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    Nursing care for people living with diabetes and associated conditions in Fiji : an iTaukei community context : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy, Massey University, Palmerston North, New Zealand
    (Massey University, 2021) Ravono, Akisi Nailaba
    This research examined the experiences of iTaukei (indigenous people of Fiji) patients and nurses in the context of the diabetes epidemic in Fiji. Vanua theory, which has some influence on iTaukei health beliefs and practices through its physical, social and cultural elements informed the design and conduct of the research. Despite the voluminous global literature on diabetes and non-communicable diseases (NCD), there was little written about the topic for Fiji and the Pacific. Fiji was among the first few countries to adopt public health initiatives that were developed to curb the incidence of NCD. However, such initiatives have faced a perpetual challenge in terms of implementation, monitoring and evaluation. The research used the Fijian Vanua Research Framework and veitalanoa, a data collection method, to gather information from twelve patients and eleven nurses from four medical areas in Fiji. The veitalanoa groups were complemented by four veitalanoa individual sessions and field observations. Findings revealed that patients struggled to cope with diabetes and associated complications while nurses were challenged to deliver best practice in inadequate nursing practice environments. Specifically, patients had difficulties both living with diabetes and accessing planned care and were culturally unlikely to question or challenge medical decisions, simply expecting safe and trustful care. Nurses were not able to nurse in the way they know is needed; they provided rudimentary and sometimes inappropriate care, and experienced extreme frustration while attempting to provide holistic care in a highly medicalised model of care. The nurses were aware of vanua etiquette and their connections with iTaukei patients, however, they could not apply such protocol. Despite study findings revealing significant challenges for patients and nurses, the participants suggested a way forward for the improvement of nursing care and primary health care in Fiji. Such changes may represent considerable challenge to the accepted hierarchies of power and decision making and will need to be strongly supported by a focus on patient centered care. 
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    Social support, automatic thought processes and coping style as predictors of compliance with treatment among adult diabetes patients in Northland : a dissertation presented to the School of Psychology in partial fulfilment of the requirements for the Masters Degree of Psychology
    (Massey University, 2004) Goosen, Tanya
    Little research has examined the relationship of automatic negative thought patterns, coping styles and depression to compliance with treatment for diabetes. A questionnaire consisting of demographic questions, the Ways of Coping Checklist, the Automatic Thoughts Questionnaire, a depression inventory and a compliance rating scale was completed by 114 adult diabetes patients attending the Northland Health retinopathy clinic. There were equal numbers of men and women, whose median age was 59 years (M = 59.2, SD = 14.9). Clinicians who were responsible for one or more of the patients independently completed a separate compliance rating scale for their respective patient(s). Multivariate analysis of variance revealed that there were no significant overall difference for gender and ethnic identity on any of the variables. Automatic negative thoughts, avoidance and blaming coping styles were positively related to depression, and negatively related to patients' ratings of compliance. A problem focus coping style correlated positively with patients' ratings of compliance. Patients tended to rate their own compliance as better than the staff ratings. According to staff ratings, Maori patients who identified less strongly with their culture, were also less likely to comply with treatment than the other ethnic groups. Staff and patients seemed to differ on what 'compliance' meant. Staff appeared to see compliance as how well the patients followed the treatment instructions. Patients were concerned about their thought content (i.e. positive or negative thinking) and their ability to act or decide for themselves. Hierarchical regression analysis showed that negative thought patterns and problem focused coping were significant predictors of patients' compliance ratings, while negative thought patterns and depression were significant predictors of staff's compliance ratings. The findings were discussed in terms of risk factors for lack of compliance and psychosocial treatment options for diabetes patients.
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    Starting the conversation about eating and body image : the clinical experiences of young women with type 1 diabetes : a dissertation presented in partial fulfilment of the requirements for the degree of Doctorate in Clinical Psychology at Massey University, Manawatu, New Zealand
    (Massey University, 2013) Barry, Raewyn Janice
    A diagnosis of type 1 diabetes, in particular the concomitant restrictive eating and insulin regimen and the threat of short- and long-term complications associated with poor metabolic control, may introduce or exacerbate psychosocial or psychological stressors for young people. Moreover, the focus on eating and the increase in body mass index that is often associated with a diagnosis of type 1 diabetes may exacerbate eating, weight and body image issues for young women in particular. Whilst weight control measures can be healthy, there are a variety of disturbed eating behaviours that young women may employ for this purpose. These behaviours range from those that may be relatively benign through to more risky behaviours, including the practise of manipulating or omitting insulin for weight loss, which can jeopardise optimal health outcomes. To understand the milieu in which eating, weight and body image issues develop as well as talking about them in a clinical setting, this qualitative study aimed to explore the both lived and clinical experience of young women with type 1 diabetes. The participants in this research were 12 young women with type 1 diabetes attending diabetes services and 5 health professionals working with this group. The stories of both groups were explored thematically and analysed using a narrative methodology on two levels, namely the personal story and the public narrative. Firstly, the analysis demonstrated the variations and contradictions within the lived experience stories of the young women and the areas of congruence and discordance between the clinical experience stories of the young women and the health professionals. Secondly, the socially available narratives that shaped the stories were explicated. The analysis showed that there is often a paradigm clash between the biomedical goal of stable metabolic control and living a “normal” life. Whilst the health professionals described their collaborative approach, some of the young women perceived that their clinical interactions were dominated by biomedical goals. These perceptions threatened the functionality of the clinical relationships. This suggests that health professionals should seek to minimise and manage the discordance that young people may experience between living a “normal” life and living with diabetes. Exploring the lived experience of diabetes, the young women experienced a range of eating, weight and body image issues, and 2 young women had engaged in insulin omission, culminating in serious health complications. The clinical experience stories indicated that, if weight was talked about at all clinically, it tended to be in medical terms, and weight gain was not always discussed if it fell within medically acceptable parameters. Moreover, health professionals were reluctant to ask about disturbed eating behaviours unless they had cause to suspect them. These findings suggest that there are two possible areas of intervention. Firstly, talking about weight and body dissatisfaction may help identify risk factors that foster the development of disturbed eating behaviours. Secondly, screening for disturbed eating behaviours may help identify them before they become entrenched.
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    The importance of establishing an integrated approach to diabetic care for Māori patients within the Taranaki region : [a thesis presented in partial fulfilment of the requirements for the degree of] Master [of] Health Science, Māori Health, at Massey University, extramurally, Palmerston North, New Zealand
    (Massey University, 2013) Atkins, Michelle Ann
    “Ki te kahore he whakakitenga ka ngaro te iwi” - Without foresight or vision the people will be lost. Health and wellbeing discrepancies exist within Aotearoa, with the Maori population showing signs of lagging health status, due to long standing experiences of poor socio-economic determinants, access to health care, and quality services essential for good health. This thesis will therefore explore the determinants and foundations of health, along with historical events which have shaped contemporary Maori health, with particular reference todiabetes mellitus. This qualitative research is directed by kaupapa Maori, with the kaupapa of the topic expanding on previous research conducted by the research. This research presented has provided the opportunity to discuss ‘The importance of establishing an integrated approach to diabetic care for Maori patients within the Taranaki region’. The aim of this research is to explore diabetic status within New Zealand, using Taranaki as a particular focal point. This will be completed byutilising various health professionals, and the services they provide in Taranaki. The thesis also provides a platform to analyse integrated services within Taranaki, and assess how patient participation can be encouragedto ensure and safeguard Maori health and well being for future generations. Maori health research is an essential area for continual research, which will ensure future health developments for the indigenous population of New Zealand. Thus being said, this research will contribute new information, and respond to a relatively unknown area of Maori health. This project has the ability todirect future leadership for ongoing service integration and development. Questions will be posed, and recommendations will be proposedthroughout the research which has the potential to enhance understanding of Maori health needs, and direct Maori health development.
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    Igniting the diabetes self-care pilot light : understanding influences on health activation : a thesis presented in fulfillment of the requirements for the degree of Doctor of Philosophy, Massey University, Palmerston North, New Zealand
    (Massey University, 2011) Snell, Helen Julia
    Diabetes presents a serious health challenge for New Zealand because it is a significant cause of ill health and premature death. It is well recognised that self-care in diabetes, can be demanding and is influenced by numerous factors. Health activation is a composite notion focusing on four major elements believed to influence active engagement in self-care: these are beliefs, knowledge, skills and confidence, and behaviours. In this study I set out to elicit an understanding of influences on diabetes-related health activation in general, and specifically to provide explanations for how diabetes-related distress and/or health professional communication and decision-making styles impact on health activation. An additional aim was to generate new ideas on how diabetes care can be structured to maximise personal resourcefulness and promote health activation. Mixed methods methodology allowed for a pragmatically structured research approach. In particular the use of both quantitative and qualitative methods ensured that participants’ perceptions were comprehensively explored. Two hundred and twenty participants completed a semi-structured questionnaire and eighteen participated in a subsequent interview. Health activation was found to be dynamic and influenced by many factors. Diabetes-related distress and health professional communication and decision-making styles explored in this study were important contributors to health activation. This information has complemented and expanded knowledge of these constructs and has extended understanding on relationships between them. In particular it has generated knowledge about health activation, diabetes-related distress and health professional communication and decision-making styles specific to the New Zealand context.