Journal Articles
Permanent URI for this collectionhttps://mro.massey.ac.nz/handle/10179/7915
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Item General practitioner and nurse experiences of type 2 diabetes management and prescribing in primary care: a qualitative review following the introduction of funded SGLT2i/GLP1RA medications in Aotearoa New Zealand.(Cambridge University Press, 2024-09-16) Norman K; Mustafa ST; Cassim S; Mullins H; Clark P; Keenan R; Te Karu L; Murphy R; Paul R; Kenealy T; Chepulis LAIM: To explore the views of general practitioners (GPs) and nurses on type 2 diabetes (T2D) management, including the use of recently funded T2D medications in New Zealand (NZ) and their perceived barriers to providing optimal care. BACKGROUND: T2D is a significant health concern in NZ, particularly among Māori and Pacific adults. Characterised by prolonged hyperglycaemia, T2D is generally a progressive condition requiring long-term care. METHODS: Semi-structured interviews were conducted between July and December 2022 with 21 primary care clinicians (10 GPs and 11 nurses/nurse prescribers) from nine different general practice clinics across the Auckland and Waikato regions of NZ. Framework analysis was conducted to identify common themes in clinicians' perceptions and experiences with T2D management. FINDINGS: Three themes were identified: health-system factors, new medications, and solution-based approaches. Lack of clinician time, healthcare funding, staff shortages, and burn-out were identified as barriers to T2D management under health-system factors. The two newly funded medications, empagliflozin and dulaglutide, were deemed to be a positive change for T2D care in that they improved patient satisfaction and clinical outcomes, but several clinicians were hesitant to prescribe these medications. Participants suggested that additional education and specialist diabetes support would be helpful to inform optimal medication prescribing and that better use of a multi-disciplinary team (clinical and support staff) could support T2D care by reducing workload, addressing cultural gaps in healthcare delivery, and reducing burnout. An improved primary care work environment, including appropriate professional development to support prescribing of new medications and the value of collaboration with a non-regulated workforce, may be required to facilitate optimal T2D management in primary care. Future research should focus on interventions to increase support for both clinical teams and patients while adopting a culturally appropriate approach to increase patient satisfaction and improve health outcomes.Item Reflexive thematic analysis and men's embodiment following injury or illness: A worked example(Wiley Periodicals LLC on behalf of American Association for Anatomy, 2025-05-28) Terry G; Hayfield NReflexive thematic analysis (reflexive TA) originated within psychology and the social sciences and has become an increasingly popular qualitative analytic method across a range of disciplines. In this article, we offer a brief methodological guide for researchers hoping to use the method, suitable for beginners through to those experienced in qualitative research. Reflexive TA can be used to analyze data generated via a range of methods. Reflexive TA is highly flexible, and we outline the choices that researchers need to address when conducting their research. These choices relate to the theoretical approach (realist through to relativist/experiential to critical), their orientation to analyzing the data (inductive to deductive), and the depth in which they analyze their dataset (semantic to latent). We offer an accessible but comprehensive discussion of the six phases of reflexive thematic analysis and how best to produce a rigorous analysis. Starting with familiarization of the dataset as a foundation for analysis, data are then coded, before using these codes to generate initial themes. These early themes are then reviewed and developed, before the researcher moves to defining and naming them. The final phase of analysis is the writing up of the research, at which point final changes may still be made to the results. Written from the basis of our experience of using, teaching, and training reflexive thematic analysis within psychology and the social sciences, we see it as useful for those working across a range of disciplines.Item Participants' and caregivers' experiences of a multidisciplinary programme for healthy lifestyle change in Aotearoa/New Zealand: a qualitative, focus group study.(BMJ Publishing Group Ltd, 2021-05-11) Anderson YC; Wild CEK; Hofman PL; Cave TL; Taiapa KJ; Domett T; Derraik JGB; Cutfield WS; Grant CC; Willing EJObjective Child and adolescent obesity continues to be a major health issue internationally. This study aims to understand the views and experiences of caregivers and participants in a child and adolescent multidisciplinary programme for healthy lifestyle change. Design Qualitative focus group study. Setting Community-based healthy lifestyle intervention programme in a mixed urban–rural region of Aotearoa/New Zealand. Participants Parents/caregivers (n=6) and children/adolescents (n=8) who participated in at least 6 months of an assessment and weekly session, family-based community intervention programme for children and adolescents affected by obesity. Results Findings covered participant experiences, healthy lifestyle changes due to participating in the programme, the delivery team, barriers to engagement and improvements. Across these domains, four key themes emerged from the focus groups for participants and their caregivers relating to their experience: knowledge-sharing, enabling a family to become self-determining in their process to achieve healthy lifestyle change; the importance of connectedness and a family-based programme; the sense of a collective journey and the importance of a nonjudgemental, respectful welcoming environment. Logistical challenges and recommendations for improvement were also identified. Conclusions Policymakers need to consider the experiences of participants alongside quantitative outcomes when informing multidisciplinary intervention programmes for children and adolescents affected by obesity. Trial registration number Australian New Zealand Clinical Trials Registry (ANZCTR):12611000862943; Post-results.Item Participant and caregiver perspectives on health feedback from a healthy lifestyle check(John Wiley and Sons Ltd, 2024-01-12) Lee MD; Wild CEK; Taiapa KJ; Rawiri NT; Egli V; Maessen SE; Anderson YCIntroduction The usual output following health consultations from paediatric services is a clinical letter to the referring professional or primary care provider, with a copy sent to the patient's caregiver. There is little research on how patients and caregivers perceive the letter content. We aimed to: first understand child, young people and caregiver experiences of and preferences for receiving a health feedback letter about the child/young person's health measures within a healthy lifestyle programme; and second to provide a set of recommendations for designing letters to children, young people and their families within a healthy lifestyle programme. Methods This qualitative study, informed by Kaupapa Māori principles, included focus groups of children aged 5–11 years and young people aged 12–18 years who were participants in a healthy lifestyle programme in Taranaki, Aotearoa New Zealand and of their respective caregivers (total n = 47). Discussions were audio-recorded, transcribed and analysed using thematic analysis. Findings Key themes were identified: letters sometimes acted as ‘discourses of disempowerment’—some participants experienced a lack of safety, depersonalisation with medical jargon and ‘feeling like a number’. Participants described the need for acknowledgement and affirmation in written communication—health feedback should include validation, choice regarding content, respectful tone and a strengths-based approach to health messages. Interpretation Letters to referrers, copied to families, can be perceived as disempowering, and participant and caregiver perspectives of content should be considered. This study challenges conventional practice in communicating health feedback with broader implications for written communication in healthcare. We propose separate letters aimed at the child/young person and their caregiver that offer choice in the information they receive. The administrative burden of multiple letters can be mitigated by advances in digital health. Patient Contribution This study originated in response to feedback from service users that current health feedback was not meeting their needs or expectations. Patient perspectives, especially from children, are rarely considered in the generation of clinic letters from health professionals. Participants were child participants in the community-based clinical service and their caregivers, and care was taken to represent the demographic backgrounds of service users. Collection and interpretation of Māori data were led by researchers who were local community members to ensure prioritisation and preservation of participant voice. Where possible, results are illustrated in the text by direct quotes from participants, whose identities are protected with a pseudonym.Item Introducing 'Ngaruroro', a New Model for Understanding Māori Wellbeing.(MDPI AG, 2024-04-05) Johnson FN; Wehi P; Neha T; Ross M; Thompson V; Tibble S; Tassell-Matamua N; Shedlock K; Fox R; Penman Z; Ritchie T; Winter T; Arahanga-Doyle H; Jose PE; Wright MIndigenous peoples around the world are revitalising their ancestral beliefs, practices, and languages, including traditional understandings of health and wellbeing. In the Aotearoa (New Zealand) context, a number of ground-breaking Māori health- and wellbeing-related models have emerged, each with their own scope and applications. We sought in our qualitative studies to explore and identify several key sources of wellbeing for Māori individuals. Nine interviews were conducted with members of Māori communities to identify key themes of Māori wellbeing. We performed a Reflexive Thematic Analysis on these data and then conducted a further fifteen interviews to revise, refine, and reposition the previously generated themes. The Ngaruroro model describes wellbeing as the embodied and active process of being well in relation with one's (1) here tāngata (social and familial ties), (2) te taiao (the environment), and (3) taonga tuku iho (cultural treasures) while doing what one can to make lifestyle choices that are conducive to the health of one's (4) tinana (body) and (5) wairua (spirit) while cultivating a balanced (6) ngākau (inner-system), fulfilling (7) matea (core needs) and exercising your (8) mana (authority). These themes illustrate that Māori wellbeing is dynamic, interconnected, and holistic.Item Exploring digital interventions to facilitate coping and discomfort for nurses experiencing the menopause in the workplace: An international qualitative study.(John Wiley and Sons Ltd, 2023-05-09) Cronin C; Bidwell G; Carey J; Donevant S; Hughes K-A; Kaunonen M; Marcussen J; Wilson RINTRODUCTION: The global nursing workforce is predominantly female, with a large proportion working in the 45-55 age group. Menopause is a transition for all women, and; therefore needs recognition as it can impact work performance and consequently staff turnover. BACKGROUND: Women will go through the menopause, but not all women are affected. The menopause transition presents a range of signs and symptoms both physical and psychological which can impact the quality of life and individuals' work/life balance. The nursing workforce is predominantly women that will work through the menopause transition. OBJECTIVES: The study explored perspectives on digital health interventions as strategies to support menopausal women and to understand the requirements for designing health interventions for support in the workplace. DESIGN: A qualitative explorative design. SETTINGS: Nurses working in a range of clinical settings in England, Finland, Denmark, New Zealand, Australia and USA. METHODS: Nurses (n = 48) participated in focus groups from six different countries from February 2020-June 2022 during the pandemic from a range of acute, primary care and education settings. Nurses were invited to participate to share their experiences. Thematic analysis was used. RESULTS: All participants were able to describe the physical symptoms of menopause, with some cultural and possible hemisphere differences; more noticeable was the psychological burden of menopause and fatigue that is not always recognized. Four themes were identified: Managing symptoms in the workplace; Recognition in the workplace; Menopause interventions; and Expectation versus the invisible reality. These themes revealed information that can be translated for implementation into digital health interventions. CONCLUSIONS: Managers of nursing female staff in the menopausal age range need greater awareness, and menopause education should involve everyone. Finally, our results demonstrate design attributes suitable for inclusion in digital health strategies that are aligned with likely alleviation of some of the discomforts of menopause. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.Item Honouring Differences in Recovery: Methodological Explorations in Creative Eating Disorder Recovery Research(MDPI (Basel, Switzerland), 2023-04-01) LaMarre A; Healy-Cullen S; Tappin J; Burns M; Parton NWhat would it look like to honour differences in eating disorder recovery? Recoveries from eating disorders and eating distress are enacted in relation to discursive, material, and affective flows that open and constrain different possibilities for differently embodied people. Yet, the pull toward establishing consensus on “what recovery is” continues to dominate the landscape of both qualitative and quantitative eating disorder recovery work. While researchers from a variety of perspectives, disciplines, and methodological traditions have sought to establish consensus on what recovery “is”, a singular definition remains elusive. Indeed, when researchers continue to adopt the same methodologies—which largely emphasize establishing patterns of sameness—the opportunity to dig into contradictions and tensions that enliven recoveries is missed. In this paper, we reflect on our experiences conducting creative, collaborative, generative research to re-write, re-design, re-draw, and otherwise re-imagine recoveries. The knowledge generated in our research is co-constructed with people with living experience of disordered/distressed eating/eating disorders who spoke back to mainstream recovery discourses (e.g., the idea that recovery is about perfection, that recovery is linear, that one is either recovered or not, that the word “recovered” encapsulates the experience, etc.). We engaged with 12 participants: four in an online group workshop and eight in individual online sessions. Participants held a variety of experiences and backgrounds from Canada, the United States, and Aotearoa New Zealand. We explored their journeys into this conversation with us, the meaning of recovery, and their thoughts on what makes recovery im/possible. Participants were offered several options for creative engagement and took up the idea of “creativity” in ways as different as the stories they shared. Participants created collages, short stories, poems, drawings, and told stories about their experiences. Here, we discuss methodological insights gained from asking participants to lead the creative process. We also explore how this project potentially enables different ways of thinking about and doing eating disorder recovery. Delving into the differences in both method and content opens up opportunities to take seriously the different relational, material, and affective constellations of participants’ living experiences of eating distress/disorder “recovery”.Item Women’s perspectives on long-acting reversible contraception: a critical scoping review of qualitative research(Taylor and Francis Group LLC, 2021-05-18) Morison T; Eagar DLong-acting Reversible Contraception (LARC) has significant promise both from a public health outlook and a social justice perspective. However, if women’s empowerment is to be supported, then perspectives and experiences of LARC must be considered. This scoping review assesses research about contraceptive users’ perspectives and experiences of contraceptive decision-making and practices. A content analysis was conducted to identify research trends in qualitative studies of contraceptive-user perspectives (n = 54), located by means of a systematic search. Interpreting findings through a reproductive justice lens, three main limitations in the scholarship were identified, viz., (1) an instrumentalist, individual-level focus; (2) a lack of consideration for diverse perspectives; and (3) an uncritical focus on young women. While the small body of qualitative research on LARC offers some valuable insights, when viewed from a sexual and reproductive justice perspective, it is not sufficiently user-centered or grounded within the reproductive politics surrounding contraceptive care and provision. Research is needed that draws on appropriate social theory; widens its focus beyond dominant groups; and is cognizant of the multi-level power relations surrounding LARC. Such work provides a nuanced picture of the complex social and contextual factors at play and inform person-centered approaches in sexual and reproductive health policy and programming.Item Lessons from the implementation of residential methamphetamine contamination policies in New Zealand(John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs, 2023-03) Sanchez Lozano CD; Wilkins C; Rychert MIntroduction Methamphetamine contamination of housing has been discussed as a significant issue in New Zealand. However, scientific evidence to determine a threshold level at which health harms occur is inconclusive, resulting in conflicting and changing guidance. The initial strong precautionary policy, with significant unintended impacts on vulnerable public housing tenants, dramatically changed following a scientific review. This study explores the policy response to residential methamphetamine contamination in New Zealand over the past decade. Methods Thematic analysis of semi-structured interviews with 13 key stakeholders involved in policy development/implementation, including those from government, industry, residential housing and academic sectors. Results Consistent application of a methamphetamine contamination threshold for housing has been problematic due to legislative and regulatory gaps. Stakeholders in the residential sector have been influenced by perceptions of methamphetamine contamination as a health risk, political views on drug use, media coverage and the testing industry's business practices. Public housing tenants have faced disadvantages when resolving methamphetamine contamination disputes. The testing industry's participation in committees shaping the regulatory response presents a possible conflict of interest. Wide media coverage heightened public anxiety about the problem but may also have stimulated policy changes to alleviate unintended consequences of the precautionary approach. Discussion and Conclusions New Zealand's fragmented policy response to residential methamphetamine contamination is likely rooted in the lack of scientific evidence, with some key actors further exacerbating the response. Future policy development should seek to produce overarching regulation that guides the whole sector while balancing powers of the stakeholders involved.Item Grounded Theory Method and Symbolic Interactionism: Freedom of Conceptualization and the Importance of Context in Research(Institut für Qualitative Forschung, Internationale Akademie Berlin gGmbH, 30/09/2022) Hewitt S; Mills J; Hoare K; Sheridan NSymbolic interactionism (SI), a perspective used to understand human conduct, is commonly said to underpin grounded theory methodology (GTM). However, the purpose of GTM is to produce substantive explanatory social theory from data without reliance on prior assumptions. Therefore, some argue that SI is an unnecessary theoretical constraint on the principal aim of GTM —the free conceptualization of data. In this article we use examples from an ongoing constructionist grounded theory study into the negotiation of nurses' roles in general practice in New Zealand, to demonstrate how SI can inform GTM regarding conceptual development and context. We argue that by asking three questions from a symbolic interactionist perspective, at each stage of the research process, freedom of conceptualization may be enhanced and awareness of contextual matters promoted to better bridge world views.