibitions regarding physical activity. They especially

liked the attention given to participants on the show in terms of advice on their

everyday diets, and expressed a desire for help from GPs to better manage their

weight, as this participant explained:

Yeah I don’t want them to sit there and tell me you need to eat this on this day, and this on this day, but

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if they could just write down a list of what the most healthiest foods are, I could make my own list.

The data unpacked a negative construction of physical activity in this context, and

found that it was a concept that did not make them feel positive about themselves,

and for which there were currently few avenues or trusted sources for seeking

assistance for changing its awkward position in their lives. The stories told here

describe links between structural features of poor environments, a decreased

propensity to be physically active, an increased propensity to be overweight, and a

negative social construction around the concept and promotion of physical activity

by health professionals.

7.13 Reflections on Methodological Limitations

Theoretically, this case study allows us to propose that what we find out about this

scenario may be relevant to other similar settings and urban environments. The

knowledge produced via the investigation of this case study will be used for future

testing to see how widely the theories or key concepts are able to be applied. The

findings are valid within the case study, and cannot be generalised to other urban

environments and contexts. However, it does allow a case for producing knowledge

for testing in other populations and areas.

7.14 Discussion and Conclusion

The aim of this study was to begin to unearth the properties and processes within

poorer living contexts that give rise to less active and healthy lifestyles. Thus, the

qualitative approach taken here allowed us to open up a microcosm of urban life to

examine what goes on in these poorer contexts – both past and present – to equip

socioeconomic contexts with powers to predict lifestyles and health, and in

particular, physical activity. In the online and face-to-face stories told by the

participants, these contextual factors were revealed as the social properties of poverty

that were most harmful to participants’ sense of self and their chance of survival – let

alone good health, and which provoked particular reactions to try and counteract the

hostile aspects of these environments. As seen in the data, the ironic and invariable

consequences of these various strategies resulted in worsening circumstances for the

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participants in a type of downward spiral effect. For example, child abuse leading to

homelessness, leading to drug abuse and dependence, early pregnancies, and ongoing

poverty and so on.

Participants had generally shared similar contextual experiences in relation to

difficult and hostile physical and social experiences which formulated identities

around being fat, unfit, and separate from people who had the luxury of looking good

and being able to exercise in public. There are qualities attached to harsh

socioeconomic environments that affect children from a young age in relation to their

sense of place, their sense of self, and their identities in relation to health and healthy

living. Aside from suffering from a poor body image and a ‘fat’ identity, the kinds of

social interactions within these contexts triggered an interesting psychosocial and

behavioural response in participants. The high levels of neighbourhood conflict in

poorer areas created a tendency to ‘stay indoors and keep to yourself’; these kinds of

strategies of-course being counterproductive to staying fit and active and maintaining

a healthy body weight. This essentially introverted response to the context had two

key underlying motivations: firstly, physical protection, and secondly, identity

protection.

What appeared paramount to participants in these contexts was defining ‘us’ against

‘them’ no matter how similar their circumstances were to that of their neighbours.

This managing of identity in light of their poor individual circumstances within the

broader context of an equally poor and disadvantaged context was a crucial part of

their every day psychological survival there. The demarcation participants constantly

made between themselves and the other occupants of poorer living environments

shed light on how important it was to them to appear to have ‘moved on or up’ and to

somehow have shed the baggage of having grown up with and lived through similar

hardships as those around them. Poorer contexts appear to act as powerful and

unwanted mirrors of their pasts, their present and ongoing struggle with poverty, and

their fear of a future wherein things do not improve, or perhaps get worse. It appears

that poor ‘composition’ (individual measures of socioeconomic position) is

negatively compounded by poorer ‘contexts’ (group measures of socioeconomic

position), the latter of which acts as some kind of psychological maze of mirrors

from which individuals feel unlikely to escape or move on from into environments

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that generate stronger, more positive, and ultimately healthier identities. Future

studies need to consider socioeconomic position and contexts – however they are

‘measured’ – as meaningful social properties and environments in which self is

constructed and health is affected in a cyclic and reinforcing manner.

For our purposes, the Berger and Luckman premise laid the groundwork for

investigating the social processes and dynamics via which the ‘treatment’ of physical

activity by a particular group is habituated and institutionalised in those contexts

over time. It brought into question what physical activity as a concept or practice

means in that setting, if anything, and why. The Berger and Luckman framework

navigated a focus onto the context itself in order to try and understand what goes on

there, and what happens to physical activity there. For example, whereas as health

researchers and practitioners hold a behaviour, such as physical activity, high on their

list of goals and priorities, and have a fervent interest in reducing the obesity

epidemic, this is not necessarily the case in lower socioeconomic living

environments. Nor does the simple provision of health-related resources for people

living in poor contexts mean that they will immediately become more physically

active, or interpret and engage with those resources in ways that improve their health.

A linear relationship between access and use cannot be assumed. Researchers and

practitioners need to understand where ‘health’ is in poorer living contexts – and the

processes by which it got there – in order to create more informed and insightful

intervention responses.

The unearthing of the core category of identity in this study names a central

psychosocial phenomenon mediating the relationships between people, place, and

health. Identity is affected in an iterative and ongoing sense wherein people’s sense

of self is moulded and compounded by where they live, who they live with, and how

they perceive the composition of this context or environment. This development of

self-in-place-in-society affects how people view themselves, how confident they are

about their bodies, and their use or exhibition of their bodies in public space. Their

consequent health-related behaviours and practices then feed back into their sense of

identity, with the individual developing and living at the core of the people, place and

health dynamic.

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In a substantive sense, this data revealed that highly sensitive programs are needed

for people who have experienced poor or hostile living contexts, and who have

negative body images and associations with exercise. Affordable spaces that are

socially, psychologically, and physically safe for them to become active within and

achieve a greater sense of both health and self are needed. In an empirical sense, the

research conducted here provides contextual depth or ‘background information’ to

the evidence established in social epidemiology that notes that people from lower

socioeconomic backgrounds are more likely to be overweight than their wealthier

counterparts (Mokdad, Ford, Bowman, Dietz, Vinicor, Bales & Marks, 2003), are

less likely to engage in recommended physical activity levels (Lindstrom, Hanson, &

Ostergren, 2001), as well as with findings from a study showing that people living in

poor neighbourhoods are less likely to be physically active, even in cases where their

access to facilities is superior to those living in wealthier areas (Giles-Corti &

Donovan, 2002).

In a conceptual or theoretical sense, this qualitative study demonstrated how being

poor or unhealthy or living in a poor place are all dimensions of context that

comprise an individual’s social and psychological experiences and construction of

self over time; and that this process cannot be understood effectively in a linear, or

causal sense. It pitches the concept of context as something people carry in their

heads, and which develops over time to comprise their frames of reference, their

boundaries, and their individual and social identities. Contexts in this sense are far

more related to a person’s outlook, perspective, and lifestyle than they are a measure

of geographical region or socioeconomic position. While ‘poorer contexts’ in a

geographical sense exist for economic reasons, ‘unhealthy contexts’ are generated by

the social interactions and psychological processes that make unhealthy lifestyles the

cultural property of poorer territories over time. We propose that a conceptualisation

of ‘contextual effects’ as the social and psychological constructions of self in place

over time, with implications for health is likely to produce more insightful studies

into socioeconomic health inequalities, and generate more sensitive and refined

interventions amongst poorer groups in the future.

The substantive knowledge that has been unearthed brings implications for health

promotion, health inequalities research, and urban design. The conceptualisation of

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contexts as socially constructed, and the attention paid to agency, time, and the

human production of collective responses to a social context provided an abstraction

or theoretical paradigm for thinking about poorer households and neighbourhoods as

they pertain to health in future. We advocate the use of post-positivist approaches,

such as the methodological framework devised by Charmaz (1995; 2006) that was

followed here as a means of exposing in greater detail the mechanisms linking

various measures of socioeconomic position, especially overtly social, contextual

measures, such as area of residence and occupation, to unhealthy behaviours. Greater

collaboration between quantitative and qualitative researchers is needed in order to

understand and more effectively intervene in lower socioeconomic contexts in the

future.

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Chapter Eight

Contribution of the Thesis to Knowledge

8.1 Were the Research Questions Answered?

As argued in the beginning of this thesis, a competent contextual analysis involves

efforts to both observe and understand patterns of human behaviour. The

epidemiological efforts that go into tracking trends in population behaviours that

affect health are crucial as they highlight target groups who are engaging in higher

risk behaviours, and note inequalities within and across different population groups.

However, this thesis demonstrates that observational efforts alone are insufficient, in

that they are unable to capture the processes and mechanisms – the everyday

reasoning, norms, rituals, and decision-making processes – that go on within

different living contexts to produce these patterns or disparities. Ideally, population

health research needs to mesh with disciplines such as urban design and sociology,

and embrace qualitative approaches if it is to be successful in effectively

conceptualising, researching, and ultimately understanding the trends and

inequalities it so accurately observes. Without this interdisciplinary, mixed-methods

approach aimed at capturing both patterns and processes, future interventions and

policy responses are unlikely to be contextually sensitive or socially informed or

effective.

This thesis began with the question of ‘What are the patterns of physical activity

amongst a lower socioeconomic residential group living in a new urban

environment?’ This research question stood to be best addressed by a quantitative

approach to measuring the levels of physical activity amongst the group of interest,

and potentially the use of analytical tools to assess differences between higher and

lower socioeconomic residential groups living within this particular urban context.

While a survey was conducted, the N was too small overall to demonstrate

significant differences between socioeconomic groups in the area. However, it was

able to display early trends and patterns amongst the lower socioeconomic group,

wherein moving to the urban village appeared to be having a positive effect on their

physical activity levels, with graphs depicting an increase in walking and daily

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exercise since moving there. In a reflective sense, this stage is a vital component of

contextual analyses, and the importance of a mixed-methods approach is strongly

advocated for future research efforts into health inequalities.

While the quantitative aspect of the thesis did not reveal statistically significant

relationships between place and physical activity variables, the evidence-base in the

literature review indicating that lower socioeconomic contexts are powerful

proponents for leading less active and healthy lifestyles made a convincing case for a

deeper examination of poorer contexts to unearth the processes producing these

patterns. The case of the poorer residents living within a new urban village provided

a research opportunity to reflect on how previous disadvantaged living contexts had

affected residents’ propensity to lead active lifestyles now. Thus, the flow of research

questions that followed on from the initial question about the current state of play in

physical activity patterns, focused on exploring people’s relationships with place,

their responses to the physical and social components of their neighbourhood, and

which aspects of – or relationships within – these contexts most strongly influenced

their lifestyles with implications for their health. A subjective, insider’s view was

sought to ascertain the detailed social processes that influenced how residents

identified within a place, how they managed their sense of self there, and how the

dynamic interplay between self and place influenced health.

Importantly, and in line with the social constructionist framework, the research lens

remained focused on how physical activity had been socially constructed within

residents’ poorer living contexts over time. The research methods successfully

unearthed a series of events, interactions, experiences, and incidents that had shaped

what physical activity and healthy living had come to mean to them over time, and

why in many respects it remained elusive and within the social and cultural territories

of more well-off or successful population groups. It also highlighted the interplay

between experiences in harsh living contexts in the past, and their moving into a new

urban village that contrasted these experiences – aesthetically, socially, and

economically. As well as providing a useful and effective conceptual framework for

researching and understanding how patterns in health-related behaviours within

different population groups are constructed over time, and the role of socioeconomic

and design factors in these processes, the study held strong implications for health

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promotion. The study highlights that when it comes to health promotion ‘one size

does not fit all, and that in-depth qualitative analyses are required prior to the

development of health-promotion campaigns and rhetorical strategies designed to

result in behavioural change. Without this type of research, the current trends that

separate the rich from the poor in terms of lifestyles and health are set to continue, if

not widen.

8.2 Using Social Constructionism: Reflecting on the Conceptual and

Methodological Contribution

The gaps identified in the literature of this thesis pointed to the need for questions to

be addressed about how and why poorer living contexts are reliable predictors of less

healthy living for the people who occupy them. To achieve this, it argued for a shift

in focus from objective depictions of how people, place, and health are connected

statistically, to an emphasis on how people interact with places according to who

they see themselves as being, where they come from, and how they see the world.

Further, it explored what these interactive processes mean for how active and healthy

different people (both individuals and groups) are likely to be in various contexts. It

noted the need for a philosophical conceptualisation of socioeconomic living

contexts which would allow the processes connecting the ‘people’, ‘place’, and

‘health’ variables within them to be more effectively investigated. Methodological

approaches from within the urban design literature provided direction for a focus on

the subjective ways in which people interpret and respond to their living

environments, as well as an emphasis on the nuanced and sensitive relationships

between people’s perceptions of a context and their practices there. In line with this

methodological approach, the thesis focussed on unearthing descriptions of living

contexts as people perceived, understood, interacted, and responded to them, and

what this ultimately meant for how physically active they were likely or able to be.

Subjective accounts and narratives of people’s strategies for managing their

individual circumstances within the social and living spaces they inhabit was sought

in order to develop an insider’s view of how particular health-behavioural patterns

within different contexts are constructed and sustained over time.

A social constructionist perspective on how patterns or orders in human behaviours

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develop in social contexts led to the development of a methodological approach with

an empirical focus on the processes and interactions via which particular physical

activity profiles had developed amongst a lower socioeconomic residential group:

temporally, geographically, socially, and psychologically. Berger and Luckman

(1966) argued that social scientists should not ignore the ways in which people

exercise agency and consult with others in a particular context to develop patterns of

behaviour that they take for granted as being the normal or done thing there, and

which they ultimately perceive as being some kind of objective reality, or normality.

They made the case that there is nothing inherently natural about the order of human

behaviour; rather that we construct it according to our needs and goals in particular

situations. Further, that as time goes on, these established procedures provide new-

comers with the benefit of having ‘norms’ to refer to for their code of conduct there;

norms which then act as powerful forces for influencing what others will do there.

However, in order to understand these patterns of functioning within a particular

context, it is necessary to ask those who perform them as ‘routine’ and understand

them to be ‘normal’ how and why their perspectives have formulated in the fashion

that they have over time.

Thus, as the focal point for the thesis was to gain an understanding of the relationship

between people living in poor contexts and low levels of physical activity, there was

a need to acknowledge the researcher’s role as ‘outsider’ and clear the way for a new

conceptualisation of what a lower socioeconomic context is according to those who

comprise them. Specifically, it opened up an opportunity to study lower

socioeconomic living contexts as defined, described, and explained by those who

inhabit them. It instigated a ‘ground-up’ approach to studying the ways in which

occupants of these social spaces managed their own circumstances in light of their

broader living environments, and how their living contexts had shaped and

influenced their beliefs, attitudes and practices over time. Participants were invited to

tell their own stories about what it was like to live in poor households and

neighbourhoods as they were growing up, the kinds of things that happened to them

there, and what this meant for their health and well-being. As the focus of the thesis

was on the behaviour of physical activity as a concept and practice with unique

meanings across different contexts, I sought to unearth how it had been socially

constructed within these types of living environments over time. Thus, the social

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constructionist framework and grounded theory methodology allowed insights to

both the nature of these contexts as well as the meaning and relative importance of

physical activity there. The findings outlined how the qualities of, and experiences in

these living contexts efface values of being fit and healthy and created barriers to the

treatment of physical activity as a high-priority or a feasible or attainable goal.

8.3 What Did a Social Constructionist Grounded Theory Approach

Reveal About the Context of the Lower-Socioeconomic Lived

Experience?

For my purposes, the Berger and Luckman premise laid the groundwork for

investigating the social processes and dynamics via which the ‘treatment’ of physical

activity by a particular group is habituated and institutionalised in those contexts

over time. It produced an interpretive, reflexive view of how the contextual

relationships between poorer groups and physical activity are formed, or not formed,

over time. It allowed me to look at physical activity within a lower socioeconomic

urban demographic, and examine the dynamics and processes within these social

contexts that either connect or disconnect the people there from engaging in that

behaviour in ways that would improve their health. It brought into question what

physical activity as a concept or practice means in that setting, if anything, and why.

The Berger and Luckman framework navigated a focus onto the context itself in

order to try and understand what goes on there, and what happens to physical activity

there. For example, whereas health researchers and practitioners hold a behaviour,

such as physical activity, high on their list of goals and priorities, and have a fervent

interest in reducing the obesity epidemic, this is not necessarily the case in lower

socioeconomic living environments. Nor does the simple provision of health-related

resources for people living in poor contexts mean that they will immediately become

more physically active, or interpret and engage with those resources in ways that

improve their health. A linear relationship between access and use cannot be

assumed. Researchers and practitioners need to understand where ‘health’ is in

poorer living contexts – and the processes by which it got there – in order to create

more informed and insightful intervention responses. Further analyses of the social

construction of everyday life in poor contexts, and this contextual relationship to

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health behaviours such as physical activity, are likely to provide more sensitive and

sophisticated community-level responses in the future.

A social constructionist framework allowed me to examine how poverty was

understood, experienced, and interpreted at a social level where poor residents live in

close proximity to one another. In this condensed-poverty housing situation, I was

able to explore how poverty was managed in situ on an everyday basis. It also aided

in the opening up of associated variables or properties of poverty, and the

understanding that aside from having a low-income or living in a poor area, poverty

is manifested and understood in relation to the presence of factors such as drug

addiction, mental illness, physical illness, disability, fear, mistrust, violence, and

having high numbers of children in care. Aside from understanding that the

participants were ‘poor’ in the sense that they met the requirements for government

supported housing according to their incomes, I explored the experiences of that

poverty – the psychological and social properties – that were keeping them from

being able to pursue physically active, healthy lifestyles. Further, I unearthed the

impact of past experiences in poor contexts on how participants anticipated and

perceived new living environments, their understanding of them, and what they

sought to do there. By pursuing the perspectives of the poorer residents, a sensitised

picture of contextual influences on physical activity emerged; and a clearer

illustration was drawn of how the subjective construction of the aesthetics, semiotics,

and social dynamics within a new urban neighbourhood acted as barriers to engaging

in the neighbourhood in ways conducive to health and well-being.

Families of origin, as well as previous neighbourhoods were described in rich detail

during interviews, and were linked by participants to their current ‘code of conduct’

in a neighbourhood. Participants reported the importance of looking for signs in the

neighbourhood, which interestingly were usually a mix of demographic factors and

health-risk behaviours, such as IV drug use, alcohol abuse, high unemployment

levels, domestic violence, and a high number of children in care, and if these were

present to keep a low profile by staying indoors and not talking to neighbours. The

shared mantra of ‘it’s a roof over your head and you keep to yourself’ was attributed

to a range of experiences ending in intra- or inter-household conflict in previous

living contexts, as well as experiences in places with high levels of theft. Thus, these

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coping mechanisms and strategies for managing risk on a daily basis were greatly

cultivated by previous living ecologies, and strongly influenced the level of

engagement with neighbours and neighbourhood resources.

Participants reported a heightened sensitivity to being exposed to other people with

mental illness and drug addiction – with a perception that any behaviours that

indicated a struggle or an abnormality were directly reflective of themselves – and

were eager to define themselves against the ‘others’ living in the complex. Each

participant, although clearly experiencing their own difficulties with both poverty

and health in different ways, was quick to identify as not belonging in the apartment

block, because they were not that ‘poor’ or that ‘bad’. Identities were constructed

around the ways in which they could define themselves against the group, who they

defined based on previous experiences with poverty – in their families and in their

neighbourhoods. They feared that the stigma of the apartment block, or a poor

reputation due to a high number of police call-outs and ambulance visits would

reflect on them and their families, but weighed this up with the benefits of living in

the framework of the broader Village, near the University and near the city, which

they said created a positive emotional and psychological response to their living

place. A social constructionist framework assisted in unearthing the processes via

which neighbourhood ‘realities’ were anticipated, created, and reinforced in poor

areas, and further, the barriers this created to living active and healthy lifestyles.

8.4 What Did Social Constructionism Tell Us About What Physical

Activity Means in Poorer Contexts?

By reflecting on the participants’ childhood and adolescent experiences with poverty,

and by paying attention to the role of historicity in shaping attitudes, beliefs,

practices and indeed the habituation and institutionalisation of a negative

relationship with physical activity over time, a better understanding of the tenuous

relationship between poor contexts and poor health was ascertained. Early on in the

interviews, it became apparent that the kinds of abuse, neglect, and general

maltreatment participants had experienced in their early lives made the pursuit of

behaviours to improve their health almost ludicrous in light of the everyday

challenges they were facing. Physical activity to improve or maintain health was not

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a priority amongst their carers, and as such was not emphasised or even mentioned as

being something of importance. The difficulties participants highlighted – mostly

including abuse and neglect – contributed to most of them leaving home by their

early teens, and having to cope with poverty and independence at very young ages.

Again this ensured the exclusion of health-related behaviours as a goal or a priority.

Further, the nature of these early experiences had resulted in many of them being

overweight, and suffering from other kinds of illnesses and disabilities, including

diabetes, anxiety, depression, and even some cancers. These made the pursuit of

physical activity – especially in public places, no matter how ideal the resources –

difficult, if not impossible. Due to feeling ill, afraid, depressed or self-conscious

about their weight they were reluctant to engage with the neighbourhood to improve

their health or fitness levels. Further, many of them had caring roles as a result of

having many young children early in their adult years, or having ill relatives to care

for. As such, a number of structural constraints and negative social experiences had

led to the construction of physical activity as out of reach, and an almost impossible

goal.

Further to experiences in their household and neighbourhood environments that had

created barriers to more active and healthy lifestyles, experiences in broader aspects

of society aided in cementing high levels of inhibition about being physically active.

From the broader mainstream media depicting images of models and celebrities with

body weights and shapes that this group felt were ‘ideal’ but unattainable, to having

to deal with being overweight in public, many broader contextual experiences

contributed to the tendency for the female participants to stay indoors. Some

participants were bullied about their weight by family members at an early age, and

this continued through schooling and broader social and neighbourhood experiences.

Aside from living in neighbourhoods in which they feared for their lives and safety,

the participants also expressed a great reluctance to be outside due to their

perceptions of themselves as being ugly or overweight. Even in cases where some of

the participants sought medical help to lose weight, their experiences were

unpleasant, and they reported feeling powerless and misunderstood in doctors’

surgeries when discussing their weight. As such, the participants would require

assistance to become active that took these histories and experiences into account,

and worked in conjunction with the highly sensitised social construction of physical

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activity in these social settings.

The conceptual and methodological approach that was used to gather these insights

would be highly suited to exploring any social context of interest to find out how and

why particular health behaviours are clustered within them. It could be applied to

occupational contexts as well, such as blue-collar males, who have been shown to

consume dangerous levels of alcohol on a daily basis (Najman, 2007). A social

constructionist grounded theory approach would be able to explore the nature of that

context and the meaning of alcohol and binge drinking within it amongst that

demographic of male workers. This would be a useful approach for ensuring more

effective and well-matched intervention programs in future. Further research is

needed that employs a social constructionist perspective to contexts in which

behaviours of interest are identified as being problematic in order to understand what

they mean in those contexts, and how both the health behaviour of interest and the

social contexts are created and understood by those who occupy them. This would

lead to more effective health communication and promotion amongst vulnerable

demographics in the future, as well as more effective responses at the level of

planning and development for diverse, urban populations.

8.5 Implications for Health Promotion and Communication: The

Challenge of Encouraging Behavioural Change in Poor Settings.

From a communication perspective, it is crucial to have a sound understanding of the

context in which you are delivering a message in order for that message to be

effective. Thus, the theoretical framing of a context in order to be able to examine

what happens there, what is important there, and where health sits as a priority there,

is vital in gaining insights into future efforts aimed at effecting behavioural change.

The following sections highlight some of the key factors and processes emerging

from the data with implications for communicating about, or promoting healthy

lifestyles amongst, poorer groups. These bring clarity to how lower socioeconomic

position, and its various properties, operate at the individual, household and

neighbourhood level to generate both real and perceived barriers to being more

physically active.

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• Individual-level barriers

A range of properties of individuals were located as salient inhibitors of increased

levels of physical activity. Participants discussed not being able to afford a gym

membership or a regular activity due to low incomes. While this was mentioned

briefly in the blog, it was discussed in some depth in the in-depth interviews with the

BHC women, who all expressed a desire to do more exercise and focus on their own

physical fitness and well-being, but who could not due to lack of money to join a

gym, as well as other costs of childcare while they exercised. Many participants, both

older and younger felt that they did not get enough time out of caring roles to engage

in recommended levels of physical activity, and lamented the benefits they felt they

were missing out on, such as endorphin release that made them feel good, and not

feeling overweight, unattractive, and self-conscious in public. However, all seemed

to have sporadic attempts at exercising via one-off gym visits as parts of special

offers by commercial outlets, or by purchasing home gym equipment, which they

ended up not having space for, or time to use with young children at home. Other

individual-level barriers included physical illness, mental illness, disability, and time

constraints from shift-work or casual work. Many of these factors are inextricably

linked to their low incomes, and are effective in sustaining both poverty and less

healthy lifestyles. It was observed that all the women interviewed were all

overweight and smoked cigarettes, and during the interviews these health and

lifestyle factors were also cited as inhibitors of physical activity; thus demonstrating

the complexity and close interconnection between a range of factors in poor contexts

that sustain poor health, and a need to intervene in a contextually sensitive way on a

number of fronts.

• Household and neighbourhood factors influencing physical activity

Households and neighbourhoods were studied for their capacity to allow individuals

to act on messages promoting physical activity for health and well-being. As outlined

in vivid quotations in the published papers, previous households and neighbourhoods

exerted a powerful and negative impact on health and health-related behaviours due

to the hostile nature of these early childhood and teenage environments. Families of

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origin for all participants comprised contexts of abuse, neglect, alcoholism, drug

abuse, and poverty. These difficult beginnings led to what might be called a ‘series of

unfortunate events’ in that they acted as catalysts for early homelessness, early

pregnancy, drug experimentation leading to addiction, and time in and out of hostels

and rehabilitation centres. Having a high number of children in their care while still

young greatly limited what the women in the interviews were able to achieve on a

daily basis, and coupled with little or no partner support – some partners had been

incarcerated – and a low income, they are living in situations not conducive to health

and well-being.

Further to this, having neighbours in similar situations and facing similar hardships

acted to reinforce their situations in psychologically detrimental ways. In

neighbourhoods where many of the residents are poor, or who have drug and alcohol

dependencies, the collective struggles of people within these contexts generate an

atmosphere of hopelessness and frustration, making it difficult to make health-

behaviours a priority. Encouraging people to use the neighbourhood resources for

physical activity is a steep task when they fear theft, violence, used needles lying on

the ground, and regular police call-outs on a daily basis. Such factors need to be

considered by those attempting to promote active and healthy lifestyles in hostile

contexts. Importantly, interventions need to occur at a community-response level,

rather than at an individual one, where resources, supportive services, and social

assistance comprise as much of the program as messages about behavioural change

for health reasons.

There were aspects of the broader KGUV neighbourhood that appeared to alleviate

some of these difficult structural factors present within the BHC apartment blocks,

indicating that a neighbourhood environment supportive of physical activity and

residential mobility does dilute some of the more potent effects of poverty on health.

Residents reported that they enjoyed having access to green spaces, were

appreciative of the wide, even pathways for walking, enjoyed being in close

proximity to a number of useful and desirable destinations and felt positive about

being associated with the University and other locations such as the La Boite

Theatre. These aspects of the environment gave a great lift to residents, many of

whom had only ever lived in poorer neighbourhoods that were situated far from

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central shopping areas and parks, with little or no facilities for walking or recreation.

This feedback from residents demonstrates the importance for strategic links between

health promotion experts and urban designers, wherein residents require an

environment supportive of physical activity, while simultaneously gaining the social

support they require in order to be able to respond to the design of their

neighbourhood in ways that benefit their health.

• Attitudes, beliefs and responses to mass-media health promotion of

physical activity

Overall there was a deep scepticism displayed by participants, in both the blog and

offline data about mass media efforts promoting physical activity for health. There

was a general merging amongst participants regarding information about physical

activity from both government and commercial sources, with references to both

government health promotion pamphlets and advertisements for diet foods and

exercise equipment being made in response to questions about health-related

messages. With regards to official sources promoting health, such a pamphlets in

doctors’ surgeries, participants claimed that they read them, but then forgot about

them afterwards, or did not have the time to follow up on the advice they had read.

They made numerous references to commercial sources of information, which they

felt were trying to take their money, and therefore they tended to switch off from

messages delivered on the television about getting fit or creating an active lifestyle.

Most participants also felt the pursuit of fitness was akin to the eating disorders of

celebrities and a pressure to stay extremely thin in accordance with unrealistic weight

goals set by supermodels, and felt that the concept of physical activity belonged

largely in the arena of the famous and the wealthy, and was not a part of their social

territory or concern. A few participants reported starving and binging habits to try

and achieve the weight of models or TV celebrities, and some felt that ideal weights

were obtained by surgery or diets given by nutritionists that were financially out of

reach. Shows such at The Biggest Loser, however, were cited as inspirational in

terms of showing that losing weight was difficult, but that it could be achieved.

Overall, however, participants had their own methods of managing their lifestyles

and health in accordance with what they could manage and what made them feel

good, and were not receptive to outsiders, especially those as far removed as

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government health officials or mass media advertisements, making suggestions for

how they could be ‘fitter’ or more active.

The social constructionist theoretical framework was particularly useful in teasing

out how physical activity is conceptualised or treated in the everyday lives of

participants in this study. The amalgamation of highly commercialised sources of

images and information with official government sources is of particular interest, as

there is little differentiation amongst them about which sources are reliable,

trustworthy, credible, and most of all achievable. When asked what kinds of images

came to mind, or what they thought about when someone said ‘physical activity’

most of the women interviewed spoke about models and thinness, or people

promoting health who they felt must have somehow ‘cheated’ to look that thin or fit.

Because of the low income and high caring responsibilities present in their lives,

there is little or no chance of leaving the house to pursue exercise, so achieving a

thinner body weight is discussed or fantasised about, but not acted on. Even though

participants engage critically with what they see in the mass media about physical

activity, they held a cynicism to these messages overall. They felt that those

promoting physical activity were akin to companies trying to sell ‘Thigh Masters’ or

other ‘get-thin-quick’ gimmicks, and were to be ignored. Given the power of the

food, exercise, and fashion industries to blur and distort messages about active

lifestyles and a healthy body image, health promotion will need to conduct further

research into how they can differentiate their messages from the bombardment of

commercial media in all living contexts. Further, the unrealistic images of models

and expensive home gym equipment or memberships need to be counterweighted by

affordable and accessible options to stay strong and healthy, given the restrictive

circumstances of poorer groups.

Finally, the diversity of interests in terms of types of physical activity was notable,

with implications for a broad range of affordable options of exercising needed, even

in demographics with some common core characteristics. A wide range of interests

amongst the adults and the children were exhibited, along with an expressed

appreciation of community models such as the Police Citizens and Youth Clubs

(PCYCs) in other suburbs that families had accessed previously. They claimed that

these clubs hosted a range of activities for children to keep them active and healthy

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after school in a safe environment, and were affordable. Mothers wanted to be able to

do aerobics, but could not afford childcare or gym memberships, while older people

were interesting in Tai Chi and social walking groups. Some younger people were

not interested in social walking groups, but rather games such as netball and football,

and individual fitness activities, such as jogging. A community level response to

increasing physical activity in a poorer neighbourhood would have to offer a broad

range of recreational pursuits to accommodate diverse interests, abilities, and time

constraints.

8.6 Implications for Urban Design: What Neighbourhood Traits

Work Well for Vulnerable Demographics?

From an urban design perspective, the blog, interviews and community focus group

provided rich feedback on how the Kelvin Grove Urban Village design is working

for the Brisbane Housing Company apartment dwellers. It must be remembered that

the blog provided data on specific aspects of the neighbourhood that have been

shown in previous studies to be important for improving physical activity and health,

while the interviews allowed the aspects of the neighbourhood that were most salient

to BHC dwellers to emerge in conversation. Thus, while design features such as

pathways, bikeways, and green spaces were discussed in a positive light when

participants were asked about them, they did not emerge naturally in the interviews

as being an important part of the neighbourhood affecting health and well-being. Far

more important to the BHC dwellers were building aesthetics and functionality,

stigma, geographic location, and neighbourhood relationships. That is, these key

psychological, social, and cultural aspects of the neighbourhood were at the forefront

of participants’ consciousness about where they lived, who lived there, and how it is

perceived by the broader public. These factors were key in shaping how satisfied

they were living there, how safe they felt, and how likely they were to want to

‘move-on’ again. In terms of vulnerable populations who are usually highly transient,

this mobility is a major social challenge, as support and health services cannot keep

reliable records or provide a continuity of care to the people most in need of it. Thus,

design plays a vital role in potentially providing peace, stability, and relief to social

groups who tend to struggle from neighbourhood to neighbourhood. It is vital that

future design and health literature targets and questions demographics most at risk in

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research concerned with changing trends in health inequalities by altering aspects of

context that sustain them. Without mining the contexts of lower socioeconomic

demographic in ways that assist in understanding their experiences in

neighbourhoods and with health services and information, neither urban design nor

health interventions are likely to be accurate or truly responsive. Table 1 summarise

the key aspects of design that emerged as important for residents, and their insights

regarding their experiences with these dimensions of their living contexts.

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Table 8.1 Aspects of Urban Design important for Healthy Living

Feature of Urban

Design

Participant Insights Future Recommendations

Mixed-land use Positive response to a diverse

range of desirable locations

within walking distance

Social and health services

needed as well as retail

outlets and public spaces

Having a number of locations that are useful,

desirable, and accessible for the local

demographic is important for enabling walking

to local destinations and engaging with the

people and resources in the neighbourhood.

Health-Related

Resources

Well-used and add to sense

of safety

Not necessarily viewed as

relating to health or physical

activity

Increased daily walking

Increased leaving the house

and social interaction

Parks, wide, even pathways and bikeways all

contribute positively to aesthetic, feelings of

safety, wanting to share the neighbourhood

with friends and visitors, and increased

walking. Excellent for improving PA levels of

demographics that walk for transport and

logistics, ie A to B, not necessarily exercise.

Aesthetics and

Functionality of

Housing Design

Appearance of apartments

important for sense of self

and identity

No elevators – stair dangers

Too noisy

No room for children

No parking

No public telephones

Government supportive housing needs to be

non-distinguishable from other buildings in the

neighbourhood, have a pleasing aesthetic, and

be built in ways that accommodate the

demographic group it is housing. Apartment

blocks not suitable for families unless park

area and play facilities surround building, or in

close proximity to supportive social and health

services.

Geographic

Location

Close to CBD and other

facilities very positive

Close to public transport that

is regular and reliable very

positive

Close to university and

theatre very positive

Positive responses by participants who were

glad not to be stuck in ‘dumps’ or in the

‘middle of nowhere’. Location idea for those

who have no transport, or with limited cash

flow. Some issues raised with proximity to city

and West End being too close to drug dealers

and networks. Positive media image greatly

enhanced positive feelings about living there.

Mixed-Tenure

Arrangements

Problematic for all residents If BHC is to continue to use apartment blocks

to house low-income groups this cannot be

done successfully without linking to relevant

services or the implementation of support

networks and facilities close-by.

Security Low sense of security near

BHC apartments due to

violence, crime, and needle

use.

Without supportive health and community

services, including access to resource support

(food vouchers, clothing, etc) and financial

counselling, theft and conflict likely to remain

problematic. Police response may reinforce

images of high crime already associated with

blocks such as Grey Gums.

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From an urban design perspective, such new urbanist planned communities are likely

to be successful in so far as they decrease dependence on automobiles, and increase

people’s access to – and hence propensity to walk to – local shops and services.

Having access to affordable food outlets is a vital resource for all residents, but

especially for low-income families who often have to wait until they can afford taxis

to go grocery shopping. Having the reputation of the place elevated via proximity to

more esteemed establishments, such at a University, also seemed to detract from the

stigma poorer residents are used to living with and within.

However, there were also many pitfalls inherent in this particular design. The idea of

heterogeneity was largely theoretical in this Village. True heterogeneity either comes

from a long, historical build up of eclectic and diverse populations choosing to live in

close proximity to one another, or else needs to be planned in a more authentic way.

That is, affordable housing needs to be integrated far more subtly into these

communities, instead of being built up as easily identifiable apartment blocks where

poverty is condensed. In this case, the stigma of poverty may not perforate through

the entire Village, but is certainly attributed to the affordable housing apartments.

Typically, and as has been shown time and again in the past, placing people with

similar social and economic problems in close proximity to one another acts to

exacerbate the challenges they already face, primarily through fear of, and conflict

with, one another. This study highlighted in particular how these apartments acted as

unwanted mirrors of their pasts and aspects of their lives they would have preferred

to leave behind. A community design that dilutes stigma and provides healthy, green,

and spacious resources for families to be active within are recommended.

8.7 Implications for Health Inequalities Research: What Do We

Know About the People, Place, and Health Relationship That We

Did Not Know Before?

The key contribution from the methodology and findings in this study stem from the

re-conceptualisation of ‘area effects on health’ from being a set of linear, catalytic,

causal relationships between a number of set variables within a place, to a notion of

socioeconomic living contexts being social, dynamic, cultural, and organic. That is,

poor health is a trait of poor living contexts in the same way that a low income, or a

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low education level are defining elements here, but there are a number of ongoing

everyday material struggles and psychological barriers that continuously prevent

lifestyle changes from occurring that could improve both wealth and health. Health-

related behaviours themselves are entrenched in the norms and circumstances of poor

environments in ways that reduce people’s chances of improving their financial

prospects, as well as their health and well-being. This creates powerful cyclic effects

in that the poor stay both poor and unhealthy, and pass these contextual effects on to

their children and grandchildren in rapid succession due to early child-bearing.

Further research is needed into the psychological, social, and cultural processes that

prevent poorer demographics from making important changes that would improve

their life quality and chances overall. Further, the importance of diluting these potent

contextual effects by preventing a ‘ghettoisation’ of the poor in urban areas, or an

increased integration of those who are struggling on a number of levels into

communities that are rich in resources, education, social support, and healthier

lifestyles is yet to be fully explored and evaluated.

This thesis makes the case that contexts do not exist because they are called into

being by the drawing of a geographical boundary, or defined by socio-demographics

or particular physical components of an area. These measurable qualities are merely

the infrastructure of a social space. Further, while such contextual elements or

features are as tangible as the health behaviours and health outcomes that can be

located there, these things do not exist in causal relationships with one another.

Instead, they are the artefacts and ‘by-products’ of a particular setting, in the same

way that coffee consumption, conversation and chairs can be found to cluster in

cafés, along with similar variable congregations such as kneeling, praying and the

presence of steeples in church buildings. Once we understand context to be

meaningful, socially constructed, and subjectively perceived and responded to, then

neighbourhoods can be conceptualised more clearly as contexts that ‘produce’ health

or health-behavioural profiles. To explore neighbourhoods or other socioeconomic

contexts such as occupations or households as social and meaningful, a point of

departure needs to be made from an epidemiological imagining of these settings.

Once we have established that socioeconomic context matters from a health

perspective, a competent framework for thinking about how contexts work needs to

be applied to this phenomenon, and studied with appropriate or matching

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methodologies that are sensitive enough to shed light on how poorer health

behaviours cluster in poorer areas.

There are a number of useful theoretical and conceptualisations of context available,

but health inequalities researchers will need to cross over and explore other

disciplines if they are to locate the philosophical and methodological frameworks

that suit research questions regarding why and how health-risk behaviours prevail at

higher rates in lower socioeconomic contexts. These methodologies are not in

competition with, nor are they incompatible with, epidemiological approaches; they

are simply different tools for different research questions on a particular topic. That

is, epidemiological methods are needed to track and locate where problems are most

prominent, and the nature of these difficulties from a health perspective. For

example, there are areas that seem to suffer from high levels of depression and

mental illness, while others exhibit higher levels of other types of illness, disease,

and even injury. It is vital to know the types of health challenges facing particular

areas before bringing in the research lens for a closer look at the micro-processes

contributing to these effects. Further, these research methods could be applied to an

extensive range of demographic, geographic, behavioural, and health variables that

stand out as significant or problematic, including health patterns in workplaces,

occupations, suburbs, or ethnic groups. It is vital to examine the everyday, social

processes, norms, and ‘sharing’ of ideas and behaviours to gain a more competent

idea of why health patterns cluster in particular areas. To do this, theoretical

frameworks and qualitative methodologies that suit the nature of the problems

identified in epidemiological studies are required.

To sum up the key contributions of this study to the fields of health inequalities and

health and place research, the following points have been outlined below:

• The importance of conceptualising and studying neighbourhoods and

households in a holistic, contextual sense was highlighted via the insights

retrieved in this study as to why physical activity is less likely to get done in

poorer living environments.

• The value of tracking stories and ‘real life’ processes over time was

demonstrated in this investigation through revelations about the interactive

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and compounding influences of both migration and area on health-related

behaviours and, in particular, on physical activity.

• A number of contextual factors – psychological, behavioural, social, and

economic – were found to be operating together over time in iterative and

collective ways to create barriers to healthier lifestyles; with these effects

gaining exponential powers in relation to health when in close proximity to

one another.

• Some of the key contextual factors in poorer living environments likely to be

impinging on more active and healthy lifestyles include disadvantaged

childhoods, high levels of fear based on childhoods and previous poor

neighbourhoods, increased chances of having children in teen years, having

large caring responsibilities in combination with low incomes, boredom,

depression, feeling trapped, lack of hope for something better, fear of

neighbours, inclination to abuse drugs and alcohol, having family members in

jail, lack of sufficient space for safe interaction and recreation, concerns

about body weight/image, smoking habits, and other household-level

constraints and influences, such as partners who are unemployed and not

interested in pursuing physical activity.

• These contextual factors require intervention on a number of fronts, as it is

not one variable or factor – be it social or economic – causing or shaping

entire lifestyles or steering people away from health. Health promotion

experts, health communicators, community workers, urban designers, and

economic and social policy makers need to work collaboratively to better

understand the nature of lower socioeconomic contexts as they pertain to

poorer health, and to respond in a more sensitised and informed way.

8.8 Using the Theoretical Knowledge Built in this Thesis to Develop

Effective Research and Policy About the Relationship Between

Poverty and Physical Activity.

The knowledge generated in this thesis lies in its exploration of the properties and the

processes within poorer living contexts that collectively create strong and reliable

barriers to healthier living. Within these contexts, individuals constantly manage risk

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in order to alleviate harm and increase their quality of life. However, this quality is

relative, in the sense that their responses ensure some kind of survival, but are not

conducive to improving their circumstances. Ironically, in many cases, their

responses – which are restricted by a diminished range of choices in most scenarios –

actually lead to a worsened set of living conditions, which they in turn respond to as

a means to survive, and so on and so forth. It is insights into these conditions, the

consequences for the humans in them, and the choices made within them that make it

clearer as to how these contexts yield such powerful, and apparently deterministic,

forces over lifestyle and health.

Importantly, and as is discussed in the papers published in this thesis, the opening up

of these contexts to understand the factors and processes within them that lead to the

unravelling of particular styles of life on particular social, economic, and geographic

landscapes, allows us to see more clearly how health promotion ‘bounces’ off these

demographics, and how the best of intentions in urban planning and design do not

elicit the types of responses one would ordinarily expect or hope to achieve. What is

clear from the analysis, is the cyclic and catalytic effects that disadvantaged

childhoods in poor households and neighbourhoods can have on individuals that

ensure that their sense of place – social, economic, or geographic – does little in the

way of shifting upwards during their lives, and how health remains firmly locked

outside of these contexts. The core category of identity management identifies the

constant daily psychological, emotional, and behavioural responses of people who

occupy hostile living environments, and how these responses, in these complex and

often paradoxical situations, both ensure survival and preclude health.

Future policy-making in the area of reducing the obesity epidemic needs to

acknowledge that, firstly, this is a socioeconomic issue as much as it is a health issue

and, secondly, that so long as class differences exist, then gaps in health will follow

suit. The problematic and paradoxical relationships between poverty and being

overweight are not issues that are openly and publicly discussed or addressed, and

the findings in this thesis point to the importance of studying the relationships in

depth to make the case that poverty affects identity, and this in turn affects health-

related behaviours. The findings in this study also revealed that it is unlikely that

these relationships are linear, uni-directional, or causal; it is however, highly

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catalytic, with the various properties of poor contexts – such as abuse, violence,

neglect – eliciting a chain of events and behaviours that appear to keep people both

poor and unhealthy.

What is needed is research to further investigate the characteristics within poorer

living contexts that are at work to increase the chances of poor children growing up

with no real hope of finding a pathway to higher education, training, income

generation, housing security, or health. In the context of their lives, physical activity,

fitness, and ideal exercise regimes and body images become associated with people

in ‘other worlds’, such as celebrities, and the rich and the famous. What is needed are

policies and interventions that are able to protect children who are at risk, provide

them with respite from hostile living contexts, and simultaneously offer feasible

pathways along which they can grow and live without fear and insecurity. Further,

health promotion needs to be pitched as something within the reach of vulnerable or

struggling demographics, and accompanied by the provision of low-cost community-

based options for sport and recreational physical activity. Change needs to occur on a

broad front with open, direct, and robust discussions on how differences in

socioeconomic status affect people’s sense of place, sense of self, and ultimately

their health.

8.9 Critical Reflections: Limitations of the Methodology and Future

Considerations

On critical reflection of the conceptual theory introduced in this thesis, and the social

constructionist approach that followed, a recommendation for future research using

this framework is that both the context and the health-related behaviour of interest be

very specifically defined or characterised. To effectively employ the Berger and

Luckman (1966) idea that behaviours or artefacts within a human context come to

hold specific meanings as they are socially negotiated over time, then the process of

theoretical sampling is of paramount importance in ensuring that you are analysing a

context that is theoretically representative of the people and relationships you wish to

study. This approach would arguably be more suited to studying smaller, or more

specific, contexts with less discrepancy in the characteristics of the people or the

places under investigation. This way, a deeper and more convincing focus could be

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placed on the social pathways connecting particular groups to particular patterns of

consumption or lifestyles. For example, I suggest that this approach be used to study

particular health-behaviour patterns found to be evident in specific occupations or

workplaces. To this end, this type of methodological approach may indeed be useful

for exploring potential social processes underpinning ‘clusters’ in risk-taking

behaviour, or in illnesses caused by lifestyle. These clusters could be studied using

this methodology in many and various social groups, including teenagers in schools,

online communities, courses within universities, and specific social or religious

groups.

Although the difficulty associated with locating relationships between households,

neighbourhoods and patterns in health-related behaviours has been addressed with an

arguable degree of success within this thesis, there is room for extending the

possibilities of philosophies and conceptual frameworks that may indeed be better

suited to studying people’s relationships with their places of residence in more detail.

Methodologies from the urban design literature, and the work of philosophers such as

Lefebvre, Lacan, and Foucault hold much potential for further unearthing the

powerful relationships between where one lives, and how healthy one is likely to be.

Further, it is proposed that the work of Bourdieu – and in particular his work in

Distinction (1984) – be applied to further studies on the strength of the association

between socioeconomic position and patterns in consumption and behaviour.

Although Bourdieu was not concerned with health or geography, his philosophical

paradigm, which demonstrates rigorous ways of studying and understanding how

class and consumption are linked, hold great potential for health inequalities studies

generally.

Finally, although the survey data in this thesis was not successful overall, it is

strongly recommended that mixed-methods approaches to understanding and

redressing health inequalities be used in future. This way, an evidence-base to

locating a target group can precede any contextual investigation to unearth the social

processes determining the patterns evident in the epidemiological data. An

interdisciplinary approach that brings together epidemiological approaches with

sophisticated philosophical paradigms and well-suited qualitative methodologies

would go some way to shedding light on how best to think about, discuss, and

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redress the relationships between the context of social class and health.

8.10 Conclusion

This thesis makes a contribution to the ways in which socioeconomic contexts are

studied for their propensity to produce particular lifestyles in relation to health. It has

highlighted key aspects of the experiences of those who occupy poorer living

contexts that detract from the pursuit of active and healthy lifestyles. The

methodological, theoretical and substantive contributions are highlighted in the

published papers of this thesis, but its core contribution is the in-depth insights it

brings to the evidence repeatedly showing that inequalities in a population’s social

and economic circumstance generate inequalities in a population’s health. It

highlights the associated properties of lower socioeconomic position within living

contexts as a range of lived experiences that force ‘health’ or ‘healthy living’ down

the list of priorities in the lives of those who occupy them. These experiences have

been thematically organised and theorised in the published papers in this thesis, and

identify many key areas for future intervention. Early childhood interventions were

located as vital in stemming the rapid cyclic manner in which unhealthy patterns are

produced and propagated from generation to generation. Housing options and

neighbourhood designs that allow children from poorer families opportunities to

engage in activities that are safe, affordable, and local are recommended. Respite for

these children from their harsh household lives would go some way to preventing

early homelessness and a repeating of the difficulties encountered by their parents

and carers.

Further, health promotion efforts amongst the adults in these families that allow them

respite from their caring duties and an opportunity to pursue healthier and more

active living in safe, sensitive, and affordable spaces is vital. The promotion of

physical activity in poorer neighbourhoods needs to be accompanied with social

support and an approach that accounts for the various barriers to health faced by all

ages in these settings. The provision of parks, bikeways, and pathways alone is an

insufficient response in light of the aspects of these people’s experiences preventing

exercise in public from being a straight-forward or achievable goal. Further, the high

costs associated with gym memberships or hobbies for children that allow them to be

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active are likely to continue to act as barriers to healthier living for low-income

families. Physical activity programs in schools also leave out the children in these

neighbourhoods, as many do not attend school regularly, or change schools too often

for this to be effective or sustainable. Specially designed community intervention

targeted at the provision of physically active recreational pursuits for people living in

these contexts is needed. Ideally, government provision of activities such as

swimming, tennis, martial arts, performing arts, and sports need to be made available

locally in all neighbourhoods, with costs subject to income levels.

Finally, this thesis advocates the importance of increased collaborative efforts

between quantitative and qualitative researchers in the health inequalities research

area. Further, a more interdisciplinary approach between health inequalities, housing,

education, health promotion, sociology, and urban design would create a more

effective case for macro-policy changes in relation to the many aspects of life that

affect human health. The qualitative research in this thesis highlights the many

aspects of context that were identified as salient by the participants as affecting their

ability to lead active and healthy lives: as such, their stories make the case for a

broad intervention front, and an understanding of the complex and varied barriers

that ‘poor living’ creates in relation to better health.

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APPENDIX A

QUT Ethics and KGUV Research Committee Approval

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APPENDIX B

Information and Consent Forms

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Participant Information Sheet

Project Title: Kelvin Grove Urban Village Study on the Ecological Processes

Contributing to Patterns of Physical Activity among Different Residential Groups.

Researcher One:

Julie-Anne Carroll

Telephone: 07 3719 5640

Email: [email protected]

Researcher Two: Researcher Three

Dr Barbara Adkins Dr Elizabeth Parker

Telephone: 0419 6500 90 Telephone: 07 3864 3371

Email: [email protected] Email: [email protected]

Description

This project is being undertaken as part of a PhD thesis for Julie-Anne Carroll at The

Centre for Social Change Research (CSCR) at the Queensland University of

Technology (QUT). The purpose of this project is to determine the extent to which

urban design and social diversity contribute to the likelihood of residents engaging in

physical activity. The specific purpose of this study is to understand the ways in

which physical activity gets done in your everyday life, and how this particular

behaviour is linked to your perception and experience of where you live.

The research team requests your assistance to participate in an online discussion or

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‘blog’ that will contain photographs of different aspects of KGUV urban design,

including housing, pathways, parks, and cultural and educational facilities, as well as

questions for you to think about and answer in relation to how these characteristics

affect the amount of physical activity you do. A ‘blog’ is a webpage set up

specifically for discussions and forums around a topic of interest. In this case, the

topic will be KGUV as a case-study and the relationship between people, place and

physical activity more broadly. The blog will stay open to participants for a fortnight,

during which time you will be required to respond to the questions and photographs

posted there on every second day. If you do not have access to a computer or the

Internet, QUT will provide these resources to you for the purpose and the duration of

the study only.

The information accumulated on the blog over the fortnight period will be analysed

to gain an understanding of the processes and daily practices that link people, place,

and health.

Participation

Your participation will involve logging on to the blog address from your computer

every second day for a fortnight (ie 14 days). This means that you will be required to

give as little or as much information you like in response to a photograph or question

that is posted on the blog every second day, providing us with 7 entries in total. You

will be able to respond to other entries posted by other participants, or write in your

own unrelated entry.

You will NOT be contacted for further participation following the completion of the

entries over the fortnight.

Expected benefits

It is expected that this project may benefit you in terms of gaining an insight into the way you

relate to your living environment, as well as why you do or do not use your neighbourhood for

physical activity. It may also provide you with access to a computer and the Internet which you

may not have otherwise had. Additionally, you may acquire computing skills that you did not have

prior to the data collection, as any assistance or training you need will be provided by the

researchers. It will be of benefit to the researchers in terms of data collection for this study, but

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also to the wider, international academic community interested in understanding the processes

that connect people, place and health, who are then able to pass this data on to policy makers in

the area of urban design and health.

Risks

There are no additional risks associated with your participation in this project.

Confidentiality

All comments and responses are anonymous and will be treated confidentially. The names of

individual persons are not required in any of the responses.

Voluntary participation

Your participation in this project is voluntary. If you do agree to participate, you can withdraw from

participation at any time during the project without comment or penalty. Your decision to

participate will in no way impact upon your current or future relationship with QUT.

Questions / further information

Please contact the researchers if you require further information about the project, or to have any

questions answered.

Concerns / complaints

Please contact the Research Ethics Officer on 3864 2340 or [email protected] if you have

any concerns or complaints about the ethical conduct of the project.

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QUT Letterhead

Participant Information Sheet

Project Title: Kelvin Grove Urban Village Study on the Ecological Processes

Contributing to Patterns of Physical Activity among Different Residential Groups.

Researcher One:

Julie-Anne Carroll

Telephone: 07 3719 5640

Email: [email protected]

Researcher Two: Researcher Three

Dr Barbara Adkins Dr Elizabeth Parker

Telephone: 0419 6500 90 Telephone: 07 3864 3371

Email: [email protected] Email: [email protected]

Statement of consent

By signing below, you are indicating that you:

• have read and understood the information sheet about this project;

• have had any questions answered to your satisfaction;

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• understand that if you have any additional questions you can contact the research

team;

• understand that you are free to withdraw at any time, without comment or penalty;

• understand that you can contact the research team if you have any questions about

the project, or the Research Ethics Officer on 3864 2340 or [email protected] if you

have concerns about the ethical conduct of the project;

• agree to participate in the project.

Name

Signature

Date

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Participant Information Sheet

Project Title: Kelvin Grove Urban Village Study on the Ecological Processes

Contributing to Patterns of Physical Activity among Different Residential Groups.

Researcher One:

Julie-Anne Carroll

Telephone: 07 3719 5640

Email: [email protected]

Researcher Two: Researcher Three

Dr Barbara Adkins Dr Elizabeth Parker

Telephone: 0419 6500 90 Telephone: 07 3864 3371

Email: [email protected] Email: [email protected]

Description

This project is being undertaken as part of a PhD thesis for Julie-Anne Carroll at The

Centre for Social Change Research (CSCR) at the Queensland University of

Technology (QUT). The purpose of this project is to determine the extent to which

urban design and social diversity contribute to the likelihood of residents engaging in

physical activity. The specific purpose of this study is to understand the ways in

which physical activity gets done in your everyday life, and how this particular

behaviour is linked to your perception and experience of where you live.

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230

The research team requests your assistance to participate in an online discussion or

‘blog’ that will contain photographs of different aspects of KGUV urban design,

including housing, pathways, parks, and cultural and educational facilities, as well as

questions for you to think about and answer in relation to how these characteristics

affect the amount of physical activity you do. A ‘blog’ is a webpage set up

specifically for discussions and forums around a topic of interest. In this case, the

topic will be KGUV as a case-study and the relationship between people, place and

physical activity more broadly. The blog will stay open to participants for a fortnight,

during which time you will be required to respond to the questions and photographs

posted there on every second day. If you do not have access to a computer or the

Internet, QUT will provide these resources to you for the purpose and the duration of

the study only.

The information accumulated on the blog over the fortnight period will be analysed

to gain an understanding of the processes and daily practices that link people, place,

and health.

Participation

Your participation will involve logging on to the blog address from your computer

every second day for a fortnight (ie 14 days). This means that you will be required to

give as little or as much information you like in response to a photograph or question

that is posted on the blog every second day, providing us with 7 entries in total. You

will be able to respond to other entries posted by other participants, or write in your

own unrelated entry.

You will NOT be contacted for further participation following the completion of the

entries over the fortnight.

Expected benefits

It is expected that this project may benefit you in terms of gaining an insight into the way you

relate to your living environment, as well as why you do or do not use your neighbourhood for

physical activity. It may also provide you with access to a computer and the Internet which you

may not have otherwise had. Additionally, you may acquire computing skills that you did not have

prior to the data collection, as any assistance or training you need will be provided by the

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researchers. It will be of benefit to the researchers in terms of data collection for this study, but

also to the wider, international academic community interested in understanding the processes

that connect people, place and health, who are then able to pass this data on to policy makers in

the area of urban design and health.

Risks

There are no additional risks associated with your participation in this project.

Confidentiality

All comments and responses are anonymous and will be treated confidentially. The names of

individual persons are not required in any of the responses.

Voluntary participation

Your participation in this project is voluntary. If you do agree to participate, you can withdraw from

participation at any time during the project without comment or penalty. Your decision to

participate will in no way impact upon your current or future relationship with QUT.

Questions / further information

Please contact the researchers if you require further information about the project, or to have any

questions answered.

Concerns / complaints

Please contact the Research Ethics Officer on 3864 2340 or [email protected] if you have

any concerns or complaints about the ethical conduct of the project.

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QUT Letterhead

Participant Information Sheet

Project Title: Kelvin Grove Urban Village Study on the Ecological Processes

Contributing to Patterns of Physical Activity among Different Residential Groups.

Researcher One:

Julie-Anne Carroll

Telephone: 07 3719 5640

Email: [email protected]

Researcher Two: Researcher Three

Dr Barbara Adkins Dr Elizabeth Parker

Telephone: 0419 6500 90 Telephone: 07 3864 3371

Email: [email protected] Email: [email protected]

Statement of consent

By signing below, you are indicating that you:

• have read and understood the information sheet about this project;

• have had any questions answered to your satisfaction;

• understand that if you have any additional questions you can contact the research

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team;

• understand that you are free to withdraw at any time, without comment or penalty;

• understand that you can contact the research team if you have any questions about

the project, or the Research Ethics Officer on 3864 2340 or [email protected] if you

have concerns about the ethical conduct of the project;

• agree to participate in the project.

Name

Signature

Date

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APPENDIX C

The Physical Activity Survey

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Kelvin Grove Urban Village

A Survey on Physical Activity Patterns in the Urban Environment

For further information please contact:

Julie-Anne Carroll07 3719 5640

[email protected]

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Instructions for filling out this Survey

The questions in this survey are about the physical activities in your everyday life before and after moving into Kelvin Grove Urban Village (KGUV).

Think about your everyday life and the activities that you do on usual days during the week when you are answering the questions in this survey. By ‘everyday life and activities’ we mean all the different ways that physical activity happens or gets done in your daily life - for example, walking to get places, doing housework, hard labour, or gardening - not just when you are exercising.

Please tick the box next to each question that you feel most applies to you.

Note: The questions about the use of health-related resources at KGUV refer to the following geographical area only. Specifically, they refer to the parks, walkways, bikeways, and green meeting spaces in and directly adjacent to KGUV.

The Kelvin Grove Urban Village

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Section One – Your Life before Moving into KGUV

Note: Section One is about your everyday life before moving to KGUV

The first two questions in this section are about the amount of brisk walking you did for any reason on a usual day before moving to KGUV.

1. On a usual day before you moved into KGUV, did you do more than 30 minutes of brisk walking for any reason?

Always Often Sometimes Rarely Never

2. On a usual day before you moved into KGUV, did you do more than 10 minutes of continuous brisk walking for any reason?

Always Often Sometimes Rarely Never

3. On a usual day before moving to KGUV, did you walk to get to and from places instead of taking a car, taxi, bus etc? (You can include walking to a train station, bus, or ferry if it is far away enough to potentially drive or take another mode of transport there.)

Yes No (Go to Q 4)

If you ticked ‘yes’, please list the main places that you walked to and from, your main reasons for walking, and the estimated total time spent walking.

3.1 Please list the main places you walked to and from (e.g. from home to school, shops, work, ferry etc):

3.2 Please list main reasons that you walked to and from places rather than using another form of transport (eg to lose weight, lower stress levels, to avoid parking fees, no car available, etc):

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3.3 Please tick the estimated total amount of time in minutes that you walked to get to and from places on a usual day:

0-5 6-10 11-15 16-20 21-25 26-30 30 minutes

4. On a usual day before moving to KGUV, did you do any brisk walking within and around a particular place, such as your home, workplace, university campus, shopping centres that was not done as a means of transport or exercise?

Yes No (Go to Q 5)

If you ticked ‘yes’ please list the main places where this walking occurred, the main reasons this walking occurred, and the estimated total time spent walking.

4.1 Please list the main places where the brisk walking occurred (e.g around the house, to get around a uni campus, between wards in a hospital, between shops, along local streets, etc)

4.2 Please list the main reasons for walking briskly (e.g housework and childcare duties, to get to class, to get to work meetings, boredom, as part of your job, etc)

4.3 Please tick the estimated total amount of time in minutes this walking took on usual day?

0-5 6-10 11-15 16-20 21-25 26-30 > 30 minutes

The next questions are about the amounts of vigorous and moderate physical activities you did before moving into KGUV. They are NOT related to activities that are part of your paid work, volunteer work, or work around your house and garden. You may wish to include any sexual activity you did if you feel it fits these categories.

5. Before living at KGUV, did you do any vigorous exercise or physical activity at least once a week for 20 minutes or more? (Vigorous physical activity makes you sweat or breathe hard, e.g. cycling, football, swimming, jogging, netball etc)

Yes No (Go to Q. 6)

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6. Please list up to four types of vigorous activity that you did regularly in a usual week, the number of times per week that you did them, and the total amount of time in hours and minutes you spent in each session.

Eg Jogging 4 45 minutesActivity Frequency per week Time spent in each

session

7. Before living in KGUV, did you do any moderate physical activity at least once a week for 30 minutes or more? (Moderate physical activity causes a moderate increase in heart rate and makes it a bit difficult to talk, e.g. walking for exercise, yoga, pilates, bowls, golf, etc)

Yes No (Go to Q.8)

8. Please list up to four main types of moderate physical activity that you did regularly in a usual week, the number of times per week that you did them, and the total amount of time in hours and minutes you spent in each session.

Eg Yoga 3 1 hour 30 minutesActivity Frequency per week Time spent in each

session

The next two questions are about the physical activity you did in your paid work, volunteer work, or house and gardening work immediately prior to moving to KGUV.

9. Before living in KGUV, did you undertake jobs or tasks during a usual week that made you sweat or breathe hard (eg bricklaying, moving furniture, tree chopping, industrial cleaning, etc?)

Yes No (Go to Q 11)

10. Briefly describe this work and how long you would spend doing these tasks in hours and minutes:

11. Before living in KGUV, did you undertake jobs or tasks during a usual week that caused a moderate increase in heart rate and made it difficult to talk (eg wheeling equipment, delivering goods, caring for a sick/elderly relative, repairs and paint jobs, gardening etc)

Yes No (Go to Q 13)

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12. Briefly describe this work and how long you would spend doing these tasks in hours and minutes:

The last questions in this section are about how you view your lifestyle and yourself as a person (in terms of the amount of physical activity you did) immediately prior to moving to KGUV.

13. When you think about your daily life before moving to KGUV, which category do you think best describes yourself? You can tick more than one box to describe your previous lifestyle.

A person who exercises

A person who avoids exercise where possible

A person who is active in their daily life and tasks

A person who is inactive in their daily life and tasks

14. If you ticked ‘active in their daily life and tasks’, please explain why you chose this option (e.g. ‘I was looking after a toddler and didn’t get to sit down much’, or ‘I had multiple tasks to complete in one day and did a lot of running around’, or ‘I did hard labour as part of paid work’)

15. If you ticked ‘inactive in their daily life and tasks’, please explain why you chose this option (e.g. ‘I spent a lot of time indoors watching TV’, I had a desk-job’, or ‘I drove a cab for a living’)

16.Before moving to KGUV, did you have any health problems that limited the amount of physical activity you were able to do?

None of time Little of the time Some of time Most of time All of time

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Section Two- Your Life in KGUV

Note: The questions in this section are about your everyday life in KGUV

The first two questions in this section are about the amount of brisk walking you do for any reason on a usual day since moving to KGUV.

1. On a usual day since moving to KGUV, do you do more than 30 minutes of brisk walking for any reason?

Always Often Sometimes Rarely Never

2. On a usual day since moving to KGUV, do you do more than 10 minutes of continuous brisk walking for any reason?

Always Often Sometimes Rarely Never

3. On a usual day since moving to KGUV, do you walk to get to and from places insteadof taking a car, taxi, bus etc? (You can include walking to a train station, bus, or ferry if it is far away enough to potentially drive or take another mode of transport there.)

Yes No (Go to Q 4)

If you ticked ‘yes’, please list the main places that you walk to and from, your main reasons for walking, and the estimated total time spent walking.

3.1 Please list the main places you walk to and from (e.g. from home to school, shops, work, ferry etc):

3.2 Please list main reasons that you walk to and from places rather than using another form of transport (eg to lose weight, lower stress levels, to avoid parking fees, no car available, etc):

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3.3 Please tick the estimated total amount of time in minutes that you walked to get to and from places on a usual day:

0-5 6-10 11-15 16-20 21-25 26-30 30 minutes

4. On a usual day since moving to KGUV do you do any brisk walking within and around a particular place, such as your home, workplace, university campus, shopping centres that is not done as a means of transport or exercise?

Yes No (Go to Q 5)

If you ticked ‘yes’ please list the main places where this walking occurred, the main reasons this walking occurred, and the estimated total time spent walking.

4.1 Please list the main places where the walking occurs (e.g around the house, to get around a uni campus, between wards in a hospital, between shops, along local streets, etc)

4.2 Please list the main reasons for walking briskly (e.g housework and childcare duties, to get to class, to get to work meetings, boredom, as part of your job, etc)

4.3 Please tick the total estimated amount of time in minutes this brisk walking takes on usual day?

0-5 6-10 11-15 16-20 21-25 26-30 > 30 minutes

The next questions are about the amounts of vigorous and moderate physical activities you do since moving to KGUV. They are NOT related to activities that are part of your paid work, volunteer work, or work around your house and garden. You may wish to include any sexual activity you did if you feel it fits these categories.

5. Since moving to KGUV, do you do any vigorous exercise or physical activity at least once a week for 20 minutes or more? (Vigorous physical activity makes you sweat or breathe hard, e.g. cycling, football, swimming, jogging, netball etc)

Yes No (Go to Q. 6)

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6. Please list up to four types of vigorous activity that you do regularly in a usual week, the number of times per week that you do them, and the total amount of time in hours and minutes you spend in each session.

Eg Jogging 4 45 minutesActivity Frequency per week Time spent in each

session

7. Since moving to KGUV, do you do any moderate physical activity at least once a week for 30 minutes or more? (Moderate physical activity causes a moderate increase in heart rate and makes it a bit difficult to talk, e.g. walking for exercise, yoga, pilates, bowls, golf, etc)

Yes No (Go to Q.9)

8. Please list up to four main types of moderate physical activity that you do regularly in a usual week, the number of times per week that you do them, and the total amount of time in hours and minutes you spend in each session.

Eg Yoga 3 1 hour 30 minutesActivity Frequency per week Time spent in each

session

The next two questions are about the physical activity you do in your paid work, volunteer work, or house and gardening work since moving to KGUV.

9. Since moving to KGUV, do you undertake jobs or tasks during a usual week that make you sweat or breathe hard (eg bricklaying, moving furniture, tree chopping, industrial cleaning, etc?)

Yes No (Go to Q 11)

10. Briefly describe this work and how long you spend doing these tasks in hours and minutes:

11. Since moving to KGUV, do you undertake jobs or tasks during a usual week that cause a moderate increase in heart rate and made it difficult to talk (eg wheeling equipment, delivering goods, caring for a sick/elderly relative, repairs and paint jobs, gardening etc)

Yes No (Go to Q 13)

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12. Briefly describe this work and how long you spend doing these tasks in hours and minutes:

The last questions in this section are about how you view your lifestyle and yourself as a person (in terms of the amount of physical activity you did) since moving to KGUV.

13. When you think about your daily life in KGUV, which category do you think best describes yourself? You can tick more than one box to describe your current lifestyle.

A person who exercises

A person who avoids exercise where possible

A person who is active in their daily life and tasks

A person who is inactive in their daily life and tasks

14. If you ticked ‘active in their daily life and tasks’, please explain why you chose this option (e.g. ‘I look after a toddler and don’t get to sit down much’, or ‘I have multiple tasks to complete in one day and do a lot of running around’, or ‘I do hard labour as part of paid work’)

15. If you ticked ‘inactive in their daily life and tasks’, please explain why you chose this option (e.g. ‘I spend a lot of time indoors watching TV’, I have a desk-job’, or ‘I drive a cab for a living’)

16. Living in KGUV now, do you have any health problems that limit the amount of physical activity you are able to do?

None of time Little of the time Some of time Most of time All of time

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Section Three – Your Use of the Urban Environment

The next questions are about how you use the resources that have been built for residents at KGUV.

The questions only refer to the resources that fall within area on the map provided with the survey instructions.

Next to each of the KGUV resources listed below, please tick the box if you use it for any reason. Then name up to four reasons that you use them, and how many hours per week on average this occurs.

For Example:

1. Parks (in and adjacent to KGUV) Yes No

Four main reasons for using this resource Amt of hours spent per week (average)

Jogging 2 hoursMeeting up with friends 4 hoursPlaying with children 6 hoursTo take a short-cut 1 hour

1. Parks (in and adjacent to KGUV) Yes No

Four reasons for using this resource Amt of hours spent per week (average)

______________________________ ___________________

______________________________ ___________________

______________________________ ___________________

______________________________ ___________________

If you did not tick the box to indicate use of this resource, please state briefly why you do not use it:

2. Pathways/Walkways Yes No

Four reasons for using this resource? Amt of hours spent per week (average)

______________________________ ___________________

______________________________ ___________________

______________________________ ___________________

______________________________ ___________________

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If you did not tick the box to indicate use of this resource, please state briefly why you do not use it:

3. Bikeways Yes No

Four reasons for using this resource? Amt of hours spent per week (average)

______________________________ ___________________

______________________________ ___________________

______________________________ ___________________

______________________________ ___________________

If you did not tick the box to indicate use of this resource, please state briefly why you do not use it:

4. Green meeting places, eg BBQ areas Yes No

All reasons for using this resource? Amt of hours spent per week (average)

______________________________ ___________________

______________________________ ___________________

______________________________ ___________________

______________________________ ___________________

If you did not tick the box to indicate use of this resource, please state briefly why you do not use it:

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Section Four - Your Social and Cultural Neighbourhood

The questions in this section are about the social and cultural environment in which you live. Specifically, they refer to your perceptions of your neighbourhood, your tastes and preferences in terms of where you live, and your feelings about where you stand in society at this time in your life.

1. How often do you see people walking for exercise, jogging, or playing sport in the KGUV neighbourhood on a usual day?

Always Often Sometimes Rarely Never

2. What do you think when you see people in your neighbourhood doing jogging or exercise? List some brief thoughts and feelings.

3. How comfortable would you feel jogging or exercising in the KGUV neighbourhood?

Very comfortable Comfortable Uncomfortable Very uncomfortable

Q. 4 For each of the statements below, please tick the box that best describes the extent to which the following neighbourhood qualities appeal to you, and are important to you when deciding where to live. These questions are NOT about where you have lived before, or where you live now, they are about the type of place you would ideally like to live in.

Very im

portan

t quality

Som

ewhat im

portan

t

Unim

portan

t

I don’t valu

e this q

uality

A neighbourhood where people often out and about keeping fit

A quiet neighbourhood where people keep to themselves

A neighbourhood where people are not seen out and about in the streets much

A neighbourhood where you can call on your neighbour for a hand

A neighbourhood with residents who are similar to you in their tastes and preferences

A neighbourhood that will tolerate a certain amount of noise, eg parties, children etc

A neighbourhood where other people keep their houses/units well-presented

A neighbourhood where there are lots of specialty shops close together in the streets

A neighbourhood that is close to a big shopping centre

A neighbourhood that has lots of parks and green open spaces

A neighbourhood that contains one of the major take-away food stores, eg ‘McDonalds’

A neighbourhood with international food available to purchase, eg sushi, Thai, Chinese etc

A neighbourhood with a gym or venue where you are able to exercise

A neighbourhood that has easy access to public transport

A neighbourhood that has a lot of greenery, overgrowth, and Australian wildlife

A neighbourhood with neatly mowed lawns and trimmed greenery in the gardens

A neighbourhood with wide open pathways or pavements for walking

A neighbourhood where the houses look very different from one another

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Q. 5 The following questions are about how you feel about your social living environment at KGUV.

When you think about the accommodation you live in and your immediate neighbours (e.g. your building and the people in it), please tick the box that best describes the extent to which you agree or disagree with the following statements:

Note: The words ‘this group’ refer to all the people living in your building.

Stro

ngly A

gree

Agree

Undecid

ed

Disag

ree

Stro

ngly D

isagree

When someone criticises this group it feels like a personal insult

I don’t act like the typical person of this group

I’m very interested in what others think about this group

The limitations associated with this group apply to me also

When I talk about this group I usually say ‘we’ rather than ‘they’

I have a number of qualities typical of members of this group

The group’s successes are my successes

If a story in the media criticized this group I would feel embarrassed

When someone praises this group, it feels like a personal compliment

I act like a person of this group to a great extent

When you think about the KGUV neighbourhood as a whole, including all of the other residents, please tick the box that best describes the extent to which you agree or disagree with the following statements:

Note: The words ‘this group’ now refer to KGUV as a whole

Stro

ngly A

gree

Agree

Undecid

ed

Disag

ree

Stro

ngly D

isagree

When someone criticises this group it feels like a personal insult

I don’t act like the typical person of this group

I’m very interested in what others think about this group

The limitations associated with this group apply to me also

When I talk about this group I usually say ‘we’ rather than ‘they’

I have a number of qualities typical of members of this group

The group’s successes are my successes

If a story in the media criticized this group I would feel embarrassed

When someone praises this group, it feels like a personal compliment

I act like a person of this group to a great extent

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The following two questions refer to how you feel about your own standing in society at this time.

Think of this ladder as representing where people stand in Australia. At the top of the ladder are the people who are best off – those who have the most money, the most education, and the most respected jobs. At the bottom are the people who are worst off – have the least money, the least education, and the least respected jobs or no job. The higher you are on the ladder, the closer you are to the people at the very top; the lower you are, the closer you are to the people at the very bottom.

Where would you place yourself on this ladder? Please place a large X on the rung where you think you stand at this time in your life, relative to other people in Australia.

At the top of this ladder are the people who have the highest standing in the KGUV community. At the bottom are the people who have the lowest standing in the KGUV community. Please place a large X on the rung where you think you stand at this time in your life relative to other people living at KGUV.

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Section Five

Socio-demographic Information

1.Please state your date of birth

__________________________

2. Sex Male Female

3. Do you identify as Aboriginal or Torres Strait Islander? Yes No

4. Do you identify as a person with a disability? Yes No

5. If yes, what is the nature of the disability?

6. Do you currently hold a Healthcare card? Yes No

7. Do you currently hold a pensioner card? Yes No

8. Do you have private medical cover? Yes No

9. Do you have daily access to a car? Yes No

10. Which of the following best describes the highest level of education you have completed? Please tick.

No schooling

Completed primary school

Completed junior school (to Grade 10)

Completed senior school (to Grade 12)

Trade, technical certificate or diploma

University or college bachelor/undergraduate degree

Postgraduate qualifications

Other _________________

11. Which of these best describes your current employment status? Please tick all the boxes that apply to you.

Employed full-time

Employed part-time or casual

Self-employed

Home duties

Unemployed

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Full-time student

Part-time student

Retired

Permanently ill/unable to work

12. Before tax is taken out, which of the following ranges best describes your household’s approximate income, from all sources, over the last 12 months? Less than $25,000

$25,001-$50,000

$50,001-$100,000

Over $100,000

13. Please tick the category that best describes the home in which you currently live. Public Housing (rental)

Private Housing (rental)

Privately owned (paying mortgage)

Privately owned (fully purchased)

Student accommodation

Retirement accommodation

14. Which of the following best describes your living situation? Single living alone

Single with flatmate/s

Single with child/ren

Couple on their own

Couple with flatmate/s

Couple with children

15. What was the name and postal code of your previous residential suburb/town?

Finally – please tick this box if you would be willing to be contacted for a follow-up interview where we will ask you about your answers in further detail. (It is unlikely that you will be selected due to the small number we plan to follow-up, however, we are very grateful for your willingness to chat to us further!)

Yes you can ask me a few more questions in a few months time Ph:_____________

No I do not wish to be contacted further

Thank you for your time today!

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APPENDIX D

The Blog

Note: Some of the comments made on the site were removed by

the principle researcher, as the participants had accidentally

pasted their answers in twice, thus resulting in a duplication of

data. However, no data has been omitted from the blog.

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The Effects of a New Urban Context on Health

Friday, October 13, 2006

Self, Health and Space: What Moves You?

This is an extra post to provide space for thinking and writing about how you interact

with your living environment and how this affects your lifestyle and your health. You

can write a story, comment, opinion or perspective on where you live and how active

you are able to be here and why. You can use this online SPACE for any of the

following reasons:

1. To talk about a social interaction or event/incident that affected how you felt about

living in the KGUV neighbourhood.

2. To suggest activities and get others together to pursue activities eg, birdwatching,

walking groups, games in the park (perhaps for mums with young children) , theatre

outings, coffee or book clubs or a swimming team... anything that interests you!

3. To give feedback on stories and ideas of others, to swap email addresses and

phone numbers, to get in touch, and to get socially connected and physically active.

posted by Julie-Anne @ 7:08 PM 13 comments

Sunday, September 17, 2006

Social and Psychological Aspects of Physical Activity

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This is the last post for questions about the Kelvin Grove Urban Village and the

amount of physical activity you do. Please write as much as you can...

1. Would you say that, in a general sense, you are aware of how much physical

activity or exercise you achieve during the day, and do you worry about it, or try to

increase the amount? Do you ever consider taking more exercise, or are you content

with how active you are?

2. If you see an ad on the TV telling people to do more physical activity, or hear a

health promotion message about it on the radio does this make you want to become

fitter? Do you ever act on these messages, or do you forget about them soon after

hearing them?

3. What types of thoughts do you have that would make you want to increase your

physical activity levels? What kinds of things play on your mind or which life events

might suddenly make you motivated to exercise?

4. If you see people out and about exercising, does this inspire you to become more

active? Do you compare yourself to others' bodyweights in and around the area that

you live? How does this make you feel?

5. How interested would you be in being part of a social group that organised group

walks, or bicycle rides, or games in the local park? Why/why not? And would you

like to hear about such events online, by mobile/home phone, texting, or pamphlet in

the mailbox?

posted by Julie-Anne @ 8:32 PM 73 comments

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Depth of Engagement with Neighbourhood Resources for Physical Activity

For this post, I am interested in finding out the degree to which you are aware of

what is available in your neighbourhood, and which resources you are most

interested in using or accessing for physical activity.

Q1. Are you aware of the public transport options available to you from the Village,

and do you use them? If so, which ones to you use and why?

Q2. Do you ever use the parks or BBQ areas to socialise, rest, play sport, care for

children, exercise or any other reason? If so, how often? What is your opinion of the

local KGUV parks and green spaces? How could they be improved to make you use

them more?

Q3. Do you use any of the pathways or bikeways? If so, what do you use them for,

and do you find that they help you to walk or exercise more than you could where

you were living previously?

Q.4 Are you aware of any other health-related resources that are near to the Village

or that will be available to you soon, eg health clinic, GP, gymnasium, pool etc. Do

you think you are likely to use these kinds of resources? WHy/why not?

Q5. Overall, would you say that KGUV is a place that promotes or allows physical

activity for residents? If so, in what ways does it achiev this or not achieve this?

posted by Julie-Anne @ 6:47 PM 80 comments

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Thursday, August 10, 2006

Moving into a New Urban Environment...

For this first post, I am interested in how much choice you had in deciding to move

into your current accommodation; what your expectations were before moving in;

and whether you feel that your everyday routine and lifestyle have changed

significantly since moving to KGUV. Importantly, I would like to know whether you

intended to become more PHYSICALLY ACTIVE once you moved in - or whether

you did not expect much change in lifestyle and physical activities to occur. Please

answer the following questions.

1. What brought you to KGUV? What persuaded you to choose this accommodation

option over any other? How much choice do you feel you had in moving here?

2. How much did you know about KGUV prior to moving in? What types of

expectations or images of the housing, resources, and neighbours did you have in

mind before you came here?

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3. What kind of lifestyle did you hope to lead once you were here? Did you have any

expectations that your daily activities would be more interesting, or that you would

more become more physically active once you moved in?

Please click on the COMMENTS link below and number your answers 1,2 and 3. Be

as open and honest as you like, and feel free to respond to other comments that you

see - whether you agree or disagree. Please write as much as you can.

posted by Julie-Anne @ 3:46 AM 48 comments

Saturday, June 03, 2006

The Effects of a New Urban Context on Health

This is a site for conducting qualitative research into understanding the processes

connecting people, place, and physical activity in a new urban village in Brisbane,

Australia. The name of the case-study under investigation is the Kelvin Grove Urban

Village (KGUV). I am interested in finding out about how urban design and social

diversity contribute to lifestyle patterns and communicative processes that influence

health behaviours. Digital photography of the place, and comments and opinions of

residents from different housing options will be posted. An analysis of the digital

stories that emerge will provide an opportunity to build theories and interprative

frameworks for understanding the empirical relationship between people, place, and

health in the future.

posted by Julie-Anne @ 8:04 PM 2 comments

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About Me

Name: Julie-Anne Carroll

Location: Queensland University of Technology, Brisbane, Queensland,

Australia

View my complete profile

Links

• Centre for Social Change Research

• Health and Place

• IPAQ

• PLACE, UQ

• VicLanes Study

• RESIDE - Uni of WA

• SEID - Uni of WA

• GOLD

• RAW

• Health Behaviour News Services

Previous Posts

• Self, Health and Space: What Moves You?

• Social and Psychological Aspects of Physical Activ...

• Depth of Engagement with Neighbourhood Resources f...

• Moving into a New Urban Environment...

• The Effects of a New Urban Context on Health

Archives

• June 2006

• August 2006

• September 2006

• October 2006

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BLOG POSTS AND COMMENTS

Post a Comment On: The Effects of a New Urban Context on Health

"Self, Health and Space: What Moves You?"

13 Comments - Show Original Post Collapse comments

participant 1 said...

1.Personally, I absolutely love living in the KGUV. The neighbourhood is

friendly and the people are approachable. Since most of the shops are now

open, the convenience is wonderful. I will definitely be shopping locally.

6:16 PM

participant 1 said...

2. As I don't normally find a great deal of spare time, organised events during

the week do not necessarily suit, but I was thinking whether perhaps a

weekend market may be of interest.

6:19 PM

participant seven said...

The difference in living in a university area at the Kelvin Grove Urban

Village is the educational value for one of my age group (aged) I have already

been to Sharing Stories which was so interesting and am off to the Human

Rights Lecture by Dr. Carmel lawrence The mature age students who live in

the complex are so kind and give us lots of information on all social activities

that are on at the village .I love the shopping complex and am looking

forward to the community hub opening soon to enjoy the company of

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different age groups .

2:13 PM

participant seven said...

2.I have lots of interest outside the village and have lots of physical exercise

but maybe a card night for people that can not exercise due to ill health would

be a good idea .I think once the village gets under way the community hub

would be great for people to interact with others to organise some activities .

Ballroom dancing classes come to mind as well and music soothes the soul ...

2:22 PM

participant seven said...

3.Parks are wonderful places for exercise and there are some great ones

around the village so maybe an evening class of Tai Chi ?? or very gentle

exercises for families with a B.B.Q afterwards would be an idea for getting to

know the residents .

2:37 PM

participant 1 said...

3. The idea of having Tai Chi classes would be perfect and also to continue

the yoga. Unfortunately, I haven't been able to go because it has been

conducted on a week day so perhaps a Saturday morning class would be

good. I would also really enjoy the idea of ballroom dancing as well.

6:16 PM

participant seven said...

1.during the week I enjoyed having a birthday morning tea with residents

from Ramsgate Street and was so thrilled that these people who I have only

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known for a short time would do this for me .

I know Anne has so much to do but she went out of her way to have the

morning tea at her lovely unit .

This is why I love the atmosphere of the village as although we have other

interests outside people are very caring of others

and it goes to show how a community like this can succeed .

At present the shops here are still not up and running but the future looks very

bright for the residents because of the convenience and locality here.

9:01 PM

Julie-Anne Carroll said...

Yoga in the park

The Kelvin Grove Urban Village has a comprehensive community

development program in place for new and surrounding residents, as well as

students, staff and others who work in or visit the Village.

The program includes a series of free low impact yoga classes on the Parer

Place lawn, led by Yoga Chi Gung teacher Geraldine Carty. Classes are

designed to respond to the needs of beginners through to intermediate

participants, and are suitable for a broad range of age groups.

Classes are being held on Tuesdays from 7am to 8am until 28 November.

Free entry, no booking necessary.

9:41 PM

Anonymous said...

Participants Eleven

1. Living in Kelvin Grove Urban Village is convenience not only its location,

5 minute walking distance to KG campus but the facilities available around it

these including supermarket, flight centers, wet market, restaurants and many

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more. Every evening I can sit in the garden next to my apartment and at the

same time watching children with their parents walking and playing which

remind me about my home back in Brunei. The most interesting to me is that

I can push the supermarket trolley straight to my kitchen which I never

experience in my whole life. The first two weeks living in KG Urban Village

I can access to the University off Campus wireless which is very convenience

to me. I can communicate with my children and wife via msn chat box and

webcam which make me feel like we are closed. I don’t do much exercise but

walking up hill going to the campus is sufficient for me at this age.

8:54 PM

Participant Thirteen said...

A community BBQ would be a great idea - and we could all put in, sit down,

meet people, and get to know each other.

5:16 PM

Participant Fourteen said...

Our neighbour next door - you couldn't wish to meet a nicer couple. And the

lass with the baby she is fine now that the baby has a cot - but before she was

crying alot. The smokers drive us mad, because they are chain smokers. And

we had to call the police because a man was throwing shoes at our louvres at

4am in the morning.Most of our neighbours are good, but we need to get rid

of some of the rubbish, but BHC dont seemto listen to us when we complain.

We're not whinging, but we just want to live peacefully.

6:06 PM

Participant Fifteen said...

Someone started a fire in our refuge. Someone smelt the smoke and saw the

burnt paper. But we dont think anyone will help us stop these kinds of

problems

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6:11 PM

participant 16 said...

1. I have so far enjoyed living in the area and i have made many new friends,

my neighbours are some of the most wonderful and interseting people you

will ever meet. There are no worries what age you are as we all get along

very well. I would be very interested if there was a weekend market of some

sort and everyone loves a bargain. I enjoy talking to people to hear their

stories and think it is great that we are not finding it too difficult to mix with

others older or younger than ourselves. The shops all have lovely and kind

people working in them and most would do anything for you, very helpful.

7:09 PM

7:08 PM Post a Comment On: The Effects of a New Urban Context

on Health

"Social and Psychological Aspects of Physical Activity"

73 Comments - Show Original Post Collapse comments

test user said...

this is a test

8:12 PM

Study participant number eight said...

1. Constantly trying to do more activity. I know that more walking will be

good for me.

7:44 PM

Study participant number eight said...

2. I take it on onboard but I am generally aware of my own health needs from

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use more reliable sources.

7:45 PM

Study participant number eight said...

3. When I worry about my weight or other risks to my health, such as the risk

of diabetes.

7:48 PM

Study participant number eight said...

4. Don't worry about others too much.

7:48 PM

Study participant number eight said...

5. Yes I would be interested in organised walks including, for example,

birdwatching. Pamphlets in the post are best.

7:51 PM

study participant seven said...

1.i don't worry about how much exercise I do but try to be as active as

possible with a social tennis game weekly and linedancing twice weekly and

now the summer is here I intend to do more swimming .

2.No. T.V

does not sell me on anything .I think there is too much said about diets and

exercise and I think it is only up to one,s own self to participate in looking

after your own body .

5:10 AM

study participant seven said...

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3.My thoughts on physical exercise is in a group session maybe aqua aerobics

or a walking club in the village .Weight is always a problem especially after

winter when one tends to hibernate for the winter months

4.I do get motivated by older people exercising and try and do as much as

possible .I have arthritis in both knees and find movement is restricted at

times but feel better after exercise.

5:39 AM

study participant seven said...

5.Very interested in a social group with walks etc. E-mail is fine for more

information or pamplets in the mail.

5:44 AM

participant two said...

Yes I am aware that I do little physical exercise other than around the home

or wheeling Ted when going around shops etc., as I am unable to leave Ted

unattended even to take a quick walk around our pathways. We go when I

wheel him to QUT!s coffee shop, and it is a slightly uphill pathway therefore

I am exercising muscles, though not as good as straight walking. With

community centre offering e.g Tai Chi or gym with light exercises, we could

be together there. I am unable to leave Ted unattended at home, nor am I able

to leave anyone other than a nurse should I have to leave Ted.Yes we would

definitely love to have more regular exercise which we really believe we all

need for healthier living.

9:22 PM

participant two said...

I am not usually prone to just accept because TV or papers tell me this or that

will benefit my health wise or physically, e.g. I would not go ahead and

purchase equipment that TV has told me is !for me!. I would take in an

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exercise that I could readily do at home if I could see it would benefit.

Overall I know myself that I do need physical exercise and mental

stimulation if I wish to live a healthy life and I would do all I could to achieve

this should facilites be close to home that would enable to enhance my life

and again this refers to diet.

9:28 PM

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9:28 PM

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9:28 PM

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9:28 PM

paparticipant two said...

I don!t really as I am a good weight I do the exercises I am able at home,

being that I would love to be able to get out, to do more. I am sensible in not

letting myself become overweight, am aware of what consequences could

develop. So no I am aware I must always try to keep as fit as possible for me.

9:40 PM

participant two said...

Whilst I would love to do my share to help in these activities, with my Ted

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totally wheelchair bound I would not be able to share in the organising of

these unless the folk participating would be happy to be led by myself and my

darling precious wheelchair bound husband who is my priority. Perhaps on

reflection this could be one fun activity in itself!

9:45 PM

participant four said...

1. Yes, and recently yes, I have been taking steps to excercise more.

1:02 AM

participant four said...

2. Sometimes, if I feel like I haven't done much during the day.

1:03 AM

participant four said...

3. Feeling weak or easily exhausted is my major kick start.

1:04 AM

participant four said...

4. Yes, and no.

1:06 AM

participant four said...

5. Not sure, I feel I best excercise by myself and am not much of a socializer,

yes I would be interested in a pamphlet.

1:08 AM

participant nine said...

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1. I have some heart problems, but most days I do exercises because I want to

stay healhty. I walk around the place with my neighbours or myself.

6:58 PM

participant nine said...

3. If you do things that make you feel good your life improves and if you

interact with people and get going in activities you start to feel better. So I

know to do this.

7:04 PM

participant nine said...

4. When I was younger I did compare myself to others, but I dont think that

matters to me anymore. When you are young you worry about how you look,

but when you get older you dont worry.

7:06 PM

participant nine said...

5. I would be keen to do something like that but I worry about the effects

about my accident... would you I be able to do it? I would need to tell people

about my accident. But it would be a great idea to do. By phone or pamphlet

would be the best way to tell me about it.

7:10 PM

participant nine said...

5. I would be keen to do something like that but I worry about the effects

about my accident... would you I be able to do it? I would need to tell people

about my accident. But it would be a great idea to do. By phone or pamphlet

would be the best way to tell me about it.

7:10 PM

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Anonymous said...

1. I am quite aware of the exercise I do and do not worry about the extent

because it varies according to how much time I have. I definitely would

increase my physical activity if I had the time to do so.

6:26 PM

participant one said...

2. I never act on advertising and am not influenced by other people's

comments regarding becoming "fitter". I feel quite confident regarding my

own judgement of how fit I am and will only increase my activity if I wish to.

6:30 PM

participant one said...

3. As I said previously, I chose when to exercise according to the availability

of time. Most exercise consists of getting from A to B. No particular thoughts

influence me to increase my activity expect if I'm running late for an

appointment or something similar.

6:35 PM

participant one said...

4. I never compare myself to others as everyone has different body shapes

and each can decide for themselves whether they need to increase their fitness

levels. I chose not to be influenced by others.

6:38 PM

participant one said...

5. I generally prefer to exercise alone except for Thai Chi which is pleasant to

do as a group. I generally find out about any available exercise groups

myself. I do not like having what I can consider junk mail.

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6:42 PM

Participant Six said...

1. I think so. I always time myself doing physical activity, I want to put more

exercise into my day. I would exercise at night, but at night time I am too

scared of what will happen to me out walking by myself. So I walk to work

and to the shops, but the fear hinders me at night to put more exercise into my

day. Walking from the city is OK because of all the lights, but I feel brave if I

do it. But exercise by myself is just too scary in the night - the news always

says that old ladies are being attacked, so I don't go out.

6:04 PM

Participant Six said...

2. If you hear anything to promote your health then you can know more about

what to do. You need to become fitter if health promotion says to become

fitter. I don't forget the messages, I listen to them and acquire the knowledge

about what to do. I never ignore that I need to become healthier.

6:06 PM

Participant Six said...

4. You have to organise people around your area to do some more activity

that makes you feel happy among the group and this will be a good increase

in your personality and of your health. If there are ads inviting you to attend

some kind of activity then it is nice for you to join, because it involves your

physical body. Encouragement from other people who are doing exercise

inspires me so much to become more active. I always think why they can do

it and why can I not do it? So if I see people I think that is lovely and it is

inspiration for others.

6:09 PM

Participant Six said...

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5. I am very much interested to join if there are people who can organise this

kind of activity. Games in the park would be great. But I wonder if they will

invite me, but I am always available. You go with the flow with what the

groups are doing otherwise you isolate yourself. A phone call would be the

best way to get me. If you don't come and talk face to face or verbally with us

then we won't go, but a home visit is much more important - person to person

to talk about these things and organise activities is better.

6:13 PM

study participant three said...

1. i am not really aware of how much physical activity i do, except that it is

not enough and i should be doing alot more! i only walk and would love to be

running and playing a sport. i have been getting healthier, quitting smoking,

and as a result am recently motivated and have been running sometimes, to

get back into cross country and track that i did when i was younger.

4:12 PM

study participant three said...

2. if i see an ad for physical activity i feel guilty for sitting in front of the tv

and want to do excercise, but soon forget or get too lazy.

4:13 PM

study participant three said...

3. my weight is a huge factor in my wanting to excercise, having illness cause

me to put on 25 kilos and quit track. i would love to get back into it when i

feel better, and when my treatment is goin well i generally do more excercise.

also, if i feel bad about my weight or my fitness, this motivates me to

excercise, for example if someone makes a comment negatively on my looks

of my fitness, or if i feel generally run down and unfit.

4:16 PM

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study participant three said...

4. if other people excercise i feel bad, as they are fitter and better looking than

i am and i feel if people see me excercising i will just look fat and stupid, so it

quietly motivates me to better myself but makes me feel bad.

4:17 PM

study participant three said...

5. i think i would be interested in like an indoor netball team or social soccer

team or something, but not just a social walking group. i am not really

motivated unless i take what i am doing quite seriously and need the

motivation right now to improve my fitness.

4:20 PM

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7:37 PM

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7:38 PM

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7:50 PM

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7:52 PM

Anonymous said...

Participants Eleven

2. As I mention earlier I don’t do much exercise but walking up hill going to

the campus is sufficient for me at this age. In the evening I preferred sitting

outside in the garden in front of my apartment. Sometimes I meet my

Bruneian friends who are also studying at QUT. Living away from home with

entirely different environment and cultures sometime it make me feel lonely.

But KG Urban Village is so different though I hardly know my neighbor; I

feel this is the best place I ever experience for the last 4 semester living in

Brisbane.

8:54 PM

Participant Twelve said...

1. It does not really worry me that I don't always do the amount of exercise I

need to do or that other people say I need to do. If some one is big it does not

necessarily mean they are unfit.

7:19 PM

Particcpant Twe.ve said...

2, Seeing ads about exercise or other things like that does not really motivate

me as I do as nuch as I can cope with at a certain time. There are some times

when I am more active than others and sometimes my body tells me to veg

out.

7:21 PM

Participant Twelve said...

3. I have been told by the doctor to watch my weight mainly because of pre

diabetes and when I think carefully about what I put in my mouth and do

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moderate exercise I do lose weight. I mainly want to be fit to care for my

husband and I was a carer for my mother before him so when I got

overweight once when looking after her I lost 20kg.

7:25 PM

Participant Twelve said...

4. Some people can be inspirational but in general you have to be happy with

yourself and if YOU want to lose weight or be active you have to do it for

yourself. I don't really look at body image as sometimes this can put people

down and not give them any self confidence. Start off being happy with who

you are and then you can go where you want to go.

7:28 PM

Participant Twelve said...

5. I already go with the walking group but if there were activities in the park

that I enjoyed doing and I had the time I would probably join in. I do see the

Hub newsletter in my mailbox and things are posted up as well.

7:30 PM

10 said...

1.10 I have physical limitations. I can do moderate exercise until I reach a

pain threshold which is quite low as I have pinched nerves in my neck and

other disabilities.

7:41 PM

10 said...

3.10 Nothing

7:44 PM

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10 said...

4.10 I don't compare myself. Seeing people exercising makes me feel sore.

7:46 PM

10 said...

5.10 Because of my medical condition I would be limited in what I could do.

7:47 PM

Participant Thirteen said...

1. I have a pedometer that I got from a friend of mine. You can get them from

health stores or chemists - it tells you how many steps you have taken and

how many kilometres you've walked. I dont reset it, I just see how much I've

added on to my last count to see how much I have walked during the day. I

just love walking and exercise, although I smoke, and it keeps me healthy

from my perspective. I have done martial arts since I was 5, and bike riding

since I was 10 - I worked in a bike shop and that is how I got into bike riding.

I was 19 or 20 when I started smoking.

5:01 PM

Participant Thirteen said...

2. No, I already have my own fitness and do so much walking so I am happy

and content with that. I can eat as much as like and I don't put on weight.

5:04 PM

Participant Three said...

3. I am just high on life and that motivates me to move and walk. I feel like I

am moving, meeting people, out and about seeing things, smelling the roses,

and it beats sitting at home. I walk at the New Farm Neighbourhood Centre

right across from the park, so I walk there.

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5:07 PM

Participant Thirteen said...

4. I already have my own thoughts about what my fitness is, and I already

like walking. Once I get a bike you won't see me for dust! There is a bike

event from Toowoomba to Maryborough over a few days, and that is ideal for

me. I might just volunteer this year, but I can do up to a 100k per day.

5:10 PM

Participant Thirteen said...

5. Yes I would - Tai Chi, Kung Fu - or anything like that. I got trained in

Samurai. Martial arts or yoga would be great. I am flexible in that way.

5:12 PM

Participant Fourteen said...

1. No I am not happy with my current activity levels. I would like to work

and could do light activities or tasks like cleaning. But I need to find out

where I can get work.

5:44 PM

Participant fifteen said...

1. I'd like to get out in the garden and get active, but I can't here. They were

going to let me go down and do volunteer gardening at Northey Street in

Windsor, but this hasn't eventuated yet.

5:47 PM

Participant Fourteen said...

2. Yeah we do listen to them and try to take notice of them, but they aren't

effective in getting me to change behaviour

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5:49 PM

Participant Fiffteen said...

2. Not really no. I walk every day, so I'm happy with that.

5:50 PM

Participant Fourteen said...

4. I have had thyroid cancer in 1975 and my weight went up since all the

treatment, and they blasted my metabolism. I am not influence by what others

are doing.

5:52 PM

Participant Fourteen said...

4. I have had thyroid cancer in 1975 and my weight went up since all the

treatment, and they blasted my metabolism. I am not influence by what others

are doing.

5:52 PM

Participant Fifteen said...

4. No this has no effect on me.

5:53 PM

Particiipant Fourteen said...

5. I would be interested. We go into concerts in the city hall and I am

interested in things like that. We went to the concert at the Con and it was

very good. I would like to hear about activities through a pamphlett in the

mail.

5:56 PM

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Participant Fifteen said...

5. Gardening would be great. Pamphlet would be great because we don't have

a computer.

5:59 PM

participant 16 said...

I am currently very aware of how much exercise i do as i'm on the tony

furguson diet and i am trying to lose the excess weight. I go walking, running,

riding and do pilates and tae kwon do.

6:50 PM

participant 16 said...

2. I do not listen to anything that i hear on the radio or t.v as i believe it is just

some money making scheme or ploy to get people to spend money on stuff

that probably dosen't work anyway. I am also aware of my bodys needs and

do not need t.v to tell me what i need.

6:54 PM

participant 16 said...

3. I exercise everyday, i do pilates at home and i have an exercise bike, a gym

ball, a skipping rope and i practice my Tae kwon do at home as well as

running and walking and if the pool is ever ready i will swim too. I also do

weights once a week at my boyfriends.

6:56 PM

participant 16 said...

4. Invite friends to exercise with me sometimes but others do not interest me

much.

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6:57 PM

participant 16 said...

5. used to do Tae kwon do at club, but when moved here tried BTC down the

road and did not like the "you are invisible" approach by staff members. Also

did not enjoy the environment there and now prefer to exercise alone or in the

company of friends. Group situations no longer interest me.

7:00 PM

8:32 PM

Post a Comment On: The Effects of a New Urban Context on

Health

"Depth of Engagement with Neighbourhood Resources for Physical

Activity"

80 Comments - Show Original Post Collapse comments

test user said...

test

8:11 PM

Study particpant number 8 said...

1. Yes. I use the northern busway, pensioner's taxi and buses on Kelvin Grove

Road.

7:29 PM

Study participant number eight said...

2. I use the BBQ facilties in the BHC complex. I have taken my

granddaughter for walks in the parks. More shade is needed, especially near

the BBQ areas.

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7:35 PM

Study participant number eight said...

3. I use the pathways for walking. They are better than the walkways I

previously had access to, which was a hilly area.

7:39 PM

Study participant number eight said...

4. Looking forward to the medical centre starting up. Yes I will use some or

all them becuase they are nearby.

7:40 PM

Study participant number eight said...

5. Hard to tell just yet but I hope so.

7:42 PM

study participant seven said...

1.Yes public transport is very convenient here being close to Kelvin Grove

Road .I go to the city quite often now as I have joined the city library and find

shopping very easy .Also walking to the bus stop easy as it is all on one level

(no hills)South bank and the lyric theatre are only 15 mins away for all the

activities one enjoys and buses are available every 10 mins.

2:21 AM

study participant seven said...

2.I have used the parks to play with my Grandson and enjoy the walks on the

pathways as it is very safe and secure .The B.B.Q. in the Ramsgate complex

is often used as it is very convenient and a nice way to engage in a meal and

conversation with the other residents. I usually show visitors around the parks

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and often relax as the seating is excellent around the pathways and parks

.maybe more shade in the B.B.Q in the parks during summer

2:38 AM

Studyn participant seven said...

3.My thoughts on Physical activity is in a group maybe walking for pleasure

and ball room dancing or line dancing (anything that gets the body moving)

!!!!Swimming is great 1n Summer and aqua aerobics is fun in a group .A

walking club in the shopping centre when finished would be a great way to

meet people and also be great for the heart rate.

3:49 AM

study participant seven said...

4.Sorry Julie I messed these questions up so hope you can follow !!!!

yes Human resources is a good place to go for exercise in the gym if needed

.I would be interested in using all the facilities .I have my own doctor but

would use a medical centre if close by .

5:08 AM

study participant seven said...

5.I think in time KGUV will promote physical activity as it is a new concept

in living so I am looking forward to new ideas and maybe a swimming pool

in the future for the residents as the walking paths are great and the parks are

well estabished for all sorts of fun and games.

5:19 AM

participant two said...

We realise there is a great bus service within easy reach however as Ted is

totally wheelchair dependent we are limited to maxi-cab transport. This is not

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as satisfactory as we could hope, as the maxi cabs are short we believe in

supply and we have had more than hours waitin unpleasant weather at times.

8:07 PM

participant two said...

2. We believe these are great, however with Ted in wheelchair we are limited

in our use. The paths are not so easy to push the w.chair. We do have good

neighbours to help at times, I have a frozen shoulder, and do not at the same

time wish to impose. The Ramsgate Residences do have a wonderful

barbecue set-up which we use with our neighbours and family.

8:25 PM

participant two said...

3. Yes we use the pathways again with help of neighbours to push my special

husband in wheelchair, going to QUT!s coffee shop where they provide

excellent morn.,afternoon teas and lunches. Again it is much better accessed

for us than previously in that we could not get Ted out in wheelchair at all to

walk and QUT coffee shop provides me with gluten free foods as I am coeliac

and they are so anxious to please. This we could not do at either of our 3

previous addresses.

8:32 PM

participant two said...

We are aware that a medical practice is to open in the new shopping complex

which would be a bonus being on our doorstep. Also a swimming pool may

be a help for Ted together with help which may be available through our

Allied Health services which have been wonderful for us in assisting with

physio for each of us and may extend to help for Ted who would need their

assistance. A community centre with its facilites e.g. card games, exercise

programmes such as tai chi perhaps, just mingling socially perhaps. We

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would use these and it would greatly benefit Ted in that he does not have

these social outings presently. A library would benefit us also, both of us are

great lovers of books.

8:40 PM

participant two said...

We hope with facilites offering to us such as community centre!s facilities,

swimming pool, walking paths,

QUT!s coffee shop and maybe library with its computer access and maybe

any learning programmes such as writing we all will grow and at the same

time learn and also help others. We feel privileged to have all these wonderful

people ready and so kindly willing to help us to live a more gracious and

healthy lifestyle. We are most grateful for this.

8:48 PM

participant four said...

1. Yes, I use the buses and taxi's. I prefer them to buying a car and the costs

associated with running it.

12:51 AM

participant four said...

2. Yes, more often recently, as I have tried to increase my physical actvity

outside the house. I find the green areas outside the KGUV complex to be

good but small. I would prefer them to be bigger, since there are many roads

and hills in this area and it's hard to find a place for a quiet walk or ride.

12:55 AM

participant four said...

3. Yes, I use them for walking and riding, and no, I find them to be simply a

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requirement of a small urban area and not specifically built as a walkway for

excercising or riding.

12:57 AM

participant four said...

4. No, and yes, for relaxation and enjoyment.

12:59 AM

participant four said...

5. It's hard to say at this point, since I don't believe that KGUV has been fully

finished but I imagine it would promote more physical activity.

1:00 AM

participant nine said...

1. Yes and I think it is a very good connection here actually... the buses are

great, I use the ones on Kelvin Grove to go shopping. But sometimes I walk

to the shops. I go to the City for something to do. I catch the bus there to look

around.

6:42 PM

participant nine said...

I use the BBQ area to socialise with my neighbours. I love the Victoria park,

if you walk there at night is it wonderful sightseeing, you can see the

beautiful city. It is nice to look at, if you don't get disturbed by a golf ball!

6:45 PM

participant nine said...

It is a bit too hilly,but i can cope with it, it is no problem. The surrounding

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areas are very nice to look at and you can meet the students and talk to them.

The international students have come to visit us.

6:47 PM

participant nine said...

I am not sure if they are still building the health building... so I am doubtful at

this stage about the health resources available.I would use a gym if it was

made available. I couldn't swim after my accident.... no muscles.

6:50 PM

participant nine said...

5. It will be good for physical activity especially walking and jogging and

going sight-seeing is good exercise. And going to the shops.

6:51 PM

participant one said...

1. I do not have a car so rely heavily upon public transport. I use the bus

services, usually the Northern Busway, and mostly the shuttle bus services

between the Uni campuses.

6:46 PM

participant one said...

2. I rarely use the parks or BBQ areas because I tend not to have the time.

The green spaces in KGUV seem to be adequate but am worried they will not

accomodate the influx of people once the construction of all the units are

completed. It is unlikely that I will be using them until I can access more time

to do so.

6:50 PM

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participant one said...

3. I use the paths and bikeways to get from A to B and find them very useful.

Lighting along the bikeways could be improved though. Again I tend to walk

more because I do not possess a car.

6:53 PM

participant one said...

4. My daughter and I will be using the pool on a daily basis, if possible,

depending on time available. To have a health clinic close will be an extra

benefit.

6:55 PM

participant one said...

5. The lack of car spaces and parking tends to force people into choosing

alternatives to private transport which I see can have it's benefits except for

those who depend upon private transport to access either their work or family.

KGUV appears to promote a healthier lifestyle through its advertising

promotions.

7:00 PM

Study Participant Six said...

1. I was very much aware of the public transport because I always choose

accommodation that has good public transport, this is a priority for me. I use

the buses because they go to the city all the time. I always walk to the bustop.

5:43 PM

Participant Six said...

2. I do not use the BBQ areas yet because I cannot do that because I am

alone. I like the parks surrounding the area because they are so gorgeous and

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I feel comfortable and satisfied with the air. I just walk around and sit down

and with the other people resting there. I want to have more people coming

over and being here because of the beauty. One of my friends said the place is

beautiful because of all the green spaces, and it is pleasing to visitors. I hope

there will be no more buildings infront of us, because we cannot see the green

beauty of the gardens around us then. It does need more flower though, I

wanted to donate some flowers to make it prettier with additional lovely

flowers.

5:47 PM

Participant Six said...

3. Although I dont have my bike, I do use them for walking. It is convenient

and very suitable. Absolutely I walk more here, I didnt have parks or

pathways where I was before, which was a new suburb. I walk more here,

because that has been my life - walking.

5:50 PM

Participant Six said...

4. I would use the medical centre. I dont swim, but I like to go and watch

others swimming. I want to see others involved in recreation. I feel very

happy and good just looking at others using these kinds of things. I would go

and watch a swimming contest or something like that.

5:53 PM

Participant Six said...

5. This is a good example for all people who are fond of physical activity, and

this is the right place for them to do it. You will live longer because a good

environment and a clean one makes you live longer! Anywhere you go the

environment and the behaviour of the people living there - if they have self-

discipline - then this is healthier. They need to have good morals. If people

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are making trouble and people are making you stressed then this makes your

health unfit for your physical body. Otherwise there will be no happiness and

harmony among the people living here. I have only had one problem with

people throwing water and rubbish out of their apartments and we have

complained. This is not healthy. Otherwise it has been pretty good.

5:59 PM

study participant three said...

1. I am aware of the northern busway as well as buses going down kelvin

grove road, along with the student bus that goes direct to the city QUT. i use

the buses from the busway and kelvin grove road as i dont have a car and rely

solely on public transport. i find it efficient means of travel and catch the 390

or 345 mostly, and connect to where i need to go from the city if that is not

my destination. i find they come frequently enough, and are usually very

efficient.

3:56 PM

study participant three said...

2. I use the parks to play around and do some physical activity, but not to

really socialise. Usually the parks are just to pass through on the way to the

bus. I feel i would use them more when the contruction is finished, as i will

be feeling safer in the area then.

3:58 PM

study participant three said...

3. I use the pathways to get to the red hill shops and find i am walking more

than previously, although i used to have a car but dont anymore. I have also

been motivated to go for a run in the area, which i havent done for years due

to illness, and have found the pathways useful for this as they are broad.

4:01 PM

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study participant three said...

4. i am hoping there will be a GP, gym and chemist, and plan on using them. i

am hoping to use the gym if i have enough money, which is a new thing for

me as i am not into excercise, but the convenience would be great and

motivating. i may or may not use the gp as i have a great gp at red hill

already, but would consider it due to convenience.

4:05 PM

study participant three said...

5. i think KGUV does promote health and wellbeing. the parks are

encouraging to have a fun activity, while the pathways are great for a run and

if there is a gym, more serious fitness activities. i think it will also promote

social activities and be a very active area.

4:07 PM

Anonymous said...

Participants eleven

The location of KGUV, facilities offered surround it really well for the

residents.

8:16 PM

Anonymous said...

Participants Eleven

3. I regularly, used the QUT shuttle bus not because of it free fare but this the

only bus that know where it drop me when I go to the city and pick me up

back to the KG UV. To this day I do feel KGUV is the better place for student

from abroad. Apart from it distance to KG campus but also the facilities it

offer.

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8:55 PM

Comment deleted

This post has been removed by the author.

6:54 PM

Comment deleted

This post has been removed by the author.

6:57 PM

Comment deleted

This post has been removed by the author.

7:01 PM

Comment deleted

This post has been removed by the author.

7:04 PM

10 said...

1. 10. Yes we use the northern bus way mainly as it is shorter by one stage to

CBD. My wife pushes me in the wheelchair as the length of walk is

sometimes more than i can cope with.

7:05 PM

Comment deleted

This post has been removed by the author.

7:06 PM

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10 said...

2. 10. We generally do small walks as this is all I am up to these day.

Whenever we have visitors we walk the around the parks in the area. At these

times I usually use the wheelchair. In future we will use the BBQ facilities.

7:13 PM

10 said...

3.10. The pathways are good quality and especially as one gets out of the area

does one notice how much better they are than the general walkways around.

I find the inserts very interesting and they are among the features we point

out to visitors.

7:19 PM

10 said...

4. 10. I am aware of those facilities but I probably will not use them very

much as my health problem will not allow it. However my wife is very much

looking forward to the pool in particular. The medical centre will be of great

interest to me.

7:27 PM

10 said...

5.10. I think this is a fine concept it is fine in its promotion of walking and

cycling I really hope others will use it . If my health allowed I certainly

would be greatly benefited.

7:32 PM

Participant Twelve said...

1. Yes, we knew we could use buses in the village. We picked up timetable

but it took us a while to work them out and where to get back on in the City. I

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push my husband in the wheelchair through QUT to the busway and we catch

the bus into the City to go to the Public Library. We have also caught the bus

from Kelvin Grove Road. When we lived in Strathpine we used to catch the

train into the City and use the ticket for bus or ferry and we do the same now.

4:42 AM

Participant Twelve said...

2. On one of our walks we visited all the parks in the area and I saw that Grey

Guns park would be ideal when small children of my friends and family come

to visit as we can take them for a walk up there and let them kick a ball

around and we can sit and talk. I will be going to the movie in Kulgun Park

and I have sat there with friends who have visited us and I have shown them

around.

4:45 AM

Participant Twelve said...

3. Yes, as I said before we use them to walk and to get to the bus stops.

Where we were renting before it was newish and there were good pathways

we used to use; the only thing here is that there are more pleasant pathways

which encourage you to use them more.

4:47 AM

Participant Twelve said...

4. Our neighbours go to the doctor in QUT but as they are sometimes not

there and my husband needs to see the doctor every month we decided to go

elsewhere. We do use the Chemist. I am also very much looking forward to

the swimming pool being completed in the commercial retail building next

year. In the meantime I have a lady I know going to the Centenary pools and

because I know the walking track there now I am gong to walk and meet her

there thisw Friday for a start and see how I go and maybe do that weekly.

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4:50 AM

Participant Twelve said...

5. I think the village is trying hard to promote the use of the pathways, parks

etc. Information is given out and we do have a community meeting once a

month. One suggestion at the meeting was to use the park for a market once a

month. I'm sure more input will be given as time goes on.

4:52 AM

Participant Thirteen said...

1. Yes I do. Buses and trains. It all depends where I am going to.

4:47 PM

Participant Thirteen said...

2. No not a great deal. It is great, its nice to have nice parks, it is wonderful in

that way. It's a good thing for the community to get together and

communicate in that way.

4:48 PM

Comment deleted

This post has been removed by the author.

4:51 PM

Participant Thirteen said...

4. Theres a Red Cross getting built, a pool is coming soon too. I know about

the doctors and the chemist. I will definitely use the gym and the pool. I know

there is a gym up at QUT. I 'm looking forward to things getting developed

alot more so I can use the facilities.

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4:54 PM

Comment deleted

This post has been removed by the author.

4:56 PM

Participant Thirteen said...

3. I love the pathways because I cycle, I do Tour de France type of cycling. I

do Flatland cycling too where they do tricks etc. I only have that kind bike at

the moment. A car hit me on my bike years ago in 1994.

4:14 PM

Participant Thirteen said...

5. I do, derinitely. Like with the parks, a couple of the hills give great

exercise. It's good in the walking sense, even walking to the buses and there

are so many bus services here - you can get to the Bulimba ferry, Valley, city -

so it's easy to walk to those things.

4:15 PM

Participant Fourteen said...

1. I use the buses all the time, three four times a week.

5:18 PM

Participant Fifteen said...

1. I use the buses to go to my RSL meetings down at Gaythorne.

5:18 PM

Participant Fourteen said...

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2. No we never use them. We have no BBQ at Kundu Park. We have tables

there, but no swings for the children. But we don't use the parks. If they had

something at Kundu Park I woudl take my grand-daughter down.

5:20 PM

Participant Fifteen said...

2. The green spaces are important - we overlook the city in our apartment and

we overlook Kundu Park and that is great. They reckon the view from the

fourth floor is beautiful, but that is full of homeless people - and this is a

problem. People out of jail are in there. We're on teh ground floor wiht good

neighbours - so that is good, but some of the neighbours are terrible. We have

nowhere to hang our washing here - I have to dry my sheets in the shower,

and I need a clothes hoist.

5:25 PM

Participant Fifteen said...

3. I use the bikeways and pathways. Some parts are too rocky and to thin, but

the rest are fine, and I go on the community walks - we go along Herston

Road - there are three walks and we have done two of them.

5:28 PM

Participant Fourteen said...

3. I will walk around the shopping centre and to the bus and around town. I

spend alot of time with my grandchildren and children.

5:29 PM

Participant Fourteen said...

4. We go to the QUT optometry and the health clinic, the doctors up there.

5:31 PM

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Participant Fifteen said...

4. We are waiting for the pool and I reckon I will get alot of use from that. We

can walk around to Centenary Pool, but when the one is in here that will

better.

5:32 PM

Participant Fifteen said...

5. Could be better. The walking club there was nine of us at first, then seven

and last week only two, so what we are going to do is kick off at 4pm and do

an hours walking. That is my neighbour and I. The walks start too late

otherwise because when it gets dark the pathways are narrow and a bit

dangerous. And there have been rapes on the news.

5:36 PM

Participant Fourteen said...

5. Not really. I think things have to be cleaned up and changed in Hartop

Lane because of retired people who want to live a peaceful life and this is

difficult because there is no communication with the manager at Rental

Express. This is all about people in the unit and no-hopers.

5:38 PM

participant 16 said...

1. New about buses and busway and where they go because a friend lives and

works close by and told and showed me where to find all the public transport

that i needed.

6:34 PM

participant 16 said...

2. New about the parks as i use these for exercise or just sitting in the sun on

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a cool day. Have not used the BBQ's as i do not know how often they are

clean if at all and needs more seats as it will only accomodate a small group.

6:36 PM

participant 16 said...

3. The Paths and bike way are good for going running or riding. have only

used these a few times but it seems fairly good. The paths are clean and tidy

and luckily are not in need of repair like others i have used before moving

here. It is also good as it means there is no excuse for walking on the road.

6:39 PM

participant 16 said...

4. Not currently aware of any GP's in the immediate area, need to travel to

newmarket for this and when not well, catching the bus sucks. Looking

forward to getting one soon.

6:41 PM

participant 16 said...

5. fairly friendly in that there are walkways, bikeways and parks for physical

activity, i have used these already.

6:42 PM

6:47 PM Post a Comment On: The Effects of a New Urban Context

on Health

"Moving into a New Urban Environment..."

48 Comments - Show Original Post Collapse comments

study participant one said...

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1. this is a test

6:34 PM

study participant one said...

this is a second test

1:08 AM

study participant seven said...

1.Because of financial restraints I has no choice about living in low cost

housing .Brisbane Housing appealed to me because of location and having

parks theatre and transport near by .Also the village will be a great concept

when finished so shopping will be in walking distance.

I read about the village about 2 years ago so kept in touch with Brisbane

Housing so I was prepared to move as soon as a unit was available and I am

not sorry I moved .The only problem is all my friends and family live in

suburbia so I have furthur to visit and as petrol is so expensive these days

vists are not as frequent.I was concerned about living in an environment with

so many different ages and so many units but because of good management,

problems that have arrived have been dealt with in a polite and professial

way.

9:01 PM

study participant seven said...

2.I was interested in the urban village for a few years so kept an eye out for

advertising on the site.The housing commission was very hard to access

accomadation so the only alternative was look elsewhere and Brisbane

Housing contacted me and offered me a one bedroom unit so I thought go for

it I can always leave if it does not work out !!!Also young people keep you

young and I have met some really interesting people here and have had a

great social experience as well .

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9:23 PM

study participant seven said...

3.When I inspected my unit I was very impressed because of the gardens and

the decor of the building so did not hesitate in signing a lease .Rent is a bit

higher than i anticipated but the concept of the whole enviroment appealed to

me .I have always been into exercise and find the walks here very peaceful

and as the building progressed very interesting to see.

The Q.U.T provides fitness tests for all ages and I have already had one

meeting at the Human Recources and found the students very helpful in their

field.

My lifestyle has not changed a great deal as I have had lots of interests in

linedancing ,tennis and swimming so continued those interests since I came

to live in the Village .

9:47 PM

Study particpant number eight said...

I had temporary accomodation and needed a permananent alternatve. I was

listed with the Housing Commission and after 18 months waiting was given

an opportnuity through BHC to join KGUV. KGUV is close to transport and

is an attractive place to live. While my choices for accommodation were

somelimited, the KGUV met all my requirements.

6:59 PM

Study participant number eight said...

2 Until BHC approached me, I had heard nothing of KGUV. Given the

information BHC provided, I expected people living there to be of various

ages and backgrounds. I expected the village would have many amentities

and that I would be able to be involvled in activities through the QUT.

7:18 PM

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Study particant number eight said...

3. I hoped there would be many people to get to know, which has eventuated.

I had hoped the gym would be useful although in reality it is not sutiable. I

have increased the amount of walking I do on a regular basis, largely as a

result of the assistance I obtained from the QUT podiatry clinic.

7:26 PM

study participant one said...

1. I felt I had full control over my accomodation choices and chose Brisbane

housing because it suited me best. Financially, I am better off living in low

cost housing and am more than satified with the accomodation. I don't

possess a car so needed to be close to transport. My daughter attends the local

school which is only a short walk away. I thoroughly enjoy living in this

environment.

5:31 PM

Anonymous said...

2. I discovered information about KGUV through the website when looking

for suitable accomodation close to the University and was very interested in

the concept presented. I was impressed by the concept of mixed housing and

the close association with the Uni. I am usually extremely busy studying,

being a single parent and working part-time to truly get to know the other

residents but I feel very comfortable and secure with my neighbours.

5:38 PM

Anonymous said...

3. It has been necessary for me to become more physically active because of

the lack of private transport. I thoroughly enjoy walking so this has become

an added bonus more than intentional. When the complex opens that houses

the indoor pool, myself and my daughter plan to be using the facilities

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regularly.

5:43 PM

participant two said...

1. I was at my lowest stage stress wise having my husband slowly recovering

from heart surgery, strokes, hip & prostate surgery. Also I myself had angina,

other health problems & then had fallen whilst Ted in rehab, shattered right

upper arm & taken shoulder blade out & unable have surgery then fallen

broken left hip December 2005. Private rentals had become too costly as well

as we had relocated from Melbourne 1998 due to my really serious ill-health.

We had to move from our unit after Ted!s heart etc problems with his

inability to use stairs, the next unit was too costly, I had to purchase all white

goods, furniture really everything and with no help as no family here. We had

a granny flat and again had to move when house occupants were

moving.Stress wise I was at a low stage having Ted in & out of hospital &

had to move quickly.Again our owner died,, we had our names with Qld

Housing & needed better affordable housing and help.

6:38 PM

participant two said...

2. Brisbane Housing had asked us if diversity of culture would be a problem..

we had no worries, looking forward to learning new cultures maybe helping

anyone with problems. Ted is unable to walk and the unit is designed totally

wheel-chair friendly, no carpets, no steps. The Village was designed with

great foresight, we had no idea that all the medical services and all health

services would be so readily available.

7:48 PM

participant two said...

3. We had hoped our lifestyle, once we were settled and stresses lifted

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gradually, that we would be able to perhaps enjoy outings to e.g. Southbank,

Museum, Roma Street Gardens as we now were living within easy access of

these wonderful facilities.Also we hoped we could take walks, of course I

would be wheeling Ted and in this regard hoped level paths would be

available, perhaps a walk to university coffee shop and knew when the new

shopping complex was ready in some months time, we would have much

easier access as it would be within walking distance. We looked forward to

use of facilites at new community centre to be built. Yes we definitely looked

forward to a less sressful and healthier lifestyle.

7:58 PM

participant four said...

1. We moved into KGUV because of time and money restraints, the unit we

had lined up was lost because of a Real Estate error, so we had to find new

accomidation quickly.

12:43 AM

participant four said...

2. We knew where the KGUV would be and we knew what it looked like due

to the presentation given to use by the Brisbane Housing staff, apart from that

we didn't have many expectations due to us having to move so quickly.

12:45 AM

participant four said...

3. I expected to have the same amount of physical activity before moving in.

And expected my lifestyle would change little.

12:47 AM

participant nine said...

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I was waiting on the housing commissison list and they said I would have to

wait for seven years then I went looking in the private market but they said

my income was too small. I couldn't find a place to stay. So I got here

because I was listed as emergency housing and the BHC units came up.

6:35 PM

participant nine said...

I was just happy to have a place to live and had no expectations. I really was

just glad to have a place to live.

6:37 PM

participant nine said...

I didn't imagine my life would change much.. I was curious about what the

new housing would be like, but had no expectations of what it would offer. I

had no job when I came here, and I was welcomed greatly by my neighbours

and thought that was a great sign.

6:40 PM

Study participant six said...

1. I had no other choice but to take the one that they offered me. I was living

with my daughter for two and a half years and I wanted to have freedom of

my own in my own place and a friend introduced me to this housing option,

and when I saw the unit I wanted it. Then I went to the QlD Housing

Commission to apply for a bond and it was approved. And I really love the

place.

5:46 PM

Participant Six said...

2. I was expecting that is really good for me and even if I have to pay the

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price I wanted the freedom with having my own place and all the things I can

do by myself. I expected to have lovely neighbours who could help me,

especially the Australian people who are really accommodating and helpful in

any undertaking that I have encountered.

5:51 PM

Participant Six said...

3. I was so excited and happy to have the area that I got. It is so convenient

for me to go to the city and do sight seeing and see places I haven't seen

before. I wanted to improve myself and my knowledge and how I can solve

my own problems. I was going to be transfered to near my work, so I was

happy and my friends were happy for me. And I get to walk to work and that

makes me healthy and I enjoy walking to the school. Walking is my life. I

dont care if I dont if I dont have a car, I just love to walk anywhere. I am still

healthy so I don't need a car. And here I can work to work, the city. I walk to

the school to clean and I start walking at 4 o clock in the morning, then we

have a conversation before we start cleaning! I have been in Australia 22

years.

5:59 PM

study participant three said...

1. I did not have alot of accomodation choices available, having a real estate

error leave me one week away from not having a home. Taking a chance on a

referral i had received form the Department of Housing, i called Brisbane

Housing Company to discuss my options. They had two units available to us

and we chose to rent with Brisbane Housing company due to an inability to

get another rental and financial restraints. We chose KGUV over the other

rental in Red Hill because of the plan for the area, e.g. the shopping centre,

proximity to university, parks etc. I feel, although we had limited time and

resources, we had a choice in moving to KGUV and we made our decision

based on the unit being new and the features of the urban village.

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3:40 PM

study participant three said...

2. I didnt know a great deal about the urban village before moving in, and

only really know now what i am observing happening around me. We were

told about our unit and the area by the Housing Company, and were told it

was an exciting new development, close to the city and uni's, with shops to be

built and a number of other facilities. It sounded great to us as young people

and when we checked out the unit we found the accomodation exceeded our

expectations. It was alot nicer and more modern than we thought it would be.

It has been a bit annoying to be here with the construction still continuing- it

has made my allergies really bad and the noise is awful, especially of the pie

van. These were things we had not anticipated, as well as never having lived

in public housing before we had no idea what to expect of our neighbours. the

first few weeks were difficult in this respect, but the real estate dealt with

issues swiftly and efficiently. I also thought the facilities would be finished

earlier and available to us earlier, and this has been a bit dissapointing.

3:49 PM

study participant three said...

3. I thought once i moved in that my daily activities would be more active,

though i have been very ill, and that i would start feeling better, and be more

active in social activities as well as physically. i was being quite optimistic

about this, but felt the area may bring out the best in me. I also thought things

would be much more interesting, being close to a uni and a central 'hub' of

activity.

3:51 PM

Anonymous said...

Participants Eleven

4. Honestly, speaking I don’t expected much. But its location closed to KG

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campus, really motivate me to choose KGUV.

8:56 PM

Participant Ten said...

1. this is a test

6:20 PM

10 said...

1. 10 .We unfortunately have to live on disability pension as I have a

deteriorating bone/joint condition and at least four different types of arthritis.

Hence low cost housing is a necessity for us. This accommodation is very

suitable and in fact lets me get out more especially via public transport

6:35 PM

Anonymous said...

1. We have had our name down on Queensland Housing since June 2003. A

couple of years ago Brisbane Housing Company contacted us to enroll for

affordable housing within Brisbane. We did this and a couple of times we

were offered housing but it was only bedsit or one bedroom and because of

my husbands medical condition we were eligable for a 2 bed room unit. We

were offered this in September 2006.

6:43 PM

Ju said...

2. We picked up a Brisbane Magazine and there was a page of information on

KGUV and the opening in October 2006. We were interested in going along

and while reading the information saw the it had public housing as well. I

commented to my husband wouldn't it be funny if we were offered something

there. The fact that the village was sustainable appealed as well. Being new

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we thought that any neighbours we had would appreciate that as well. We

ourselves had a complete interview and we expected everyone else to as well

but since moving in we see that not all tenants are responsible and some have

had to be removed and others are in the process.

6:47 PM

10 said...

2. 10. I did not expect a whole lot as I have seen a number of low cost

housing schemes in 3 different countries and they have all been of fairly low

standard.

We did entertain some hope of at least some greater quality accommodation

as we had read a favourable write up about Brisbane Housing here at Kelvin

Grove Urban Housing Project.

6:49 PM

Ju said...

3.I do like to be active but I do have some injuries from my youth that play

up as I get older. However, the Hub has community meetings and we have

formed a walking group which I enjoy very much and one of the walks we

have done I did on my own again. The access pathways are great and if I push

my husband in the wheelchair he enjoys the area as well. Sometimes when h

e is up to it he walks a little himself.

6:50 PM

10. said...

3. 10. I never had any problems with making new friends so this was not a

issue with me. And it has worked our well as we socially seem to fit in and

are getting to know others quite easily and am able to participate in some of

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the social events being organized. I were a little worried as most of my life I

have lived on the country but it worked out fine as we overlook a park now.

6:58 PM

Participant Eleven said...

1. Honestly, speaking I don’t expected much. But its location closed to KG

campus, really motivate me to choose KGUV.

9:41 PM

Participant Thirteen said...

1. I went through Heart 4000 - an emergency housing place - I had only been

out of jail for three months and then this house came up. On the 23rd of

November 2006 I got my forms approved and moved in on the 24th.

4:42 PM

Ju said...

2. I just basically expected a place. I was actually overwhelmed because the

place was brand new and I was the first person to live there.

4:43 PM

Ju said...

3. Not really, no. I am what I am and that has never changed. I know what my

lifestyle is, and I know my boundaries. Every good man should know his

boundaries and limitations.

4:45 PM

Participant Fourteen said...

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1. Not much really. Our lease was up at the unit on the North Coast, and for

health reasons for my husband, we wanted to come to Brisbane near the

hospital.

4:57 PM

Participant Fifteen said...

1. I came here to be near Prince Charles, and for an operation at Royal

Brisbane in urology. I have had three mild heart attacks and I am a diabetic,

and they were silent heart attacks so I didnt know I had had them. Just some

pain and we found out at Nambour General Hospital. So it's easier to be the

hospitals.

5:00 PM

Participant Fifteen said...

2. We knew nothing about this, and we weren't introduced to any neighbours.

They took us through and showed us the single room units, but that is no

good to say. So now were in an adaptable unit. We were paying 240 per week

and they were going to raise the rent so were were pretty desperate to get a

place.

5:03 PM

Participant Fourteen said...

2. We dont need a car here as we're near the busway and its a wonderful

service. But we didnt know about all of this before we came. We didnt really

know what was going to be available.

5:05 PM

Participant Fourteen said...

3. I miss my garden and I have some pot plants, but I had to leave alot

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behind, so that is something I can't do anymore. I would love to work, but am

not sure what I could do. I get so bored. I have always been a very active

person. I am not as active as I should be, though.

5:12 PM

Participant Fifteen said...

3. It's been harder coz I have come out of doing shift work all my life, so I get

up very early out of habit and do word puzzles. I miss gardening here. I do

walk around here - and I can do the walks here. There is a garden here but we

aren't allowed to touch it for legal reasons.

5:15 PM

Anonymous said...

study participant seven

I have been here for 16 months now at the village and enjoy the lifestyle .I

have made some really lovely friends and we get together to play cards and

have dinners together .We also participate with the Q.U.T reserchers and find

the information very interesting and educational .There is always a mixture of

entertainment at the Block ,the theatre and meetings at the Hub so we are all

very involved with different people so find our life very interesting. I still

enjoy outside interests with family and friends but usually invite people over

for lunch or dinner so they can experience the life here .

4:39 PM

participant 16 said...

1. Moved to kelvin grove because i was looking for a place away from my

parents, my mums cooking sucked and my dads snoring and bad mood was

kind of annoying. My own space was so i can do as i please without having to

answer to anyone but myself. I am one of eleven children and sharing a room

with 4 sisters and decieded that at the age of 25 i needed my own bedroom.

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6:22 PM

participant 16 said...

2. Hoping that there were lots of shops, the possibility of part time work and a

place to meet friends. Was also hoping for parks to picnic in and lots of

friendly people to make friends with. Was excited but nervous about moving

to a place i had never been to before. was hoping for it to be a place that was

clean, friendly and fun to live in.

6:26 PM

participant 16 said...

3. Look forward to cooking really tasty food, mixing with people, doing angel

card readings, reiki and other new age stuff for other people in the area. was

looking for part time work to bring in the dollars until i can start my own

business. Losing weight? who dosen't want to? walking, running or tae kwon

do for fitness.

6:30 PM

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APPENDIX E

Interview Schedules and Transcripts

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Interview Schedule for BHC Participant Interviews

Individual Level Questions

Key themes: Socio-historical influences; Attitudes and beliefs about PA;

Presence/absence of PA and health as daily goals; Agency/motivation; Real and

Perceived Barriers to PA and health; Meaning of PA and identity

1. When you were growing up, how important was a healthy lifestyle in the family

that you came from, or the household you grew up in? Did your parents or carers

encourage you stay fit and healthy, or was it not really talked about that much?

� What kinds of advice did they give?

� What were the family/household attitudes like – what was

important as life-goals?

� What were the family/household norms – did you play sport,

go the beach, play in parks etc?

2. What is your own personal opinion about physical activity?

� Is it important?

� What are some of the benefits you might get from doing

physical activity?

� How much do you think you need to do each day or week to

get the benefits?

3. In your every-day life, how much would you say you think about doing things that

might make you healthier?

• Do you ever think about making changes to your lifestyle?

• Do you think about health when you are out walking, or

preparing food, or deciding what to do or eat or drink?

• Is health important to you?

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• Do you think you can get healthy or sick by things that you do

in your everyday life?

4. If you had no barriers or constraints to the amount of exercise you were able to do

– any kind, any place, with any equipment you needed – what kinds of things would

you be interested in doing? If any?

• What would you enjoy being involved in?

• What do you think you would get out of being able to do that?

• What are the main things that prevent you from being able to

be as active as you would like?

• Is PA/exercise something that you would like to do, and your

‘life’ wont let you, or are other things more

important/appealing to you?

REPEAT QUESTION NUMBER FOUR AROUND GOALS FOR THEIR

CHILDREN.

5. What types of images or people come to mind when you think of physical activity

or exercise? Do you associate yourself, or how you see yourself now in your life with

being a person who is physically fit/active? What kinds of things are different/same

between people who are really fit and active, and how you see yourself? When you

see images of people doing healthy things, ie eating fruit, or jogging or playing sport,

can you see yourself doing that? Why/why not?

6. If someone was trying to get a message out to people to get them to do more

physical activity, or lead a healthier lifestyle – and make all the changes that go with

that to their lives – what kinds of things would they have to say to convince you to

make these changes?

� Do scare tactics work?

� Does seeing people who are fit and health in gym gear work?

� Does motivating music/images on TV work?

� Radio health information?

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� Pamphlets in Drs rooms?

� The internet?

� What kinds of things would need to change or would you need

help with to allow you to do the kinds of PA health promotion

recommends you do?

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Household Level Questions

Key themes: Daily routines and habits; barriers to lifestyle change – people,

money, resources; Social and structural barriers to increasing PA coming from

family members.

1. Describe a typical day

2. Describe a typical weekend

3. Who does any PA in the family?

4. Is there anyone in the household who would like to do more PA? Who prefers

not to move too much?

5. What kinds of things stop the people in the house who want to be more active

from doing so?

6. Is it hard to organize to do PA altogether? Why?

7. Is there anything about your housing type/style or neighbourhood that makes

it harder or easier to do more exercise?

8. When you seem pictures or images of families doing things together like

playing in a park, or running on a beach, or doing sport, can you see the

family you are in now doing things like that? Why/not?

9. If someone suggested putting some exercise into the families daily routine,

what do you think the reaction would be from other family members?

10. Does your family ever talk about getting fitter, or losing weight, or changing

your lifestyles to become healthier? Who initiates this talk/what is the

response?

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Interview One.

For the first question, if you had to think about some of the places you lived in

the past five to ten years, which ones come to mind as places that make you feel

good or healthy, either mentally, physically or emotionally?

Here. (laughs)

Here? Really?

Yeah.

So if you think about the other places you have lived over this time, and I guess

for you that was raising your children…

Yep.

Where… was there anywhere that made you feel particularly fantastic or

healthy or good?

Here and in Maryborough, in Clayton Street, where we used to live. The routine was

really good.

OK, in what ways?

Oh, the kids were better controlled, and I had ‘em doin’ better.

Was there anything about the actual place that was good, there at Clayton

Street?

Yeah, it was right in town, whenever we tried to get into town we were right there,

just a walk.

So it was really central?

Yeah.

Anything else good about it?

Yeah. Close to the schools, close to the parks, and big back yards.

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And you mentioned here as being good?

Yeah well this is much better, cause we’ve got more to do here. Like for the children,

‘n it’s not so stressful on me and James (laughs).

So in what ways?

Well I took ‘em to the park, and High Five was on, and I take ‘em to that, and the

shops are closer here, really closer here, and we don’t got to worry about walking,

just got to jump across the paddock (laughs). Yes, the kids are more settled here, in

Brisbane (pauses). They can go to libraries n that here and a park just up the road.

What other things do they do, have they been to GOMA or anything like that?

To the art galleries or anything like that?

Yeah, we’ve took ‘em to the museum.

Oh great. Cool.

And um…

And so you were talking about your stress levels…it makes is easier for you

how?

We’ll if they’re bored, we just take ‘em, take ‘em out, instead of stuck here at home,

and that stops me from being a bit stressed. And that’s even better.

And do you feel that you are being more active?

Yeah, more so here. Cause in Maryborough we weren’t that active. No, we were

always stuck at home cause it was too far to go… but here is not too far, see we just

take ‘em to South Bank… run around Southbank all day, it’s good there.

That’s terrific.

We ended up just finding out the new water fountain bit? That was brilliant. Really

good.

And in the summer too, I guess?

Well them lot (points outside to her four children) are going out in the winter time

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too! (laughs).

So, on the other hand, have there been places that made you feel less good, or

not so great? And why? What was it about the place that made you go ‘Don’t

feel so great here?’

That was probably Ipswich. When we used to live there, cause we couldn’t take the

kids anywhere cause of the needle use everywhere.

Needles?

Yeah, yeah, couldn’t take ‘em to the park cause there was needles everywhere, and

that was the stress bit for me.

So, too dangerous?

Yeah, yeah.

So what about the feel of the place?

Yeah, not so good.

So if you think about KGUV and where you live now, in this unit, how would

you describe it and how does the place make you feel?

I feel good actually. This is the best place we’ve ever had really. The other places

we’ve had like bit of a dump, you know?

When you say this place, do you mean the unit you are living in?

Yeah! Well the whole place, the whole little village kind of thing, it’s great for all of

us, actually.

If you had to describe the place to someone how would you do that?

It’s beautiful (laughs) It is. It’s lovely. Nice and peaceful.

OK. How does it make you feel about yourself and your family?

It makes us feel really good. It makes us feel poshy for once, you know?

It makes you feel poshy?

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Cause we’ve had dumps all the time, and we haven’t been in anything like this

before.

And does this reflect on you?

It does, it does. You feel down, you feel like you’re nothing, but now here we feel

like we’re something, you know, cause we’re in something nice. It makes us feel

good.

What are the bits that are doing that for you? Is it the way the unit is designed?

Is it what’s in the Village, who’s in the Village?

I think it’s the way that they’ve got it all set up, so I can set it all up into a nice little

home. The kids can go out and we’re not worried about ‘em, in the last places we had

to go out check what they’re doing every five seconds, cause there are too many bad

people around. Well, over in West End, before we come here, we used to see people

trying to shoot up in the main street, and here you’re not really worrying about it,

cause you are not really seeing anything like that. Me and the girls walked into the

toilet and seen someone in the toilets shooting up, and that really shocked me cause I

didn’t think I was going to see something like that, and I ended up seein’ it.

And this place?

No. no. And it’s nice and clean here. It’s just got a clean feel. It’s not like over there

where the streets are dirty.

And that affects how you feel about yourself?

Yeah, yeah.

And does it affect what you feel like doing during the day?

Yeah well it perks you up a bit, you don’t feel like laying around doing nothing.

Ok, now this question is going back in time. When you were growing up, how

important was a healthy lifestyle in the family you grew up in? Were your

parents or carers encouraging you to be fit and healthy or was it not really

talked about that much.

Not really talked about. We used to bring ourselves up. My mother was a real, you

know. She wasn’t a very nice person. We brung ourselves up and looked out for each

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other.

So you had a lot of other things to worry about, besides health?

Yeah, well my mum used to get flogged up somethin’ fierce, so.

Can you tell me what you mean by that?

She used to get, what’s it called? Like, domestic violence.

Oh, your mum was beaten up? By your dad?

Yeah, by my stepfathers. Not my real father, cause I didn’t know who my real father

was until I was 18. I’ve never met my father.

So you grew up in quite a violent situation?

Yeah I left when I was thirteen. Me and James’s been together since I was about

thirteen. James is the one that’s brought me up

So he’s been your mentor

Yeah yeah

So in this quite violent beginning, how do you think it affected you in later life…

your goals or what you wanted out of life?

Yeah it sort of did, cause I ended up having children really young, so I was fifteen

when I had Christian and that ended up stopping a lot of things. I used to be a

champion athlete when I was at school… but that ended up stopping it, cause I ended

up falling pregnant. I was a runner.

So where did you live, when you were 13 but still at school and being a runner?

I lived with James. They let me run for a couple more months, but then I ended up

getting bigger and they said it would be too stressful

In year 9?

Yeah, going into Year 10. I ended up getting out of school in year 10. Halfway

through it. I did a lot of things, I did childcare and hairdressing…

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So you trained in various areas?

Yeah yeah

Then you had your other three babies?

Yeah we just done it by ourselves. My mum was a bit there to help me a little bit, she

used to teach mea little bit what I didn’t know, but I told her back off, if I need help

I’ll ask for it, you know?

So in this that you’re telling me the thing that has stood out as being obviously

about physical activity, is that you were this athlete.. do you think it will

influence how you encourage your children? Will you want them to be athletic,

or will you want to go back to it one day yourself?

I have thought of doing it again. Once the kids are older n that. And I can see my kids

doin’ it… I can see they’re pretty fast at the moment (laughs). I keep them trying to

do something, like Christian is a real little gymnast, he can do the splits and

everything.

Does he go to training?

Nah, nah. Up in Maryborough he went to the Police Youth Club. And he used to go

there and meet other kids and do gym. And through school n that. Athletics at school.

With anything they do I make sure they push it along, it doesn’t matter what it is,

they have to see it through. Even if they’re colouring in or something, you don’t just

leave it and do something else, they gotta finish something what they’re doing. Or I

make sure they go to the parks, and that they are doing something properly.

OK, and what do you think about physical activity? Is it important, and if you

think it’s important, what do you think the benefits are?

You feel nice and relaxed and you’re not so grumpy. You feel good. Well. You’re

healthier with your weight. Cause James has weight trouble there, and we try to push

as much exercise as we can. And the kids, if we go and do lots of exercise, the kids

sleep really well. We take them swimming all day, and then when we come home

they’re not, they just want to sit down and watch TV, not running a muck. And that is

what we need for ours because they are so full on (laughs).

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Fair enough. Thanks. Now, in your every day life, how much would you say you

think about doing things that make you healthier?

Sometimes we don’t think healthy, but sometimes we do. We always make sure there

is something healthy for them to eat. And during the day I make sure the children

don’t eat heaps of junk food.

So if you are thinking healthy, in terms of food, what kinds of foods do you

think need to be put in it, for you to consider it healthy?

A lot of fruit and veggies is the main thing. Cause Shakira won’t eat meat, so we

make sure she has fruit and things like that, but the other two will eat anything, so we

make sure there isn’t junk food around, cause if they see it they will want it.

What about other things? Do you worry about alcohol or smoking?

Well I don’t drink. I have never drunk alcohol, I can’t stand the stuff.

Is there a reason for that?

I just don’t like it, I cant stand it. Hubby will, once in a blue moon, but he will ask

me first (laughs). We smoke, but not a lot.

Do you worry about that in terms of your health?

We should worry about it heaps. We’ve tried to quit heaps. I can’t take the patches,

they make me sick. I can’t take codeine either. The ambulance won’t get here quick

enough. I gotta watch out what medication I take, and sometimes I just have to ride it

out, cause most medicines have codeine in them. It’s really hard when I am sick.

OK. If you had no barriers or constraints to the amount of exercise you were

able to do… any kind, any place, any equipment, what are the sorts of things

you would be interested in doing? This is a wish list.

I do exercise all the time. If I’m not runnin’ I’m walkin’. Swimming would be great.

Just to have the time to relax and swim, cause you don’t get that with the kids, you’re

always worried about them. When I take them I never get any time for myself to be

in there, just gotta be running around making sure they’re alright. You don’t get time

to have a relaxing swim.

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So, going back to here, to The Village, if you could say ‘oh I would really love if

they put in this’ – what would that be?

A gym.

Yeah?

Yeah, cause James would too and so would Christian. Something outdoors would be

good too. Something to do, more to do in the park.

I think they are putting in a gym and a pool.

Oh they are, are they?

Yeah

Well something else to do in the park during the day would be good too.

What else would you and the family be interested in doing?

Well Christian wants to do Karate. Martial Arts. Cause I was a brown belt in Karate.

And Christian wants to do this, but I think they need to get self-control first, before

they try and do that kind of thing. They cant just do it when they want.

But if they set up something like that here locally would that be good?

Yeah karate, or gym would be good. Yeah and not too far away.

OK, I have another question, what types of images or people come to mind when

you think about physical activity or exercise? And do you see yourself as being

really fit and active?

Yeah well we’re really not a fit type like other people you see running and that

(laughs). We’re not really like that at the moment (laughs again).

So what do you think about those people and those activities?

We would like to make them be in our life a little bit more, its just really hard to get

to them kind of places to do that sort of stuff.

So what are the main barriers?

Transport. And money can be the biggest problem too, sometimes.

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OK when you see pictures of people doing healthy things, say in an ad, eating

fruit or jogging or something like that, do you relate to that? Do you see yourself

being a bit like that?

Not at all, not at all. Um we wish we were like that. Like a bit healthier and that

sometimes. Sometimes we are, but sometimes we get a bit lazy and don’t want to do

any exercise, but then the next day we will be running around non-stop.

What makes it vary, do you think? What is it about the days that make you stay

in – is it about feeling, money, or…

Money, it’s about the money. When we’ve got it we will get out a bit more, and when

we haven’t got it we will just sit around and we wont do big things, unless we find

out it’s free. When we have money we might travel somewhere – if it is far away we

can travel to do something.

If someone was trying to get a message out to people to do more physical

activity, or lead a healthier lifestyle, what kinds of things would they have to say

to convince you to make these changes? Scare tactics, or images of people who

are fit and healthy… Is any of this convincing?

Yeah some of it. Usually the smoking ads sometimes. And the way they’ve stopped

smoking in the park has really pulled us up. And mostly the cancer, the one that says

it causes cancer, cause James has got cancer, it makes me sit down and think well

should I stop, you know?

So did he go for tests?

Yeah he has to go for an operation to see what it is – it’s bowel.

So what about health pamphlets, say in the doctors’ surgery – do you read

those?

Sometimes. Getting five minutes to sit still and read something like that is pretty

rare.

What about seeing images of people doing exercise or ads to tell you to be active

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or get your children to get fit?

Yeah that does sometimes, with the kids a lot more, if they tell us to do more for the

children then we usually push it to go and do activities with them. Better get up and

do it, you know?

What kinds of things would need to change in your world or in your life to allow

you to do the amount of physical activity that would improve your health, make

you feel fit and healthy and feeling fantastic? What would need to happen or

change?

Like something for the kids, more for the kids to do, instead of just a park and them

playing on the slippery slide and they get bored just swinging on swings. We try to

take balls usually, but still they need something that is going to be fun. And

somewhere where I can take them to do something where I can sit down and relax.

Yeah and the money situation, the transport to get them to these places.

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INTERVIEW TWO

If you think about the places that you have lived in the past five or ten years, or

in your life, what places come to mind as places that made you feel good or

healthy or positive?

The Gap.

The Gap? And why?

Surroundings? It’s ten minutes from the city, but it’s the whole rain forest feel. All

the bush and the trees. And no-one bothers you out there.

Oh, OK?

Yeah, you know what I mean? From my past it’s a bit of an upheaval in my past, but

out there you feel safe and secure and yeah no one bothers you and you can change

your lifestyle.

So how would you describe your lifestyle out there at the Gap?

Good, yeah, there were horses out the back. This is a bit different, living here, but it’s

turning out alright.

Yeah alright, because I am going to ask you about here in a minute, but you said

the Gap is somewhere that made you feel good, what about the places that made

you feel less good, and why was that?

Nowhere is really less good, it’s just lifestyle wise, the people you associate with.

The city, you know, is closer for them. I suppose…it was a pretty bad lifestyle I used

to live, so the elements of those people follow with that, like in Spring Hill or the

Valley and that. It has in way, but it hasn’t rotated back to that. My lifestyle has

changed heaps, but those people and those elements still live around you, you know

what I mean?

But the Gap made you feel?

As soon as you say The Gap, they go nah I’m not going out there it’s too far. And it’s

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like, OK then, that’s good.

These are the people that you didn’t want to associate with.

Yeah. And all the bushland is all there. And it’s just yeah good.

So it removed you from a lifestyle you weren’t happy with?

Yep.

So this place now. KGUV, how would you describe it, how does it make you feel?

This place, we’ve had a few hiccups along the way, we’ve had a man come in and it’s

the wrong house… with a gun. So that’s why we’ve got the dog here. But um,

someone came in with a gun, and they came into the wrong place, so…it was a bit

full on. It’s a bit like the Bronx here at the moment.

Is it?

Yeah. We’ve had someone get burnt by hot water by her boyfriend, and the police

rock up here like every day. I think it’s calming down a bit now, but it’s become like

pretty full on, like that all comes with the people who are being moved here as well,

like yeah, we’re all from the same lifestyle but some of us have changed and some of

us are still there. So its difficult in that way, where they have tried to put all lower

class people in one building, where some people have moved on and some people

haven’t.

How does it affect the people who have moved on?

It’s been quite difficult. I’m not coping at the moment.

OK?

Not because of things that I’ve done, but things that have been brought to me

because of moving here, I’m just not coping. A lot of elements are being opened up,

like I think it’s picking up a bit now, so it’s my mind set I have to change now, and

get back into that positive, ‘it’s gunna be good’….

So what about in relation to the Village itself, and what’s there, is it a good

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place? Despite the troubles here, say?

Well, the children are going to move to Kelvin Grove State School, so it’s gunna be

good. (child interrupts, and mum lights cigarette). You’re moving next term mate,

I’m sorry (to child). Child says – but I like my Chinese lessons at the Gap. The

mother says: I’ll get you private ones.

So she’s at the Gap?

Yeah she’s in Grade Four, and it’s the perfect school out there but it’s just too

difficult to get her there. We’re doing quite well and getting her there in the mornings

lately.

So your partner’s here as well?

No, he’s my ex as of yesterday, and he’s in jail.

And are these all your children?

No the boy’s not mine, only the girl is mine. But the three boys were living with us

when we moved here, and we needed somewhere cause we were living in hotels.

Hotels?

Yeah, they’re expensive.

OK, now we are gong back in time to when you were growing up.

[Interruption here where her daughter tells her that foster parents have arrived

for one of the other girls living there, and the interviewee says ‘that’s fine I

wanted her to move anyway’. This situation wasn’t explored further or clarified,

and the couple left with the young girl]

Sorry – when you were growing up, how important was a healthy lifestyle in the

family that you came from? Or the household that you grew up in? Did your

parents encourage you to be fit and healthy, or was it not talked about much?

It was only my mum for most of it and she was a workaholic. She’s an accountant

now, and she was an acupuncturist, but she always worked.

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And how did that affect you?

Well nothing seems to have changed so far. I cooked for mum, I did all the cooking.

[NOTE: There is a gap in the interview here where the interview failed to record in a

way that was audible for transcription]

If you could get involved now with any kind of physical activity, with everything

you needed to do it, what kinds of things would you be interested in doing?

The aerobics is a big one for me. I used to go at um, trying to remember what it’s

called now, we used to go twice a day, I mean after work and before I dropped my

daughter at school I would go again. And it’s the one just at Chermside at the back,

you know in the back streets of Rodie Rode there. Used to be Tai Bo and High

Impact and that, so…

And for your kids, your daughter, if you could get her involved in any kind of

sport or activity, what do you think she would like?

She loves Ju Jitsu. She did that at the um, YMCA. Oh no, PCYC sorry. There at

Arana Hills, they had a really good. She’s not doing activities at the moment. She

was doing Street Funk at Madhouse of Dance. [daughter interrupts ‘why don’t I go

there anymore’ and the mother responds ‘you have to turn up to classes for me to pay

for that’]

On the topic of physical activity, what kinds of images or people come to mind

when you think of physical activity or exercise? Your idea of physical activity

Healthy people (laughs).

And how far away do you see yourself as being from these images or these types

of people now?

No. A couple of years or twelve months working on it, then yeah. I need to eat

regular meals, and getting the motivation to get those endorphins working where you

actually go ‘ok this is what I want to do this morning’

[Daughter interrupts – ‘we need a work list’ and mother replies ‘well go on then, you

start it, go on, write it up’ – they both laugh]

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When see images of people doing healthy things like eating fruit or playing

sport, do you see yourself as being like that, or is that another world, or is that

your world in 12 months time?

Probably another world at the moment. But just a good week of starting at it, and it

would just become habit.

And is this a good place to allow you to do that, where you’re living now?

Yeah I think so, now that it’s being fixed a bit. But with those elements that got

moved in here it’s hard to change your mindset into ‘oh it’s positive’.

When you say it affects your mindset, what do you mean about that being

affected?

It just lapses you back, you know, and I get stressed and my health has gone down

hill something severe, so yep, it really, it’s ten years of my life being thrown back in

my face in one, you know what I mean? Um it sort of brought my mindset back to I

haven’t advanced as much as what I thought I had? But even though it wasn’t me

slipping, it still sort of just delusionalised me, well maybe I am still at that stage.

Does that make sense?

Yeah, so the associations here made you feel like you were still a part of

something that you wanted to feel you had moved on from?

Yeah it’s funny, I’m a big addiction person, and um its even like associating in the

same complex as those people then it goes OK, it’s really nice and everything, but

you haven’t moved on, it’s still housing commission. Yeah…

Ah, OK. And what about being in the Village, with it being all different people,

like some being housing commission, some people have bought units, you’ve got

all these different groups, does that affect how you think about things?

Yeah – even just being at the front of the complex instead of the back has made a

huge difference, because it was mainly the back that had different elements and you

know, at the front people seem more like they are going places, you know, here. It

seems to make a difference in this place, well to me anyway, if you’re at the front or

the back… I think I would have gone more back if I had been back there… you

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know?

Yeah I guess I can kind of understand that. So anyway, if someone was trying to

get a message out to people to change their lifestyles to be healthier, what kinds

of things would they need to say to convince you of that, or what would they

need to show you, like the scare tactics in the smoking ads?

See those smoking ads, they just make me go, ‘oh I haven’t had a cigarette in a

while’…silly things like that, like as a scare tactic… yeah and um with those ads

they don’t seem to… like that drink driving ad with the baby crying that’s amazing.

But does it affect you and make you feel that you would never drink drive?

No because I would never drink and drive, but with an ad like that, that has a

powerful message, it doesn’t matter who I’m speaking to, they all get affected by that

ad.

OK, so that’s a good one. What about when you are say at a doctors’ surgery or

community center and you see health pamphlets? Do you ever use anything like

that to find out about health?

Sometimes, but I have never found anything more effective than that one particular

baby ad for drink driving, it’s the most powerful thing. I’ve been watching that

smoking ad where he says he feels like he’s been hit by a truck? You seen that one?

It’s the new one out, where they have someone who is like me, who says once I’ve

been hit by a truck then I will give up smoking, and the person who is actually dying

of smoking, or like, cancer, they say they feel like they have been hit by a truck, and

they are the exact same age sort of thing, but he’s sick and the other one’s not?

And how does that make you feel?

Yeah it’s starting to get a bit more real. I’m trying to give up now.

So what kinds of things would you need to have now do you think, to help you to

lead a really active, say to get that aerobics going again, what kinds of things to

get that off the ground? Is it an inside thing or an outside thing?

It’s a bit of both. Cause you have to be in that sort of mindset to do it, for one. And I

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suppose if you see a lot of people doing it, and it’s not a hassle to get to, then it’s like

OK, and usually it’s financial. The gym is expensive and things like that. Money

would make a difference with a lot of things, but then I have just gone through 10

000 dollars in three months and it hasn’t made me happy, it doesn’t make you happy,

it makes you more depressed because more people rob you.

So you’re saying you’ve been through a lot of money in a short amount of time

and it hasn’t made you happy?

No it hasn’t. And that is why I am not coping at the moment, because people make

out to be your friends and they’re not. Yeah, people just being surreal to you. The

money comes through proceeds, and we needed to use it because of low income, you

know, and his friends, who basically aren’t his friends all took tabs at the money. And

it doesn’t make you happy. It makes you less stressed in that you can go ‘well we’ve

got money there and we don’t have to worry about how are we gunna pay for that’

we just pay it. So $5000 has been stolen from me. I feel totally ripped off.

Are these people from your past, or from around here?

Pretty much both, yeah.

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INTERVIEW THREE

So we’ll start with questions about place, and places you’ve lived in, if you had

to think about places you’d lived in the past 5 to 10 years or even before, which

ones come to mind as places that made you feel good or healthy or happy and

what was it about those places that did that?

No idea really. No they’ve all been pretty much the same. It’s a roof over your head

and you keep to yourself. I don’t really make use of parks, although this one is so

close I really should make use of it but I haven’t bothered. Most of the time I haven’t

had to have public transport close by sometimes I have needed that.

What about relationships with neighbours? Has there been a place where the

community felt good?

Well I’ve always been someone who tried to keep to myself, cause once you get

involved, the neighbours know your business, and then fights break out, so I try to

steer away from that.

Is there a place you can remember that you felt particularly bad about?

Just mainly the neighbours, it would have been the neighbours. Lived in Sydney,

there was a place in the South West called Airds?? And it was near townhouses and I

hated that place. I hated going out after dark ‘cause it was pretty scary, with a high

unemployment level. Just um walking down the road, they knew you would have a

few dollars on ya, so they’d roll ya for the money for grog or smokes.

So if you think then about KGUV and where you live now, how would you

describe it and how does it make you feel?

Because it has a lot of people living in the same spot it reminds me of that, so after

dark you don’t go out by yourself.

So similar issues?

Yeah and a lot of these people don’t work here either. Like you’re meant to live in

peace and harmony, but as far as that goes it went out the window pretty much

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straight away. Like living right next to each other, and any amount of noise you make

that person next to you will straight away snap you up for making too much noise…

I notice sitting here how close you are to your neighbours here, just sitting here I

can see straight into their units and their verandahs

That’s right. And with the lights on I always feel ‘oh god I hope no-ones looking in’

and it’s just a feeling I get that I’m not comfortable with, probably cause I have lived

in houses for ten, fifteen years, individual houses, you know… you can hear

footsteps and you think ‘god I hope that roofs solid’ (laughs). The only conversations

we hear are on the balconies, unless they’re screaming and fighting, but on the

balconies you can hear, so I’m not out here much. I very rarely venture out onto the

balcony. Brooke will come out here for fresh air to have her cigarettes. When you’re

out here, who knows who’s watching you and from where. It’s all open. The front

has a better design with their brickwork with the little holes in them and they have

some privacy.

Can you think of any specific examples that have made you feel that this is a bit

intense, living here?

Everything. Like the police have been here, like, in the first week we were living

here, like a half a dozen times. Yeah just through people fighting and bitching and

things. And other domestic violence incidents’s like 6 o clock in the morning there

were people having domestics downstairs…

Which you can hear?

Yeah, and most of the people living in here do have children, so when they want to

have their rowdiness they’ve gotta, they haven’t stopped to think about the families

living in here. Which is nearly everyone.

OK, now this question is going back in time and talking about lifestyle and

health, really, and back when you were growing up, as a kid, how important was

a healthy lifestyle in the family you came from and grew up? Did your parents

and carers encourage you stay fit and healthy, or was that not really talked

about?

It was important because there was no, uh, it was expensive when you went to the Dr

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or pharmacy, so um, so it’s better to health. And I was fairly sickly, and fairly sick

when I had flu’s and things and had to have two weeks off school. Um, I tried to stay

as healthy as possible. Always had veggies every night, you know. Pretty much a

health diet.

OK.

But I was pretty much an only child until I was fourteen.

Oh, OK?

Um, yeah. Didn’t like to go the doctor’s too often, but when you had to, you had to.

Did you play sport ever, or…?

Yeah there were always some sports I would have a go at, but some I was no good at,

so I would stay clear (laughs). Generally we attended the sports carnivals.

Did you have any of your own particular interests or hobbies?

What, sports?

Yeah well, any kind really…

Sewing, all sorts of stuff like that.

What kinds of things were important as goals in the family? What kinds of

advice did your parents give? Did they tell you to stay fit and healthy?

All of the above. Good money values were taught strongly. Budgeting, saving, things

like that.

So what is your opinion now about physical activity, do you think it’s important,

and if you do, what kinds of benefits do you think you get from it?

Yeah well being active as in I prefer to walk than drive any day. You don’t even

realize that you’re exercising when you just walk to the shop. If you exercise then

you don’t feel so headachy and lethargic. So just general exercise, you don’t need to

go to aerobics every day.

And do you see yourself as being active like this?

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I feel I am active, but I don’t get out and about a lot. I am more active in terms of

housework and cleaning up messes, all every day errands. I haven’t lied down in the

lounge room all day now for many years now (laughs). You don’t much rest anyway,

someone always has to do the dinner or the washing, or whatever. I see students

running up those stairs, there are two women who run up and down those stairs every

morning… I haven’t used that park yet. I don’t know why, really, but when I am

sitting on my veranda I see those people doing exercise.

[Dughter interrupts: Hey I help out a lot and mum replies ‘shoosh you get your turn

in minute]

In your every day life, how often would you say you think about doing things

that are healthy, say when you make a meal?

I try to have all me veggies, potatoe, punkin, and your mixed veggies, greens and

peas and all that, I try to.

What about smoking or anything else… do you worry about those sorts of

things?

I’ve quit smoking now for ten years. Not only that it doesn’t make you feel very

well, and your mouth feels like an ashtray, and the expense of it, but I just stopped.

But I still sit and see everyone else smoking and think I may as well smoke too. I

have to tell people that I’m not a boring person, cause everyone thinks I’m boring,

like a goody-goody two shoes, and I would have fun, it’s all you lot (points to

daughter) that makes me not have fun.

What about alchohol?

I’ve just given up alcohol recently because um, I just don’t drink at the moment. Just

a few issues that I felt, I gave up with someone else.

Do you go to get support for that?

No, not at this stage, it’s only been a week (laughs). But I’m not a heavy drinker, if

nobody else is drinking then I wont have a drink, it’s more a social thing, so if that

person won’t drink, I wont even think about it, I can do without it.

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What sort of issues was it raising for you? Was it monetary, emotional?

Everythink. Alcohol raises a lot of stuff, and you name it, it was coming up. I was

watching on the local news last night at the local pub, the Normanby there was a bit

of drama there. I guy was pinned down and they smashed a bottle in his face and cut

his eyelid. It always involves alcohol.

If there were no barriers or constraints in terms of to the amount of exercise you

could do… any time, any place, any equipment what kinds of things would you

be interested in doing?

Oh probably just about everything. I haven’t had a massage in ages! That’s just

indulgences, but I am interesting in everything.

So you would like to be able to spend more time relaxing or more time on

yourself?

Yeah but that’s not exercising

No that doesn’t matter, I am also interested in other lifestyle activities.

I have joined a gym a couple of times over my lifetime, but I just couldn’t be

bothered. Nah. I joined with a group of people. I always join cause they are doing

specials and someone gets me to join to get them something.

Is there a kind of gym that would appeal to you?

Nah. I really used to like bike riding when I was younger. I haven’t had the time or

opportunity… we used to have a bike lying around, but no-one wanted to ride it.

Mainly cause it had a flat tyre (laughs). Also time is a big issue, we drive the car

because we have to get to places and rush around.

What kinds of images or ideas come to mind when you see people doing physical

activity? Do you associate yourself with those sorts of images?

I am pretty fit and healthy too, however, it wouldn’t hurt me to do something else. I

used to watch Aus Aerobics on TV and think I am not like them…

Oh yes, I remember them, they used to be up at the crack of dawn in white

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leotards! (laughs)

Yeah men mainly perve on them and we don’t do that, we can’t do what they are

doing. I think it was male oriented. But you can get exercise videos.

OK, so if someone was trying to get a message out to people about health, as I

am sure you have seen them do, to tell them to lead a healthier lifestyle, what

kinds of things, like when you think of the smoking ads and the pictures…

It probably works for me. Probably the baby one. The premature baby on life

support. It says like smoking can harm your unborn baby, and the baby is like skinny,

small.

What about things like health pamphlets in doctors rooms or information about

health.

Most of the time, I get interested in a pamphlet and the minute I’ve left the doctor’s

surgery I’ve forgotten about it. I go, I really must remember to look into that and then

something else, and it’s gone, and the next time you see it, you go, oh yeah I was

meant to look into that..

What about TV ads telling you do more exercise?

I don’t know, you can get that just walking down the street. I can do it walking up

and down the stairs, and if we are emptying the car, that can be up and down three

times, once for missy, then if there’s something else to carry, lots of carrying we do

between the two of us (Referring to herself and eldest daughter). Like, when first

moved in we couldn’t do the full set of stairs, we had to stop half way for a break.

OK, getting back to the place here, has this changed your lifestyle, or your..?

Everything, yeah everything. Cause I come from houses, and that was private rental,

and very expensive that was, I mean this is meant to be affordable renting, but it’s

not? Like that other woman over there, she was asking me, cause I was downstairs

cause any noise and I’m like ‘huh!’ and I sleep with one eye open. Just a few

experiences I have had since moving in, like I thought I was moving in to a normal

place, although these days what is normal (laughs). But we were here and people

were yelling out any time, doesn’t matter if its midnight, three o clock on the

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morning, or whatever, and screaming, barnying, over whatever…

How does it affect you?

Sighs. Pause. Well I don’t want to stay here much longer, I am going in my head ‘it’s

only temporary, it’s only temporary’. So yeah it’s, she was out there just hanging her

washing out and I was out there on the little steps and I am thinking ‘Shit, what is

with all these people that live here?’ And she goes ‘Hi’ and so I go ‘Hi’ cause I had

spoken to her in the stairwell one of the nights the police were here and we weren’t

allowed to like go anywhere sort of thing, like a lock in, and we had a big chat about

it all. It was an age group thing, she also has older children and she was saying ‘God

how much are you paying here?’ And I said a lot, and we talked about the cost and

then we all agreed that we paid the same amount.

So you’ve been a bit shocked and disappointed?

Yes.

And so maybe there are people in the buildings that could relate to each other,

it’s just that some others are making it problematic?

But I am still not into the socializing thing, in the units. As the years have gone by I

have just learnt to keep to myself. It’s nothing personal, as soon as you socialize, you

accidentally say too much sometimes and then your problems are spilled all over the

block. I’m sure they have their own skeletons and that, that they’ve let out, but I

think it should be ‘hello, goodbye’ if you have to say that. Just not to, you know, get

involved. And the kids don’t like that about me, and I say well cause over there, a

couple of years ago, they go and spill everything and then a few weeks later that’s

not their best friend anymore and they have blabbed it all over to their other friends

and they are fighting about it, you know? It’s just (pauses) they will learn that

eventually.

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INTERVIEW FOUR

What I am going to do, is start with a couple of questions about places where

you’ve lived in the past, and how those places have made you feel. So if you

think about the places you’ve lived in your life, which ones come to mind as

places that make you feel good, either mentally, physically or emotionally?

This is the very first place that has made me feel really good. Yes.

OK, tell me why.

Before I was living in Fortitude Valley, and it was very unsafe there. I could go to

places, but not at night time. As soon as it starts getting dark, it’s time to stay in.

OK, and what were the dangers?

People robbing you of money, and stalking you.

So the Fortitude Valley you felt was a dangerous place, so what about this place,

you said this place makes you feel really good, what is it about this place that

does that?

It makes me feel good, because I am like around a university, and the people round

here, I’ve sort of noticed, it’s sort of like a respectful place. And it makes me feel

younger (laughs). And even sometimes you know I would like to get to learn what I

could. Because I had a disability from my brain hemorrhage and I used to have to

learn to walk again, talk again. I had to relearn everything. I used to be computer

whiz, crossword whiz, everything, and I just can’t do it anymore.

And so you see the University as a place where…

Yeah I see the University as a start, although you get scared to start at my age.

It’s scary to start at any age (both laugh). And what else do you like about the

place?

It beautiful, it’s not unsafe, everybody’s friendly, even outside of the block, on the

university campus, in the village.

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How do you think it affects your wellbeing?

Well it makes me feel younger and that makes me feel good.

I guess we talked about the Fortitude Valley as being a place that is not so good

in terms of how you felt, can you think of other places where you think ‘oh I

didn’t feel good there?’

In Woodridge. Same thing, people would be looking for money, you know like bums,

you turn your back and they’re gonna get you, if they see you walking along.

Kingston also no good.

All pretty much for the same reasons?

Yeah. All pretty much for the same reasons. Like mainly where the low income

earners are, like this is different cause it’s a mixture. Not all low income earners but

it’s a mixture of the good, the bad…

So it’s diverse and that it’s a good thing?

Yeah it’s a good thing. Since I’ve been here I have come across some really nice

people. Yeah because after my bad experiences I refuse to talk to anybody, but when

you come her it’s different.

You feel safer?

Yeah.

And would you say it affects how you feel about yourself?

Yes! Um, it makes me feel more positive about myself and gives me a lot more

confidence. Yeah.

And does this affect your lifestyle?

I found that I am more myself more young and doing a lot more things, and not be

hidden indoors like I was before.

So you can come out and be part of it all.

Yeah, I can. It’s not just one low income earners…

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So what about the block of units? Here?

The block of units still needs a little bit more attention to it, but that is something we

will discuss in our meeting tomorrow. A community meeting. If we do have problems

they… we come out and settle it.

That’s good.

Yeah it’s good.

And what about the design of these units?

Yeah I am happy with the design, it’s very nice.

Alright, this is going back in time now. This is about health and lifestyle. When

you were growing up, how important was a healthy lifestyle in the family you

came from?

Um. No, no, I had a hard time with my parents because my parents were alcoholics.

Yeah and like my mother had children, and my father had children and they came

together and had us. And me and my brother always felt like we came last. Because

they paid more attention to them than they did us.

So it was a tough childhood?

Very tough.

And with the alcoholism, that obviously comes with a lot of problems.

A lot of problems. A very lot of problems. Cause with alcoholism, I got molested by

an uncle and I felt the best thing to do was to tell my mother? And I remember the

guy saying, you can tell you and she’s not going to believe you, and I told my mum

and she would not believe me and I was really just hurt in the heart. I ran away. That

was it, you know. She didn’t believe me. Although before she died, before she died

she knew that I was telling her the truth.

How old were you when this happened?

Eight years old.

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Eight? And you ran away?

Eight. And I kept on running away and running away.

Where did you live?

Friends houses, wherever.

Did you get an education?

Til year nine. Only til year nine.

That’s still impressive, considering…

Yeah but I wish I went back to school

Yeah that’s a tough childhood. (Pause). And now obviously you have since met

your husband and had your own children…

Yeah it must be good cause I have been here for 25 years

You’ve been married 25 years?

Yes I have. My eldest son in 34. The others are 32, 29, 24, and 25 years old.

You have five children?

Yes.

And did you find you encouraged things in your children, or did things

differently, given the difficulties you faced in the past, did it make it hard for

you as a parent?

It didn’t make it hard, I always find, that the more parents work, that is where the

problems come from for the children and not enough time spent with them. So while

my daughters were growing up with us, I was very open and anything you could tell

me, anything, even if it was going to hurt me, I would rather know. I found a lot of

their friends had troubles and a lot of the reasons why were because the parents were

working.

What about health, now, in terms of your own children, do you emphasise

health as a goal?

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Yes.

In what ways.

Exercising, even if it’s just walking, or swimming and going out and doing

something.

So just being active in life?

Yeah just in every day life.

In every day life, how often would you say you think about doing things that

make you healthier… do you think ‘oh I’ll walk to the shops’… or anything?

Yeah I think about a lot of vegetables, and I discourage donuts and things like that,

sweet things, even Coke, you know, I don’t like Coke. I put my teeth inside a cup and

show the kids, and say ‘You can, you can drink Coke, but this is what is going to

happen to your teeth’ (laughs).

And do you ever think about making changes to your lifestyle, do you think ‘I’m

sort of healthy, but I could be healthier?’

Yes. I would like to work with troubled teenagers. I still have that agoraphobia, and I

really don’t get out in the public, and because of my past experience and because of

what I have heard about so many people, so many children having those kinds of

experiences and not being able to go to their parents…

So you would like to look for more work…

Yeah to help children.

If you had no barriers or constraints to the amount of exercise or physical

activity you were able to do every day, if you could do any kind, any place, with

any equipment what kinds of things would you be interested in doing?

Exercising? Swimming. I love swimming (laughs).

You know they are building a pool here?

Yeah (laughs)

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So you are going to use that?

Yeah. Swimming and meditating. I was interested in doing Tai Chi but I never got

around to it… a lot of things like that I would find simple, and soothing…

If they did or held activities like that in the Village, would you go?

Yeah, yeah.

OK, what type of images or people come to mind when you think about people

who exercise.

I don’t mean to be like that, but Asian. Asian people are more free to do the exercise

or the Tai Chi. I see them out doing their exercising.

That’s really interesting. Do you associate yourself with that, or can you imagine

yourself being a part of a lifestyle like that?

Yeah.

So you don’t see a big gap between your lifestyle now and people who are living

a fit and healthy lifestyle?

There’s probably people a lot more people are more fit than I am. I am getting there

though, cause I haven’t been out and about, but since I moved here I am going for

these walks four, five times a day.

So this place has affected the amount of walking you do?

Yeah, and before if I did, I could never walk alone…

So here you feel…

I feel really good because we have the park right up here, so I get up and take my

grandson right up here and sometimes I go up to New Farm. Now that’s a distance…

Yeah that’s far. But you walk all the time here?

Yeah

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And this is good for physical activity?

Yeah, yeah and I’m not scared, seee that’s the main thing, I’m not scared when I am

walking around here, and it makes a big difference.

OK, so I am sure you have seen ads on TV and around the place encouraging

people to live a healthier lifestyle or do more physical activity…

Yeah

What kinds of approaches do you think work? If any? Or do you think

pamphlets and TV ads don’t do much?

Nup. I don’t think they.. pamphlets I don’t mind, pamphlets I don’t mind…

But what do they need to say for you to say ‘ah! I’m interested in that, or

interested in that lifestyle?’

The one that I see on the TV, if it’s meditating or Tai Chi, that’s the kind of thing

where you go ‘yeah I’d be interested in that’.

Ah OK, cool. And what about things like scare tactics where they say if you

drink too much or smoke too much, all these kinds of things, you know all the

scare tactics, do they work do you think?

It should work, I reckon it should and does work on children now because my sons

grew up and they hate cigarettes because you know mum did and dad did, so it does

make a difference. When we were growing up they didn’t tell you nothing.

So you smoke?

Yeah I do.

So what kinds of things do you think would need to change or be in place to

allow you to do more physical activity? Availability of it? Or other things.

Availability is important. If things are not around, then I feel bored and have nothing

to do, um the expense if it, if it costs too much, then no good.

So joining a gym, no good?

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No, no. Joining a gym is alright, but it’s a lot of money too as well. If you could just

pay as you go then it might be OK?

Pay by class?

Yeah, yeah.

And what about distance? Is it important for it to be local.

Yes, it’s important for it to be local cause I don’t drive.

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Interview Five

OK, firstly we’ll talk about place, think of some of the places you’ve lived in the

past five or ten years, or even further back, I don’t mind, which ones come to

mind as places that made you feel good or healthy, either mentally, physically or

emotionally?

Ah the closest I can see where I enjoyed it and where I wanted to go out was when

we were living in Harvey Bay

So what was good about Harvey Bay?

Everything was close. You had the beach a five, maybe six minute walk away, you

actually were happy to get up and walk out cause you knew at the end of the road the

kids were going to have fun, you were going to be able to sit and relax and don’t

worry about nothing. The weather was always beautiful… not like here where it’s

cold then hot.

So, nice even temperatures?

Yeah and they had like a really big park and stuff like that. Like nothing like what

you see here.

And that made your life easiers?

In Harvey Bay, they’ve got the Esplanade, which is just one really long road down

the beach which went forever, I think it was about 10 ks, and just the whole thing

was there was a place where you could get on push bikes and it looked like a car with

three in the back and two in the front, but everyone’s gotta cycle, and they can go up

and down the footpaths…

Wow.

And it was just like non-stop parks for the kids, and eight to ten BBQs and we

walked three steps and were right at the beach

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And how did all this make you feel?

Energetic. Like, we used to walk from where we were right down to the big fishing

pier and that was 3ks exactly from where we were, we’d go there, we’d fish until 4, 5

o’clock at night and then walk home and we’d cook the fish. Never put on weight. As

soon I left, I started putting on weight.

You think that was to do with the place, like just not being able to…

Yeah cause there’s nothing to do, you don’t want to do anything. I mean the most

you’ve got here is the city, there’s no beaches, the parks aren’t fun enough to amuse

the kids for longer than five minutes, the BBQs are always ruined ‘cause non-one

wants to clean up after theirselves. And in Harvey Bay, people with pets constantly

cleaned up so you never had to worry about any pet mess anywhere. It was

constantly clean.

That sounds really really good. Was there anywhere that was really bad?

Yeah we come from Mt Druit (sp?) that’s down in New South Wales.

So that had some bad stuff?

Everythink. You can’t even walk out your backdoor…

For fear of?

For fear of the kids, they can’t ride their pushbikes ‘cause they will get bashed and

robbed for ‘em. If you’re out, after a certain time you will get rolled for shoes, your

money, your wallet, different things like that. It was just… a lot of the areas aren’t

safe no more. I mean, people used to say this area used to be like this 20 years ago,

and it’s nothing like it, and that’s when I say, if I could come back and live in any

time, it would be back when you could always leave your front door unlocked or

window open if it’s hot, whereas now you’ve got to lock up everythink and you don’t

know if you’re gunna wake up in the morning and your TVs still there…

Yeah I understand. So OK, that was a rotten place, Harvey Bay was good,

what’s here like?

Hectic.

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Is it?

Yes

In what ways?

Instead of people if they don’t like each other not talking to each other, they are in

conflict.

You’re talking about here in the units?

Yes. So that’s why I keep to myself. The only time I go out is when I have to go out.

Like I said, the park’s no good here.

What about outside these units, cause you’ve got quite a mix in the population,

you’ve got the uni, people who have bought their own units, how do you feel

about the broader Village even if you don’t like School Street so much?

I think, down the shopping centre they could do with a few more things. I find that

the shopping centre is very dear.

The IGA too?

Yes, compared with Woolworths or something like that, yes it is. And its hard also

cause to get it home you have to get a taxi, and then what’s worse, if you live in these

units, if you’ve got a big shop you’ve got to leave half of it down, run up, to run back

up, to run down, and by the time you’ve done those stairs twice you’re absolutely

beat and that’s where you lose your energy, and you think I’ve done my exercise,

I’ve just walked up all that.

Fair enough. OK, question is going back in time now to when you were growing

up, how important was a healthy lifestyle in the family that you came from?

Well growing up, my uncle owned a farm so like we always had a healthy life. I was

in dancing from the age of four through til when I had the kids, and my brother well

he had horse-riding. It wasn’t until teenage years that the family started laying back

as the kids got older…

So do you think that had an effect on your health in terms of being less healthy

during teenage years?

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Yeah well I moved out of home soon after my first son was born, and that was at 15,

so… In the last 12 months my father had a heart bypass, my mother is due to go in

and have one…

Was this due to their lifestyle?

In the last ten to fifteen years I would say yes.

What do you think contributed to that?

Smoking. And then they couldn’t be bothered… with us being older and their

grandchildren not nearby they don’t get out like they used to, not like when we were

younger and used to go camping and different things like that… no more.

And do you smoke?

Yes I do. I gave it up for eight weeks and then I went down to Sydney and with the

stress of dad being ill and mum going off her head twenty four seven I started

smoking again. I told my boys though that I am going to quit again cause for that

eight weeks that I did quit, I could walk. Walking around I didn’t get the chest pains

and I didn’t always get puffed out, like I could walk up a hill and I was alright. But

with smoking again, even just here at Kelvin Grove walking to the shops and back,

by the time I get back I am just so puffed my back hurts, and my legs start to

cramp…

Amazing what a difference it makes…

And I find that I get to sleep a lot easier when I am not smoking, whereas now I am

back to it being one, two o clock in the morning before I get back to sleep.

So your whole lifestyle is healthier when you’re not smoking?

Well I smoked from age fifteen right through, I gave up for both pregnancies and

started again, and when I gave up recently that was the first time I had quit without

being pregnant and oh, I could tell the difference. And the zits stopped too.

In your every day life, how often would you say you think about doing things

that make you healthier? Obviously you have mentioned the smoking but do

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you think about it when you are making a meal or something like that?

Yes, but we have been talking as a family and we’re going to get a weights system

done and we’re all going to start eating healthier and we’ve already sat down and

talked about how with the kids lollies and chocolates and stuff will no longer be in

the cupboards. Because he’s twelve, he’s actually at an age where he wants to start

getting muscles…. So I said let’s do it. With me, going from a size eight to a size

fourteen to sixteen in less than twelve months is like, I cant handle it anymore. When

I go into the bathroom now I don’t even want to put makeup on because I just don’t

see the point.

So it’s really affected how you feel? And you feel that weight loss will…

Yeah, cause I’ve always been size eight except for in the pregnancies, and so for me

being five foot one and people say you’re only 70 kilos, but for me that’s big, I’m

used to being 49 to 50 kilos and I had an eight pound and nine pound baby…

And do you see that weight loss goal as being achievable?

Yes, because what I weigh now is what I was at nine months pregnant with him.

Yeah I can relate to that, my weight went up greatly after my third pregnancy…

Well I’ve put on weight once after the boys were born, but that was when I was on

the injections from falling pregnant, they’ve got injections that you get every three

months and I put on weight with the very first one, so I never went back. Well I put

on like 10 kilos, so when I stopped I went back to my normal size, and I’ve never

been a big girl.

So if you had no barriers to the kind of physical activity you were able to do,

any kind, any place, any equipment, what kinds of things would you pursue?

Oh God. (sighs). Yeah. Um, I’d like to, if I had the money to be able to afford to get

to a gym to get taught how to do anything properly. I don’t want to end up with big

arms and thin legs or anything – like toned and normal, like still look like a female,

and I don’t want to be one of these females that you see that look more muscly than

the men. I’d just like to be happy in myself. But even when I am small, I still have a

baby belly.

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So a gym would be good?

Yeah. Swimming I’m no good at ‘cause I get asthma again. Me and swimming pools

don’t seem to get along (laughs).

So what kinds of images or people come to mind when you think of physical

activity?

As soon as I think of exercise, I think of models.

So for you it’s mainly about body image and appearance?

I think that that’s the time we live in now, the bigger you are, the more down you get

put. Everything is about image. Once upon a time it was about brains, or what you

could give to somebody, but now it’s about how you look first, and how you present

yourself first, before mind or what you can do comes into it. I mean I don’t

remember it being like that when I was a kid. But nothing everything, you can’t

watch TV without, even ads like for awareness of anything, they’ve got a nude

model.

So you feel it puts a lot of pressure on women…

Men too. And men too. Like if a man is not a certain structure, people don’t look at

them in the way they do if they look good. So it’s for both, it’s not all one sided. But

I believe that is the way the world is.

If someone was trying to get a message out there to do more physical activity or

lead a healthier lifestyle, what kind of things do you think they would need to

say to convince you, or are you not really affected by things like the media or

pamphlets?

The only message that I like looking at is The Biggest Loser. Like, when you see

them going from such a big person to such a small person, and even if they don’t

win, they can look at how much weight they have lost and go on and live their lives

afterwards and still stay thin.. and it just shows people, whereas you get ads like

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Jenny Craig before and after shots and its like ‘nobody can lost that amount of

weight and look that good in six weeks’ .You don’t think?

No.

But the Biggest Loser is better?

Yeah you can watch them week by week go from being these big people to these

small people, whereas Jenny Craig, or the ads where they are selling all these gym

products ‘You can look like this, just 20 minutes three times a day’ and that is just

like ‘Yeah right!’

So does the Biggest Loser motivate you?

It motivates me to lose weight. That’s why.

Would you seek other support while you were trying to work through a weight-

loss program, like a counselor or a doctor?

Nah. I would like to seek somebody who would like give me, but see like that is the

only problem is that it’s too hard. If you don’t have the money to find somebody, like

in The Biggest Loser, where a doctor or someone will sit there and check and tell you

your body is this, and you are this age group, and if you eat these sorts of food..

Like more individual attention?

Yeah I don’t want them to sit there and tell me you need to eat this on this day, and

this on this day, but if they could just write down a list of what the most healthiest

foods are, I could make my own list. But you cant get that just anywhere. Like I’ve

been to the doctor wanting to know how come I have put on so much weight in such

a short time, and they are just like ‘you are fat, you just need to lose weight’.

And that’s not helpful. What about things like diet groups?

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Yeah

I was really interested in that bit at the end where you said it would be good for

doctors to be able to help you out with your diet…

The thing that hit me the most in terms of my weight gain was when I went to the

shopping centre just a couple of weeks ago, and I was putting on makeup because I

was going for interviews for a job and I was with my girlfriend at the time and I said

to her ‘Quick!’ cause she loves to try on all the make-up all the time, and I said

‘Quick! I gotta go to the toilet!’ and a lady turns around and says ‘Well that’s what

happens when you are expecting!’ And I was like ‘I’m not pregnant.’ And it just hit

me like a ton of bricks, so I felt so horrible, so I went to the doctor and I said look

I’ve put on all this weight gain and my feet have swollen and all the rest of it, and I

said I want to know what I can do, what tests there is, and she just turned around to

me and said ‘Lay up on the bed’ and she grabbed my stomach and said ‘You’re just

fat, you need to lose some weight, can you do that?’ It shouldn’t be like that.

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INTERVIEW SIX

If you had to think about the places you’ve lived, in the past five or ten year, or

even throughout your life, which places come to mind as places that made you

feel healthy or good or made you feel that you really loved the place, and why?

Probably Sydney. I dunno it was just, I dunno, I love it…fresh air. It wasn’t so

suburbia as a lot of places I’ve lived in…

OK?

It was more spread out, and people kept to themselves.

And that’s a good thing?

For me, yes. I personally feel that I don’t like to get too involved in other people’s

business.

What’s good about keeping to yourself, for you?

That’s just a personal thing for myself because I’ve been involved and been friends

with neighbours and it doesn’t turn out a good thing.

Oh, OK?

For myself, it always turns out it always seems to be a bad thing, and I dunno

whether it’s the people I meet or whether it’s just myself, who knows? (Laughs)

But this place was good?

I just loved it. It was pretty far to walk to places too, which I liked cause I’m really

bad at exercise, so if I have to walk to childcare and it takes me 40 minutes, well then

I’ll do it. Yeah that was the best place.

And how old were you then?

Um that was only this year.

Oh, OK, so you were there just before here?

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Yeah and that was probably the best place.

Thanks, now, on the downside, what about places that you hated, or just

thought ‘oh yuck, get me out of here?’

Um, well, this probably one of them, Kelvin Grove.

I am going to ask you about Kelvin Grove in a minute, is there anywhere else in

the past that you have not liked living in?

Probably Chatsworth. it’s in New South Wales it was really country it was too far to

travel, you’d have to go by bus and um you’d just sort of, I just felt really isolated

there myself. There was no shopping centres, so you’d have to catch a bus to go into

town and not really many people around and you just felt like you were stuck in on

an island

So it was really isolated?

Yes.

So getting back to Kelvin Grove Urban Village, I have a lot of questions here,

and am wondering about how you would describe it, and how does it make you

feel, and how does it make you feel about yourself and your family?

Um. I don’t like it here. Um community housing is probably the biggest downfall. I

have never lived in community housing before and um, so, just the people, the kinds

of people that are your neighbours. I have made one really good friend, out of it all,

but apart from that, I have been assaulted twice since I have lived here already. That

was pretty scarey. I’m not into drugs whatsoever, wheras the majority of people who

move into these houses are.

And so how does this make you feel, being surrounded, and being in close

proximity to these people?

Can’t stand it. I just think it’s disgusting. I mean, fair enough everyone’s got their

own lifestyle but when you are living in a box and you’re in the middle of it, and you

don’t fit in with the people who live here. I feel like I’m an outsider, especially

because they leave lots of needles lying around near the bins, so I don’t want my kids

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even going outside. And if they do, I have to make sure they always wear shoes.

So did you get housing before this? Did you go through private rental?

Oh yes, just real estates and yeah, when I came to Brisbane, I ended up being

homeless so I was in a hostel for two weeks, which I have never been.

You and the two boys?

Yes and that’s when my family support worker said ‘Well they’ve got units going at

Kelvin Grove and you can get in’ and I thought anythings better than there…

Of-course.

And at the time I thought this would be really good, at least I could settle down and

get a roof over my head and you know and things would work out. But now I am

actually thinking that I am rather have stayed at the hostel than live here.

Wow, that’s really bad. What about the broader Village? I understand what

you’re saying about Grey Gums, but what about the broader Village?

I think, personally I am finding they are doing a lot of Department of Housing

developments everywhere and um, I just feel that um, I dunno. Look, I just don’t

want to live in a Department of Housing area. When you say Urban Village to

people, they just think of it as Department of Housing.

Really?

Yeah. They think ‘Oh you live at that community housing place’.

And do you think it reflects on you?

Oh it does. Yeah. I think well they think I’m a drug addict just like everyone else is

around here. And I feel like ‘I’m not one of them!’ And I don’t want to be

categorized into that. Just because I needed help with housing, doesn’t mean I am

here for that same reason, like that I’m poor, well OK, I was a little bit poor, but not

like some of these people who have ruined their own names and they can’t get

anywhere else, so they come here. I feel that this should be an opportunity for people

who do do the right thing, and do need some help. I mean, the IGA’s wonderful.

That’s probably the bonus about living here, cause it’s just around the corner.

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Yeah, sure.

Um, but to me it feels like its more of a student thing. More for the Uni. I think it’s

meant for the uni students and not really for the Department of Housing people like

us.

Mmmm. I’m very interested in that answer, I have noticed that other people in

the interviews are saying similar things, and it does sound frustrating.

Oh look, it is really frustrating. We ring the real estate up, and it’s a ‘police matter’.

You ring the police up and they come over so many times that it gets ridiculous. And

it gets to the point where you just ignore it.

What do you think would be a better set-up? I actually haven’t asked anyone

this question before, but you’ve given me these really cool answers, and I would

like to hear from you, what kinds of alternatives do you think would work

better?

[door knock, child wanting to visit, participant returned the child to her mother in

neighbouring unit]

For someone like you, who genuinely needed the housing, and this is the

government response, do you think it would be better to have individual living

arrangements so people aren’t all so close together?

I think individually would be so much better. Like having one house in a street, and

that one house is Department of Housing. Um and not put a whole bunch of people

in one block of units who all have so many problems. Um I reckon, because I looked

at Sydney and I watched a documentary on MacQuarie Fields…

Oh, OK?

And that was Department of Housing and to me that just says it all. They’re wasting

their time. I mean, these were brand new units and you could imagine the majority

of them will be wrecked by the time people leave, and they probably wont get their

rent money. I mean you can just imagine. And even now, everyone’s calling these the

Drug Units. And they say the Real Estate is running the Drug Unit.

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That is really interesting. Thanks for those answers. Now, this question is going

back in time a little. When you were growing up, how important was it in the

family you came from, or the household you grew up in to be healthy? Did your

parents or carers emphasise this as a goal, or was it not so important?

Um, I as a, well, growing up in my household, well there were lots of problems we

faced on a daily basis.

What kinds of problems?

My stepfather abused us, um, my mum ended up staying with him for twelve years,

which we in the end, just you know, got to the point where we were sick of it, cause

we had enough. And my mum ended up carrying on a few of his traits, and me and

mum clashed a lot, so…

Right…

I did have a weight problem when I was young, but I did something about it, I went

and joined Jenny Craig and you know, and started losing weight, and you know, I

dealt with it myself, because my mum used to call me horrible names about being

overweight and that didn’t help me. But then I moved out of home at fourteen

anyway, so…

So where did you go?

I ended up going into a homeless shelter and ruining my life, and then I ended up in

rehab.

So you got into some drug use and then rehabilitated.

Yup and haven’t been near it since I was 16. Nearly 10 years.

And then your boys came after that?

Yeah I was nineteen by then.

Great, thanks for that. Great answers. So thinking about now, do you think

about doing things that make you healthier on an every day basis, in terms of

you and the boys?

Um. (long pause). At the moment I’ve been really lazy, because of my pregnancy,

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and I just don’t want to move. I like eating healthy with the kids especially. We don’t

have lots of sugary stuff. If we do, it’s just occasional. I mean we have a few bickies,

but I try to give them the cream ones and not the chocolate ones.

Oh, OK

And yeah, they don’t eat a lot of sugar, otherwise they just run around crazy all day. I

try and … I think it starts with healthy eating and if you’re going to overload with

sugar, you’re not going to motivate yourself to want to go for a walk, cause after half

an hour of running around crazy you just wanna go (pretends to collapse) and go

sleep.

Anything else you worry about? In terms of diets?

No, they’re pretty good. Jacob’s really bad when it comes to eating vegetables. I

don’t pressure him, or push him otherwise it’s just a big argument. And he doesn’t

like mash potato, so I substitute that with wholemeal pasta. They like their,

personally I think it starts with waking up early in the morning. Um yeah, I wake up

early, they wake up early. We get up at six and have breakfast and then go and do

something, even if it’s just a walk to the IGA and back, at least it’s something that

gets us out of the house. We walk up to the bus-stop too. I use public transport a lot

and the bus-stop isn’t that far away, so that is good. You can go up that hill, if you

can call it a hill, but it certainly feels like one.

So do you go to bed early?

Yes I do. I like my sleep, so I am usually in bed about nine.

That sounds like a good routine. Cool.

Yeah.

Ok, um in terms of this health aspect, is health important to you as a goal?

Um, when I’m pregnant, I don’t really have any… I like to eat healthy, but I can sort

of let myself go a little bit, cause I am getting bigger so it’s OK to put on that extra

five kilos, but when I’m not pregnant I’m really full-on about my health. I do lots of

exercise and keep healthy and um I do smoke cigarettes, which is probably a

bummer.

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Yeah, yeah…

I don’t smoke as… I’ve cut down a lot. I just try and… I’m not a like a going to the

gym twenty four hours a day seven days a week kind of person, but I don’t really feel

that you need to go to a gym to get exercise and all you have to do is walk around the

block. If you keep doing that every day, just at least to keep, then at least you are

doing something. I like swimming, the kids love swimming, so we do that.

There’s a pool going in there soon

Oh wow

Yeah there is just across the road from IGA, a pool and a gym. It is an

improvement, so it probably is going to get a little bit better…

Wow.

So, just say, if you had no barriers to the amount or type of exercise you were

able to do, that you could do any time, any place, with any equipment you

needed, what would you be interested in doing?

(Long pause) Do you mean like, what, exercise?

Yeah, or any kind of active recreation.

I like doing pilates. I dunno, I like tennis, I like basketball, all kinds of sports. I mean

my biggest concern about going up there and using the park there is that there’s

needles. I know it sounds terrible, but I worry to take the kids up there and go for a

run around with the ball just incase they stand on them.

Oh my goodness. Yeah, I got you. So safety is a big issue here?

Safety is really huge around here in that there’s not a lot of it. I don’t feel safe at

night when I go to bed here.

Oh, OK that’s pretty bad. So an important part of how active you are able to be

where you live is about safety?

Yep

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Your neighbours?

Yep

These are all important things?

For myself they are pretty huge, it seems. I would like to live in a community where I

could be safe and my kids, feel comfortable and safe too. I would like to just be able

to go off and do the normal things other people are able to do in a normal

environment. To me the community here isn’t classed as normal.

(Both laugh).

So what kinds of images or pictures come to mind when you think about

physical activity or exercise.

Um

When you see image of people jogging or keeping fit, do you think ‘yeah that’s

pretty similar to me and my lifestyle, or something I would like to be, or that’s

another world?’

I think, I would love to go for a jog or a run, but I dunno. I just prefer walking. I like

to walk. I think when I look at them that they’ve probably had liposuction and they

probably never really run (laughs). I mean that’s probably just me being in denial

(laughs again). No, yeah, I would love to be fit. I walk past gyms and see people, and

it really makes me think of going in, joining up, and using it.

Ah yeah, really?

But as soon as I walk past it, I think it’s just a dream.

Now if someone was trying to get a message out to people to do more physical

activity or lead a healthier lifestyle, what kind of things would they have to offer

you, or say for you to be convinced of that?

Dunno, really. I think what they are doing now is a good job. Just with all the

advertising. I think it does work. I notice with the heart foundation and those kinds of

ads that, and with the Skip, Jump, Run ad? They’re good. They motivate me and the

kids. Cause they look at it, and they go, ‘we can go running or we can go skipping’

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and I go, ‘yeah we could’ (laughs). I think I find it um, with health and physical

activity, there’s too much in the magazines that really make women go ‘oh my gosh,

I wish I looked like that, but then it becomes a depressive thing. They just go away

and eat more!’

So you think it’s an unhealthy idea we have about weight?

Yeah. It’s unhealthy. Especially when you are looking at pictures of women, and you

know they have the money, and they have the cash to go and get plastic surgery and

you know they are not going out and jogging, and even if they are, they aren’t eating

a balanced healthy diet, and you cant expect to look like that. They are all either

undereating and exercising at the same time and look like they’re dying, or then they

stop exercise and they just pile it all on again, so it’s all a big yo-yo diet. And I think

its how it happens to us. I look at them and think ‘oh well, they do it’. I would go ‘I

wanna lose weight, I wanna lose weight’, and end up starving myself to the point

where I was going two weeks down the track, ‘oh my god I am so hungry’

Of-course

I need to eat, so I would eat, then get angry with myself for eating and I think it

stems from the magazines. We look at them, and want to be like them, but we don’t

want to eat actually eat the healthy food and do the exercise to get like that, we think

there must be an easier way.

I guess that’s a pretty unhealthy relationship to have with food? Not just

thinking about it as something we need to live?

Basically there was a program I watched called what you are is what you eat. And its

pretty much true. If you eat McDonalds five days a week, pretty much they look like

a big hamburger (laughs).

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Interview Seven

So I guess I have spoken to you a little about what the study is about, it’s about

how place, or where you live, your neighbourhood affects your health…

Sometimes when I first moved in n that, it was really nice, but when the neighbours

at night n that are having big arguments, and a lot of the time they come and there’s

the police or the ambulance and you can see the lights when the ambulance comes,

and at times like that, I feel like I am in Once Were Warriors or something like that…

Oh really?

No, it’s just like, the apartments make me feel like, you know how you see it on TV

and in America in Harlem how they’ve got those units n stuff, and sometimes when

they’re all having their domestics and the cops are coming over all the time? That’s

what I’m thinking.

So it paints that image in your head?

Yeah, it paints that image in my head and then people are saying, um, we had that,

Vicky came that time, we had that talk downstairs for all the people in the units, and I

didn’t know all that stuff was going on and when she said all the neighbours had

been having a big scrap together… mainly the people at the back of the units, not the

front, then that’s what I had in my head ‘oh great, it’s like Harlem, all the units are

together and they’re all scrapping it out’. But most of the time I don’t think of it like

that, but when we had that meeting that day, that’s what I thought.

And how does that, I guess, do you feel part of that? And how does that make

you feel about you and your family and the situation?

I just think ‘ah no, that’s I’m keeping to myself’. That’s why. I mean I see the

neighbours and I am not rude and I say hi and stuff but I don’t really go over and

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have a cup of tea with them and go over their house or anything and they wont come

to my house and the reason is, that after that meeting, I thought that it’s been the

same in other places I have lived… I mean you are friends with them one minute and

the next things are going missing out of your house, and that is why you can see how

I have set up this place; where I have put the cots and the beds and everything, and

where I set the TV up, so if we have any visitors or if people come through, like

Friday, the neighbour upstairs… the water was leaking through my bathroom and it

was just pouring down and she actually made me a coffee and brought it down to me

and yeah that was really nice of her. But I still have my things where they aren’t

seen, ‘cause I don’t know people.

So this is also influenced by previous experience?

Yeah by previous experience and by I think sometimes common sense, ‘cause you

don’t really know people. And you can know people, but not know people.

So you were saying, that sometimes it makes you feel you are in some kind of

America scene, and…

Yeah like when we were at the park that time, and that young boy said ‘Oh School

Street, that’s the bad place!’ and people say that kind of stuff to me, then I think I am

living in Harlem.

Yeah

But most of the time I feel ‘ah this is cool’ cause I am living right in the city, and

most people would be really happy to be living in my spot and yeah this is the place

where most people wanna be. I mean, I used to live in Ipswich, and everyone wanted

to live in the city. But ever since I came from New Zealand I have mostly lived in the

city. And city areas. Not in the suburbs.

So this is good, and what you need, there are just aspects that….

People make comments like when I tell them where I live, they say ‘oh there, that’s

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got such a bad reputation’ and other people say that.

So would it make a big difference if the reputation changed, and the police visits

slowed down and it was more positive… would that affect you a lot?

I don’t think that it affects me. I think that maybe it does affect me, um where if I got

more of a good vibe from my neighbours, whereas in the back of my mind I am

thinking, cause I can hear them arguing at night and I can hear people abusing each

other and saying ‘you junkie blah blah’ and that is one reason why I don’t want to

know the neighbours, and you know which house it’s coming from cause you can

hear the yelling through the doors, and I’m thinking ‘I’m not going near that door or

that house’.

Sure, so you can tell who you want to socialize with and who to avoid?

One evening I had my window open and I could hear someone yelling ‘you junkie,

blah blah you junkie, you’ve left your kid with me for 11 and a half hours!’ and this

is like 11 at night, and this guy had just dropped off her kid and I could hear him

yelling, so I was thinking ‘I’m not going near that house.’ And the kid, the the little

boy was there, and I could hear him yelling ‘I brought your son back, ya blah blah’. I

could hear the guy yelling at the girl. I think you know them, they’re from that unit

over there

Oh, yeah, Ok

Well I know her son is about my son’s age and I was thinking ‘I don’t want my kids

to mix with you know, I don’t mean to sound mean, but I don’t want my kids mixing

with, I mean I do want them to meet kids that are there age, but not where that is the

other parents’ lifestyles.

So the problem is a big one here?

Yeah I think it is. It’s just that girl over there – you know her from the park.

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Ah yeah.

Cause he was yelling at her and saying her name, so I know who it is. And he was

saying ‘you leave your son with me!’ and he was screaming his head off and saying

‘I’m going to scream even louder!’

So that must be a difficult context… although you say you are happy with a lot

of it, and we can talk more about the good stuff in a minute, but there are some

difficult things here as well, hey?

Yeah, when I am sleeping at night and then I hear some guy yelling that out, or the

time I said, when I was going out to hang out my washing, cause I usually do my

washing at night and then go out at around 10 to hang it out, I just like doing my

washing late, cause then the kids are asleep and I can get up and clean the house a bit

better and do the washing and hang it out, and so I am walking out to hang the

washing out and I hear some lady screaming ‘You stabbed me, you blah’ so I just

bring the washing back in and shut the door (laughs). I think ‘I’ll hang out the

washing tomorrow’ (laughs again).

That sounds pretty full-on. Now if we can talk about some of the positive aspects

of living here, not just in the units, the whole Village, what’s good about it? And

the whole Village too?

Um, I like where I am. I like this area that I am living in. I like that I am close to

Roma cause Roma is close to everything and you can get to anywhere from Roma.

And I like how the buses run every 15 minutes from the park. I like the shops, and

that they are just right there, and more stuff is being built all the time. I like how they

have a taxi rank right there at the park. Yeah so sometimes it’s perfect if I have to go

somewhere with all the kids, I can just jump in a taxi.

What about other things are good? Like, what is it like having the uni, or the La

Boite theatre right there?

I haven’t been to any of those, but I like the feel of having the uni students n them

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going pastyou know when you see them going past you think oh wow cool things are

happening around here and people are um getting on with their lives n doing better

for themselves and it’s good when you see other people doing that. I did go to uni in

new Zealand n stuff and I got excited about that and you feel really good cause

you’re at university

What did you do at Uni?

I was doing a paper for pre-school, then I changed my mind. Yeah I did it for a year.

But when I was doing papers at varsity it was really exciting for me, and when I see

the students walking out the front here, I just remember that feeling of how exciting

it was, cause they have got so much to look forward to.

(phone interruption)

OK, now I would like to talk to you about lifestyle and health. Just generally.

And I will go back to when you were growing up, how important was a healthy

lifestyle in the family you came from, and what that a big deal or not so much of

a goal? Where did health kind of figure in your life when you were growing up?

Um, when my mum and together, my dad was the person who did everything. He

was the one who took care of the house, went to work and came home and did the

cooking and everything. Yeah like when I was sick he would open the windows up

and cover us up and put us on the couch. He would give us our medicine and make

our food, but he always had the windows and doors open. I would always think, man

I am freezing, but he’d always say it was to let the bad air out so you can let some

good air in, whereas my mum was the opposite. She would lock up the house, so

you’re sitting there with a cold and you’re sick and the whole place is stuffy. It’s just

common sense to let the bad air out.

So what about things like, would he encourage you to do sport or activity?

Ah yeah, well dad, he did, they got divorced when I was seven, yeah? I lived with

my mum’s family, my mum was too busy, but my mum’s parents raised us. My dad

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had us for the second weekend, and he always took us everywhere. He always made

sure we had like fruit and veggies, we always had everything for school, he always

came and saw our principal. We were never without with our dad? And that’s funny,

our mum was the opposite of that. On the first day of school, my dad introduced

himself and us to the principal. If he couldn’t get us anything, like books or anything,

he would say to the principal, I will get this on this day. But usually he had

everything beforehand. He made sure we had lunches and everything. While mum

was totally the opposite (laughs). My mother wasn’t really children focused. For a

woman who had ten children she wasn’t very children focused. Everyone else looked

after her kids.

So where were you in the ten?

I am number five.

Cool. And do you think how your mum or dad were then influenced how you

lived or how you are now?

Yeah well, my dad always said make the best of what you’ve got. Not my mum, she

was always a poor me kind of attitude, like if it wasn’t for this, or if it wasn’t for that,

like negative all the time. But dad was always thinking. Like what can he do better,

how can he do more for his kids? And always helping other people. Every holidays

we went to the beach, to the zoo, we always did those kinds of things with my dad.

But the weekends he and his wife would cook dinner and we’d go to the park to eat

it, like not just stay home, you know? Whereas mum was busy with her own life. She

just had a life. A social life.

And so what did your dad do as his job?

Practically everything. He had some billiards that he owned. He would rent them to

the billiards room and get money back on that. His wife was working. He mainly

raffled things at the pub. He was always at the pub. My dad was a drinker, but he was

a good drinker. My dad always went to the pub and raffled seafoods and meats. And

most mornings of his raffling nights we would get up early and go down to the wharf

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and my dad would get a sack of mussels, fish and mussel bottles and he raffled it. He

would go out fishing. He was always thinking of something.

And his drinking wasn’t a problem?

No he wasn’t a problem drinker. And plus he had six pool tables at home and it was

the kind you had to put money in so he had his mates come over and drink, they still

had to pay to use the pool table (laughs).

That’s great. Now in terms of now, do you think about or worry about healthy

living or eating, or not really, or…

Well only when it gets near pay day, then I have to think I had better make this last.

Then I am thinking like that, but most times I am not worried. Then I think, what

would dad do? My dad always bought fruit and vegetables, and my mum bought

eggs and bread. Dad was the cook.

(baby interruption)

So your dad had a positive attitude about what to do when things were low?

Yeah, and my dad was always into community stuff, so he was always doing stuff in

the community, so even if he ran low, there were people he had helped who would

help him. He was like always helping out, so if they saw him in need they helped him

out.

Gee that’s good. Is he still around?

Yeah he still lives in New Zealand with his wife. He doesn’t do as much now. His

wife still works, but he is on a pension. He has diabetes. He can’t do as much. But he

had a good life as a wharfie, and working at the meatworks, a lot of different stuff.

I just need to ask, in terms of physical activity and exercise? Is this an

important thing now for you in your life now, and for your kids?

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Not really. Not since I have been here.

Does this place in anyway influence how active you are?

I think it makes me less active cause we are right in the city, and there isn’t much for

the little ones here. I think when it gets sunnier.

Are there facilities that you have seen that you think you might use when it does

warm up?

I haven’t really looked. Just mainly that park over there for them to play with.

How about the park at the park at the back of the building.

I actually haven’t been up there.

It looks beautiful.

Is it? I would take them to the park more if I had walked around to find it.

Sure, no worries. So would you say if you had no barriers to the amount of physical

activity you could do personally, what kinds of things would you like to do?

Yeah I would do it. I used to love going to the gym. But not right now iwht the kids

cause they are too young. I used to love the walking machine. I used to own one at

home, and I used to do that every day. If I had someone to look after the kids, I

would definitely go.

Yep, cool. What kinds of images come to mind when you think of physical

activity or exercise and do you associate yourself with some of those images?

No not really. I used to be a fitness fanatic in the past, but not now. It made me feel

good. I used to run to the pool, swim laps, then go to work, then go to the gym after

work. Before I had children. Even after my first son, but now all I do is push the

pram (laughs).

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So if you see ads with people encouraging people to become fitter or do more

exercise or messages about improving your health, what do you think of them?

Well, if they had crèche facilities I would go to a gym. Free ones. If you didn’t have

to pay for childcare I would go. I would have to pay for each child and then myself? I

don’t think so. I am better off just pushing the pram around.

And at a household level, do you think who you live with influences how active

you are?

Yeah cause ……. Is really into rugby, so we go to games n stuff. Or take a ball to the

park.

And what about neighbours, or where you live? If you see people jogging or

doing activities does that influence you, in terms of how you live your life?

Not now. With the kids I am sweating before I leave the house (laughs). I buckle

them in the pram so they don’t mess up the house again while I have my shower and

get ready to leave!

Yeah, I use the TV to keep them still sometimes! And these are barriers to you

being fitter or pursuing more physical activity?

Yes! And I have four kids, who will look after them?

Well, that is kind of all I needed to know - thanks so much for that, I am really

grateful!

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Interview Eight

Alrighty, we’ll start off with questions about place. If you think of the places you

have lived in over the last 5 or 10 years or so, which ones come to mind as being

places that made you feel great? Or even further back than that? And what was

it about those places that you liked?

Like suburb or house?

Both, either.

A place in Labrador I had a cottage-house. I liked that house.

What did you like about it?

It was homely and had a wall, and tiled, and it was nice. I haven’t really lived

anywhere other than that where I felt great or I was happy, so….

No? Alrighty. Fair enough. So what about these places? Why were they not so

good?

Um, Eagleby. It was the household members and the area. Just trouble. Beenleigh,

NSW, heaps of places are like that. Just negative. The people. Attitudes in just liers,

two-faced trouble-makers. Gossipers. And the area, there are other areas, and you

know, that is what I have experienced.

(visitor interrupts)

Ok then thinking about KGUV and where you live now, how do you feel about

the village and where you live now?

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Well there are certain people that lived here that I didn’t get along with. This

apartment is alright. It’s meant to be one bedroom, but I don’t actually have a

bedroom door, so… I am not happy with it. And I have only met a couple of people,

and I stick to myself. As I said, I haven’t been out or associated with anyone, so I

cant really say.

And what is your feeling about the place in the broader sense?

It’s different.

Different how?

I don’t really know. Just different.

Do you like what’ s here?

There could be more. We need a Woollies. And there is no entertainment. They need

more retail. There’s so much food, but no retail. I understand there is a gym being

built. I am with Fitness First. That’s the gym I joined.

What about things for kids, do they need anything?

Yeah they need a community childcare and entertainment for children. More things

were children can go and play. And somewhere where the children can go and the

parents can have time-out. Um some kind of playgroup or something.

How do you think this place affects your lifestyle much? Does it affect what you

are able to do or not do?

Yeah because I, you gotta be weary you know. Living in units in general, you know,

people have their dramas, you know. When you want to live in peace, it doesn’t

always happen.

Is that because there are so many people living close together do you think?

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And um people, how do I put this? You know what I mean. They should have

screened people before they let them in.

(Visitor interrupts).

Ok, so screening would have helped?

I don’t mean to be judgemental and nasty. But they should have thought about who

they selected and who they put together. It doesn’t work. Their ways, their attitudes –

some don’t go well together. I’ve had my clash in personality here. And people

thinking they can stand over you and standing over you with their big bad egos.

Especially with public community housing they have to be so careful with who they

put in.

In terms of when you were growing up, how important was a healty and active

lifestyle int eh family you came from, was it an important thing?

Yeah it was, but you know, I chose…. I drink heaps of coffee, and I only just joined a

gym. Dad did basic veggies and he did the casseroles. He raised us.

How many of you did he raise?

Three.

Does that influence how you live now, do you think? Your childhood and your

time with your dad?

Yeah, well I’ve chosen you know, like, it’s my own choice. It alls boil down to some

choose to be healthy and some don’t. I am a smoker.

And that’s a choice thing, yeah?

Yeah and I regret it now, cause I am trying to quit and I am having so much trouble.

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You know the damage its doing and then you’re worried and paranoid and think I

wonder if cancer is developing. So… I sit there worrying about it – smoking and

worrying about it.

So you are fully aware of all the risks?

Yep. Circulation, everything. And when I don’t smoke I eat a lot. And I will just eat

whatever. If my mouth waters for chocolate, I will go for chocolate. And the ciggies

help control that. I have self-discipline problem. But having the kids and no childcare

doesn’t help.

So childcare is an issue in terms of health?

Yeah. And me self-discipline.

In your everyday life how often would you say you think about doing things that

are healthy… aside from the ciggie worry?

I worry about it everyday and all the time, and it’s just getting that motivation.

So it’s on your mind a lot?

Yeah.

And what about your kids – your little boy and your little girl – do you think

worry about their eating, or how much exercise they’ve had in a day or not that

much?

I do with me daughter, but that’s cause she is only just back in my care, she’s been

with her father for the last six months and everything. She does love her fruit, but

she’s hyperactive so I have to watch what I give her. I give her fruit, vegies,

mueslies…

What about activities, I know she’s still little…

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She runs everwhere, so she never walks.

And do you use your urban environment, your neighbourhood, do you use that

for your activities, for you and your daughter, does it affect what you can do

with her, like the design of the place?

Yeah well its small, cramped, claustrophobic, no big yard, no swing set or anything -

so it does have an effect.

Ok, if you had no barriers or constraints to the amount of exercise you could do,

any kind any place with any kinds of equipment you needed, what kinds of

things would you be interested in doing?

Ah, I love dancing. I would love take dance classes. The funk classes are great.

So you really enjoy your exercise and your movement?

Yeah I do. Movement is an important thing, your body movement.

Does it affect how you feel emotionally?

It does, I do believe it does, cause it’s like energy build up, see? And releasing

energy, and it feels good.

What kinds of images or people come to mind when you think of physical

activity or exercise, and do you think of yourself as being like that.

I do visualise it, you know. It’s like you see your celebrities, them determined people,

focussed people, and think you can be like that too. It’s just mind over matter, that’s

all it boils down to.

By celebrities do you mean women, or…

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No, just other people.

People in the media?

Yeah and people in general.

Is there any celebrity that you can think of in particular that you go, wow

about? For motivation?

Not really, it’s just seeing other people. Cause we’re all the same, you know, no-one

is better or worse but just everyday people…

Who are exercising?

Yeah, even just walking, dressed in Nike tracksuits, sort of just everyday people, and

you see ‘em happy, and you see how their bodies are and you know that energy, and

that is motivation and inspiration to me.

So, in a neighbourhood where people were doing a lot of exercise, that would

affect you psychologically? It would affect how you think?

Yeah cause you think well if they can do it, I can do it.

Thanks for that. If someone was trying to get a message out to people to do

more activity to lead a healthier lifestyle, what kinds of things would they have

to say to convince you to make changes in your life to achieve that?

Um, I would need to think that they knew what they were going on about, I would

need a 100% guarantee of that. You need a strong positive influence. It is about

personal power.

So it would need to be someone inspirational.

Yeah and someone wise who knows what they are talking about. Having the

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knowledge. Without being pressuring and nasty in the process.

And for you to trust them?

I would need a 100% guarantee they knew their stuff.

What about scare tactics? Does that work? Does that work to get people to

change their behaviour or not?

In some ways. It depends, you know, what it is actually about, the way it’s

approached and what’s used, you know. Yeah it just depends.

Yeah great. Thanks for that, that’s terrific.

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APPENDIX F

Community Focus Group Schedule and Transcript

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COMMUNITY FOCUS GROUP

HELD AT LOCAL NEIGHBOURHOOD BBQ AREA

Six participants were present, but not all contributed to the

discussion about people, place and health.

I: What we might start off talking about, is how you feel about your current

living place – how do you feel about where you are living now?

P1: Um I think it’s not ideal for me, and not ideal for my children. I really wanted a

house, but had to move out of where I was living like straight-away.

I: OK –so was it a crisis situation?

P1: Yeah I was going through a crisis accommodation service and if it was up to me I

wouldn’t have moved here.

I: Right?

P1: If I had no children then I would have loved living here without children and that

would have been ideal for me..

I: OK

P1: I had to move out like right now and that was crisis accommodation and I had

applied for other places and I didn’t get them

I: So there are aspects of the place that are good, yeah?

P2: It would be great for single people, but not for me with my toddlers and my little

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ones. The unit living is no good for my little ones, we need a yard and a fence and a

place where they can run under the trees. And we used to have a house like that, with

grass and trees and yeah, the units are great, but it is not what I would have preferred.

I: OK?

P3: It’s a great place, I really like it but…. Yeah I actually really like this area that

I’m in now I like the feel of it.

I: By ‘the feel of it, can you tell me what you mean?’

P3: Just living in Kelvin Grove, and the types of people here, and being near the uni

and everything, and the things that are happening are starting here. I like that buzz

about how people think about Kelvin Grove.

I: Can you tell me more about that?

P3: People I know all live in the suburbs – and they look at me and go ‘you’re right

in the city, right by the uni, right by everything’ like if I was still going to uni that

would have been great for me. But yeah, we still need yards and grass and trees.

I: What about the parks, like the one we are sitting in today?

P2: Well today the weather is crap, and it has been to cold to come out all the way

here.

P1: But since my car has been playing up I have been walking through here a lot.

I: Yeah? How does it make you feel to see other people out and about in the

parks?

P3: Yeah good. It feels family oriented. I see mainly the uni people walking past, and

you just see them walking past and doing their thing.

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I: It’s nice that, yeah? And what about you Melissa – how are you feeling about

living here now?

P4: My kids love running over to the IGA all the time, and they run in the paddock.

We find good stuff and we find bargains.

I: Um Ok I might just ask – and I am not really following a structure here – but

I am thinking now about neighbours. How is that going? How are your

relationships with your neighbours? Do you have a relationship with your

neighbours?

P4: I don’t really talk to em. I might talk to em, but I don’t go into their houses or

anything like that. No. Well, most of them just stay inside all day. And you see em

coming out at night time.

I: They come out at night time?

P4: Yeah they go and do their thing at night time.

I: What work or…?

P4: Night time and the afternoons you see them coming out and doing their business.

P2: I have one friend and her sister and we are friends, and we just go backwards and

forwards through each other’s apartments all the time.

I: Did you know them from beforehand?

P2: Yeah we’ve known them from hostels. They’ve been in the hostel with us.

I: And what about you in terms of neighbours and your relationships?

P3: I usually see my neighbour at the side there and I say hello. I see them walking

out my door. It’s an old man and an old lady. I’ve been into one of the neighbours

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houses yesterday. Cause the water was leaking down through my roof and I had to go

and say ‘Hello is your tap running, cause it’s leaking all through my roof!’ And we

had to turn off the electricity and everything…

I: And other than that?

P3: Before I moved here I had neighbours – one minute you are really good friends

and the next minute they are talking about you and having hassles with each others

kids. They are like ‘Your kids did this!’ and so we just like to keep to ourselves.

I: So it’s too stressful?

P3: Um, yeah, I just don’t want to feel uncomfortable around my neighbours . I’m

alright just us being us, I don’t need to have other people around me. I have already

had a full life – I don’t need to have people next to me, I don’t need to have friends

close to me all the time. I had old friends anyway, who I could ring and even though

we haven’t spoken in years we would be talking like we just saw each other a coupla

hours ago.

I: So you have your social networks already?

P3: Yep.

I: And where were these places before where you said you had trouble?

P3: Bowen Hills, Ann Street, and then I moved to Stafford. I had their child against

my child… and I used to have their child sleep over all the time and my child has

never been in trouble in his whole life and then the boy next door and him went to

old building sites. They were touching stuff and mucking around and now he’s got a

police record. And so she blamed my son for that. We thought that was funny cause

everyone in their family had a record and were very well known down at the police

station (laughs). And they are yelling going ‘our child never done nothing til your

child came along!’

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I: So it was good to move I guess?

P3: Well the house we were living in was being torn down, so… they were building

apartment blocks, so…

I: So what things are important – when you have children – what is important

in a neighbourhood, what do you value?

P1: Well, we are just having troubles with people not using needles properly. And its’

all laying on the ground out the front…

P2: And I have seen them when I take my rubbish down.

P1: In the bins…

P2: And I have children, so I don’t want them seeing this.

P3: They are supposed to put them in those special bins.

Are there bins available?

P3: No, no. They just throw them in the wheelie bin and then it gets tipped over and

we can stand on them

P4: I have seen that in my apartments too.

P2: The landlady came and talked to us all about it.

P3: Yeah but it hasn’t changed.

That is a huge risk, yeah?

P4: Yeah. And the rubbish is bad too.

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P3: I find the rubbish bad too. Sometimes I ask my son to take the rubbish down and

its full and he has actually stuck it in the bin, but when we went back someone threw

my rubbish out, and the bag had torn and my stuff was everywhere. They took it out

to put their rubbish in.

That’s horrible. Well – so would you say its fighting over space to put your

rubbish?

P4: Yeah well there isn’t much, there’s not really enough bins..

P1: I think not so much more bins, they should just collect twice a week.

P3: One big doesn’t last me one week. And once the bins fill that’s it, it all just goes

on the ground

P2: And I saw a man just throwing his alcohol bottles on the ground.

So how does this make you feel when you see stuff like this in your

neighbourhood?

P2: Pretty angry actually. There are small kids, and they just never think of the kids.

So overall what is the most important thing in your neighbourhood – the design,

the building, the people?

P3: The people who live there. And how they behave.

I: Do you think having the BHC units altogether is a good thing? Or should it be

broken up more? How is it with all the BHC units being in one spot?

P4: I don’t mind, it’s just the people who move into the units is all. We had a meeting

the other day and apparently one unit has already been completely trashed. They

trashed the whole unit. And all the apartments are great, but then the people do that

and it makes them really ugly and gives them a bad name. Like someone said to me,

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‘Oh I have heard about that place and it’s really bad there’. I know it’s got a bad

reputation.

P2: Didn’t you have a man with a gun at your place or something?

P3: Yeah I heard that, and one of the ladies up stairs, I was about to go out and…

P4: Yeah she got stabbed in the arm with a key or something.

P3: I was just about to walked out and she said ‘you stabbed me you blah blah’ and

then the ambulance came and the police came, and I went back inside and shut the

door and went into my house and turned my TV up til it was all over.

P4: Yeah so there has been a lot of police visits and stuff.

P2: I think when I actually hear that stuff happening – and its always in the back

units – and when the landlady said there were troubles, it was all the back units. I

think seven apartments are fighting with each other.

Why is that? Why is it the back apartments do you think?

P4: It’s where it is – and where the bad people end up.

P2: They put all the bad people there.

P3: I have talked to some other people. There was, just this week, maybe Tuesday

night, my son walked down to take the rubbish down and this man walked and

followed him back and cause my son let the door shut slowly, the man followed him

back into our apartment. And he was like drunk and all he wanted was ‘Do you have

a cigarette? I really need a cigarette!’ and it was like nine o clock at night and he just

walked into the bathroom and I just saw this huge man – I was only up to his

underpits and he was like ‘do you have a cigarette?’ And I was like ‘Out out out my

house!’ I was so angry. If I had something in my hand I swear I would have wacked

him.

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I: That’s pretty bad.

P3: He was huge and he could have knocked me out though.

P4: I don’t feel safe. I never feel safe.

I: So in terms of safety and your relationships with your neighbours, does the

place allow you to get out and about, and be physically active – getting out of

the house, doing things, going places?

P2: I have been getting out here a little. Well, being close to Roma Parklands and

being close to Southbank has made us want to get out more and do things.

P4: But it has to be warmer though.

And the parks here?

P2: Yeah, we even use the local school’s park and oval. We cheat like that.

P4: We used to just jump into the schools pools and go swimming. We loved doing

that. When it was all shut down. We jumped off the roofs.

P3: There is a pool being built here.

P2: Yeah but how much is that gunna cost?

P3: It’s free.

P2: Yeah?

P3: Yeah it’s free.

I: And what about the local health services, do you use them?

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P3: No we use the one in West End.

P2: West End, yeah what’s it called?

P3: Kambu.

I: What’s Kambu?

P3: It’s the Aboriginal Medical Centre.

I: Is that far does it take you long to get there?

P3: No, they pick you up from your house.

P2: Yeah! They do that in Ipswich too. Do you know if they do this area?

P3: Yeah yeah they do.

P2: Can I have their number?

P3: Yeah yeah

P4: So what is this Kambu?

P3: It’s just a medical centre.

P2: I think its just Ipswich and this one.

P3: I had my pregnancy check-ups there.

I: Oh prenatal care? And are the doctors good there?

P3: Yeah yeah, no they are so good.

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P2: You just gotta ring em up, make an appointment and they pick ya up

P3: And they drop you off. And you get your scans done on your medicare card

there. That is probably the only one that does that.

I: I remember having to pay for that.

P2: They wanted me to pay eleven dollars just to get one of these scan sheets

P3: And they just get you one for free

I: So you had you twenty week scans there?

P3: Yeah they don’t charge you.

I: And do they do counselling as well and other services?

P2: They do everything. You just book in even if you don’t have any money.

I: Gee that’s good.

P2: And I get my respite there for my son, he’s got ADHD.

[Interruption from children in the park]

P1: You know what we need here though is a public phone box. Not that one across

the road, it’s too freaky crossing here. Plus the one at the Red Rooster has the kids

there after school and you cant hear the person you are trying to talk to cause of the

traffic and the kids.

P2: And the kids beep you at the back of you saying ‘I need to call my mum, I need

to call my friend, someone’s gotta pick me up…’ And I am like, ‘you can just wait!’

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I: Yeah you need a phone here.

P3: Yeah well I asked Vikki for a phone. I asked her for a latch on my door and she

said no cause it’s a fire hazard, and I was like yeah well it’s driving me crazy ‘cause

my kids can get out all the time.

P2: So does your latch turn easily at yours? Cause at mine my little ones can just

open it and get out.

P4: Yeah when you are inside they can just open the door and go out.

I: How far can they get?

P4: They get into the lift and go up to level five, and they play with the intercom and

get into trouble.

P2: If you want to get the kids to play you gotta take em right out, the apartments are

not kid-friendly.

P4: Nah.

P3: Plus you cant let your kids out by emselves cause you don’t know if strangers are

gunna take em.

I: Is there anything else before we end, that you want to tell me about, any

stories, suggestions, recommendations about where you live?

P2: Yeah well my partner was pulled up by the police last night… he was just getting

my mates keys out of her apartment and they thought he was breaking in (laughs),

but yeah no, it’s all good.

P1: I guess people are on the look out.

I: Do you have neighbourhood watch?

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P3: No! No I hate neighbourhood watch.

I: Why don’t you like it?

P3: I dunno. My childrens dad was drinking one time on our balcony and um the

cops came over and asked me if we were number twelve or whatever number and

they said a number, like are you number blah blah, and someone had called the cops

cause there was an argument and someone was drinking and they saw him having a

drink on his balcony and automatically assumed it was him! (laughs). And he’s a big

Islander guy, and they were questioning him and he was upset about that.

P2: I was just having a smoke and the police asked me if it was me. I was just having

a smoke.

I: OK. Well we might end it there. Thanks everyone…

P3: Oh and don’t mail my IGA voucher to me someone will raid my mail and steal it,

can you drop it at my unit?

I: Sure.

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