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    Disabled people's experiences accessing healthcare services during the COVID-19 pandemic: a scoping review.
    (BioMed Central, 2023-04-06) McBride-Henry K; Nazari Orakani S; Good G; Roguski M; Officer TN
    BACKGROUND: Disruptions to healthcare services during the COVID-19 pandemic are well-recognised problems. However, a dearth of research exists on disabled people's experiences with accessing these services. A scoping review was undertaken to identify and explore research on the experience of disabled people in accessing healthcare services between 2020 and 6 February 2023. METHODS: PubMed, Web of Science, CINAHL, and OVID were employed to search for research that included the voice of disabled people, or their parents or caregivers. Over two distinct phases, a total of 2,201 articles were reviewed according to article titles, keywords, and abstracts. Eighty-one studies were identified that met the inclusion criteria; these were reviewed in full. RESULTS: Eighteen studies specifically described the experiences of accessing healthcare or disability services, and sixty-three raised healthcare challenges as a secondary consideration. Many disabled people struggled to access healthcare services and felt they were invisible; as a result, individuals' mental health was negatively affected. Disabled people with compounding vulnerabilities were at the most risk of experiencing a lack of healthcare access. CONCLUSIONS: There is an urgent need for research and policy that is responsive to disabled people's access to healthcare during the pandemic; currently many health policies are 'disability-blind' and exclude these members of the global community. Furthermore, to assist in creating disability-responsive research, funding needs to prioritise researchers within the disabled community.
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    The New Zealand policies to reduce inequalities of access to healthcare : a thesis presented in partial fulfillment of the requirement for the degree of Master in Public Policy at Massey University, Auckland, New Zealand
    (Massey University, 2007) Widodo, Shita Listyadewi; Widodo, Shita Listyadewi
    This research aims to provide an insight into different policies and strategies in addressing issue of inequality of access to healthcare in New Zealand's health system. Inequalities in health exist between ethnic and socioeconomic groups, people living in different geographic areas, people belonging to different generations, and between males and females. In New Zealand, as in most countries, socially disadvantaged and marginalized groups have poorer health, greater exposure to health risks, and lesser access to high-quality health services. The research attempts to pinpoint policies based on equity to promote equal access to healthcare in order to reduce inequality in health. The research design is a qualitative research and utilized system theory and policy analysis approach. The researcher derived information from primary and secondary data, and analyzed the issue of equal access to healthcare from Social Democracy, Neo-Liberal and Third Way perspectives. The main difference in the abovementioned perspectives is the perceived role and responsibility of the State in promoting equality of access to healthcare. The focus of the research is equity policy for Māori and Pacific people to access healthcare at primary care level. The findings discover that New Zealand has shifted from mainly universalism approach to a mix of universalism and targeted benefits approach; it also shifted from mostly State sector provision to a mix of public and private sector provision, and partnership with nonprofit sector. Māori and Pacific health providers are also encouraged. The key lever of the equity policy is the Primary Health Care Strategy. The thesis concluded that, being so used to swinging between different ideologies and reforming the health system accordingly, New Zealand government should make use of experiences from a readily available and proven established strategy rather than engage in further radical reform. Additionally, the government needs to find balance between universalism and targeted benefits.
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    Ethnic and socioeconomic inequalities in breast cancer survival : a thesis by publications presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Epidemiology, Massey University, Wellington, New Zealand
    (Massey University, 2010) McKenzie, Fiona; McKenzie, Fiona
    There are likely to be many contributing factors to inequalities in cancer survival. The most commonly theorised are: differences in access to cancer care, screening, diagnosis, quality of care and treatment; biological differences; lifestyle/behavioural differences; and differences in comorbidities. To investigate explanations for inequalities in survival for women with breast cancer, a conceptual model was used to illustrate potential pathways, and studies conducted to isolate which pathways could explain ethnic and socioeconomic differences in survival. The substantive body of this work comprises a systematic review, and analyses of datasets from England and New Zealand. Firstly, breast cancer survival differences between ethnic minority and majority groups are reviewed to examine the relationship between social determinants and behavioural factors. Secondly, inequalities by socioeconomic position (SEP) in screen-detected breast cancer survival in the South West of England are presented to examine social determinants and healthcare systems. Next, prognostic factors for New Zealand women with breast cancer by ethnicity and SEP are presented to examine the relationship between social determinants and biological factors. Finally, two separate analyses examine the relationship between ethnicity and SEP respectively, and biological factors and healthcare systems, as determinants of breast cancer survival in New Zealand. SEP was found to explain a sizeable proportion of ethnic inequalities in breast cancer survival; however other factors were also identified as important. The largest contributors to ethnic inequalities appear to be factors associated with access to timely healthcare. There are considerable SEP inequalities in breast cancer survival, which are independent of ethnicity. A large proportion of the observed deprivation-gap in breast cancer survival can be accounted for by early detection. Efforts to eliminate inequalities in breast cancer survival should focus on increasing attendance at breast screening for women of lower SEP. However efforts should also be made to ensure equal access through the secondary care system to address the attenuated survival inequalities that remained even among screen-detected women. Both timely access to and through healthcare will likely have an important impact on ethnic survival disparities. Biological tumour differences, which indicate breast cancer subtype, do not appear to explain survival inequalities, between women of different ethnicity or different SEP.
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    Obstructive sleep apnoea syndrome among taxi drivers : consequences and barriers to accessing health services : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Sleep/Wake Research Centre, Wellington Campus, New Zealand
    (Massey University, 2006) Tupai-Firestone, Ridvan
    Untreated Obstructive Sleep Apnoea Syndrome (OSAS) increases the risk of motor vehicle accidents and morbidity. Its prevalence among taxi drivers is unknown. The goals of this thesis were to: (1) estimate the prevalence of OSAS symptoms and risk factors among taxi drivers; and (2) identify the barriers to accessing health care services for the diagnosis and treatment of OSAS. Between June and July 2004 questionnaires were mailed to 651 taxi drivers from two Wellington taxi companies (response rate 41.3%, n=241). Excessive daytime sleepiness (ESS>10) was reported by 18% of drivers. The estimated proportion with a pre-test risk of OSA (RDI≥ 15/hour) was 15%, according to a questionnaire-based screening tool. Pacific drivers were more likely to report OSAS symptoms than people of "other" (non-Māori) ethnicities. Logistic regression analyses identified the following independent risk factors for OSAS symptoms: increasing neck size, age groups: 46-53 years and 61-76 years, and self-reported snoring 'always'. Three focus groups were conducted in November 2004. Thematic analyses identified the following barriers to accessing health care: (1) sleepiness was not a perceived health problem; (2) personal demands; (3) industry demands; and (4) driver avoidance and dissatisfaction with general practitioner's services. Detailed examination of these themes indicated that drivers were deterred from seeking care by limited knowledge and awareness of OSAS, confusion about responsibility for health and safety, medical costs, and the risk of finding out about other health conditions. General practitioners reportedly failed to screen for OSAS symptoms and demonstrated little knowledge about sleep health. These barriers are a major cause for concern, and they are used to support the belief that earning a living is more important than personal health and safety. The key finding is that improving drivers' knowledge is unlikely to change their behaviour, without concurrent measures to address systemic issues in the taxi industry and in the health care system.
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    Hide and seek : parents' perspectives on children's access to health care : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University, Wellington, New Zealand
    (Massey University, 2009) Pocknall, Helen
    Children are often referred to as the 'hidden' generation, a powerless group who in infancy and childhood depend on their parents and families/whanau to ensure they receive everything in life required to enable them to grow into healthy young people and adults. Some are more disadvantaged than others due to the socioeconomic circumstances they grow up in. This can have lasting effects on their health in childhood with associated impacts later in life. In New Zealand the populations of children most disadvantaged are those from Maori, Pacific and other low income families/whanau. The disparities that exist between children from these populations and other groups whilst lessening, is still significant. The purpose of this study was to explore with Maori, Pacific and low income parents and caregivers why they choose to 'seek' health services for their children, or not as the case may be. Patterns of use are established early in life therefore it is important to understand children's health care use. The literature suggests that children's access to health care is influenced by predisposing factors such as their socioeconomic status, ethnicity, the availability of services, choice of providers, availability of school–based health services, outreach services, relationships between the community and health service providers and having a regular source of primary health care. A qualitative exploratory design was the methodology chosen for this research. A modified 'community as partner' model (Anderson, 2008) formed the conceptual framework for the research. Sixteen Maori, Pacific and Pakeha parents and caregivers participated in three focus groups to discuss their perceptions of children's access to health care. Thematic analysis was used to identify codes, categories, themes and sub themes from the data. The New Zealand Child Health Strategy (Ministry of Health, 1998) was used as a model to inform the discussion. The main themes were: reality of life, visibility, knowing you, knowing me and kids come first. The findings suggest that relationships with primary health care providers, the cost of health care for children over five years, awareness of services and a need to prioritise children's needs, enable or prevent children's access to health care. Decisions made regarding further service provision for children will be enhanced by health providers and practitioners having a clearer understanding of the enablers and barriers to access and the factors that influence parental choice of services.