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    "Peer-led support for long term health conditions : its functions, benefits and challenges and how the role of a facilitator could increase effectiveness" : a Masters thesis
    (Massey University, 2017) Hughes, Emily
    Peer-led support groups for long-term health conditions are inexpensive and beneficial resources. However, literature on peer-led support is minimal and suggests that these groups face many challenges. The current study endeavored to explore the challenges and functions of peer-led support groups for long-term health conditions; further, examining how the implementation of the role of a Facilitator for these groups could negate some of the challenges and increase the prevalence and effectiveness of groups. Through focus groups and individual interviews with Group Leaders, Health Professionals and Group Participants involved in peer-led support groups, the current study identified 7 emergent themes. These themes were discussed and analyzed, particularly in relation to the experience of peer-led support groups and the possibility for the development of the role of a facilitator in the future.
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    How do people with multiple long-term health conditions experience the self-management approach to health care? : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy, Massey University, Palmerston North, New Zealand
    (Massey University, 2017) Francis, Helen Catherine
    The health system in New Zealand has devised approaches intended to meet the needs of people with long-term conditions (LTCs) based on the international theories of the Chronic Care Model (CCM) and a self-management framework (Bodenheimer, Wagner, & Grumbach, 2002b; Lorig, 1993; Wagner, 1998). LTCs and multimorbidity are socially patterned so often people with several LTCs are also contending with chaotic lives as well as the implications of their Illnesses. The self-management framework is based on the assumption that everyone has the agency or freewill to make the daily decisions that would benefit their health and ignores the powerful effect of social context. Because the behaviours recommended to optimise health are so entwined with a person’s social context, LTCs are particularly sensitive to the social determinants of health. This multiple case study follows the complex lives of sixteen people with several significant long-term health conditions using the theories of both Cockerham (2005, 2010, 2013b) and Link and Phelan (1995, 2010) to explore their experiences. Ongoing contact with the patient-participants comprised two interviews, four-weekly contacts and interviews with their primary health care clinicians. The patient-participants’ stories reveal complex, entangled lives marked by loss, poverty and daily challenges. They are significantly constrained by the overwhelming social contexts of their lives and reduced to survival mode by their cumulative losses across the four domains of the Whare Tapa Wha model. Personal agency is neither a choice nor readily achieved. They are left too exhausted to work their way through a health system that does not recognise their needs, empower them or compensate for their lack of energy. The weary patient-participants in this study bear little resemblance to the idealised expert patient of the self-management framework. Clinicians are left manoeuvring to compassionately and pragmatically support the patient-participants as best they can within an unhelpful system. The findings however do surface examples of care that are valued by both patient-and clinician-participants that sit outside the self-management approach. These valued aspects are explored alongside the harm reduction, recovery and palliative models of care. These all offer contributions towards an approach that would optimise the quality of life for people with significant, multiple LTCs. An exploration of this re-awakened approach to care is described. Care that is constricted self-management approach could wrap around the patient and support them to use their residual agency in a direction of their choosing. Clinicians would be released from their current programmed response be able to more fully utilise their clinical expertise. Clinicians and patients would have the freedom to be more pragmatic around quality of life and the issues that matter to the individual with LTCs.
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    Living a healthy life : an evaluation of a self-management for chronic conditions course, Arthritis New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science (Health Psychology) at Massey University
    (Massey University, 2004) Pretorius, Charlene
    Chronic disease management is a major challenge for health care systems in the developed world. Self-management has the ability to help improve health status, health behaviours and reduce health care utilisation for people with chronic disease. In this exploratory before-after cohort study, questionnaires were distributed to people with chronic disease attending a self-management course offered by Arthritis New Zealand. Ninety-four people at baseline, and at six months, 67 people, completed eight health status, four health behaviour, one self-efficacy, and six health care utilisation measures. The 67 participants at six months also completed seven course evaluation measures in addition to course delivery, social support, course barrier and course attendance measures. The relationship at onset between self-efficacy and health status was analysed using a stepwise regression. Self-efficacy, which accounted for 27% of variance, was significantly related to health distress and to the energy levels of participants. To determine the relationship between self-efficacy and self-management behaviours at baseline, standard multiple regressions were run. Self-efficacy was unrelated to the self- management behaviours of the participants at the course onset. To analyse the mediation effect of self-efficacy on health status a stepwise regression was run, while holding self-efficacy constant. Self-efficacy at six months explained 42% of the variance in baseline self-efficacy, after controlling for baseline self-efficacy in the second model, self-efficacy at six months was significantly related to perceived illness intrusiveness and accounted for an additional 58% of the variance. Two hierarchical stepwise-regressions assessed the mediation effect of self-efficacy on self-management behaviours. Self-efficacy at six months accounted for no additional variance in the participants' self-management skills. Paired t-tests and Wilcoxon matched-pairs signed ranks measured changes in health status, self-efficacy, health behaviours and health care utilisation. No significant improvements occurred in health status. Significant improvements occurred in four health outcomes. Independent t-tests and the Mann- Whitney tests identified significant differences between gender, age and location with health status, health behaviour and health care utilisation outcomes at baseline and at six months. The process evaluation of the course showed general satisfaction. Explanations for the results are offered, limitations of the study are highlighted, and suggestions for future chronic disease self-management research are proposed.
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    Two year follow-up of long-stay chronically mentally ill inpatients transferred to the community : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology, Massey University
    (Massey University, 1995) Huzziff, Robyn
    The present study was undertaken to evaluate the affect of transferring long-stay chronically mentally ill clients from Lake Alice Hospital to community placements. Thirty chronically mentally ill clients were followed over two years in the community. Follow-up assessments were completed at 12, 18, and 24 months to assess clients' community adjustment. Community adjustment was conceptualised to include measures of general adaptive functioning, maladaptive behaviour, inpatient readmission, client satisfaction, subjective well-being, and levels of distress. The results showed that clients' general adaptive functioning and deviant behaviour remained stable from the hospital baseline assessment into the community follow-up phases. With respect to client characteristics, clients who exhibited more maladaptive behaviour were found to be significantly more likely to be readmitted to a psychiatric unit or hospital, and older clients were more likely to be socially isolated and exhibit poorer levels of adaptive functioning. Many clients remained socially isolated from family and friends, suggesting that if community support were withdrawn neglect may occur. Clients were significantly more satisfied with community than hospital services at 12 months follow-up and clients were found to be globally satisfied with community services. Nevertheless, up to 10% of client's showed poor community adjustment, with frequent readmissions to a psychiatric hospital, poor adaptive functioning, and high levels of maladaptive behaviour and distress. The implications of the findings for chronically mentally ill clients and service providers are discussed, with several recommendations for future research.