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Item The relationship between loneliness and quality of life in informal dementia caregivers : a thesis submitted in partial fulfilment of the requirement for the degree of Doctor of Clinical Psychology at Massey University, Auckland, New Zealand(Massey University, 2024) Jenkins, BrieonieBackground Informal caregivers are an essential part of dementia support in New Zealand. The number of people affected by dementia is increasing. Previous studies have indicated that informal caregivers are at risk of poor mental and physical health outcomes, due to the stressors in the caregiving role. These stressors have been identified as risk factors for loneliness. Research in other populations highlights strong links between loneliness and poor health outcomes. This research explored the relationship between primary caregiving stressors, loneliness, isolation and quality of life (QOL) within the framework of the Stress Process Model. Methods This research investigated hypothesised factors leading to loneliness and quality of life in a New Zealand sample of informal dementia caregivers (n= 134). It used a cross-sectional survey design and structured questionnaire to explore background and context factors (care duration, hours per week caregiving, relationship length and help hours per week), primary stressors (Activities of Daily Living dependency, frequency of challenging behaviour, caregiver reaction and relational deprivation), loneliness, isolation, and quality of life. Descriptive analysis, correlational analysis, confirmatory factor analysis and path analysis were used to examine the relationships between variables and conduct mediation analyses. Results The findings indicated that QOL was moderate, with the average rating between ‘neither good nor poor’ and ‘good’. The psychological domain was significantly lower than all other domains. Within the sample there was a high prevalence of loneliness (88%) and lower prevalence of isolation (21%). Overall QOL and QOL domains were significantly associated with total loneliness. Among the primary stressors, only the frequency of challenging behaviour correlated to loneliness. Both the frequency of challenging behaviour and caregiver reaction had significant correlations to QOL. Total loneliness partially mediated the relationship between primary stressors and QOL. Social loneliness was also found to partially mediate this relationship while emotional loneliness did not. Conclusions The findings show that there was a high prevalence of loneliness in the sample. They also show that primary caregiving stressors are associated with loneliness and that loneliness is associated with quality of life. This research highlights the importance of addressing loneliness in this population, suggests targeted loneliness interventions and recommends caregivers be screened for loneliness to increase access to appropriate support.Item An exploration of factors that have facilitated and constrained access, adoption and availability of mind-body therapies as adjunctive interventions to treat trauma-related conditions in Aotearoa, New Zealand : a thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University - Te Kunenga ki Pūrehuroa, Albany, Aotearoa New Zealand(Massey University, 2025-06-29) Standing, MeredithThis qualitative study explores factors that facilitate and constrain the use of mind-body interventions to treat trauma-related conditions in Aotearoa New Zealand (NZ). The phenomenon explored references mind-body therapies as an adjunctive treatment option with a focus on trauma-sensitive yoga. This study is intended to examine mind-body interventions as a complementary treatment approach and augmentation of interventions such as cognitive behavioural therapies and other validated, evidence-based approaches to treating trauma-related conditions. There is a significant body of literature that supports the use of talk therapies, such as cognitive behavioural therapy, to treat symptoms associated with trauma-related mental health conditions. Recent research has revealed that in many cases, trauma cannot be resolved through interventions that utilise talk therapies alone, as trauma, according to some theorists, is located not only in the core of the brain but also within the body. A practical treatment approach to mitigate individual experiences of trauma is to integrate Western psychological talk therapy approaches with those that focus on calming the nervous system, such as trauma-sensitive yoga, romiromi, mindfulness, and somatic experiencing. The current study highlights factors across the social system that have facilitated and constrained the access, adoption, and availability of mind-body therapies as complementary approaches for treating trauma-related conditions in the NZ context. Findings in the current study highlight that in the NZ context, few factors have facilitated access, adoption and availability of mind-body therapies as adjunctive interventions to treat trauma-related mental health conditions. A more significant number of factors, it appears, have constrained access, adoption and availability of mind-body therapies. Findings illuminate an overall positive attitude toward the utility of mind-body therapies as adjunctive treatments for trauma-related conditions, which highlights the potential for greater use of such interventions in the NZ setting.Item Pakiaka Tupuora Parenting From the Start : evaluating a preventative intervention to improve attachment and health outcomes for mothers and their babies : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Te Kungenga ki Pūrehuroa Massey University, Manawatū, New Zealand(Massey University, 2024-12-06) Morrimire, LeithBackground: Parenting interventions can improve individual and societal outcomes but few are brief, preventative, or consistent with Indigenous knowledge. This is the first based on the latest multidisciplinary theory – the evolved developmental niche (EDN). Objective: To evaluate the one-day (8hr) preventative antenatal Parenting From the Start workshop in terms of infant attachment and other medium-term outcomes. Methods: Randomised controlled trial with two parallel arms open to pregnant residents of the Manawatū/Horowhenua regions of Aotearoa New Zealand. 57 English-speaking women aged 24 to 44 years were randomly assigned to intervention (n = 27) or wait-list control (n = 30) groups alongside standard free maternity care and parental leave. Retention rates were 81% at the home visit (n = 22 intervention; n = 24 control), and 74% at the clinic assessment (n = 20 intervention; n = 20 control). Primary analyses were based on maternal sensitive responsiveness as measured by the Ainsworth Sensitivity Scales, Mini-Maternal Behavior Q- Sort, and Observational Measure of Sensitivity and Responsiveness (11 to 24 months post birth) and infant attachment on the Strange Situation Procedure (11-22 months post birth). Secondary outcomes included a range of self-reported parenting intentions and strategies. Findings: Intervention group infants had higher rates of secure attachment (90%) than the control group (64%). This effect was significant at the level of 3-way attachment security (p = .011, Cramer’s V = 0.448), and attachment subcategory (p = .047, Cramer’s V = 0.552), but not 2-way attachment security (p = .059, Cramer’s V = 0.342). Maternal sensitive responsiveness did not differ across study conditions (p = .097, RBC = 0.288). Parenting intentions relating to breastfeeding, proximal care, room sharing, and elimination communication were significantly increased in the intervention group, as were responsive parenting beliefs, and frequency of positive care reported over the infants’ first year. Interpretation: The intervention significantly increased responsive parenting intentions and beliefs, positive care over the first year, and rates of secure attachment. Parenting From the Start warrants further study as a brief, preventative, bicultural intervention. Trial registration ACTRN12617000321347, universal trial number U111111840331. Trial information can be found at: http://www.ANZCTR.org.au/ACTRN12617000321347.aspxItem Māori women's perspectives of raising a loved one who has autism (Takiwātanga) : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology, Massey University, Palmerston North, Manawatū, Aotearoa New Zealand(Massey University, 2025-02-17) Hastie, Jeanette LouiseThis thesis presents research that explored the understandings, worldviews, and approaches of eight Māori māmā (mothers) with children (tamariki) or adolescents (rangatahi) who have been diagnosed with autism (takiwātanga) in Aotearoa New Zealand. An interpretivist qualitative research design was utilised that combined methods from Western methodologies and Kaupapa Māori and Mana Wahine theory and research. The methodology was transformative (whakaahua) in nature, as the concepts behind the Western methodological tools were transformed into the concepts of te ao Māori (the Māori worldview) through the application of Kaupapa Māori and Mana Wahine theory. Eight Māori māmā attended one of four small focus groups consisting of two māmā and the researcher, during which they were encouraged to create an artwork while telling their lived experience of takiwātanga through pūrākau (narratives). Over approximately four hours, the māmā were asked to describe how they navigated the New Zealand education and health systems, and their home and community, with their tamariki and rangatahi with takiwātanga. The pūrākau revealed that the māmā had brought about a transformation of their own by resisting the Western deficit-based model of autism and drawing on their cultural understanding of takiwātanga to change their negative Western-based experiences into positive Indigenous-based ones. This led to the development of a model inspired by the taiaha, a Māori weapon of war, that demonstrates how a deficit-based Western ideology about autism can be transformed into a strengths-based Indigenous ideology about takiwātanga, from both the researcher’s perspective and that of the participants. The findings also identified strong connections between the māmā and those professionals and others who supported them, whom they called “game changers”. Professionals who were not supportive were circumnavigated or dismissed as the māmā held onto their own expertise and developed their own knowledge about takiwātanga. The te ao Māori concepts of whakawhanaungatanga (relationship building), manaakitanga (showing respect, generosity and care for others) and tuakana-teina (the relationship between an older [tuakana] person and a younger [teina] person) were woven throughout the pūrākau, which the māmā drew on to strengthen their mana wahine (power as women) and mātauranga wahine (female knowledge). The thesis concludes that cultural competence for registered professionals in education and health should include formal assessments of their knowledge of te ao Māori concepts such as manaakitanga, whakawhanaungatanga, and tuakana-teina in relation to takiwātanga.Item Multigenerational caregiving for older people in Bali : combining macro and micro perspectives to understand ageing, family, and caregiving : a thesis presented in partial fulfilment of the requirements for the degree of Doctor in Philosophy in Psychology at Massey University, Manawatū, New Zealand(Massey University, 2022) Lestari, Made DiahMost of the existing research on family caregiving focuses on the nuclear family, consisting only of parents and children as the research population and women as the primary caregivers. Research on family caregiving needs to take into account demographic and social-cultural contexts. Thus, I sought to explore caregiving and ageing in multigenerational households. As populations continue to age, older people’s needs for special care has become a critical issue that affects families as the primary support of older people and sometimes presents a burden for families in terms of caregiving. While we are witnessing the development of public provisions to support our ageing population, at the same time, the cultural obligation to care for older generations may be reinforced by policies, effectively shifting state responsibilities to the private sphere. The study was framed by a critical gerontology approach to ageing issues from two perspectives: political-moral economy and humanistic gerontology. Critical gerontology provides space for a dialogue between macro and micro perspectives in understanding ageing and family caregiving. The research was conducted in Bali, where most older people live in multigenerational households. At the macro level of caregiving, this study aimed to critically review the regional ageing policies in Indonesia. Using critical discourse analysis, this study explored constructions of older people’s identities in regional ageing policies and found two identity constructions, namely “material ageing” and “cultural ageing”. Such positioning has macro and micro effects on ageing and caregiving practices. At the intersection between macro and micro levels of caregiving, individual narrative interviews were conducted from January until May 2020 with 49 members of 11 multigenerational households to explore the social construction of ageing and family caregiving specific to Balinese culture. Thematic analysis, narrative analysis, and discursive positioning analysis were used to analyse the interview data, exploring: (a) important aspects of local knowledge about multigenerational caregiving reported by participants; (b) the role played by the local narratives in shaping family members’ stories of multigenerational caregiving; and (c) how two dominant ageing discourses in regional ageing policies, “decline” and “successful ageing”, were taken up by older people and their family members in constructing their stories on ageing and family caregiving. I discussed the collective implications of these findings for the micro experiences of ageing and policy and developed a theoretical model of multigenerational caregiving, including its opportunities and challenges by synthesising the findings into a socioecological model. This model provided the basis for an analysis of the intersection between private and public domains of multigenerational caregiving and suggestions for initiatives at the family, community, society, and cultural levels to ensure the sustainability of family caregiving in Bali as well as providing support for the family caregivers.Item 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 NailabaThis 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.Item Fostering a new approach : how alternative care models in Greece are meeting unaccompanied minors' rights : a thesis presented in partial fulfillment of the requirements for the degree of Master of International Development at Massey University, Palmerston North, New Zealand(Massey University, 2019) Finlay, LiselleUnaccompanied minors seeking refuge in Greece are met with woefully inadequate care structures for meeting their needs. Despite the United Nation’s Convention on the Rights of the Child [CRC] stipulating children’s entitlement to appropriate care arrangements, there is a gap between this rhetoric and the reality of alternative care provision for minor refugees. Significantly, institutions are prioritised over familybased solutions. There is also a lack of research addressing the processes of power and exclusion in refugee hosting countries, and how these structural conditions influence unaccompanied minors’ situations and their wellbeing. To address these issues, this study adopts a socio-political construction of children’s rights to understand both how different care models are meeting unaccompanied minors rights, and why these models were selected. In conceiving rights as a socio-political process, this thesis addresses issues of power and agency in the navigation of rights. Tensions between restrictive migration policy and commitment to the CRC will be shown to compromise care provision for unaccompanied minors through conscription to control over care. Despite the overarching structural limitations, young people in this study find avenues for exercising their agency, albeit often risky ones. What emerges is a need to understand both young people’s vulnerabilities and strength, and how they are both these things in different parts of their lives. This thesis presents results of fieldwork largely undertaken in Athens over a six-week period in 2018. A cross-section of care providers engaged in the welfare of unaccompanied minors participated in the study. Also interviewed were the foremost experts in Greece’s child protection system: young people who themselves have experienced these care models. Findings reveal the impact migration policy has had in undermining care provision for unaccompanied minors, and the corresponding tensions that emerge for NGOs looking to address urgent needs and find sustainable solutions. This study recorded that rights violations and risks are occurring. It also explored the barriers and opportunities to expand the spectrum of care options and strengthen optimal care, which were identified as family and community-based alternative care initiatives.Item He pito ora : exploring the role of Māori cancer navigators : a thesis presented in partial fulfilment of the requirements of the degree of Doctor of Philosophy in Public Health (Māori Health)(Massey University, 2019) Koia, Monica NgaireIn Aotearoa, New Zealand, cancer is now the leading cause of death. The cancer burden is disproportionately high for Māori, the indigenous people, compared with non-Māori across all stages of the cancer continuum. Additionally, Māori experience access barriers to timely and quality cancer care. Māori cancer navigator positions were created to assist patients in negotiating the complex cancer system. To date, no research has examined the Māori cancer navigator’s contribution to cancer service provision, including the ways in which they undertake their key role of providing supportive care to patients with cancer. The overall aim of this study was to examine the implementation of Māori cancer navigator/coordinator roles, and their contribution to and impact on the experience of Māori health consumers, patients, and whānau during their cancer care journey. The objectives of the study were to: 1) describe the ways in which Māori cancer navigator positions have been developed across the cancer continuum; 2) examine the contextual factors impacting on Māori cancer navigator roles; and 3) identify key success factors relating to the ways in which Māori cancer navigator positions make a difference to the patient/whānau cancer experience. The study is underpinned by kaupapa Māori methodology. Participants were recruited from Māori health consumers, patients, whānau, Māori cancer navigators, and clinical and non-clinical health professionals involved in cancer care. Data was collected via semi-structured interviews, observation and hui (n=24), and an online survey (n=52). The data were analysed using thematic, whakapapa and experiential analysis and the emergent themes applied to a continuity of care framework. The major themes/principles identified from this work were: whanaungatanga, which relates to trust and multiple relationships; whakamōhio, which encompasses communication and the sharing of information and; manaakitanga, where consistency in care and system influences are the key factors. These principles were developed into a model He Pito Ora for this thesis. Māori cancer navigator/coordinator positions help facilitate patient/whānau continuity of care. Greater integration of Māori cancer navigators/coordinators within cancer services will help address fragmentation in care and improve communication between health professionals and with patients and whānau. These are key areas which can improve the quality of care and potentially make a difference to patient/whānau cancer outcomes.Item The foster caregiving relationship with newborns who have feeding difficulties : a thesis presented in partial fulfilment of the requirements for the Master of Arts endorsed in Psychology at Massey University, Albany, New Zealand(Massey University, 2018) Hann, NariThe purpose of this study was to expand on foster care and attachment literature by investigating how the relationship is impacted between a foster caregiver and newborn who experiences feeding difficulties. The most common types of feeding difficulties experienced include reflux, allergies, colic, arousal to feed, and sucking problems, with prenatal methamphetamine exposure being the most frequently cited reason for causality. Newborns who have been prenatally exposed to methamphetamine are at higher risk of preterm births. Prematurity has been widely associated with developmental issues in newborns, such as poor sucking reflexes. All newborns discussed in this study were of Māori descent, highlighting a possible association between Māori children in care and feeding difficulties. This association is thought to be strengthened by the social determinants faced by many Māori, and the punitive neo-liberal nature of the welfare system. Phenomenological interpretive analysis was used to understand the experiences of seven foster caregivers who were highly skilled in caring for newborns with feeding difficulties, and how the feeding difficulties could impact the attachment relationship and contribute to placement breakdowns. Additionally, the strategies that foster caregivers used to minimise the impact of the difficulty and optimise attachment interactions were explored. The feeding difficulties of newborns were found to make attachment interactions more difficult to achieve, but due to the fortitude of the caregivers in providing the best opportunities for newborns in their care, attachment interactions were reportedly always accomplished. Although feeding difficulties placed extra demand on the caregiver role, the commitment and motivation of the caregivers, and the intervention strategies they used to reduce the impact, promoted bonding and stabilised placements. Therefore, feeding difficulties were not associated with placement breakdowns. Rather, unanticipated extended placement timeframes, which impacted the caregiver’s ability to provide a consistent and stable environment, were found to be more detrimental to the placement stability. Understanding feeding difficulties and their impact on attachment for babies in foster care is crucial when caring for the nation’s most vulnerable citizens and ensuring that they have the greatest opportunities for healthy development from the start of their lives.Item Insight into adult epilepsy care in New Zealand : an exploration of the nurses' role and care they provide for adults with epilepsy : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Philosophy in Nursing at Massey University, Wellington, New Zealand(Massey University, 2018) McCarthy, KinukoEpilepsy is one of the most common neurological disorders that has an on-going tendency for reoccurring seizures. It is estimated to affect between 20,000 and 28,000 people in New Zealand (Bergin, Sadleir, & Walker, 2008). Epilepsy care includes not only giving treatment but also providing continuous support to people with epilepsy (PWE). Nurses have the potential to play a significant role in epilepsy care by providing education and support to PWE and their families. Through my working experience as an Epilepsy Speciality Clinical Nurse, I recognised issues in epilepsy care and I found out that there have been no studies in New Zealand relating to a nurse’s role and care of PWE. This is why I decided to undertake study of and exploration of the nurses’ role and care they provide for PWE. Grounded theory methodology was adopted to explore adult epilepsy care by interviewing nurses who provide care to PWE. Data was collected using semi-structured interviews by telephone, Skype, or face-to-face from the nurses. The data was analysed by open coding, development of categories, and theoretical coding. During this process, the epilepsy care pathway and the negative cycle of epilepsy diagrams were developed. At the end of the analysis two theories ‘Epilepsy care in New Zealand is far from ideal due to the lack of guidelines for nursing practice’ and ‘If the profile of epilepsy nursing is raised in New Zealand, delivery of the epilepsy care would improve’ were developed. The findings are discussed in relation to these two theories and consequently four recommendations: creating guidelines, building epilepsy nurses’ network, promoting more research on epilepsy nurses’ role and their value in epilepsy care, and increase utilisation of digital technologies, were made to improve the delivery of epilepsy care in New Zealand.