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    Evaluating a nutrition education component of the Ka Mau Te WEHI program : a thesis presented in the partial fulfilment of the requirements for the degree of Masters of Science in Nutrition and Dietetics at Massey University, Albany, New Zealand
    (Massey University, 2017) Gibson, Greer
    Background: New Zealand has high rates (32%) of obesity amongst the adult population; Māori (50.2%) and Pacific (68.7%) populations are most affected. Lifestyle interventions are effective in achieving weight loss, but are often expensive, whilst group and online lifestyle interventions are more cost effective. Objectives: To develop and assess a component of the nutrition education content for the Internet team-based, incentivised behaviour change Ka Mau Te WEHI weight loss intervention for Māori and Pacific adults BMI ≥30 kg/m2 at risk of or with T2DM and/or cardiovascular disease. Methods: Three Internet team-based competitions were conducted in New Zealand’s North Island, with seven teams of up to seven participants (n=146) per region. The nutrition education was developed to address key eating behaviours associated with increased risk of weight gain and improve nutrition literacy. The education delivered through daily tips on the website and weekly challenges. Eating behaviours and nutrition literacy were assessed at baseline and six-months. Results: Although 143 participants started the program; only 41.1% (n=60) completed it. Key eating behaviours changed; 18.3% decrease in drinking one or more sugar sweetened beverages/day, mean days eating fast food decreased by -1.7±2 days (p<0.001); mean days eating fruit +1±1.8 (p<0.001) and vegetables +0.8±2 (p=0.006) increased significantly. Weight loss was not significant between baseline and six months [-4.5±17.3kg (p=0.115)]. Conclusion: Although this program was attractive to the target population, a high dropout rate was evident and clinically significant weight loss was not achieved. Despite this, the innovative approach used for nutrition education led to significant dietary behaviour changes. Further research to improve retention and build on eating behaviour changes achieved in this at-risk population is warranted. Key words: Māori, Pacific Islanders, weight loss, lifestyle intervention, obese.
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    Effects of structured preoperative teaching upon postoperative physical recovery and psychological welfare : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University
    (Massey University, 1980) Eopapong-Thongkrajai, Earmporn
    An experimental study to test the effects of structured pre-operative teaching on the physical recovery and psychological welfare of patients admitted for elective surgery was conducted in a 600 bed general hospital. The 30 experimental subjects, 16 women and 14 men, received pre-operative instruction by means of a booklet issued shortly after arrival in hospital, and a group teaching and discussion session conducted on the evening prior to surgery. A variety of general and specific information about surgery and hospitalization was provided, including instructions for self-assessment after discharge. Teaching in the group was by means of slide and tape presentation. An equal number of control patients received only the preparation routinely provided in the ward. Comparisons were made between the two groups of patients according to criterion measures in three categories: physical recovery, psychological welfare, and complex criteria. The latter used subjective evaluation by independent nurse observers of physical, sensory, cognitive, psycho-social and communication aspects of the patient's condition. Measures of physical recovery were complaint of pain, analgesic consumption, nausea and vomiting, post-operative complications, time to resumption of various normal body functions, sleep pattern and sedative consumption, and length of hospital stay. For psychological welfare criterion measures included scores on a specially constructed Surgical Patient Anxiety Scale; physiological indicators in the form of systolic blood pressure and pulse: patient postoperative psychological state as observed by independent nurse observers and patients' own assessment of their feelings after discharge. The overall results supported the general hypothesis that the structured pre-operative teaching reduced patient anxiety and aided recovery. Although few direct relationships were identified between level of pre-operative anxiety and specific aspects of post-operative recovery, there was evidence suggesting a more complex set of relationships. Analysis of group interaction in the teaching sessions showed that the teaching session had served its purpose well, and also that group composition, particularly in terms of sex, had influenced both the content and structure of patient interaction. Implications for nursing practice, derived from these findings have been suggested, and recommendations for further study are included.
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    They did explain everything, but I can't remember : the search for relevant information following a heart attack : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Arts in Nursing at Massey University
    (Massey University, 2001) Phillips, Jennifer L
    This qualitative descriptive study was undertaken to find out what information patients and their partners wanted following a heart attack. There were 17 participants, of whom 11 were patients and six were partners. Semi-structured interviews were conducted with participants and then thematic content analysis was used to identify the four main themes. The first two themes relate to the experience of having a heart attack and question the widely held belief that it is a dramatic experience and that patients deny what is happening. It seems more likely that the non-specific and insidious onset leaves patients genuinely not knowing what is happening. Women have an additional problem in that once they seek professional help, the medical staff often fail to correctly diagnose that they are having a heart attack. The third and fourth themes relate to the recovery period and show that in spite of a plethora of information provided during cardiac rehabilitation, there is strong evidence that patients and partners fail to receive information that meets their own needs in relation to social, physical and psychological issues. This has an impact on the major adjustments to be made after a heart attack and the coping strategies that are a part of this. An additional problem following discharge is poor communication between health professionals, resulting in anxiety for patient and partners. The role of the cardiac educator emerged as extremely useful and valuable to patients and partners as a support and source of relevant information after discharge. Further support and training for these nurses and expansion of the service would increase their availability to patients and partners. It would also be in line with the World Health Organisation (WHO) (1997) recommendations to provide an environment, which supports and motivates people to make lifestyle changes. An additional recommendation is increased flexibility in cardiac rehabilitation with a shift into the primary care setting, thus offering wider opportunities for patients and partners to obtain support and hopefully facilitate the process of adjustment following a heart attack.
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    Evaluation of the health education process for European people with type 2 : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition Science, Massey University
    (Massey University, 2006) Ferguson, Lynette A
    Evaluation of the Health Education Process of European People with Type 2 Diabetes Mellitus Diabetes is a significant health problem in New Zealand. With a limited number of health professionals working in the area of diabetes it is essential that the educational and empowerment process is examined to ensure that the limited specialist resources are used effectively and efficiently with the best outcomes possible. For this to be achieved the holistic approach to education must be examined and evaluated. The aim of this research was to better understand the needs of European people between 45 - 65 years of age. The method used was a questionnaire to 50 female and 50 male subjects with type 2 diabetes randomly selected from patients seen by the researcher (a dietitian), within the Counties Manukau District Health Board geographical area. The results showed that most subjects were diagnosed between the age of 40 - 59 years, 64% had a relative with diabetes, 10% of females and 22% of males were overweight and 60% of females and 48% of males were obese. Group education was shown to be just as effective as individual therapy, with the preferred educators being specialist diabetes dietitians and nurses. Seventy two percent reported the best time for education was at diagnosis and 87% requested ongoing education. Once subjects knew their biochemical results 87% reduced their fat intake with 78% reducing saturated fat. The mean drop in HbAlc for females was 0.9minol/l and males 1.4 mmol/l, with both being statistically significant. Level of self reported education bore no relationship to level of HbAlc achieved. Sixty two percent of those who had three years or less of secondary education, 30 % of those with three to five years secondary education, 52% with a technical or trade certificate, and 59% of those with a degree had reached a target HbAlc at follow-up. After diagnosis 45% reduced their alcohol intake. The most popular form of exercise was walking (46%), followed by gardening (28%). Fifty percent chose an exercise of moderate intensity and overweight subjects were more likely to exercise daily. The preferred medium for education was written pamphlets (86%) follow by books (60%). The conclusions reached were that most had changed to a healthy lifestyle since being diagnosed but vegetable intake was still much less than the New Zealand Guideline (2003). From the results it is hypothesised that this diabetes population group, before diagnosis, had a higher intake of sweet drinks than the national average and this may have contributed to the development of the disease. Most were endeavouring to lose weight, improve biochemical indices and increase exercise. Both group and individual education were found to be equally effective as forums for education.
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    Information gaps : a group perspective on the management of heart failure : a thesis presented in partial requirements [sic] for the degree of Master of Philosophy, Massey University
    (Massey University, 2000) Reed, Susan
    Heart failure is a complex condition that incurs considerable socio-economic burden, and poor prognosis. Careful management of the syndrome is required if a patient is to have a reasonable quality of life. Health professionals generally acknowledge that there is a need to improve care of patients with heart failure and that there are treatment gaps between the recommended therapies, and the care patients are actually receiving. This pilot study used the grounded theory approach to discover the main concerns, and how they are continually resolved, of a group that manage heart failure. It is argued that information gaps are present in the management of heart failure. It was demonstrated that when there is an absence of a cohesive group, occurring under conditions of changing funding structures within the context of boundaries merging, it is often necessary to alert others. The alerting of others is how the group continually resolve the information gaps. However, when people are not alerted, are left out of the loop, poor symptom management is more likely to occur, and information gaps are perpetuated. The loop in this study is comprised of information relating to heart failure and the members who both send and receive it. Indeed, if the loop is able to be activated so that people are in the loop information is shared and the chances for better heart failure management are more likely. The impact of effective heart failure management for the patients means that although heart failure as a chronic disease is limiting, it is still possible in many cases, to improve quality of life and longevity. The findings of this study also suggest that there is a need for nurses as health professionals to move towards ways to reduce information gaps and improve access to information, and it is suggested that case management and information systems are the ways to do so.
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    The effectiveness of a brief psychoeducational intervention for people with schizophrenia and their families : a dissertation presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Palmerston North, New Zealand
    (Massey University, 2009) Moxon, Alicia M.
    In an attempt to replicate and extend previous research, the present study conducted a brief psychoeducational intervention through community organisations designed to overcome methodological shortcomings of past studies. The two session intervention (one session with follow-up phone call) sought to establish if a brief community intervention was effective in both improving family members’ knowledge about schizophrenia and various other indicators linked to improved client functioning. People with schizophrenia and their family members (N = 50) were recruited into a controlled trial of a brief educational intervention. Clients and their corresponding key family members were randomly allocated to a treatment group or a wait-list control group. Measures included those reflecting knowledge about schizophrenia, expressed emotion, perceived coping ability, burden of care and distress. Analyses showed that knowledge increased significantly after the intervention and not after the control condition and was maintained at a nine-month follow-up. Family members’ and clients’ expressed emotion ratings significantly decreased from pre- to post-test with changes in total expressed emotion scores improving across treatment by over twice the magnitude compared to the control condition. All gains were maintained at the nine-month follow-up, with continuing improvement seen in family members’ intrusiveness ratings. A similar pattern of findings was reflected on other indices, with significant improvements in burden of care, coping and distress that were more a function of intervention than the control condition. All gains were maintained at the nine-month follow-up. Additionally, assessment of relapse rates at this follow-up interval indicated that no client had relapsed. Overall the results suggested that although knowledge increased as a result of education, the improvements in all indicators other than knowledge appeared to be due to education combined with some non-specific factors. These non-specific factors may have included expectancy effects, setting effects, sampling bias and other possibilities. These issues are considered in terms of implementation of brief programs in supportive community settings and in terms of future research.