Massey University Departments

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    Health justice for all : the development of alternative health system capabilities in the conflict-affected context of Shan State, Myanmar : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Development Studies at Massey University, Manawatū, New Zealand
    (Massey University, 2018) Bell, Sharon Margaret
    As the 2030 Agenda for Sustainable Development advances, it is vital to determine how conflict impacts on the achievement of the Sustainable Development Goals (SDGs) in conflict-affected contexts. The United Nations (UN) regards conflict as the leading risk to development progress as these contexts have high rates of poverty and limited access to crucial healthcare services. Shan State, Myanmar is one such context, facing a critical shortage in its health workforce, considered one of the building blocks of an effective health system. Approaches to building health workforce capabilities can meaningfully contribute towards meeting SDG 3 – ‘to ensure healthy lives and promote well-being for all at all ages’, and consequently, health justice for conflict-affected communities. This research aims to understand how the approaches taken by an international nongovernmental organisation (INGO) support the development of alternative health system capabilities in a conflict-affected context. A global development agenda of state- and peace-building has meant that INGOs have been criticised for undermining state legitimacy. Meanwhile, non-state armed groups (NSAGs) in areas like Shan State, Myanmar, have established alternative regimes which seek self-determination as well as attempting to provide for the social and economic wellbeing of their people. However, little is known about how a partnership between an INGO and a NSAG contributes toward enabling alternative health system development in these contexts. This research contributes to new ways of understanding this through the development of a capabilities framework for health system development in conflict-affected contexts. This was used to analyse findings from the qualitative case study of an INGO’s health workforce training programme on the Myanmar-Thailand border. The research found that a positive partnership between the INGO and the NSAG has played a crucial role in enabling the workforce capabilities of the alternative health system, leading to promising improvements in health outcomes in communities. However, the effectiveness of the programme is restricted by the INGO’s reliance on volunteerism for staffing, where expatriate medical volunteers are selected based on their availability, rather than the appropriate skills and experience for this context. The international aid community has also reduced its funding for cross-border development programmes in Myanmar which has constrained the activities of the INGO and the NSAG. For Myanmar to achieve health justice and SDG 3, supporting health system development that focuses on improving health outcomes needs to be a priority for the international community.
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    The health seeking behaviours of ageing Niuean women in Central Auckland : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University
    (Massey University, 2002) Arapai, Doreen Minnie
    This qualitative study encompasses several features in its design. It is exploratory, emergent and the realms of discovery and description are informed by Max van Manen's (1990) human science approach. Van Manen's approach has enabled analysis of the data. Human science is comprised of phenomenology, hermeneutics and language and when coupled with the data collection method of focus groups makes for interesting outcomes. Time is needed to develop the narrative texts as phenomenological interpretation is never complete. There will always be levels of understanding waiting to be discovered. As a New Zealand bom Niuean woman, I have provided a preliminary account of the health seeking behaviours of ageing Niuean women (Matua fifine) in Auckland. The context of health seeking behaviour cannot be realized until there is an understanding of the participant's perceptions of health and illness. Understanding peoples perceptions of health and illness may give insights into the reasons for the decisions that the Matua fifine make when choosing to engage or not engage primary and or secondary health services. This also includes traditional medicine and complementary therapies. The assumption is that people make a direct move to seek a healthcare provider when well and unwell. What is not appreciated are the choices that are also available such as self management or a wait and see approach. Equally important is the role of spirituality, which encompasses Christian beliefs and traditional beliefs. Background information of history and the Niuean way of life, sets the context for this study. Consultation within the Niuean community is an ethical consideration that has paved the way for support for this study. This study will enable the voice of the Matua fifine Niue to be heard so that health services will be able to respond to and preserve their dignity and individuality which are foundational for good health and positive ageing.
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    Talanoa ile i'a : talking to Pacific Island young people in West Auckland about health : a thesis presented in partial fulfilment of the requirements for the degree of Master of Social Work at Massey University, Albany, New Zealand
    (Massey University, 2003) Faleolo, Moses Ma'alo
    The present study explores the health issues surrounding Pacific Island youth health development. The present study conducted a literature review on youth health issues in New Zealand and found that most are cultural and social related. A second literature review of theoretical dispositions to account for the emergence of youth heath issues found that Pacific Island concepts, medical sociology theory and youth health theory were relevant explanations for the emergence of Pacific Island youth health issues. The present study conducted focus groups with Pacific Island young people about youth health issues to see if the information from the literature review corresponded with the participants’ responses and whether the theoretical explanations were consistent with the participants’ responses. The present study found that a correlation exists between the literature review and the participants’ responses. The present study maintains through the participants’ responses that the key to addressing Pacific Island young people health issues is to involve their families throughout the process of assessment and in the development of response plans. This means the perspectives of those in youth health policy arenas, the perspective of service managers and the perspective of professionals are required to recognise that the perspective of the young person is an essential domain for understanding the cause of and for resolving Pacific Island youth health issues. ‘Talanoa ile I’a’ is the story of Pacific Island young people living in West Auckland. It is based on responses to questions posed to participants of the study in relation to Pacific Island youth health development issues. The present study contends that in order to understand, identify and resolve Pacific Island youth health issues it is important to talk to Pacific Island young people themselves. The present study did not conduct any research with youth policymakers, youth health services or health professionals but preferred to explore youth health with Pacific Island young people themselves. The present study is built on the participants’ responses and provides both warning signs and building blocks for youth health policy, youth healthcare services and youth health professionals. The present study is a Pacific Island approach to Pacific Island youth health issues; it is ‘by Pacific for Pacific’.
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    Māori women, health care, and contemporary realities : a critical reflection : a thesis presented in partial fulfillment of the requirements for the degree of Doctor of Philosophy (Health) at Massey University, Wellington, New Zealand
    (Massey University, 2015) Parton, Beverley May
    Māori women, health care and contemporary realities is a critical reflection on the context of my nursing practice, a Pākehā nurse employed by Kokiri Marae Health and Social Services (KMHSS), Lower Hutt, Aotearoa New Zealand. In addressing the disparities Māori experience KMHSS has the motto, “Committed to the holistic development of whānau, hapū, and iwi”. The research aimed to explore from the experiences of urban Māori women, influences on their health and health care engagement. Kawa Whakaruruhau, the critical nursing theory of cultural safety for Māori health care, informs a qualitative approach, a human rights perspective, with its categories of difference, power, and subjective assessment. In turn, whiteness theory, with its categories of white (and not so white) power and privilege, informs Kawa Whakaruruhau. The women’s stories were received in an unstructured interview method and analysed thematically. The historical, social, cultural, economic, political, racial and gendered factors contributing to Māori women’s health and health care engagement are presented as a geography of health, and as landscapes past, present and future. Landscapes past tell of the disruption of the whakapapa connections of land, language and health by the historical and ongoing processes of colonisation. Landscapes present tell of health care places and spaces that by their policies, cultures, structures, and health professional practice, network and connect to include or to exclude Māori women and their families. Landscapes future are envisioned by the women as they remember what is and has been, and then imagine for themselves and at times succeeding generations, what they require as Indigenous to be central to health care. The women imagine what they need to parent for their children to have a good life; they imagine a therapeutic landscape. (In)authentic identities are presented as chronicities of risk, inhabiting disease and poverty. The women expressed authentic mana wāhine identity uniquely and heterogeneously. Recommendations have been made for nursing practice, research site and research.
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    Living large : the experiences of large-bodied women when accessing general practice services : a thesis presented in partial fulfillment of the requirements for the degree of Master of Philosophy (Nursing) at Massey University, Palmerston North, New Zealand
    (Massey University, 2011) Russell, Nicola
    The ‘obesity epidemic’ of the past two decades has resulted in numerous studies reporting higher levels of stigma and discrimination experienced by obese/overweight women, both within the health care system and society in the main. Despite general practice being the most utilised point of access for health care services, there has been very little international or national exploration of the experiences of large-bodied women accessing these services. Utilising a qualitative, descriptive research design, this post-structuralist feminist study has enabled a group of large-bodied women to express their stories of accessing general practice services. Eight self identified large-bodied women volunteered to participate in semi-structured face-to-face interviews. Thematic analysis identified seven themes: Early experiences of body perception, Confronting social stereotypes, Contending with feminine beauty ideals, Perceptions of health, Pursuing health, Respecting the whole person and Feeling safe to access care. The women in this study articulated broader interpretations of health and well-being than those teachings reproduced within dominant bio-medical and social discourses of obesity. When these women’s personal context, beliefs and values are silenced by the health care provider, the rhetoric of health care professional claims of patient-centred care has given way to these women experiencing stigmatisation and a sense of ambiguity about general practice services. However, when space is given for multiple interpretations of obesity to exist within the patient-health care provider relationship, these women feel respected, their health needs are satisfied and they are more comfortable to engage in health screening services. Resisting the powerful socio-cultural milieu which supports the superiority of a slim female body as a signifier of both health and beauty presents a challenge for health care professionals to negotiate. I contend however, that giving consideration to the perspectives of large-bodied women and critically reflecting upon one’s own personal beliefs and attitudes about the overweight/obese, presents an opportunity to ensure clinical practice for this population is truly patient-centred.
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    Needs assessment and decision making in the Plunket nurse setting : what's the story? : a thesis presented in partial fulfilment of the requirements of the degree of Master of Philosophy (Nursing), Massey University, Wellington, New Zealand
    (Massey University, 2011) Hussey, Alison Louise
    Programmes delivered to populations of young children have had a high profile in recent years, as the relationship between childhood health and long term wellbeing is emphasised and funders and policy makers seek effective interventions to reduce health outcome disparity between some groups of children. Plunket nurses are employed by the Royal New Zealand Plunket Society (Inc) (Plunket) to deliver a programme of contacts to families with children aged from birth to five years, under a primary health care programme known as the Well Child Framework (Ministry of Health, 2010c). Seven universal or ‘core’ visits result in an assessment of family health need which informs decisions about the additional support offered to reduce risk to child health outcomes and improve health equity. This study was undertaken to clarify how Plunket nurses think about needs assessment, describe how Plunket nurses make decisions when planning care, and explore the influences on Plunket nurse needs assessment and decision making. A constructivist paradigm provided the framework for qualitative interviews with seven Plunket nurses. Data were analysed using narrative and thematic methods to construct three group narratives. The findings add to knowledge of New Zealand well child practice established through the limited previous studies in the Plunket nurse setting. Plunket nurses’ relationships with families emerged as the foundation for needs assessment, a process study participants described as complex, where a range of social, economic and community determinants are considered to establish family resilience and identify risks to child health outcomes. Decisions about planned care are contingent on family participation and agreement, and are influenced by peer and Clinical Leader supervision, the nurse’s knowledge and experience, and the available referral options. The study findings emphasise the importance of facilitative funding models to accommodate the unpredictable nature of work with families in the community, and consistent leadership to translate the underpinnings of service specifications to the reality of practice. Support for the Clinical Leader role, and further research to establish Plunket nurse professional development needs and to improve understanding of the dynamics in relationships between Plunket nurses and families are recommended.