Massey Documents by Type

Permanent URI for this communityhttps://mro.massey.ac.nz/handle/10179/294

Browse

Has files: YesSubject: search.filters.subject.Health care

Search Results

Now showing 1 - 9 of 9
  • Thumbnail Image
    Item
    Studying documentation requirements for quality assurance in healthcare software development environments following Scrum practices : a thesis submitted for examination for the degree of MPhil in Engineering at Massey University, New Zealand
    (Massey University, 2016) Wickramasinghe, Shanuka G
    Over the past decade software development has expanded into almost every sector of business and technology. Currently, Agile software development methods are much preferred over traditional software development methods which rely on heavy documentation. Agile methodologies such as Scrum (the focus of the study) rely on minimal documentation. However, software development organizations who seek accreditation against an internationally recognized quality management system (QMS) standard such as ISO 9001:2008 need to maintain a certain level of documentation to meet the requirements stipulated in the QMS standard. This study was undertaken to answer the following overall research question, in relation to healthcare software development: what would be the minimum level of documentation that would be acceptable for a Health-IT organization pursuing Scrum, if they are to maintain an internationally recognized QMS standard such as ISO 9001:2008? This overarching research question was first investigated through in-depth literature synthesis and subsequently discussed with a panel of experts. An iterative research design utilizing Delphi-like problem solving method was used to gather insights from Scrum practitioners. The study identified 23 documents to have varying levels of usefulness and importance to three categories of Scrum users, specifically Scrum Master, Product Owner, and Development Team. The study further identified the level of conciseness required in each document (to suit each category of Scrum users) and the stage in which each document should be prepared to add maximum value in using documentation. The study identified seven negative experiences Scrum practitioners come across: documents being difficult to understand by nontechnical customers; purpose of documents not being explicit; no follow-up with client’s feedback; excessive re-work on documents; deficiencies in document validation; lack of risk analysis reports and disruptions in software development. The study also identified seven problems practitioners face in creating important documents: lack of skilled document writers; last minute/hasty document preparation; misunderstanding the purpose/intent of Agile; lack of a common documentation standard; perceiving document creation as a burden; poor tooling for documentation and lack of right staff. It is expected that the study would benefit both the academia and the practitioner in gaining greater insights on the issue of documentation in Scrum.
  • Thumbnail Image
    Item
    Ageing in place : the experiences of older adults accessing health services in the Wakatipu : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University, Palmerston North, New Zealand
    (Massey University, 2013) Rose, Rachel Ann
    Access to health services is vital for maintaining the quality of life for older people. Older people living in rural and remote areas often have specific barriers to accessing good quality and timely health services. Poor health service access can make it difficult for older people in remote communities to ‘age in place’. This research explored the experiences of older residents accessing health services in the Wakatipu area of New Zealand, to provide the opportunity for older people in the area to have their voices heard, and to inform service provision in the area. The experiences of older people accessing health services in rural or remote areas are pivotal to formulating policies and building communities founded on wellbeing. A qualitative framework was chosen to record and analyse the rich and detailed experiences of the participants. Eight people aged over 75 years, who currently live in the Wakatipu basin, were interviewed. The interviews were analysed using Interpretative Phenomenological Analysis (IPA), which enables detailed attention to people’s lived experiences. Two superordinate themes of the places that people age, and strategies to maintain the positive ageing ideal, were identified. The results indicated that older adults view health services not in the narrow sense of provision of traditional GP and hospital services, but in the context of all the components required to age well in the location of their choice. This highlights the need to actively include older adults in the planning and decision making process for civic amenities, environmental design, transport, and health services.
  • Thumbnail Image
    Item
    Integrative medicine : a contested practice : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Albany, New Zealand
    (Massey University, 2012) Madden, Helen
    In contemporary Western society, the healthcare arena has become increasingly technology-based, rationalised and specialised with alternative forms of medicine being taken up alongside orthodox medicine. This shifting healthcare terrain has brought forth challenges to practitioners' and patients' identity and to the practitioner-patient relationship. Today, the expertise and autonomy underpinning general practitioners' professional identity has been challenged. In parallel, patients have become reconceptualised from subjects in need of medical expertise, to 'informed' and 'active' health consumers. Within this fluid healthcare arena integrative medicine (IM) is emerging, a practice which amalgamates orthodox medicine with forms of alternative medicine. This emerging form of healthcare produces a number of paradoxes. These occur around the paradigm clash between treatment philosophies, issues of professionalism and the standardisation of treatments, power relationships and debates around dominance and subordination, and issues relating to patient autonomy and treatment responsibility. A discursive analysis of IM practitioners' and patients' talk reveals that the practice of IM gives rise to a number of contradictions and challenges for both IM practitioners and patients. Practitioners draw on discourses of holism, liberal humanism, spirituality and empowerment to construct IM as a healthcare model which maintains elements of both allopathic and alternative medicine in place, but also to legitimate practices inherent in IM. Through doing so, they reconstruct their medical professional identity. In conjunction, patients' draw on practitioners' extended knowledge-base and open-mindedness to construct IM practitioners as trustworthy professionals and to legitimate their own engagement in exploratory forms of treatment. This has implications for patients' and practitioners' subjectivity. Patients become individuals who deserve to be understood on a multitude of levels: psychologically, spiritually, emotionally and physically through which they gain recognition. Concurrently, practitioners' become placed in a paradoxical position with respect to their practice. They resolve this by resisting the position of biomedical expert and by incorporating a range of alternative medicine treatments to extend the healthcare they offer to patients. In conclusion, the practice of IM is shown to legitimate patients' engagement in self-reflexivity practices and to reproduce Cartesian dualism. Further, the research reveals how discourses of holism and empowerment, that are held to represent the fundamental difference between allopathic and alternative medicine, are drawn on by practitioners to legitimate a more in depth practice and a deeper level of engagement with patients. Finally, the research questions whether IM constitutes a truly 'integrative' medicine.
  • Thumbnail Image
    Item
    Living large : the experiences of large-bodied women when accessing general practice services : a thesis presented in partial fulfillment of the requirements for the degree of Master of Philosophy (Nursing) at Massey University, Palmerston North, New Zealand
    (Massey University, 2011) Russell, Nicola
    The ‘obesity epidemic’ of the past two decades has resulted in numerous studies reporting higher levels of stigma and discrimination experienced by obese/overweight women, both within the health care system and society in the main. Despite general practice being the most utilised point of access for health care services, there has been very little international or national exploration of the experiences of large-bodied women accessing these services. Utilising a qualitative, descriptive research design, this post-structuralist feminist study has enabled a group of large-bodied women to express their stories of accessing general practice services. Eight self identified large-bodied women volunteered to participate in semi-structured face-to-face interviews. Thematic analysis identified seven themes: Early experiences of body perception, Confronting social stereotypes, Contending with feminine beauty ideals, Perceptions of health, Pursuing health, Respecting the whole person and Feeling safe to access care. The women in this study articulated broader interpretations of health and well-being than those teachings reproduced within dominant bio-medical and social discourses of obesity. When these women’s personal context, beliefs and values are silenced by the health care provider, the rhetoric of health care professional claims of patient-centred care has given way to these women experiencing stigmatisation and a sense of ambiguity about general practice services. However, when space is given for multiple interpretations of obesity to exist within the patient-health care provider relationship, these women feel respected, their health needs are satisfied and they are more comfortable to engage in health screening services. Resisting the powerful socio-cultural milieu which supports the superiority of a slim female body as a signifier of both health and beauty presents a challenge for health care professionals to negotiate. I contend however, that giving consideration to the perspectives of large-bodied women and critically reflecting upon one’s own personal beliefs and attitudes about the overweight/obese, presents an opportunity to ensure clinical practice for this population is truly patient-centred.
  • Thumbnail Image
    Item
    An exploration of the role of short term medical missions in health care provision in Honduras : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Development Studies at Massey University, Turitea, Palmerston North, New Zealand
    (Massey University, 2005) McLennan, Sharon Joy; McLennan, Sharon Joy
    Short term medical missions, or medical brigades are teams of expatriate health professionals and lay people, who travel to Latin America and other parts of the world for a week or two to provide health care to the poor. While the number and popularity of these teams appears to be increasing, to date there has been little literature or critical research addressing their role. This thesis addresses the role of Short Term Medical Missions (STMMs), who they are, what they do and how they fit into health service provision in developing nations. In particular it outlines the services provided by STMMs, including clinical services, resource provision and preventative services, it discusses the motivation for using STMMs as service providers and it also begins to explore the impact they have on the populations and on local health care services in the areas they operate. This is done within the context of Honduras, a nation that has seen an influx of these teams in recent years, particularly since Hurricane Mitch in 1998. Honduras faces many challenges in health and health care and STMMs have been seen by some as a means of “filling gaps”. This study questions whether STMMs are indeed actually filling real gaps, and if they are, whether they most appropriate means of doing so, as there are many limitations to the ability of short term, outside volunteers to provide quality services. While not directly measuring the impact of STMMs on the health status of the population, this study discusses the actual and potential impact of STMMs on local health services, and argues that there are potential long-term consequences to their use. These consequences include an increasing dependency on outside assistance that may be detrimental to the long-term development of National health services.
  • Thumbnail Image
    Item
    The measurement and correlates of women's health care utilization : a thesis presented in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Palmerston North, New Zealand
    (Massey University, 1998) Madison-Smith, Gillian L.; Madison-Smith, Gillian L.
    Andersen's Behavioural Model of Health Care Utilization was used to examine New Zealand women's use of six health care services. The model conceptualises health care utilization as a function of predisposing, enabling and need variables. Predisposing variables encompass the individual's characteristics which are present prior to the onset of illness that represents their propensity to use health services, for example, age. Enabling variables represent features affecting the means to obtain services, for example, income. Need variables represent the presence of illness, either self perceived or professionally diagnosed. Of the six services investigated in the present study, two were non-medical (use of disability and bed days) and four were medical (use of General Practitioners (Gps), health professionals, hospitals and prescription items). The study examined a geographically stratified sample of 964 women between the ages of 19 and 90 drawn from a range of New Zealand households. Five hypotheses were tested for each of the six health services. Incorporating new measures to capture the model's components, the first two hypotheses replicated the model by examining use of health services in terms of 'contact' and 'volume'. Contact focused on whether or not a service had been accessed, while volume focused on the amount of consumption that occurred over a defined catchment period. Predisposing and enabling characteristics were important predictors of contact; but need became more important when predicting ongoing service use. The last three hypotheses expanded the model by examining the effects of trauma and Post-Traumatic Stress Disorder (PTSD) on health care utilization. Traumatic events were associated with ongoing use of bed days and hospitals. PTSD was associated with use of bed days, hospitals, and GPs. Suggestions are made regarding future research in terms of overcoming research limitations and expanding the field. These included improving measures to capture needs for women of all ages as opposed to focusing on measures capturing chronic conditions best suited for the elderly, examination of service use in terms of episode events and suggested developments for the model incorporating reciprocal and feedback loops to account for traumatic events, PTSD, personal health habits and satisfaction with use of health services.
  • Thumbnail Image
    Item
    Survival disparities in indigenous and non-indigenous New Zealanders with colon cancer: The role of patient comorbidity, treatment and health service factors
    (BMJ Publishing Group Ltd, 2010) Hill S; Sarfati D; Blakely T; Robson B; Purdie G; Chen J; Dennett E; Cormack D; Cunningham R; Dew K; McCreanor T; Kawachi I
    Background Ethnic disparities in cancer survival have been documented in many populations and cancer types. The causes of these inequalities are not well understood but may include disease and patient characteristics, treatment differences and health service factors. Survival was compared in a cohort of Maori (Indigenous) and non-Maori New Zealanders with colon cancer, and the contribution of demographics, disease characteristics, patient comorbidity, treatment and healthcare factors to survival disparities was assessed. Methods Maori patients diagnosed as having colon cancer between 1996 and 2003 were identified from the New Zealand Cancer Registry and compared with a randomly selected sample of non-Maori patients. Clinical and outcome data were obtained from medical records, pathology reports and the national mortality database. Cancer-specific survival was examined using Kaplan�Meier survival curves and Cox hazards modelling with multivariable adjustment. Results 301 Maori and 328 non-Maori patients with colon cancer were compared. Maori had a significantly poorer cancer survival than non-Maori (hazard ratio (HR)=1.33, 95% CI 1.03 to 1.71) that was not explained by demographic or disease characteristics. The most important factors contributing to poorer survival in Maori were patient comorbidity and markers of healthcare access, each of which accounted for around a third of the survival disparity. The final model accounted for almost all the survival disparity between Maori and non-Maori patients (HR=1.07, 95% CI 0.77 to 1.47).
  • Thumbnail Image
    Item
    Exploring the health care experiences of rural Thai people living with acquired valvular heart disease : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Wellington, New Zealand
    (Massey University, 2010) Buatee, Supatra
    Valvular heart disease (VHD) is a preventable disease but it is one of the major causes of chronic illness in developing countries. As this disease is curable by surgery, access to appropriate and effective health care is necessary to prevent people from developing this disease and to treat people with VHD. The voices of people living with this condition will provide direction for health professionals in the development of better health care services for those living with VHD. This qualitative narrative study aimed to explore the experiences of individuals living with VHD. Thirty individuals diagnosed with VHD participated in this study drawn from a population of individuals attending a Thailand provincial hospital. They participated in (open and honest conversation) which was supported by a Thai cultural stance to build the trust necessary for the conversations. Conversations aimed at eliciting information about personal health care experiences were undertaken and lasted from 30 to 90 minutes, all were audio-taped and transcribed verbatim. Multistage narrative analysis methodology was used to identify emerging themes and three major themes emerged: autonomy and life with VHD, the effort of learning for life with VHD, and the maximisation of resources for the management of life with VHD. All of these themes indicated difficulty of access of acceptable and affordable care and difficulty in involvement in health care and illness management. These findings suggest that health care structures, resource distribution and the way professionals interact and communicate are important factors in the health care experiences of individuals living with VHD. Health care services that are based on the principles of equity and balance of power between institutions and clients may support the development of appropriate health care services for all individuals. Culturally-based narrative research is recommended to increase the possibility of expanding ways of knowing with the inclusion of a range of points of views for understanding health care provision. This knowledge is necessary for the development of client-centred and community-based health care services to improve health care outcomes for the rural population in Thailand.
  • Thumbnail Image
    Item
    Electronic clinical decision support (eCDS) in primary health care: a multiple case study of three New Zealand PHOs : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Information Systems at Massey University, Palmerston North, New Zealand
    (Massey University, 2009) Engelbrecht, Judith Merrylyn
    Health care providers internationally are facing challenges surrounding the delivery of high quality, cost effective services. The use of integrated electronic information systems is seen by many people working in the health sector as a way to address some of the associated issues. In New Zealand the primary health care sector has been restructured to follow a population based care model and provides services through not-for-profit Primary Health Organisations (PHOs). PHOs, together with their District Health Boards (DHBs), contributing service providers, and local communities, are responsible for the care of their enrolled populations. The Ministry of Health (MoH) is streamlining information sharing in this environment through improvements to computer based information systems (IS). By providing health professionals with improved access to required information within an appropriate time frame, services can be targeted efficiently and effectively and patient health outcomes potentially improved. However, the adoption of IS in health care has been slower than in other industries. Therefore, a thorough knowledge of health care professionals’ attitudes to, and use of, available IS is currently needed to contribute to the development of appropriate systems. This research employs a multiple case study strategy to establish the usage of IS by three New Zealand PHOs and their member primary health care providers (PHPs), with a focus on the role of IS in clinical decision support (CDS). A mixed method approach including semi-structured interviews and postal surveys was used in the study. Firstly, the research develops and applies a survey tool based on an adaptation of an existing framework, for the study of IT sophistication in the organisations. This provides the foundation for an in-depth study of the use of computerised CDS (eCDS) in the PHO environment. Secondly, a conceptual model of eCDS utilisation is presented, illustrating the variation of eCDS use by member general practitioner (GP) practices within individual organisations. Thirdly, five areas of importance for improving eCDS utilisation within PHO’s are identified, contributing information of use to organisations, practitioners, planners, and systems developers. Lastly, the research provides a structure for the study of the domain of eCDS in PHOs by presenting a research approach and information specific for the area.