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Item Parental utilisation of child medical care : a grounded theory approach : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University(Massey University, 2002) Martin, Melanie F.Within New Zealand, child medical care use is a prevalent source of concern with current medical care utilisation rates considered inadequate to achieve optimal child health. Although previous research into child medical care use has made a valuable contribution to understanding in this area, such research is plagued by various limitations that indicate the need for further research adopting a different approach. This study draws on a social constructionist perspective and grounded theory methods to investigate parents' talk surrounding child medical care use. The study investigates how parents construct their seeking treatment and prevention of childhood illness and disease from a medical practitioner or nurse looking at, in particular, seeking medical treatment for childhood illness, the use of Well Child checks, and childhood immunization. Individual semi-structured interviews were conducted to explore how parents construct the complex process of child medical care use. The findings indicate that child medical care use, in the form of treatment-seeking and the utilisation of Well Child services, is constructed as two distinct but similar processes. Generally, the findings demonstrate that such child medical care use comprises parents constantly negotiating various issues and concerns characterised by tension, conflict, and dilemma. These issues and concerns consist of doing the 'right' thing, the risk of medicines and immunisations, practical barriers to seeking care, competing demands and priorities, and social expectations and social pressure. These issues and concerns arise - and are resolved - within the wider context of parents trying to be 'good parents', trying to preserve child health (not just treat illness), the immediate environment surrounding treatment-seeking, parents trying to fulfil social roles - and individual and socially shared understandings of, for example, medicines. More broadly, child medical care use is conceptualised as a socially based decision-making process that takes place within a social context in which child health, illness, and disease are medicalised, and within which parents are trying to do the right thing for the child. The findings from this study contribute to knowledge and understanding in this area in a number of ways. These are discussed, along with the implications of these findings, and recommendations for future research are made.Item Parental resistance : mobile and transitory discourses : a discursive analysis of parental resistance towards medical treatment for a seriously ill child : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing, Massey University, Palmerston North, New Zealand(Massey University, 2007) Woods, MartinThis qualitative thesis uses discourse analysis to examine parental resistance towards medical treatment of critically ill children. It is an investigation of the 'mobile and transitory' discourses at play in instances of resistance between parents, physicians and nurses within health care institutions, and an examination of the consequences of resistance through providing alternative ways of perceiving and therefore understanding these disagreements. The philosophical perspectives, methodology and methods used in this thesis are underpinned by selected ideas taken from the works of Michel Foucault and Pierre Bourdieu and supported by relevant literature in the fields of media, law, children, parenting, caring, serious childhood illness, medicine and nursing. The thesis obtains information from a variety of texts that includes established literature (such as medical, sociological, legal, academic and philosophical), newspaper articles, radio or television interviews, internet sources, court reports and proceedings, legal experts and other commentators - and 15 interview based texts, where the focus is on analyses of narratives of parents, doctors and nurses. In the texts gathered for this thesis, there are noticeable differences between the personal experience discourses of parents, the 'in-between' discourses of nurses, and the disciplined discourses of physicians. This thesis brings these discourses into conversation with each other suggesting that parental resistance does not occur because of an infrequent and unusual set of circumstances where a few socially isolated and/or 'difficult' parents disagree with the treatment desires of paediatric physicians. Instead, it is argued that from an examination of interview based texts, parental resistance is an omnipresent but transitory occurrence that affects many of the interactions between the parents of seriously ill children and clinical staff. It is maintained that within these interactions, the seeds of this resistance are sown in both critical decision making situations and in everyday occurrences between doctors, nurses and parents within healthcare institutions. Contributing factors to parental resistance include the use of power games by staff, the language of medicine, forms of symbolic violence, the presence or absence of trust between parents and medical staff, the effects of medical habitus, and challenges to the parental role and identity. Overall, it is proposed in this thesis that parents who resist treatment for their seriously ill child are not exceptions to the normative patient-physician relationship. Instead an analysis of their discourses and practices is able to illuminate the complex interactions between patients and medical conventions. It is therefore possible to see parents who resist medical advice not as peripheral to the medical encounter but as examples of how patient-physician relationships come to be codified, constructed and crafted through everyday discourses and practices within health care settings.Item Hide and seek : parents' perspectives on children's access to health care : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University, Wellington, New Zealand(Massey University, 2009) Pocknall, HelenChildren are often referred to as the 'hidden' generation, a powerless group who in infancy and childhood depend on their parents and families/whanau to ensure they receive everything in life required to enable them to grow into healthy young people and adults. Some are more disadvantaged than others due to the socioeconomic circumstances they grow up in. This can have lasting effects on their health in childhood with associated impacts later in life. In New Zealand the populations of children most disadvantaged are those from Maori, Pacific and other low income families/whanau. The disparities that exist between children from these populations and other groups whilst lessening, is still significant. The purpose of this study was to explore with Maori, Pacific and low income parents and caregivers why they choose to 'seek' health services for their children, or not as the case may be. Patterns of use are established early in life therefore it is important to understand children's health care use. The literature suggests that children's access to health care is influenced by predisposing factors such as their socioeconomic status, ethnicity, the availability of services, choice of providers, availability of school–based health services, outreach services, relationships between the community and health service providers and having a regular source of primary health care. A qualitative exploratory design was the methodology chosen for this research. A modified 'community as partner' model (Anderson, 2008) formed the conceptual framework for the research. Sixteen Maori, Pacific and Pakeha parents and caregivers participated in three focus groups to discuss their perceptions of children's access to health care. Thematic analysis was used to identify codes, categories, themes and sub themes from the data. The New Zealand Child Health Strategy (Ministry of Health, 1998) was used as a model to inform the discussion. The main themes were: reality of life, visibility, knowing you, knowing me and kids come first. The findings suggest that relationships with primary health care providers, the cost of health care for children over five years, awareness of services and a need to prioritise children's needs, enable or prevent children's access to health care. Decisions made regarding further service provision for children will be enhanced by health providers and practitioners having a clearer understanding of the enablers and barriers to access and the factors that influence parental choice of services.