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    A culture-centered exploration of India’s Community Health Workers’ meanings of the COVID-19 pandemic and the role of mobile technology in response strategies : a thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy in Communication and Journalism at Massey University, Te Kunenga ki Pūrehuroa, Center for Culture-Centered Approach to Research and Evaluation (CARE)
    (Massey University, 2025-01-20) Pattanaik, Samiksha
    During the COVID-19 pandemic, Community Health Workers (CHWs), particularly in developing countries such as India, played a crucial role in controlling the virus's spread (Niyati & Nelson Mandela, 2020). India imposed the world’s largest lockdown (Ghosh, 2020; Mathur, 2020), swiftly deploying its CHWs known as ASHA workers for community-level COVID-19 prevention and mitigation (Niyati & Nelson Mandela, 2020). Reports indicated that ASHAs in some states were required to purchase and use smartphones for COVID-19 tasks (Brar Singh, 2020; Hindustan Times, 2020b). This top-down approach to pandemic communication and mHealth initiatives (M. J. Dutta, S. Kaur-Gill, et al., 2018; Kumar & Anderson, 2015) sidelined ASHAs' their voices in mainstream discourse, despite their essential role. Furthermore, while existing research in this area has identified the structural challenges faced by ASHAs—such as overwhelming workloads and inadequate compensation—these studies often treat these challenges in a reductionist manner (Lazarus, 2020; Nichols et al., 2022; Srivastava, 2021), often from the perspective of the researcher. This marginalisation of ASHAs' voices is particularly concerning in the context of public health emergencies, where they are thrust into frontline roles without adequate infrastructural and policy support. This thesis addresses this significant gap in research by foregrounding their voices and lived experiences as frontline workers during the COVID-19 pandemic. Drawing on the Culture Centered Approach (CCA), a meta-theoretical framework particularly suited for research in marginalised settings, this study uses semi-structured interviews to explore ASHAs’ narratives, shedding light on how they navigated the pandemic and engaged with mHealth initiatives. The study finds that ASHAs operate within intersecting layers of structural inequalities shaped by their socio-economic context and the neoliberal organisation of India’s healthcare system. This system reduces these marginalised female workers to ‘efficient’ subjects, using their labour to offload state responsibilities while offering minimal support and compensation. Through this analysis, the research advances the theoretical framework of the CCA by deepening the understanding of the layering of structures upon structures and their simultaneous interaction with culture. While existing CCA literature addresses the structure culture dynamic, this study uniquely highlights how these layered structures intersect, reinforce, and sometimes contradict each other, intensifying marginalisation. In the context of mHealth, the study uncovers the complex, multifaceted, and sometimes contradictory meanings of technology in marginalised spaces, ranging from the relevance of face-to-face communication and bottom-up uses of technology in rural healthcare, to issues surrounding data privacy, confidentiality, and digital burden in marginalised spaces. By placing these evolving and often contradictory meanings at the center of theorising, this research challenges techno-optimism and prompts a critical re-evaluation of the role of technology in healthcare delivery, with mHealth as a key example. Additionally, this study extends the concept of marginalised agency within the CCA by shifting away from binary understandings of resistance and submission, demonstrating how such agency is multidimensional and dynamic, shaped by an intricate web of cultural, social, religious, economic, and professional factors. This multilayered interaction forces ASHAs to continuously negotiate their positions, sometimes exercising their voices and demands, and at other times complying with top-down orders due to structural constraints, while drawing on cultural resources to navigate these structures. The thesis concludes with recommendations for a communicative framework that integrates ASHAs into decision-making processes, fostering resilience among CHWs and the communities they serve in future health crises.
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    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 Ngaire
    In 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.
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    Healing from the horror of war : a study of a post-conflict psychosocial program for refugees in Uganda : a research report presented in partial fulfilment of the requirements for the degree of Master of International Development at Massey University, Palmerston North, New Zealand
    (Massey University, 2018) Manson, Tim
    Uganda, a landlocked African nation of 41 million people, currently hosts 1.1 million refugees from surrounding nations including South Sudan, the Democratic Republic of the Congo (DRC) and Rwanda. Many of these refugees have suffered significant psychological trauma as a result of their conflict experiences and through the process of fleeing from their homes and communities. Tutapona is a non-profit organisation that provides group based psychosocial trauma rehabilitation support among war affected populations. This research report examines the effectiveness of the ‘Grow’ program at empowering refugees. The study was carried out in Rwamwanja Refugee Settlement in Western Uganda, which is home to 64,000 people from the DRC. Four refugees who had attended Tutapona’s Grow program were interviewed in depth about their experience and subsequent decisions to ascertain the extent to which empowerment had taken place. The research report concludes that Tutapona’s Grow program has achieved a high degree of success at empowering refugees, especially on the individual and relational levels. More broadly, it suggests that psychosocial interventions in post- conflict settings should be more highly prioritized by humanitarian and development actors.
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    When you lack the word : stories from parents of children with visual and other disabilities : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Social Policy and Social Work at Massey University
    (Massey University, 1996) Kerr, Alison Lassie
    This document, submitted as a Master's thesis, describes a research project carried out during 1994 and 1995. The study arose out of my multiple identity as a parent of two children with a visual disability, as a professional working in the field, and as a researcher. The aim of the study was to find out how parents of children with disabilities cope: what strategies they employ to deal with the situations they face; how they effect the changes they see as necessary for their children and for their families; and what they want from professionals. Research data was collected through unstructured in-depth interviews with six respondents from a group of parents of children with visual impairment. I had access to this national group through membership of it, and was also known to the respondents as a social worker with the Royal New Zealand Foundation for the Blind, of which all the children involved in the study are members. Data for analysis was also drawn from official documents dealing with disability issues, and from current New Zealand disability literature. Research methods were consistent with an emancipatory approach which aims to avoid appropriation and to share power. Strategies were employed which would privilege the stories and characterise the parents as co-researchers in a collaborative exploration of the lives of children with disabilities and their parents. Theory is used in this study to describe and explain what happens in the lives of children with disabilities and their families, and to imaginatively construct what could happen. My conclusions suggest ways in which professionals can support parents by listening to them, and by offering them respect, competence, and caring. I suggest that professionals should be prepared to take some risks and share some of the consequences of current social attitudes towards disability. I conclude that what parents of children with disabilities want is not so much partnership, but alliances with people who will listen to them and support them in their search for opportunities for their children.
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    The nurse practitioner-led primary health care clinic : a community needs analysis : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University
    (Massey University, 1999) Clendon, Jill
    Aim. To determine the feasibility of establishing a nurse practitioner-led, family focused, primary health care clinic within a primary school environment as an alternate or complementary way of addressing the health needs of 'at risk' children and families to the services already provided by public health nurses. Method. Utilising needs analysis method, data was collected from three sources - known demographic data, 17 key informant interviews and two focus group interviews. Questions were asked regarding the health needs of the community, the perceptions of participants regarding the role of the public health nurse in order to determine if a public health nurse would be the most appropriate person to lead a primary health care clinic, and the practicalities of establishing a clinic including the services participants would expect a clinic to provide. Analysis was descriptive and exploratory. Results. A wide range of health needs were identified from both the demographic data and from participant interviews. Findings also showed that participants' understanding of the role of the public health nurse was not great and that community expectations were such that for a public health nurse to lead a primary health care clinic further skills would be required. Outcomes from investigating the practicalities of establishing a nurse practitioner-led clinic resulted in the preparation of a community-developed model that would serve to address the health needs of children and families in the area the study was undertaken. Conclusion. Overall findings indicated that the establishment of a nurse practitionerled, family focused, primary health care clinic in a primary school environment is feasible. While a public health nurse may fulfil the role of the nurse practitioner, it was established that preparation to an advanced level of practice would be required. It is likely that a similar model would also be successful in other communities in New Zealand, however the health needs identified in this study are specific to the community studied. Further community needs assessments would need to be completed to ensure health services target health needs specific to the communities involved.
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    Community participation in the establishment of a primary health organisation in the Horowhenua : a longitudinal case study : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Management at Massey University, Turitea, Palmerston North, New Zealand
    (Massey University, 2005) Lockett-Kay, Janet Elizabeth
    In February 2001 the Minister of Health, in announcing the Primary Health Care Strategy (King, 2001), identified Primary Health Organisations as the vehicles for planning, funding and coordinating primary health care services throughout New Zealand. The requirement that communities be involved in their planning and development was integral to this strategy implementation. Investigation of the Horowhenua Primary Health Organisation establishment process from the inception of planning to the formation of a Primary Health Organisation provided an excellent opportunity to analyse the determinants of genuine community participation. This case study extended over a nine-month period. Data collected from multiple sources provided the basis for investigating the complex notion of community participation and the attributes which are essential for sustainable community engagement. The Horowhenua Primary Health Organisation Steering Committee comprised community representatives, iwi and local health professionals. This group along with the two external stakeholder groups - namely the District Health Board Funding Division and the District Health Board Primary Health Care Reference Group – were central to the analysis. The events recorded and observations made throughout the planning period formed the basis of identifying essential determinants of community participation. These included knowledge of the community and its unique “ways of doing”, the dynamic interdependencies both within the Horowhenua community and with stakeholders external to the Horowhenua, changing power relationships, managing material resourcing and accessibility to essential information. These all influenced how this rural community engaged in Primary Health Organisation planning. One common theme which emerges in the literature is the synergy between community participation and community development. A community development approach is a commonly agreed way of engaging communities in health service planning which is genuine, inclusive, self-reliant, and self-determining. This research demonstrated that the New Zealand context, where implementation of the primary health care strategy must be nationally consistent and comply with prescriptive, central government-determined criteria - as well as involving communities in a meaningful way - requires an alternative approach. The thesis presents a way of addressing power discrepancies, promoting interdependencies between stakeholders and achieving inclusiveness in all decision-making where “expert” stakeholders and community bring to the partnership a set of attributes and knowledge which collectively informs the entire planning process.