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    Whakaoranga whānau : a whānau resilience framework : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Wellington, New Zealand
    (Massey University, 2014) Waiti, Jordan Te Aramoana McPherson
    This research explored the capacity of whanau (family, extended family) to overcome adversity, flourish and enjoy better health and well-being. While external factors, internal dynamics, and financial pressures often constrain capacity, whanau have nevertheless demonstrated an innate ability to respond to these challenges – to make use of limited resources, and to react in positive and innovative ways. Three key objectives were identified to help seek and understand Maori notions of whanau resilience and how they are utilised by whanau for positive growth and development. The three objectives were: 1. To identify resilience mechanisms which exist within whanau; 2. To consider the cultural underpinnings of resilience; and 3. To construct an evidenced based framework for resilient whanau. A thematic analysis detailed the components of a Whanau Resilience Framework. The framework consists of four resilience platforms: (1) Whanaungatanga (networks and relationships); (2) Pukenga (skills and abilities); (3) Tikanga (values and beliefs); and (4) Tuakiri-a-Maori (cultural identity). This thesis highlights both the synergies and dissonance between Maori and non-Maori perspectives of resilience and how cultural factors might best guide Maori and whanau development. Insofar as this framework exhibits similar resilence strategies to other populations, it is at the micro-level where there are differences between Maori and other cultures or populations.
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    Satisfaction with life and social comparison among older people : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Health Science at Massey University, Manawatu, New Zealand
    (Massey University, 2015) Rodgers, Vivien Kaye
    Introduction: In a rapidly greying world, successful ageing is an important concept and goal. While this remains poorly-defined in the literature, there is wide agreement that satisfaction with life is a major contributor, together with health and functional ability. It has been suggested that the perception of satisfaction with life might be affected by social comparison, but little is known about this relationship, particularly among older people. Consequently, this study investigates the impact of health-related and social comparison variables on the perception of satisfaction with life at various stages of old age. Methods: A cross-sectional survey of 542 community-dwelling people aged 65+ was conducted to measure health (physical and mental), functional ability, satisfaction with life and social comparison dimensions. Participants were randomly selected from the general electoral role of the Manawatu region of New Zealand. The Short Form-12 Health Survey measured perceived physical and mental health, the Groningen Activity Restriction Scale measured functional ability, the Satisfaction With Life Scale measured life satisfaction and the Iowa-Netherlands Comparison Orientation Measure assessed social comparison. Additional demographic information was collected. Age groups (65-74, 75-84, 85+) were compared. Results: A marked difference was found in satisfaction with life before and after age 85 years, that was not explained by health (physical or mental), functional ability, demographic factors or comparison frequency. The oldest participants (aged 85+) consistently reported the highest levels of satisfaction with life. This same group reported predominantly making downward social comparisons (with those doing worse). Conclusions: Important links were found between satisfaction with life and downward social comparison. Better understanding of comparison drivers across older age will progress the discussion on what impacts the perceptions of satisfaction with life and contributes to successful ageing.
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    Māori women, health care, and contemporary realities : a critical reflection : a thesis presented in partial fulfillment of the requirements for the degree of Doctor of Philosophy (Health) at Massey University, Wellington, New Zealand
    (Massey University, 2015) Parton, Beverley May
    Māori women, health care and contemporary realities is a critical reflection on the context of my nursing practice, a Pākehā nurse employed by Kokiri Marae Health and Social Services (KMHSS), Lower Hutt, Aotearoa New Zealand. In addressing the disparities Māori experience KMHSS has the motto, “Committed to the holistic development of whānau, hapū, and iwi”. The research aimed to explore from the experiences of urban Māori women, influences on their health and health care engagement. Kawa Whakaruruhau, the critical nursing theory of cultural safety for Māori health care, informs a qualitative approach, a human rights perspective, with its categories of difference, power, and subjective assessment. In turn, whiteness theory, with its categories of white (and not so white) power and privilege, informs Kawa Whakaruruhau. The women’s stories were received in an unstructured interview method and analysed thematically. The historical, social, cultural, economic, political, racial and gendered factors contributing to Māori women’s health and health care engagement are presented as a geography of health, and as landscapes past, present and future. Landscapes past tell of the disruption of the whakapapa connections of land, language and health by the historical and ongoing processes of colonisation. Landscapes present tell of health care places and spaces that by their policies, cultures, structures, and health professional practice, network and connect to include or to exclude Māori women and their families. Landscapes future are envisioned by the women as they remember what is and has been, and then imagine for themselves and at times succeeding generations, what they require as Indigenous to be central to health care. The women imagine what they need to parent for their children to have a good life; they imagine a therapeutic landscape. (In)authentic identities are presented as chronicities of risk, inhabiting disease and poverty. The women expressed authentic mana wāhine identity uniquely and heterogeneously. Recommendations have been made for nursing practice, research site and research.
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    Vitamin D status and relationship between vitamin D and risk factors of metabolic syndrome : a study in Taiyuan City in China : a thesis presented in partial fulfillment of the requirements for the degree of Master of Science in Human Nutrition at Massey University, Manawatu, Palmerston North, New Zealand
    (Massey University, 2014) Yan, Xiaoning
    Background Vitamin D deficiency is widespread, and the residents in Taiyuan City in China seem to be at high risk of vitamin D deficiency. The situation might be because the city is located in north China and air pollution in the city is heavy. Meanwhile, emerging evidence suggests that vitamin D deficiency may be associated with prevalence of metabolic syndrome (MetS), which usually progress to diabetes and increases the risk of cardiovascular disease. MetS has been becoming much more common in China, and even affects younger people. Objectives This study investigated the vitamin D status of non-manual workers living in Taiyuan City; and explored the relationship between vitamin D status and markers of MetS in 200 participants attending the Health 100 Check-up Center in Taiyuan City for their usual health check. Methods In this cross-sectional study; 200 non-manual workers aged 20-80 years old, living in Taiyuan City were recruited. The participants had their serum vitamin D levels measured and were asked questions about their lifestyle, including daily exercise, alcohol use and smoking. The Check-up Center provided data relating to MetS of the participants. These data included anthropometrics (height, weight and body circumferences), biochemical data (lipid profiles and fasting glucose from blood samples taken for the check-up) and blood pressure. Results Seventy eight percent of participants had vitamin D values less than 50 nmol/L. The women’s serum 25-hydroxyvitamin D (25(OH)D) status (median; 32.70 nmol/L (upper and lower quartile; 25.80, 43.80)) was significantly lower than that of the men (44.00 nmol/L (32.30, 55.40)) (p<0.01). In females aged younger than 40 years vitamin D status (29.25 nmol/L (24.05, 40.85)) was significantly lower than older participants (age>65). In the present study, multiple linear regressions showed the determinants of the vitamin D status were female gender, smoking, and increased fasting glucose (p<0.05). The prevalence of MetS, or abdominal obesity between the groups with and without vitamin D insufficiency were not significantly different (p=0.08; p=0.07). Multiple logistic regression analysis showed that vitamin D status was not associated with MetS. Conclusions Vitamin D insufficiency was highly prevalent in non-manual workers in Taiyuan City in China during the winter season. Vitamin D status in the women was lower than the men. Among the females, younger women had worse vitamin D status than the older women. So, in the present study, female gender, increased fasting glucose, and smoking were significant determinants for vitamin D insufficiency. Vitamin D insufficiency was not associated with the risk factors for MetS in the present study. However, female gender, increased waist circumference (WC), and raised serum triglycerides were associated with higher risk of MetS.
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    Breastfeeding practices in New Zealand during the first year postpartum
    (Massey University, 2014) Jia, Ruimin
    There is a lack of research observing breastfeeding (BF) practices in detail globally and in New Zealand (NZ). This longitudinal study examined BF patterns and the association between BF duration and frequency per day in NZ infants from the birth to 12 months old. A total of 61 self-selected women in the Manawatu region were recruited during the last stage of pregnancy. The average age was 32.1±0.6 years. BF practices were obtained by 24-hour recall noting all of the infant‘s activities through a telephone interview. The interviews were conducted at approximately 2 weeks after birth and then at 2 weekly intervals during the first three months, and then once per month until the infants first birthday. Results show that the majority of infants during the first four weeks postpartum were fully BF (81% at two weeks & 82% at four weeks), 8% infants were mixed-fed and 10% had stopped BF by four weeks. At 16 weeks, 61% infants were fully BF, and 9% infants had been introduced to complementary foods (CF). At 24 weeks, most infants (93%) were no longer fully BF and 24% were receiving no breastmilk. At 48 weeks, 48% infants had stopped BF. Regarding BF patterns, throughout the first 48 weeks postpartum there was a wide variation of BF frequency/day, the longest interval between BF and the length of BF sessions. For example, at two weeks fully BF infants were fed from 5-21 times/day (interquartile range (IQR): 8-10 times/day); at 48 weeks BF infants receiving CF had from 1-22 breastfeeds/day (IQR: 3-8.3 times/day). For the longest interval between BF, at two weeks for fully BF infants the longest interval ranged from 3-10 hours (IQR:4.3-5.5 hours), and at 48 weeks for BF infants receiving CF the longest interval ranged from 3-24 hours (IQR:6.4-12.5 hours). The length of BF session, at two weeks ranged from 2-205 minutes/feed (IQR: 12-30 minutes) for fully BF infants, and at 48 weeks ranged from 4-85 minutes/feed (IQR: 5-15 minutes) for BF infants receiving CF. At the majority of observations there was a significantly lower BF frequency/day and longer longest interval between breastfeeds for mixed-fed infants compared to infants who were fully BF (p<0.05). For instance, at four weeks, median BF frequency/day for mixed-fed infants was five times/day, and for fully breastfed infants ten times/day; at 16 weeks the median BF frequency, for mixed-fed infants was 6.5 times/day, and for fully breastfed infants 9.5 times. At four weeks, the median of the longest interval between breastfeeds for mixed-fed infants was 8.5 hours, and for fully breastfed infants five hours; at 16 weeks, for mixed-fed infants the median was 11.8 hours, and for fully breastfed infants 6.2 hours. There was generally no significant difference in the length of BF sessions between these two groups (p>0.05). There was a significantly positive, but weak correlation between BF duration and BF frequency/day at two weeks (p<0.01; r=0.352) and four weeks (p<0.01; r=0.404), and between BF duration and BF frequency/day of fully BF infants at four weeks (p<0.05; r=0.289). There was no significant correlation between duration of BF/fully BF and maternal and infant characteristics, with the exception of parity (there was a positive association between parity of two or more and BF duration, p<0.05). Case studies were made of four participants who were still breastfeeding their babies at 48 weeks and whose frequency of feeding in the first four weeks after birth was outside of the often recommended 8-12 times/day. Results show that their BF practices varied widely between women during 48 weeks. BF frequency and the total length of BF sessions decreased over time. For two infants who had higher BF frequency in the first four weeks, BF frequency remained relatively high through the end of the first year. For another two infants who had lower BF frequency in the first four weeks, BF frequency remained relatively low through the end of the first year. For all cases, the total length of BF sessions per day did not generally fluctuate with the changes of BF frequency. In conclusion, this longitudinal study supplies a detailed picture of BF practices by 24-hour recall. Results show that almost half infants had stopped BF by 48 weeks. There is a wide variation of BF practices associated with successful BF. Therefore, individuals‘ particularity should be considered when making suggestions to the mother. Overall, this thesis may contribute to the literature on BF practices in NZ.
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    The implementation of trauma informed care in acute mental health inpatient units : a comparative study : 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) Ashmore, Toni Rae
    Trauma informed care (TIC); particularly related to interpersonal violence, is a burgeoning topic for mental health services in both New Zealand and Australia. This thesis compares the implementation of trauma informed care, particularly in relation to interpersonal violence, in an acute mental health inpatient unit in New Zealand and a similar unit in New South Wales, Australia. A policy analysis was undertaken of current policy documents that guide each unit, along with semistructured interviews with ten senior staff, five from each unit to investigate implementation of key features of trauma informed care, particularly in relation to interpersonal violence. Results showed a difference in overall implementation between the two units. Single interventions rather than a whole of service change of philosophy were evident. Differences were identified in relation to policies referring to interpersonal violence, staff knowledge and understanding of trauma informed care, access to training and resources, how safety was provided for, collaborative care arrangements and workplace power dynamics for both clients and staff. Across both units were identified a lack of guidance to inform implementation of TIC, consumer involvement and practice around diversity. Contributing factors for TIC implementation include having a clear definition of TIC, commitment at all governance levels, access to TIC training for all staff, and policies underpinned by TIC. Further research investigating these results may enhance service delivery, resulting in better outcomes for the promotion of recovery and healing of those with histories of interpersonal violence.