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    Synergising youth empowerment and co-design to transform Pasifika youth into agents of social change : a novel approach to advance healthy lifestyles in Pasifika communities : a thesis presented in partial fulfilment of the requirements of Doctor of Philosophy in Public Health at Massey University, Wellington campus, New Zealand
    (Massey University, 2020) Prapavessis, Dani
    Current population health statistics demonstrate the need for innovative approaches to improve health outcomes and prevent non-communicable disease (NCD) for Pasifika peoples. This research builds off pilot studies on the effects of youth empowerment programmes to address obesity-related issues amongst Pasifika communities. It developed and tested an original model of co-design embedded within the youth empowerment framework of the Pasifika Prediabetes Youth Empowerment Programme. The programme was co-delivered with two community health service providers (one rural and one urban), employing Community-Based Participatory Research (CBPR) methodology. N=29 youth (aged 15-24 years) participated in eleven educational and capacity-building modules that comprised the empowerment and co-design components during weekly sessions from MayOctober 2018. At the end of the programme, the model of co-design generated two individualised community intervention action plans to reduce prediabetes in their communities. This research employed a qualitative research design with four data collection techniques and thematic analysis to evaluate the effects of the tested programme. It used an original framework of social change to determine the impacts on the youth’s values, knowledge, and behaviours as well as the community organisations, and the socio-cultural norms of each community. It also explicated the contextual considerations of programme uptake in each location. Overall, this research illustrated that co-design is an effective addition to empowerment frameworks. It demonstrated how to operationalise co-design in a community-based setting with youth, and the tested model provided a practical framework to translate empowerment ii outcomes into the community. The programme analyses also led to a more nuanced understanding of social change. This research developed a concept of the process of social change that can be used to inform future programme development and evaluation. This research suggests future translations of the programme to maximise uptake and postulates different community contexts and settings for delivery, beyond Pasifika prediabetes prevention.
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    'Lady, is this civilisation?' : a case study of community participation in a health development programme in Aotearoa New Zealand : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Development Studies at Massey University, Palmerston North, New Zealand
    (Massey University, 2008) Batten, Lesley Susan
    Community participation is a key feature of major global health declarations and a fundamental principle of health strategies in Aotearoa New Zealand. However, the frequency with which it is espoused belies the complexities associated with its practical application. Engaging communities in primary health care programmes designed to improve their health has been identified as a major challenge. This study’s objective was to explore community members’ perspectives of participation within a health development programme. The programme chosen aimed to increase the fruit and vegetable intake of targeted population groups, including M ori, Pacific peoples, and low income earners. A qualitative instrumental case study approach was adopted to examine the programme and investigate what influenced, constrained, and sustained community participation. Data collection included fieldwork over an eighteen-month period. Two programme projects were selected as the study foci: a communityled project involving distributions of thousands of free heritage variety plants; and, instigated by health services, a project establishing community gardens. These projects provided markedly different pictures of participation occurring within the same programme. The plant distributions had widespread appeal, while the community garden faltered. Community participation fitted within a description of ‘focused social action’. Participation was motivated by needs, values, and interests. While some were personal and family based, the programme also became an imagined vehicle for addressing wider health, social justice, and environmental sustainability goals. Ongoing challenges related to defining targeted communities and groups, varying degrees and types of participation, and different perspectives of participation, especially as health sector staff worked from an equity mandate and community members spoke of equality. Programme groups established as mechanisms to foster community participation had contradictory effects, engaging some as advisors, while failing to reach communities targeted for the programme. The complexities of health sector bureaucracy both enabled and constrained the programme and community participation. This thesis provides an in-depth examination of the complexities of community participation in action, the contradictory effects of contexts enveloping programmes, and the resolve of community members. It increases our understandings of how community members perceive health programmes and community participation, which are critical factors in improving population health.
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    What underpins success in a health promoting school in Northeastern Thailand? : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University
    (Massey University, 2008) Chamusri, Somsaowanuch
    A Health Promoting School (HPS) approach is now widely accepted internationally, with a focus on children’s health, the school curriculum, and whole school environment. In Thailand, the health and well-being of children is a fundamental value. HPS programmes have been implemented in schools as a strategy to focus on young people’s health. A number of barriers to successful HPS have been identified. While there is international evidence to show the steps and the key factors in creating successful HPS, little is known about successful HPS in the Thai context, in particular, in Northeastern Thailand which has been classified the poorest region. Ethnographic methods were used to examine what understanding of the meaning of HPS is necessary for a successful school, and how all those involved acted from the adoption of the HPS programmes by the local school until it achieved HPS status. A rural school which was successful in a HPS programme was selected, in Mahasarakham province, Northeastern Thailand. The data were obtained through participant observation, ethnographic interviews, and ethnographic records, and data analysis took place simultaneously with data collection. In this study, Lofland’s strategy for the analysis of the structure of human interaction was used. A variety of techniques for improving and documenting the credibility of the study such as prolonged engagement, persistent observation, and triangulation were used. This research revealed that the informants’ views reflected diverse understandings of the meaning of HPS. Those views were based on their experiences of HPS which differed according to the degree of participation, different levels of knowledge about HPS, and in the roles they played in the implementation of HPS in the school. Thai culture and school ethos influenced the success of HPS. Community participation was also crucial in supporting the school’s achievement. Key factors that underpinned success are identified. Implications of the findings for the HPS programme, health professionals, the school and community are discussed.