Journal Articles

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    Human papillomavirus self-testing among unscreened and under-screened Māori, Pasifika and Asian women in Aotearoa New Zealand: A preference survey among responders and interviews with clinical-trial nonresponders
    (John Wiley and Sons Ltd, 2022-12) Sherman SM; Brewer N; Bartholomew K; Bromhead C; Crengle S; Cunningham C; Douwes J; Foliaki S; Grant J; Maxwell A; McPherson G; Scott N; Wihongi H; Potter JD
    INTRODUCTION: Māori, Pasifika and Asian women are less likely to attend cervical screening and Māori and Pasifika women are more likely to be diagnosed with later-stage cervical cancer than other women in Aotearoa New Zealand. This study-with under-screened women taking part in a randomized-controlled trial comparing self-testing and standard screening-explored the acceptability of a human papillomavirus (HPV) self-test kit and the preferred method for receiving it. METHODS: Māori, Pasifika and Asian women (N= 376) completed a cross-sectional postal questionnaire. Twenty-six women who had not accepted the trial invitation were interviewed to understand their reasons for nonparticipation. RESULTS: Most women found the self-test kit easy and convenient to use and reported that they did not find it painful, uncomfortable or embarrassing. This was reflected in the preference for a self-test over a future smear test on the same grounds. Most women preferred to receive the kit by mail and take the test themselves, rather than having it done by a doctor or nurse. There was a range of preferences relating to how to return the kit. Phone calls with nonresponders revealed that, although most had received the test kit, the reasons for not choosing to be involved included not wanting to, being too busy or forgetting. CONCLUSION: HPV self-testing was acceptable for Māori, Pasifika and Asian women in Aotearoa New Zealand. HPV self-testing has considerable potential to reduce the inequities in the current screening programme and should be made available with appropriate delivery options as soon as possible. PATIENT OR PUBLIC CONTRIBUTION: This study explored the acceptability of HPV self-testing and their preferences for engaging with it among Māori, Pasifika and Asian women. Thus, women from these underserved communities were the participants and focus of this study.
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    A scoping review of non-pharmacological perinatal interventions impacting maternal sleep and maternal mental health
    (BioMed Central Ltd, 2022-12) Ladyman C; Sweeney B; Sharkey K; Bei B; Wright T; Mooney H; Huthwaite M; Cunningham C; Firestone R; Signal TL
    BACKGROUND: A woman's vulnerability to sleep disruption and mood disturbance is heightened during the perinatal period and there is a strong bidirectional relationship between them. Both sleep disruption and mood disturbance can result in significant adverse outcomes for women and their infant. Thus, supporting and improving sleep in the perinatal period is not only an important outcome in and of itself, but also a pathway through which future mental health outcomes may be altered. METHODS: Using scoping review methodology, we investigated the nature, extent and characteristics of intervention studies conducted during the perinatal period (pregnancy to one-year post-birth) that reported on both maternal sleep and maternal mental health. Numerical and descriptive results are presented on the types of studies, settings, sample characteristics, intervention design (including timeframes, facilitation and delivery), sleep and mood measures and findings. RESULTS: Thirty-seven perinatal interventions were identified and further described according to their primary focus (psychological (n = 9), educational (n = 15), lifestyle (n = 10), chronotherapeutic (n = 3)). Most studies were conducted in developed Western countries and published in the last 9 years. The majority of study samples were women with existing sleep or mental health problems, and participants were predominantly well-educated, not socio-economically disadvantaged, in stable relationships, primiparous and of White race/ethnicity. Interventions were generally delivered across a relatively short period of time, in either the second trimester of pregnancy or the early postnatal period and used the Pittsburgh Sleep Quality Index (PSQI) to measure sleep and the Edinburgh Postnatal Depression Scale (EPDS) to measure mood. Retention rates were high (mean 89%) and where reported, interventions were well accepted by women. Cognitive Behavioural Therapies (CBT) and educational interventions were largely delivered by trained personnel in person, whereas other interventions were often self-delivered after initial explanation. CONCLUSIONS: Future perinatal interventions should consider spanning the perinatal period and using a stepped-care model. Women may be better supported by providing access to a range of information, services and treatment specific to their needs and maternal stage. The development of these interventions must involve and consider the needs of women experiencing disadvantage who are predominantly affected by poor sleep health and poor mental health.
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    Navigating asthma-the immigrant child in a tug-of-war: A constructivist grounded theory
    (John Wiley and Sons Ltd, 2023-07) Sudarsan I; Hoare K; Sheridan N; Roberts J
    BACKGROUND: Avoidable hospitalisation rates for Indian immigrant children with asthma is high in New Zealand and other Western countries. Understanding how children and their carers manage asthma may lead to a reduction in hospitalisation rates. The topic of asthma and Indian immigrant children's perspectives has not been investigated. Most studies on the topic focus on the experiences of family carers and health professionals. Practice cannot be advanced in the child's best interests unless the child's asthma experiences are explored. The following research addressed this gap by upholding Article 12 of the United Nations Convention on the Rights of the Child, thereby giving Indian immigrant children a voice in describing their asthma experiences. DESIGN: Constructivist grounded theory. METHODS: Intensive interviews were conducted with ten family carers and nine children (eight to 17 years old). Child-sensitive data collection techniques such as drawing, and photography were used to facilitate interviewing children younger than 14 years. The COREQ guidelines guided the reporting of this study. RESULTS: The theory, navigating asthma: the immigrant child in a tug-of-war, is the resulting grounded theory with the tug-of-war being the basic social process. This theory comprises three main categories: being fearful, seeking support and clashing cultures. The data reflected two types of tug-of-war: one between two cultures, the native Indian and the host New Zealand culture and another between family carers' and children's preferences. CONCLUSION: Acculturation and sociocultural factors may significantly influence the asthma experiences of Indian immigrants. RELEVANCE TO CLINICAL PRACTICE: The theory may assist healthcare practitioners to better comprehend Indian immigrants' asthma experiences within their wider sociocultural context. Our research indicates the need for healthcare practitioners to work in partnership with Indian immigrant families to implement culturally safe asthma management strategies.
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    An exploration of New Zealand mental health nurses' personal physical activities
    (John Wiley and Sons Australia, Ltd, 2022-06) Philbrick G; Sheridan NF; McCauley K
    This study assessed the physical activities of Mental Health Nurses (MHN) in New Zealand against the 2018 World Health Organization recommended minimum levels of moderate-to-vigorous physical activity. The research design was exploratory and descriptive as there were no previous studies about physical activity levels of MHNs in New Zealand. Quantitative and qualitative data were collected using the International Physical Activity Questionnaire (IPAQ, Long Version) which included options for free-text responses. Data were analysed using descriptive and inferential statistics. A total of 266 participants returned the survey, a response rate of 4%, and a limitation of the study. More than 50% of MHNs reported <150 min of moderate-to-vigorous exercise per week for each of the four physical activity domains. When individual physical activity domains were combined, only 10% spent <150 min on moderate-to-vigorous physical activity. Work-related physical activities were higher for those working in the inpatient area than in community settings. Transport-related physical activities were higher for those working in community settings. Participants registered from 6 to 20 years had more time sitting than other groups. Nurses aged 55 years and above showed the highest total physical activity levels. Moreover, healthcare organizations and nurse leaders need to promote physical activity and provide wellness intervention for their staff. Nurses who are physically active may be more effective in supporting their patients to increase their physical activity.
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    South Asian immigrants' and their family carers' beliefs, practices and experiences of childhood long-term conditions: An integrative review
    (John Wiley and Sons, Ltd, 2022-07) Sudarsan I; Hoare K; Sheridan N; Roberts J
    Aim The aim was to examine South Asian immigrants' beliefs, practices and experiences of childhood long-term conditions. Design This was an integrative review. Data sources MEDLINE, PsycINFO, PubMed, Scopus and Web of Science were searched for primary peer-reviewed articles published in English between January 2011 and April 2021. Review methods Articles were screened based on PRISMA guidelines. The quality of the studies was evaluated using the Critical Appraisal Skills Programme Checklist for qualitative studies and the Joanna Brigg's Institute Critical Appraisal Checklist for quantitative studies. Results Fourteen studies were included in the review. South Asian immigrant children and their family carers experienced cultural clashes as they attempted to incorporate their cultural beliefs about long-term conditions into a more westernized biomedical approach. Families were overburdened by caregiving and struggled to find additional support for their children. The main findings were categorized into three themes: (1) cultural beliefs; (2) religious, spiritual and complementary and alternative medicine practices and (3) care and support of the child. Conclusion Health-care providers should use a combination of culturally safe management strategies and a nuanced approach to educational initiatives on the biomedical aspects of various long-term conditions to effectively engage South Asian immigrant families with health services. Impact The growth of South Asians worldwide along with the increased burden of long-term conditions among South Asian immigrant children has implications for health service delivery. However, no reviews to date have explored South Asian immigrants' experience of childhood long-term conditions. Incorporating South Asian immigrants' beliefs and practices into the plan of care promotes collaborative decision-making that can lead to better treatment adherence, improved health outcomes and higher patient and family satisfaction. The findings encourage clinicians, researchers and policymakers to develop culturally safe child/family-centred interventions to address the specific needs of South Asian immigrant children with long-term conditions.
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    Development of targeted, theory-informed interventions to improve bronchiolitis management
    (BioMed Central Ltd, 3/08/2021) Haskell L; Tavender EJ; Wilson CL; O'Brien S; Babl FE; Borland ML; Cotterell E; Sheridan N; Oakley E; Dalziel SR; Paediatric Research in Emergency Departments International Collaborative (PREDICT) network, Australasia
    BACKGROUND: Despite international guidelines providing evidence-based recommendations on appropriate management of infants with bronchiolitis, wide variation in practice occurs. This results in infants receiving care of no benefit, with associated cost and is potentially harmful. Theoretical frameworks are increasingly used to develop interventions, utilising behaviour change techniques specifically chosen to target factors contributing to practice variation, with de-implementation often viewed as harder than implementing. This paper describes the stepped process using the Theoretical Domains Framework (TDF) to develop targeted, theory-informed interventions which subsequently successfully improved management of infants with bronchiolitis by de-implementing ineffective therapies. Explicit description of the process and rationale used in developing de-implementation interventions is critical to dissemination of these practices into real world clinical practice. METHODS: A stepped approach was used: (1) Identify evidence-based recommendations and practice variation as targets for change, (2) Identify factors influencing practice change (barriers and enablers) to be addressed, and (3) Identification and development of interventions (behaviour change techniques and methods of delivery) addressing influencing factors, considering evidence of effectiveness, feasibility, local relevance and acceptability. The mode of delivery for the intervention components was informed by evidence from implementation science systematic reviews, and setting specific feasibility and practicality. RESULTS: Five robust evidence-based management recommendations, targeting the main variation in bronchiolitis management were identified: namely, no use of chest x-ray, salbutamol, glucocorticoids, antibiotics, and adrenaline. Interventions developed to target recommendations addressed seven TDF domains (identified following qualitative clinician interviews (n = 20)) with 23 behaviour change techniques chosen to address these domains. Final interventions included: (1) Local stakeholder meetings, (2) Identification of medical and nursing clinical leads, (3) Train-the-trainer workshop for all clinical leads, (4) Local educational materials for delivery by clinical leads, (5) Provision of tools and materials targeting influencing factors, and prompting recommended behaviours, and (6) Audit and feedback. CONCLUSION: A stepped approach based on theory, evidence and issues of feasibility, local relevance and acceptability, was successfully used to develop interventions to improve management of infants with bronchiolitis. The rationale and content of interventions has been explicitly described allowing others to de-implement unnecessary bronchiolitis management, thereby improving care.
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    Giving voice to children in research: The power of child-centered constructivist grounded theory methodology
    (Wiley Periodicals LLC, 2022-08) Sudarsan I; Hoare K; Sheridan N; Roberts J
    There has been a growing interest in giving voice to children in response to the introduction of the United Nations Convention on the Rights of the Child and evolving sociological discourses on childhood. Using child-sensitive methodologies such as constructivist grounded theory (CGT) enables children's voices to contribute authentic, meaningful, and eventually more actionable data, capable of informing policies and practices in children's best interests. In this article, we discuss how researchers using CGT can privilege children's voices through effective knowledge coconstruction by creating a child-sensitive research space and using methods that are appropriate to their abilities and interests. We draw on selected data from the first author's (I. S.) PhD project that explores Indian immigrant children's and their family carers' beliefs, practices, and experiences of asthma in New Zealand. We encourage researchers to consider CGT as one of the appropriate methodological choices to explicitly promote the voice of the child.
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    Process evaluation of a cluster randomised controlled trial to improve bronchiolitis management - a PREDICT mixed-methods study.
    (BioMed Central Ltd, 29/11/2021) Haskell L; Tavender EJ; O'Brien S; Wilson CL; Babl FE; Borland ML; Schembri R; Orsini F; Cotterell E; Sheridan N; Oakley E; Dalziel SR; For the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network, Australasia
    BACKGROUND: Bronchiolitis is the most common reason for hospitalisation in infants. All international bronchiolitis guidelines recommend supportive care, yet considerable variation in practice continues with infants receiving non-evidence based therapies. We developed six targeted, theory-informed interventions; clinical leads, stakeholder meeting, train-the-trainer, education delivery, other educational materials, and audit and feedback. A cluster randomised controlled trial (cRCT) found the interventions to be effective in reducing use of five non-evidence based therapies in infants with bronchiolitis. This process evaluation paper aims to determine whether the interventions were implemented as planned (fidelity), explore end-users' perceptions of the interventions and evaluate cRCT outcome data with intervention fidelity data. METHODS: A pre-specified mixed-methods process evaluation was conducted alongside the cRCT, guided by frameworks for process evaluation of cRCTs and complex interventions. Quantitative data on the fidelity, dose and reach of interventions were collected from the 13 intervention hospitals during the study and analysed using descriptive statistics. Qualitative data identifying perception and acceptability of interventions were collected from 42 intervention hospital clinical leads on study completion and analysed using thematic analysis. RESULTS: The cRCT found targeted, theory-informed interventions improved bronchiolitis management by 14.1%. The process evaluation data found variability in how the intervention was delivered at the cluster and individual level. Total fidelity scores ranged from 55 to 98% across intervention hospitals (mean = 78%; SD = 13%). Fidelity scores were highest for use of clinical leads (mean = 98%; SD = 7%), and lowest for use of other educational materials (mean = 65%; SD = 19%) and audit and feedback (mean = 65%; SD = 20%). Clinical leads reflected positively about the interventions, with time constraints being the greatest barrier to their use. CONCLUSION: Our targeted, theory-informed interventions were delivered with moderate fidelity, and were well received by clinical leads. Despite clinical leads experiencing challenges of time constraints, the level of fidelity had a positive effect on successfully de-implementing non-evidence-based care in infants with bronchiolitis. These findings will inform widespread rollout of our bronchiolitis interventions, and guide future practice change in acute care settings. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry: ACTRN12616001567415 .
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    “We are the ones who will have to make the change”: Cuban health cooperation and the integration of Cuban medical graduates into practice in the Pacific (article)
    (3/05/2023) McLennan S; Werle C
    BACKGROUND: This paper responds to Asante et al. (in Hum Resour Health, 2014), providing an updated picture of the impacts of Cuban medical training in the Pacific region based on research carried out in 2019-2021, which focused on the experiences of Pacific Island doctors trained in Cuba and their integration into practice in their home countries. METHODS: The research focussed on two case studies-Solomon Islands and Kiribati. Study methods for this research included multi-sited ethnographic methods and semi-structured interviews as well as qualitative analysis of policy documents, reports, and media sources. RESULTS: The Cuban health assistance programme has had a significant impact on the medical workforce in the Pacific region increasing the number of doctors employed by Pacific Ministries of Health between 2012 and 2019. Qualitatively, there have been some notable improvements in the medical workforce and health delivery over this period. However, the integration of the Cuban-trained doctors into practise has been challenging, with criticisms of their clinical, procedural and communication skills, and the need for the rapid development of bridging and internship training programmes (ITPs) which were inadequately planned for at the outset of the programme. CONCLUSIONS: The Cuban programme in the Pacific is an important model of development assistance for health in the region. While Cuba's offer of scholarships was the trigger for a range of positive outcomes, the success of the programme has relied on input from a range of actors including support from other governments and institutions, and much hard work by the graduates themselves, often in the face of considerable criticism. Key impacts of the programme to date include the raw increase in the number of doctors and the development of the ITPs and career pathways for the graduates, although this has also led to the reorientation of Cuban graduates from preventative to curative health. There is considerable potential for these graduates to contribute to improved health outcomes across the region, particularly if their primary and preventative health care skills are utilised.