Health determinants in Australian communities: a multilevel investigation of the influence of personal and contextual characteristics

Health is thought to be influenced by individual, community, material and wider societal factors. Knowledge of how these factors interact to influence health may improve our capacity to implement targeted and equitable health policy and interventions. This thesis focuses on the influence of personal psychosocial determinants of health, such as social networks and experiences of adversity, on health and how these associations may be influenced by health related contextual factors, such as socioeconomic status, social capital and service accessibility. This thesis aims to examine whether the psychosocial determinants of health differ with the changing context associated with community remoteness in Australia. It comprises an introductory chapter, six research chapters that are presented as published papers and papers submitted for publication, and a general discussion chapter. Specific chapters address the quantification of the contextual factors thought to vary with community remoteness and their influence on health and its determinants, namely the influence of personal adversity and social networks on health outcomes. At the time of submission, four papers have been accepted for publication in peer reviewed journals and two have been submitted for review. This thesis makes a significant contribution to understanding methods and challenges of combining cohort studies to answer key research questions; and to describe how community remoteness may interact with a range of recognised psychosocial determinants of health.