Browsing by Author "Hoerara, Roy"

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    Heart to heart - He ngākau māhaki : a thesis presented in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Public Health, Massey University, Wellington, New Zealand
    (Massey University, 2019) Hoerara, Roy
    This research investigates the patient experiences of Indigenous men from Australia and New Zealand who have accessed specialist treatment for heart disease. Using mixed methods – qualitative interviews and a quantitative survey – this research aims to understand the relationship between their patient experience and their patient journey. Twenty men - 10 Indigenous Australian and 10 Māori (Indigenous people of Aotearoa New Zealand) were recruited through health services. A series of semi-structured interviews was used to generate a grounded theory which describes their patient engagement and on- going patient journey. Ethical review in two countries was a particular challenge. Each country required both mainstream and Indigenous reviews, as well as locality assessments in each of the health services. Through this research I extrapolated a theory that Indigenous men co- construct their patient journey. They rely on others (clinicians, partners, family/whānau) to recall events and comprehend health information for their journey going forward. Underpinning the theory of co-construction were themes which demonstrate both similarites and differences for the cohorts. Demographics, health status, socio-economic status and historically poor access to heart healthcare were factors in common. Healthcare systems within each country explained many of the differences. The Australian cohort was based within a large city, whereas the New Zealand cohort resided in a smaller province, dependant upon more distant services. There was strong evidence of positive behavioural change, growing trust and confidence with clinicans, effective support from community groups and improving health literacy. An innovative feature of this study is a comparative Indigenous analysis which seeks to explain the findings. The main limitations of this research is related to the setting. All respondents were male, and they were recruited by the health agencies they engaged with, which will have resulted in some biases. The sample size was relatively small, especially for the survey – however this aspect was intended to be more exploratory. Future research is needed to develop Indigenous-specific patient experience measurement tools.
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    Opening up : a grounded theory on how urban indigenous men of Australia respond to cardiovascular disease : a thesis presented in fulfilment of the requirements for the degree of Master of Public Health at Massey University, Wellington, New Zealand
    (Massey University, 2013) Hoerara, Roy
    Cardiovascular disease is a silent killer which disproportionately affects indigenous communities and families. This research aims to understand how urban Indigenous men of Australia respond, and relate, to cardiovascular disease. The prevalence of heart disease and mortality rate are sixteen times greater for Indigenous aboriginal men aged 25-44 than their non-Aboriginal counterparts. Responses and attitudes toward this disparity are also shaped by the social, economic, and cultural realities which urban Indigenous men of Australia confront on a daily basis. An emergent or grounded theory methodology, informed by an indigenous centred approach was used for this research. Information from twenty in-depth interviews across two community cohorts (New South Wales and Queensland) was gathered, analysed and compared. A number of thematic categories emerged from the data resulting in the observation that urban Indigenous Australian men respond and comprehend cardiovascular disease through the social phenomenon of Opening Up which emerges as both a barrier and a facilitator to improved cardiovascular outcomes. This research has formulated a theory that the relationship between cardiovascular diseases and urban Indigenous males of Australia is a manifestation and consequence of colonisation. This relationship is characterised thematically by four Core Categories of Knowing, Being Indigenous, Being Male and Doing Nothing. The phenomenon observed is one of ‘Opening Up’ which is characterised by three Key Processes of Making Sense, Making Sure and Making Connections. Opening Up is contextualised within a myriad of complex realities. The theory generated by Opening Up is grounded in the data collected and further reinforced by the literature sourced. While not intended to be generalisable, this theory is consistent with this community’s views, needs and expectations. The promotion of Opening Up as a process for consideration is far reaching, perhaps contributing to the Closing the Gaps policy agenda within an Australian public health domain. It may also lend itself to a wider global public health deliberation to better understand the impact of heart disease throughout the world today.