Journal Articles

Permanent URI for this collectionhttps://mro.massey.ac.nz/handle/10179/7915

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    Flourishing together: research protocol for developing methods to better include disabled people's knowledge in health policy development
    (BioMed Central Ltd, 2022-12) Martin RA; Baker AP; Smiler K; Middleton L; Hay-Smith J; Kayes N; Grace C; Apiata TAM; Nunnerley JL; Brown AE
    BACKGROUND: To positively impact the social determinants of health, disabled people need to contribute to policy planning and programme development. However, they report barriers to engaging meaningfully in consultation processes. Additionally, their recommendations may not be articulated in ways that policy planners can readily use. This gap contributes to health outcome inequities. Participatory co-production methods have the potential to improve policy responsiveness. This research will use innovative methods to generate tools for co-producing knowledge in health-related policy areas, empowering disabled people to articulate experience, expertise and insights promoting equitable health policy and programme development within Aotearoa New Zealand. To develop these methods, as an exemplar, we will partner with both tāngata whaikaha Māori and disabled people to co-produce policy recommendations around housing and home (kāinga)-developing a nuanced understanding of the contexts in which disabled people can access and maintain kāinga meeting their needs and aspirations. METHODS: Participatory co-production methods with disabled people, embedded within a realist methodological approach, will develop theories on how best to co-produce and effectively articulate knowledge to address equitable health-related policy and programme development-considering what works for whom under what conditions. Theory-building workshops (Phase 1) and qualitative surveys (Phase 2) will explore contexts and resources (i.e., at individual, social and environmental levels) supporting them to access and maintain kāinga that best meets their needs and aspirations. In Phase 3, a realist review with embedded co-production workshops will synthesise evidence and co-produce knowledge from published literature and non-published reports. Finally, in Phase 4, co-produced knowledge from all phases will be synthesised to develop two key research outputs: housing policy recommendations and innovative co-production methods and tools empowering disabled people to create, synthesise and articulate knowledge to planners of health-related policy. DISCUSSION: This research will develop participatory co-production methods and tools to support future creation, synthesis and articulation of the knowledge and experiences of disabled people, contributing to policies that positively impact their social determinants of health.
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    Reinventing the wheel for a manual wheelchair.
    (Taylor and Francis Group, 2023-11-02) Flemmer CL; Flemmer RC
    Purpose Standard manual wheelchairs (MWCs) are inefficient and pushrim propulsion may cause progressive damage and pain to the user’s arms. We describe a wheel for a MWC with a novel propulsion mechanism. Methods The wheel has two modes of operation called “Standard” mode and “Run” mode. In Run mode, the wheelchair is propelled forward by pushing a compliant handle forward and then pulling it back, both strokes contributing to forward propulsion. We report the propulsive force and preliminary testing on a rough outdoor circuit by three able-bodied participants. Results In Run mode, the peak applied force is reduced to 30% and the maximum force gradient is reduced to 10% of that for standard pushrim propulsion, for the same work output. The travel time for the 1.06 km outdoor circuit is about 60% of that for a brisk walk and about 40% of that for pushrim propulsion. At a propulsion speed of 1 m/s, the cardiovascular effort in Run mode is 56% of that for pushrim propulsion. Automatic hill-hold in Run mode improves safety when ascending slopes. The mechanism has three gears so that it can be used by people with widely varying strength and fitness. Folding the handle away converts the operation to Standard mode with the conventional pushrim propulsion, supplemented by three gears. Conclusions Despite the increased weight, width and friction, the bimodal geared wheels facilitate wheelchair travel on challenging paths. This may bring significant improvement to the quality of life of MWC users.
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    Disabled people's experiences accessing healthcare services during the COVID-19 pandemic: a scoping review.
    (BioMed Central, 2023-04-06) McBride-Henry K; Nazari Orakani S; Good G; Roguski M; Officer TN
    BACKGROUND: Disruptions to healthcare services during the COVID-19 pandemic are well-recognised problems. However, a dearth of research exists on disabled people's experiences with accessing these services. A scoping review was undertaken to identify and explore research on the experience of disabled people in accessing healthcare services between 2020 and 6 February 2023. METHODS: PubMed, Web of Science, CINAHL, and OVID were employed to search for research that included the voice of disabled people, or their parents or caregivers. Over two distinct phases, a total of 2,201 articles were reviewed according to article titles, keywords, and abstracts. Eighty-one studies were identified that met the inclusion criteria; these were reviewed in full. RESULTS: Eighteen studies specifically described the experiences of accessing healthcare or disability services, and sixty-three raised healthcare challenges as a secondary consideration. Many disabled people struggled to access healthcare services and felt they were invisible; as a result, individuals' mental health was negatively affected. Disabled people with compounding vulnerabilities were at the most risk of experiencing a lack of healthcare access. CONCLUSIONS: There is an urgent need for research and policy that is responsive to disabled people's access to healthcare during the pandemic; currently many health policies are 'disability-blind' and exclude these members of the global community. Furthermore, to assist in creating disability-responsive research, funding needs to prioritise researchers within the disabled community.
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    Ableism, Human Rights, and the COVID-19 Pandemic: Healthcare-Related Barriers Experienced by Deaf People in Aotearoa New Zealand
    (MDPI (Basel, Switzerland), 2022-12-18) Roguski M; Officer TN; Nazari Orakani S; Good G; Händler-Schuster D; McBride-Henry K; Moreira PS; Morgado P; Almeida PR
    The COVID-19 pandemic significantly affected global healthcare access and exacerbated pre-pandemic structural barriers. Literature on disabled people's experiences accessing healthcare is limited, with even less framing healthcare access as a human rights issue. This study documents and critically analyses Deaf people's healthcare access experiences in Aotearoa New Zealand during the COVID-19 pandemic. Eleven self-identified Deaf individuals participated in semi-structured videoconferencing interviews. Discourse analysis was applied to participant narratives with discourses juxtaposed against a human rights analysis. Barriers influencing healthcare access included: (1) the inability of healthcare providers to communicate appropriately, including a rigid adherence to face mask use; (2) cultural insensitivity and limited awareness of Deaf people's unique needs; and (3) the impact of ableist assumptions and healthcare delaying care. Barriers to healthcare access represent consecutive breaches of rights guaranteed under the United Nations Convention on the Rights of Persons with Disabilities (CRPD). Such breaches delay appropriate healthcare access and risk creating future compounding effects. Action is required to address identified breaches: (1) The CRPD should also underpin all health policy and practice development, inclusive of pandemic and disaster management responsiveness. (2) Health professionals and support staff should be trained, and demonstrate competency, in Deaf cultural awareness and sensitivity.
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    Physical activity participation in community dwelling stroke survivors: Synergy and dissonance between motivation and capability. A qualitative study
    (Elsevier, 2016) Morris JH; Oliver T; Kroll T; Joice SA; Willaims B
    Objectives The evidence supporting benefits of physical activity (PA) on fitness, functioning, health and secondary prevention after strokeis compelling. However, many stroke survivors remain insufficiently active. This study explored survivors’ perspectives and experiences ofPA participation to develop an explanatory framework that physiotherapists and other health professionals can use to develop person-specificstrategies for PA promotion.Design Qualitative study using semi-structured in-depth interviews. Data was audio-recorded and transcribed. Analysis followed theFramework Approach.Setting Community setting, interviews conducted within participants’ homes.Participants Community dwelling stroke survivors (n = 38) six months or more after the end of their rehabilitation, purposively selected bydisability, PA participation and socio-demographic status.Results Findings suggest that survivors’ beliefs, attitudes, and physical and social context generated synergy or dissonance between motivation(desire to be active) and capability (resources to be active) for PA participation. Dissonance occurred when motivated survivors had limitedcapability for activity, often leading to frustration. Confidence to achieve goals and determination to overcome barriers, acted as activitycatalysts when other influences were synergistic. We illustrate these relationships in a dynamic explanatory model that can be used to supportboth novel interventions and personal activity plans.Conclusions This study suggests a shift is required from purely pragmatic approaches to PA promotion towards conceptual solutions. Under-standing how synergy or dissonance between motivation and capability influence individual survivors’ behaviour will support physiotherapists and other health professionals in promoting PA. This study provides a model for developing person-centred, tailored interventions that address barriers encountered by stroke survivors.