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Introduction. New Zealand health training institutions have an important role in supporting health workforce training programmes in the Pacific Region. Aim. To explore the experience of Pacific Island country-based doctors from the Cook Islands, Niue, and Samoa, studying in New Zealand’s University of Otago distance-taught Rural Postgraduate programme. Methods. Document analysis (16 documents) was undertaken. Eight semi-structured interviews were conducted with Pacific Island country-based students. Thematic analysis of the interviews was undertaken using the framework method. The two data sources were analysed separately, followed by a process to converge and corroborate findings. Results. For Pacific Island countries with no previous option for formal general practice training, access to a recognised academic programme represented a milestone. Immediate clinical relevance and applicability of a generalist medical curriculum with rural remote emphasis, delivered mainly at a distance, was identified as a major strength. Although technologies posed some issues, these were generally easily solved. The main challenges identified related to the provision of academic and other support. Traditional university support services and resources were campus focused and not always easily accessed by this group of students who cross educational pedagogies, health systems and national borders to study in a New Zealand programme. Study for individuals worked best when it was part of a recognised and supported Pacific in-country training pathway. Discussion. The University of Otago’s Rural Postgraduate programme is accessible, relevant and achievable for Pacific Island country-based doctors. The programme offers a partial solution for training in general practice for the Pacific region. Student experience could be improved by tailoring and strengthening support services and ensuring their effective delivery. [ABSTRACT FROM AUTHOR]

Racism is a key modifiable determinant of health that contributes to health inequities in Aotearoa and elsewhere. Experiences of racism occur within the health sector for workers, patients and their whānau (extended family) every day. This paper uses stories of racism from nurses – reworked into vignettes – to examine the dynamics of racism to generate possible micro, meso and macro anti‐racism interventions. A critical qualitative design was utilised, informed by kaupapa Māori approaches. The five vignettes in this paper were sourced from a pair of caucused focus groups with nine senior Māori (Indigenous peoples of Aotearoa) and Tauiwi (non‐Māori) nurses held in Auckland Aotearoa in 2019. The vignettes were lightly edited and then critically analysed by both authors to identify sites of racism and generate ideas for anti‐racism interventions. The vignettes illustrate five key themes in relation to racism. These include (i) mono‐cultural practice, (ii) everyday micro‐aggressions; (iii) complexity and the costs of racism, (iv) Pākehā (white settler) privilege and (v) employment discrimination. From analysing these themes, a range of evidence‐based micro, meso and macro‐level anti‐racism interventions were derived. These ranged from engaging in reflective practice, education initiatives, monitoring, through to collective advocacy. Vignettes are a novel way to reveal sites of racism to create teachable moments and spark reflective practice and more active engagement in anti‐racism interventions. When systematically analysed vignettes can be utilised to inform and refine anti‐racist interventions. Being able to identify racism is essential to being able to effectively counter racism. [ABSTRACT FROM AUTHOR]

There have been growing concerns that social distancing and stay-at-home mandates have exacerbated loneliness for older people. Empirical evidence about older people's experiences of loneliness and COVID-19 have quantified this phenomena without considering how older people themselves define and understand loneliness. This paper explores how older New Zealanders conceptualized and experienced loneliness under 'lockdown' stay-at-home measures. This multi-methods qualitative study combines data from letters (n = 870) and interviews (n = 44) collected from 914 people aged over 60 and living in Aotearoa, New Zealand during the COVID-19 pandemic. We conducted a reflexive thematic analysis to conceptualise this data. We identify three interconnected ways in which older people conceptualised and experienced loneliness: (1) feeling disconnected relating to lack of emotional closeness to another often resulting from being physically separated from others and not being able to touch; (2) feeling imprisoned relating to separation from preferred identities and activities and was frequently associated with boredom and frustration; and (3) feeling neglected which often related to feeling let down by generalised and idealised forms of support, such as one's neighbourhood and health care system. Older New Zealanders experienced lockdown loneliness in three interconnected ways rather than as a stable and homogenous experience. Māori, Pacific, Asian and New Zealand European older people often discussed loneliness in different ways; attesting to loneliness being a culturally-mediated concept shaped by expectations around desirable social interaction. We conclude the paper with implications for research and policy. [ABSTRACT FROM AUTHOR]

This paper synthesises critique from Māori patients with Bipolar Disorder (BD) and their whānau to identify barriers and propose changes to improve the structure and function of the New Zealand mental health system. A qualitative Kaupapa Māori Research methodology was used. Twenty-four semi-structured interviews were completed with Māori patients with BD and members of their whānau. Structural, descriptive and pattern coding was completed using an adapted cultural competence framework to organise and analyse the data. Three key themes identified the impact of structural features of the New Zealand mental health system on health equity for Māori with BD. Themes involved the accessibility, delivery and scope of the current health system, and described how structural features influenced the quality, utility and availability of BD services for Māori patients and whānau. Structural barriers in the existing design, and potential changes to improve the accessibility, delivery and scope of BD services for Māori, were proposed including a redesign of operational, environmental, staffing, and navigation points (information, transition, fatigue) to better meet the needs of Māori with BD. A commitment to equity when implementing structural change is needed, including ongoing evaluation and refinement. This paper provides specific recommendations that should be considered in health service redesign to ensure the New Zealand mental health system meets the needs of Māori patients with BD and their whānau. [ABSTRACT FROM AUTHOR]

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Drawing on the findings from a longitudinal study of vulnerable young people's transitions to adulthood, this paper explores the ideas of shame and recognition. The young people, aged between 12 and 17 years at the first interview, had experienced chronic exposure to adversity from an early age (abuse, violence, mental health issues, addictions, and expulsion from school). They were clients of statutory and non‐governmental services: child welfare, juvenile justice, remedial education, and mental health services. This paper draws on the qualitative phase of the study (n = 107); young people and a trusted other, nominated by the young person, participated in three annual qualitative interviews. Interviews focused on young people's experiences of services, key transitions, their relationships, and the strategies they used to locate support and resources. Experiences of shame, misrecognition, and seeking recognition emerged as dominant themes in the young people's accounts, and these are explored in this paper. The paper concludes with a discussion on responsive social work interventions that generate a deeper understanding of young people's experiences of shame and misrecognition. Central to this practice are critical and relational social work practices that actively support young people to achieve recognition. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Dietetic service delivery in primary health care is an emerging area of dietetic practice in New Zealand. AIM: This paper aims to describe the dietetic services being delivered in this setting and dietitians' perceptions of the factors that have an effect on their ability to deliver an optimal service. METHODS: Individual, qualitative, semi-structured, face-to-face interviews were conducted with 12 primary healthcare dietitians from a range of age, ethnicity and professional backgrounds. Interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis. RESULTS: Participants were delivering a range of services including: providing nutrition care directly to patients, helping to upskill other primary health care professionals in nutrition, and delivering health promotion initiatives to their local community. Three key factors were identified that participants perceived as having an effect on their ability to deliver effective dietetic services in primary health care: being part of a multidisciplinary general practice team, having flexible service delivery contracts appropriate for the setting and that supported integration, and having an adequate level of dietetic experience. DISCUSSION: Dietitians working in primary health care recognise the importance of being well integrated into a multidisciplinary general practice team. This enables them to deliver more collaborative and coordinated nutrition care alongside their colleagues, to benefit patient care. Establishing flexible dietetic service delivery contracts, which support integration and take into account funding and workforce capacity requirements, may help ensure that the unique skill set of a dietitian is utilised to best effect. [ABSTRACT FROM AUTHOR]

Purpose - Clinical governance policy initiatives have been introduced in many countries and health systems. How to assess development is an important question. The purpose of this paper is to describe and reflect upon the approach taken in New Zealand. Design/methodology/approach - New Zealand's clinical governance policy of 2009 and its implementation through its public health care system are outlined. The authors' assessments, in 2010 and 2012, of this policy are described and key findings summarised. Findings - The implementation of the policy was swift, with considerable commitment across the public health care system to this. The quantitative assessments found reasonable developmental progress between 2010 and 2012. Case studies undertaken in 2012 indicated various areas that policy makers should attend to or build upon in order to better support clinical governance development. Research limitations/implications - Key lessons from New Zealand's clinical governance experience, based on the assessments, include the need for: a well-defined definition of clinical governance; resource materials that can be used by those involved in clinical governance development; recognition that clinical governance development is complicated and takes time; and commitment to new leadership and organisational arrangements. Originality/value - This paper provides useful lessons for policy makers pursuing clinical governance development, derived from two rounds of assessment in New Zealand. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Medication does not always resolve a serious mood episode, and there is evidence that it needs to be combined with an evidence‐based psychotherapy to promote symptomatic and functional recovery.There is little known about what people with serious mood disorders want from mental health services to manage their mood. What the paper adds to existing knowledge?: Participants in this study wanted a framework other than the medical model for understanding and managing their mood.Their motivation to commence psychotherapy was based on a sense of having hit rock bottom and a need for understanding what was happening in order to better manage their mood. Introduction: There is little known about the motivations for people to participate in psychotherapy for depression. Aim: To explore why people, with a diagnosis of major depressive episode, chose to take part in a psychotherapy study and what they expected it to involve. Method: This was a qualitative study of participants' motivations and understandings of psychotherapy for depression. Data were collected using semi‐structured interviews and analysed using thematic analysis. Findings: Eight females and eight males with an age range from 21 years to 55 years were recruited. Three themes were identified that described why participants chose to participate in psychotherapy: medication was not enough, a turning point and making sense of experience. The participants chose to participate in psychotherapy after finding that medication was insufficient and this combined with a sense of crisis motivated them to engage in psychotherapy in order to learn to manage their mood differently. Discussion: The participants recognized that they wanted a framework other than a medical model with its reliance on medication, in order to make sense of their experiences and develop new self‐management strategies. Implications for Practice: Our study suggests that some people experiencing a serious mood disorder access psychotherapy after "hitting rock bottom" and finding insufficient help from medications. Mental health nurses need to be aware people do not always want a medical model approach to treatment of serious mood disorders and they need to provide the opportunity of engaging in a psychotherapeutic framework in order to better understand and manage their mood. [ABSTRACT FROM AUTHOR]

Introduction: Across Aotearoa (New Zealand), there are chronic shortages of qualified Māori (Indigenous peoples of Aotearoa) health practitioners and systemic ethnic health inequities. This study, focussing on the discipline of occupational therapy, explores Māori graduates' recollections of the institutional barriers that impacted on their study in this field over a 25‐year period. Methods: This qualitative study interviewed seven Māori occupational therapy graduates using pūrākau—an innovative Māori narrative inquiry method. Pūrākau (stories) were collected in 2018 via kanohi ki te kanohi (face to face) semi‐structured interviews. They were analysed using the kaupapa Māori (Māori philosophical) framework of Pū‐Rā‐Ka‐Ū which draws on traditional Māori mātauranga (knowledge). Findings: The institutional barriers identified were (1) cultural dissonance, (2) cultural (in)competency and (3) the limitations of (Western) pastoral care. Conclusion: This study highlighted how racism is embedded within the Western tertiary education system. To create a safe learning environment for Māori students, tertiary education institutions require a planned approach to address racism within policy, procedures, the curriculum, teaching and professional staff. [ABSTRACT FROM AUTHOR]

It is well documented that Health care assistants (HCAs) provide the most hands‐on care to residents in aged care facilities, and play a critical role in the provision of care to dementia residents. Over the last 25 years, a philosophy of person‐centred care has become the preferred approach to care and this has meant that HCAs are encouraged to get to know the resident very well. This paper reports the experiences of HCAs in caring for people at end‐of‐life, identifies the skills required for their work and examines the education provided against these skills. Semi‐structured interviews were conducted in 49 facilities (n = 34) across New Zealand and data analysed thematically, with the aim of critically examining the adequacy of education for health care assistants which meets their needs within a person‐centred environment. The results confirm that the skills include traditional tasks of care (showering, feeding, toileting, and dressing) but the increasingly important communication and de‐escalation skills, both verbal and non‐verbal, have become central to their care skills. Education provided has not sufficiently shifted focus to include these more complex skills. Provision of educations that acknowledges the increased complexities of their role needs to be provided. As well, facilities need to be challenged to reconsider the HCA's position in the facility care tem. [ABSTRACT FROM AUTHOR]

Ageing does not reduce people's need to connect with family members, friends, and acquaintances, and neither does migration. For those older migrants living in a foreign land, connectedness with others plays a particularly important role in achieving a sense of belonging and sustaining their health and well‐being. This paper explores the issues of social isolation and loneliness among older Asian migrants in New Zealand. Data were collected from in‐depth semi‐structured interviews with Chinese‐ or Korean‐speaking migrants aged between 75 and 84 years (n = 10: all females), and from three focus groups consisting of Chinese‐ and Korean‐speaking migrants (n = 10: 7 females, 3 males) and Chinese professionals (n = 5: 3 females, 2 males) between June 2016 and December 2016. The qualitative data obtained were analysed applying a thematic analysis approach using NVivo software for group analysis by a multidisciplinary research team. The findings from the study show that older Asian migrants experienced high levels of isolation and loneliness at least at some points in their migrant lives. Most participants in this study were living alone or with only their spouse, and this living arrangement was likely to provide fertile ground for isolation and loneliness to grow in the context of later‐life migration. It was also observed that their lonely ageing ironically resulted from their efforts to preserve family relationships through avoiding being a burden, while allowing them a sort of space to maintain now barely connected lives. The participants revealed multiple ways of coping with lonely and isolated experiences in their limited social network, and these individual strategies allow us to make suggestions about how best to reduce older migrants' social isolation and loneliness in the New Zealand context and beyond. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known of the subject: Consumer participation in mental health services is an expectation articulated through mental health policy.Consumers as researchers could contribute significantly to mental health services. Barriers to participation are significant and limit consumer involvement. What the paper adds to existing knowledge: Enhanced understandings of collaborative relationships between consumer and nonconsumer researchers.Researchers from the health disciplines find value in consumer involvement in mental health research.These researchers can support and facilitate consumer research by being allies to consumer researchers. What are the implications for practice: Understanding the role of allies is necessary to strengthen their capacity to support consumer researchers.Involving consumers in mental health research is likely to lead to improved practice. Introduction: Australia and New Zealand mental health policy requires consumer participation in all aspects of mental health services. Systemic participation informs and improves the quality of mental health services. Collaboration with consumer researchers should be similarly required. Enhanced understandings of collaborations are needed. Aim: To enhance understanding of the perspectives and experiences of nonconsumer researchers in working collaboratively with consumers as researchers. Method: This qualitative exploratory study involved interviews with nonconsumer mental health researchers who have worked collaboratively with consumers in research. Interviews were conducted with participants from Australia and New Zealand. Results: "Allyship" emerged as a major theme. This describes nonconsumer researchers playing an actively supportive role to facilitate opportunities for the development and growth of consumer research roles and activities. Seven subthemes were identified: establishing and supporting roles, corralling resources, guiding navigation of university systems, advocacy at multiple levels, aspiring to coproduction and consumer‐led research, extending connections and partnerships, and desire to do better. Discussion: Allyship may have an important role to play in the broader consumer research agenda and requires further consideration. Implications for practice: Embedding meaningful consumer participation within mental health services requires active consumer involvement in research. Allies can play an important facilitative role. [ABSTRACT FROM AUTHOR]

Access to economic resources influences the material conditions of life for older people, as well as the freedoms and capacities of older people to achieve the kind of lives they value. Security is one aspect of later life valued by older people. Ontological security provides a sense of order and continuity and needs to be understood in terms of the situated life experiences and circumstances of older people. The study reported in this paper analysed 145 qualitative interviews with New Zealanders aged 63–93 in order to explore how participants understand ontological security. Varying levels of access to economic resources were associated with differing abilities of participants to manage the unpredictability of everyday life. Among the wealthy, security was strongly connected to the freedoms provided by ample financial resources. Contrary to what might be expected, those with the lowest levels of economic resources did not express higher levels of insecurity, but instead drew upon life experiences of managing and making do to construct a trajectory of security. Those with mid-range levels of economic resources expressed most insecurity, including anxiety over changing economic conditions and concerns over their ability to manage reductions in economic resources. In discussing the implications of this, the paper highlights the need to recognise ways in which access to economic resources intersect with life circumstances, past experiences and future social expectations to provide opportunities for all older people to pursue security as they strive to age well. [ABSTRACT FROM PUBLISHER]

A crucial development resulting from consumer involvement in mental health services has been engagement as active participants in mental health research, often conducted in collaboration with mental health researchers representing the health disciplines (referred to in this paper as 'other' researchers). Despite progress in mental health consumer research, unequal power relations continue to pose a major barrier. Although power issues are discussed in the literature, there is little research from the perspective of other mental health researchers who have collaborated with consumers on research projects. This qualitative study explored other mental health researchers' perspectives on the role of power in collaborative research with consumers. Semi-structured interviews were completed with 11 other mental health researchers. Thematic analysis of the transcript version of interview recordings was conducted. The findings were grounded in 'the table' as a literal and metaphorical site of power relations. The umbrella theme was prominence and presence (of consumers) at the table, followed by subthemes on barriers (tokenism, undermined potential) and surmounting them through reworking power (critical mass and openness to power dynamics). Overall it was found that while there continue to be significant power-related barriers to further building of robust collaborative research with consumers in mental health, there are several avenues that should be considered, much more assertively, to disrupt and transcend them. [ABSTRACT FROM AUTHOR]

Objectives Smoking during pregnancy is harmful for the woman and the unborn child, and the harms raise risks for the child going forward. Indigenous women often have higher rates of smoking prevalence than non-indigenous. Exercise has been proposed as a strategy to help pregnant smokers to quit. Māori (New Zealand Indigenous) women have high rates of physical activity suggesting that an exercise programme to aid quitting could be an attractive initiative. This study explored attitudes towards an exercise programme to aid smoking cessation for Māori pregnant women. Methods Focus groups with Māori pregnant women, and key stakeholder interviews were conducted. Results Overall, participants were supportive of the idea of a physical activity programme for pregnant Māori smokers to aid smoking cessation. The principal, over-arching finding, consistent across all participants, was the critical need for a Kaupapa Māori approach (designed and run by Māori, for Māori people) for successful programme delivery, whereby Māori cultural values are respected and infused throughout all aspects of the programme. A number of practical and environmental barriers to attendance were raised including: cost, the timing of the programme, accessibility, transport, and childcare considerations. Conclusions A feasibility study is needed to design an intervention following the suggestions presented in this paper with effort given to minimising the negative impact of barriers to attendance. [ABSTRACT FROM AUTHOR]

Young people in statutory care and protection interact with social workers, who hold potential to provide a supportive adult role in their lives. Many however, run away at an early age and end up on the street trading sex for money or other favours. There is potential to improve outcomes for young people in care if the relationship between young people and their social workers is better addressed. This paper uses data from a qualitative study of 14 young people who traded sex and who had experienced interactions with social workers. A thematic analysis identified three themes: the rigidity of social work practice; contesting the family situation; and resisting the at-risk label. We argue that to have any impact on outcomes for young people in care, social workers need to prioritise relationship-building above the need to conform to organizational protocols and guidelines. Such guidelines assist the social worker in assessing whether family situations pose high risk for a young person, but the 'at-risk' label is contested by young people, which results in a lack of trust and a barrier to relationship building. [ABSTRACT FROM AUTHOR]

Introduction. From a coronavirus disease (COVID-19) pandemic perspective, Aotearoa New Zealand (NZ) rural residents formed an at-risk population, and disparities between rural and urban COVID-19 vaccination coverage have been found. Aim. To gain insight into factors contributing to the urban-rural COVID-19 vaccination disparity by exploring NZ rural health providers' experiences of the vaccine rollout and pandemic response in rural Māori and Pasifika communities. Methods. Rural health providers at four sites participated in individual or focus group semi-structured interviews exploring their views of the COVID-19 vaccine rollout. Thematic analysis was undertaken using a framework-guided rapid analysis method. Results. Twenty interviews with 42 participants were conducted. Five themes were identified: Pre COVID-19 rural situation, fragile yet resilient; Centrally imposed structures, policies and solutions - urban-centric and Pakehā focused; Multiple logistical challenges - poor/no consideration of rural context in planning stages resulting in wasted resource and time; Taking ownership - rural providers found geographically tailored, culturally anchored and locally driven solutions; Future directions - sustained investment in rural health services, including funding long-term integrated (rather than 'by activity') health services, would ensure success in future vaccine rollouts and other health initiatives for rural communities. Discussion. In providing rural health provider perspectives from rural areas serving Māori and Pasifika communities during the NZ COVID-19 vaccine rollout, the importance of the rural context is highlighted. Findings provide a platform on which to build further research regarding models of rural health care to ensure services are designed for rural NZ contexts and capable of meeting the needs of diverse rural communities. [ABSTRACT FROM AUTHOR]

Internationally, the COVID-19 pandemic resulted in changes to services as governments funneled health-related funding and resources into stopping the spread of COVID-19. At the same time, older people were singled out as an "at-risk" group, which prompted caution from both older people and governments to limit their exposure to COVID-19. It remains unclear what the impact this has had on older people's routine health and social care access, and how older people themselves viewed these changes. This analysis investigates older people's understanding and experiences of using health and social care services under the COVID-19 lockdown restrictions in 2020. This analysis draws from a wider, letter-writing study that received 748 letters from 854 participants aged 70 years and older who were living in New Zealand during the COVID-19 lockdowns. Just over half of letter writers described access to health and social care services. Informed by Penchansky and Thomas' 5 A's of the access framework, we conducted a thematic analysis of this subsample of letters (n = 404). This analysis identified four broad categories relating to access to health and social care services under COVID-19 lockdown restrictions: (a) the system-wide strangeness of physically accessing services, (b) accommodation of services, (c) availability of resources and personnel, and (d) enhanced quality of those included by services. Rather than passively accepting changes, older people adapted to restrictions by drawing on their available materials and social resources. We conclude this analysis with suggestions for improving future interventions and policies to better older people's access to health and social care during times of crisis. [ABSTRACT FROM AUTHOR]

Aims: Investigated the experiences of Māori (the Indigenous peoples of Aotearoa, New Zealand) patients and whānau (extended family network) engaging with acute hospital inpatient services and their priorities for a Māori-centred model of relational care. Design: A qualitative Māori-centred research design using a Thought Space Wānanga (learning through in-depth group discussion, deliberation and consideration) approach. Methods: Two wānanga were conducted between May 2022 and June 2022, with 13 Māori patients who had been acutely hospitalized within the past 12 months and their whānau members. The first wānanga utilized storytelling and journey mapping to collect data. The second wānanga refined the initial themes. Wānanga were audiorecorded and then inductively coded and developed into themes. Results: Thirteen patients and whānau attended the first wānanga, while 10 patients and whānau participated in the second wānanga). Four themes were developed: (1) Whakawhanaungatanga (establishing connections and relationships), (2) Whakamana (uplifting the status and esteem of Māori), (3) Whakawhitiwhiti kōrero (the importance of communicating, discussing and deliberating) and (4) Kotahitanga (working together with purpose) all provide insights into the importance of effectively engaging and connecting with Māori patients and whānau when acutely hospitalized. Conclusions: The experiences and priorities of Māori patients and whānau affirm the international literature, suggesting that Indigenous relational concepts are critical to building relationships, connections and trust. Despite existing healthcare models for working with Indigenous peoples, their poor application contributes to sub-optimal healthcare experiences at all points of their healthcare journey. A relational mode of practice focused on engagement and forming connections better meets the needs of Indigenous peoples engaging with inpatient health services. Implications for the profession and/or patient care: Despite the existence of Indigenous models of care, Indigenous peoples consistently report a lack of engagement and connection when accessing inpatient health services. Without establishing relationships, applying models of care is challenging. Impact (Addressing): • What problem did the study address? Internationally, healthcare systems are consistently ill-equipped to deliver culturally safe care for Indigenous and marginalized peoples, evident in ongoing health inequities. Like other reports of Indigenous experiences of health services, Māori express dissatisfaction with care delivery in an acute inpatient setting. This study investigated Māori patients and whānau experiences engaging with acute hospital inpatient services and their priorities for a Māori-centred model of relational care. • What were the main findings? Māori patients and whānau recounted negative experiences with healthcare professionals lacking effective relationships and trust. Satisfaction occurred when engagement with health care professionals resembled Indigenous cultural rituals of encounter that considered their holistic, collective and dynamic worldviews. Previous models of relational care, while helpful, are not Indigenous and so do not address their needs, such as engagement as a mode of practice (how) to achieve this. • Where and on whom will the research have an impact? This research impacts Indigenous peoples' health outcomes, particularly Māori, and nurses and clinicians working and interacting within acute inpatient and other hospital settings. Indigenous research methods support co-constructing knowledge for translation into practical outcomes through transformational practices, policies and theory development. Reporting method: We used the Consolidated Criteria for Strengthening the Reporting of Health Research Involving Indigenous Peoples (CONSIDER) statement (see File S2—CONSIDER Checklist) and the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines (see File S3—COREQ Checklist). [ABSTRACT FROM AUTHOR]

This article draws on the free-text commentaries from trans-Tasman studies that used the MISSCARE questionnaire to explore the reasons why nurses miss care. In this paper, we examine the idea that nurses perpetuate a self-effacing approach to care, at the expense of patient care and professional accountability, using what they describe as the art of nursing to frame their claims of both nursing care and missed nursing care. We use historical dialogue alongside a paradigmatic analysis to examine why nurses allow themselves to continue working within settings that put their professional/personal selves aside in an attempt to deliver care within constraints that make completing care an impossible task. The findings suggest an ambivalence and conflict confront nurses attempting to provide care within the New Public Management environment. This can be seen in the tensions that draw a line between care as an art, and care as a financial target, juxtaposed with the inherent clash of values arising from the way nursing care is conceptualised within two contradictory paradigms. [ABSTRACT FROM AUTHOR]

Despite international efforts, stigma is still a significant issue for people living with HIV/AIDS (PLWHA). This paper explores the stigma encountered in health interactions, focusing on strategies PLWHA use to manage and reduce it. It is hoped that our findings will improve future interactions by contributing towards a more understanding practitioner–patient relationship. The data have been drawn from a small qualitative study conducted in Christchurch, New Zealand. Fourteen participants took part in semi-structured face-to-face interviews in 2013 and 11 of these participants were then interviewed again in 2014. Codes and themes were developed through inductive thematic analysis of the interview transcripts. Our findings identified that whilst the majority of participants had positive experiences, nearly all had faced stigma during their health interactions. Most of these encounters were due to healthcare workers holding exaggerated fears of transmission or not maintaining confidentiality and privacy. The main way that participants managed this stigma was through seeking control in their interactions. This overarching strategy could be further divided into three key themes: selective disclosure of their HIV status, self-advocacy and developing their HIV knowledge. We discuss these findings in the context of the current literature, comparing our results to strategies that have been previously identified in social settings. [ABSTRACT FROM AUTHOR]

Living with human immunodeficiency virus (HIV) in the industrialised world has for over a decade been conceptualised as living with a chronic illness. People living with HIV now are amongst the first to live and age with the virus. Drawing on a qualitative longitudinal study in a low-incidence area in a low-incidence country, this paper investigates the nuanced ways that people negotiate this condition. While it has been argued that HIV is a condition like any other chronic disease, our thematic analysis reveals some similarities and particularities around living with the condition. In comparing themselves to others with the condition, high levels of diversity of experience were identified that extended well beyond length of time from diagnosis. In comparing their illness with other illnesses, the location, for example, of their specialist service within a clinic for those with acute sexually transmitted diseases was identified as problematic. The work involved in maintaining a coherent sense of self in the face of existing and shifting challenges as a result of their infection was a second strong theme. The final theme involved flux and flex work in the ways people sought to gain and maintain control over various aspects of their lives. All of these experiences are mediated by place; that is the experience is not the same as that of those who live where there is a much higher incidence of infection. The work involved in negotiating this condition in low-incidence environments deserves more attention, but aspects of these findings are significant in higher incidence contexts as well; in particular, passivity in face of infection as one ages and the potential for medication refusal as a means of maintaining control over life and death. [ABSTRACT FROM PUBLISHER]

The incidence of diabetes in people with an intellectual disability, although unknown, is indicated to be higher than the general population. Given the challenges individuals with intellectual disability may face, this population is often dependent upon key workers to manage their health and well-being. One aim of a wider study on the self-management of diabetes by people with intellectual disability was to explore how key workers supported their self-management. That aim was the focus of this paper. Between 2009 and 2010, 17 staff from five residential intellectual disability services and two supported independent living services within New Zealand, consented to a semi-structured interview. Transcripts of the interviews were analysed using Thomas' General Inductive Approach. Three overarching themes emerged; having knowledge and understanding, being lifestyle police and ensuring future well-being. While knowledge, skills and perspectives varied, all participants were committed to ensuring that the lifestyle of the person concerned was compatible with the management of their diabetes. A range of perspectives existed between the expectations they had of themselves, colleagues and the individual with diabetes. There was an identified need for initial and ongoing education of permanent and casual staff and the people themselves with diabetes in collaboration with health and disability services to build confidence and promote self-management practices. In so doing, the impacts of this long-term condition may be reduced and the health outcomes improved for people with intellectual disability. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Youth health outcomes are poor in New Zealand and have a life-long impact on individuals, wha-nau (family) and society. Little is known about how young people view their experiences of general practice care despite it being the most common place to access health care. AIM: This study sought to explore young peoples' experiences of care in a selected, youth-friendly general practice. METHODS: In-depth individual interviews with six young people. RESULTS: Four themes were identified from young peoples' narratives in relation to their experiences of general practice care: going to the doctor is not easy for a young person; the attributes of staff make all the difference; specific youth-friendly consultation practices help young people; and a youth-friendly physical environment can help young people access services and feel safe. DISCUSSION: Even though the study general practice had explicitly instituted youth-friendly initiatives, including offering no-charge consultations and specialist staffmembers, young people still described considerable barriers to attendance. Many barriers are practice-based and could bemodified by staff training, provision of further youth care staff roles and consideration of environmental changes. Other barriers such as waiving prescription costs need government funding. [ABSTRACT FROM AUTHOR]

Maternal mental health plays a vital role in the overall wellbeing of mothers, children, families, whānau (core support network) and communities. However, many mothers face mental health challenges during the transition to parenthood. In this study, we used an online story-sharing platform to collect the experiences of mothers who have faced unmet needs while using the Well Child Tamariki Ora (WCTO) service in Aotearoa New Zealand. From the 420 submitted stories, 125 stories related to mental health need while using the WCTO service. Using thematic analysis, we identified three main themes that highlighted the experiences of mothers with the service. This includes (1) making it seem that I'm coping: Mothers' fear of being judged; (2) i wish I had connected with my WCTO nurse: Fostering meaningful relationships to facilitate personal information sharing; and (3) beyond the baby: Mothers desire for recognition and support during WCTO visits. These findings point to several missed opportunities for WCTO providers to inquire about mental health and offer support needed by mothers. To address this, a relational approach to care would prioritise families and whānau as the focus of care rather than just monitoring the development of babies. [ABSTRACT FROM AUTHOR]

Introduction. Regular diabetic foot checks, at least annually, are important for early identification of risk factors and prevention of ulceration and amputation. To ensure this, most general practices in Aotearoa New Zealand (NZ) offer free annual diabetes reviews (ADRs) which include a comprehensive foot evaluation. However, attendance rates at these ADRs are low. Aim. To explore patients' perspectives on the barriers to attending ADRs and foot checks. Methods. Semi-structured interviews with people with type 2 diabetes who were overdue their ADR (n = 13; 7 women, 6 Māori) from two urban practices were conducted. Interviews were audio recorded and transcribed verbatim and then analysed using an inductive thematic analysis approach. Results. We identified three key themes demonstrating barriers to attendance: healthcareassociated factors (suboptimal clinician-patient relationship, not having a consistent general practitioner (GP)); patient-related factors (co-morbid health conditions, issues surrounding identity, and logistical issues); and systemic factors (COVID-19 pandemic, travel distance to the practice, unawareness of available foot care services). Participants' feedback focused on patient-centred approaches for improvements to service delivery, for example using online educational materials, and utilising culturally appropriate models of health including Te Whare Tapa Whā and Whānau Ora approach. Discussion. We identified several barriers to attendance, some of which are potentially modifiable. Addressing modifiable barriers and incorporating suggestions made by participants may improve access to the ADR and reduce non-attendance. Further participatory action research could explore these insights in ways that facilitate tino rangatiratanga (self-determination) and palpable action. [ABSTRACT FROM AUTHOR]

Introduction. In Aotearoa New Zealand (NZ), type 2 diabetes (T2D) is predominantly managed in primary care. Despite established guidelines, patients are often suboptimally managed, with inequitable health outcomes. To date, few NZ studies have evaluated the primary care management of T2D at the time of diagnosis. Aim. This study aims to explore the provision of education and delivery of care to patients at the time of diagnosis, which is a crucial time in the disease trajectory. Methods. Participants were recruited from a Māori health provider in the Waikato District, and diagnosed with T2D after January 2020. Patients were texted a link to opt into a survey (larger study) and then registered interest by providing contact details for an interview (current study). Semi-structured interviews were conducted and were audio recorded, transcribed, and thematically analysed. Results. In total, 11 participants aged 19-65 years completed the interviews (female n = 9 and male n = 20); the comprised Māori (n = 5), NZ European (n = 5) and Asian (n = 1) participants. Three overarching themes were identified, including: (1) ineffective provision of resources and education methods; (2) poor communication from healthcare practitioners; and (3) health system barriers. Discussion. Evidently, there are difficulties in primary care diabetes mellitus diagnosis and management. Improvements could include locally relevant resources tailored to patients' experiences and cultural identities. Utilising whānau support and a non-clinical workforce, such as health navigators/kaiāwhina, will drastically address current workforce issues and assist patient self-management. This will allow improved diagnosis experiences and better health outcomes for patients and whānau. [ABSTRACT FROM AUTHOR]

Purpose: Many psychiatrists and trainees in Aotearoa New Zealand used telepsychiatry during COVID-19 lockdowns, despite minimal experience and training in the area. Research on a culturally safe telepsychiatry framework is lacking in Aotearoa. This study aims to provide a better understanding of telepsychiatry in the Aotearoa context and identify potential gaps with the current practice, with a focus on exploring telepsychiatry use with Maori, Pacific peoples and Asians. Design/methodology/approach: This qualitative study was guided by the principles of the Kaupapa Maori methodology and the "Give Way Rule" from Pan-Pacific studies, to ensure culturally appropriate analysis and outcomes. Semi-structured interviews were conducted with a sample of psychiatrists and trainees recruited from Aotearoa members of the Royal Australian and New Zealand College of Psychiatrists. The qualitative data were then analysed using general inductive thematic analysis to identify the major themes. Findings: In total, 18 participants were interviewed. Three key themes were identified: cultural safety such as preparation for a telepsychiatry session, cultural practices and equity issues; clinical practice such as continuity of care, patient selection and limitations; and process of running a telepsychiatry service. Originality/value: The analysis of the main themes gives both practical ideas for providing a culturally safe telepsychiatry appointment, as well as a wider base for developing a telepsychiatry service that works particularly for Maori, Pacific and Asians mental health users. Issues around resources and expertise in the field are lacking and further frameworks to support infrastructure and training are needed. [ABSTRACT FROM AUTHOR]

Introduction: The usual output following health consultations from paediatric services is a clinical letter to the referring professional or primary care provider, with a copy sent to the patient's caregiver. There is little research on how patients and caregivers perceive the letter content. We aimed to: first understand child, young people and caregiver experiences of and preferences for receiving a health feedback letter about the child/young person's health measures within a healthy lifestyle programme; and second to provide a set of recommendations for designing letters to children, young people and their families within a healthy lifestyle programme. Methods: This qualitative study, informed by Kaupapa Māori principles, included focus groups of children aged 5–11 years and young people aged 12–18 years who were participants in a healthy lifestyle programme in Taranaki, Aotearoa New Zealand and of their respective caregivers (total n = 47). Discussions were audio‐recorded, transcribed and analysed using thematic analysis. Findings: Key themes were identified: letters sometimes acted as 'discourses of disempowerment'—some participants experienced a lack of safety, depersonalisation with medical jargon and 'feeling like a number'. Participants described the need for acknowledgement and affirmation in written communication—health feedback should include validation, choice regarding content, respectful tone and a strengths‐based approach to health messages. Interpretation: Letters to referrers, copied to families, can be perceived as disempowering, and participant and caregiver perspectives of content should be considered. This study challenges conventional practice in communicating health feedback with broader implications for written communication in healthcare. We propose separate letters aimed at the child/young person and their caregiver that offer choice in the information they receive. The administrative burden of multiple letters can be mitigated by advances in digital health. Patient Contribution: This study originated in response to feedback from service users that current health feedback was not meeting their needs or expectations. Patient perspectives, especially from children, are rarely considered in the generation of clinic letters from health professionals. Participants were child participants in the community‐based clinical service and their caregivers, and care was taken to represent the demographic backgrounds of service users. Collection and interpretation of Māori data were led by researchers who were local community members to ensure prioritisation and preservation of participant voice. Where possible, results are illustrated in the text by direct quotes from participants, whose identities are protected with a pseudonym. [ABSTRACT FROM AUTHOR]

Examining the concepts underpinning the reasoning processes of social worker's decision‐making provides important insights into how social work practice is undertaken. This paper examines one of the major discourses used by social workers in decision reasoning in a non‐governmental organization child protection context in Aotearoa/New Zealand: family maintenance. This study found that family maintenance as a concept was strongly privileged by social workers. This resulted in attempts to preserve families and created a hierarchy of preferred decision outcomes. A preference for family maintenance was supported by legal, moral, psychological and Māori cultural concepts. This pattern of constructs underpinned the ‘weighing up of harms’ when considering removal, and generally reflected a child welfare orientation. In addition to this, it was found that ‘family’ was broadly defined, and could include people who had a relationship with the children, or Māori definitions of extended family, in addition to legal ones. [ABSTRACT FROM AUTHOR]

This paper reports on the qualitative phase of a New Zealand study of young people who had been exposed to "risky" environments from a young age. These young people had experienced traumatic events such as abuse, violence, addictions, mental health issues, and many had been excluded from school. The young people (aged between 13 and 17) were users of multiple services (statutory and nongovernmental services including: child welfare, juvenile justice, remedial education, and mental health services). Qualitative interviews (n = 109) explored young people's experiences in their families, communities, education, and their perspectives on support provided by services and their own support networks. Three thematic clusters emerged as central motifs in young people's experiences and are the focus of this article: navigating "risky" environments; services and support; and, working to find different pathways. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Gout remains a health equity issue; Māori and Pacific peoples are disproportionately afflicted, with increased burden and loss of quality of life, yet are less likely to receive appropriate management, which mainly occurs in primary care. AIM: This study aims to understand the perspectives of the mainly Māori and Pacific clinicians and staff at an urban marae practice about barriers and challenges to delivering effective care to a Māori and Pacific community with high burden of gout. METHODS: Semi-structured interviews were conducted with 10 staff members delivering health care to a mostly Indigenous community. Interviews sought to ascertain staff views of enablers and barriers to optimal gout management and analyse them thematically. RESULTS: Three themes were identified: community disadvantage; demands unique to Indigenous providers; and challenges and opportunities for optimising gout management. High prevalence and heavy impact of gout on wellbeing in the community was intertwined with socioeconomic disadvantage, precariousness of employment and entrenched inaccurate (yet pliable) patient views on gout, to the detriment of focused, effective care. Structural and funding demands on providers inhibited staff focus on the clear community need. Providers saw the culturally safe and competent approach necessary for improvement as requiring community empowerment with appropriate clinical tools and adequate resourcing. DISCUSSION: Despite provider intent to deliver culturally appropriate and safe care and equitable health outcomes for patients suffering from gout, general practice initiatives without aligned resourcing or incentives are inhibited when inequity is pervasive. Simply asking Māori providers to do more for the same amount of resource may not be effective. [ABSTRACT FROM AUTHOR]

This article draws on the findings of the qualitative phase of a New Zealand longitudinal study on vulnerable young people’s transitions to adulthood. The young people were aged between 12 and 17 years at the time of the first interview. The paper focuses on one key finding, how youth enact agency through their relationships with significant others: families, social workers, teachers and care workers. These youth had experienced sustained exposure to harm including abuse, violence, addictions, disengagement from school and mental health issues. The qualitative interviews focused on young people’s experiences with services (child welfare, juvenile justice, mental health and education support services) their key transitions, and the strategies they used to locate support and resources. The thematic analysis of the interviews indicated that a search for agency was a central motif in young people’s experiences. This was reflected in three thematic clusters: making sense of the world, having a voice and acting on the world. [ABSTRACT FROM AUTHOR]

Introduction: The global nursing workforce is predominantly female, with a large proportion working in the 45–55 age group. Menopause is a transition for all women, and; therefore needs recognition as it can impact work performance and consequently staff turnover. Background: Women will go through the menopause, but not all women are affected. The menopause transition presents a range of signs and symptoms both physical and psychological which can impact the quality of life and individuals' work/life balance. The nursing workforce is predominantly women that will work through the menopause transition. Objectives: The study explored perspectives on digital health interventions as strategies to support menopausal women and to understand the requirements for designing health interventions for support in the workplace. Design: A qualitative explorative design. Settings: Nurses working in a range of clinical settings in England, Finland, Denmark, New Zealand, Australia and USA. Methods: Nurses (n = 48) participated in focus groups from six different countries from February 2020–June 2022 during the pandemic from a range of acute, primary care and education settings. Nurses were invited to participate to share their experiences. Thematic analysis was used. Results: All participants were able to describe the physical symptoms of menopause, with some cultural and possible hemisphere differences; more noticeable was the psychological burden of menopause and fatigue that is not always recognized. Four themes were identified: Managing symptoms in the workplace; Recognition in the workplace; Menopause interventions; and Expectation versus the invisible reality. These themes revealed information that can be translated for implementation into digital health interventions. Conclusions: Managers of nursing female staff in the menopausal age range need greater awareness, and menopause education should involve everyone. Finally, our results demonstrate design attributes suitable for inclusion in digital health strategies that are aligned with likely alleviation of some of the discomforts of menopause. Patient or public contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Health literacy is linked to better health outcomes and underpins effective self-management, yet over one-and-a-half million New Zealanders are known to have poor health literacy skills. An ability to access and understand health information is an important component of health literacy. Little is known, however, about New Zealand consumers' health information needs. This qualitative study sought to understand the perceptions of consumers related to their needs and use of health information. METHODS: Four focus group interviews provided data for this qualitative descriptive study. Data analysis used a thematic inductive approach. Participants were from the general population, accessed through community-based health organisations. These consumers were predominantly of New Zealand European ethnicity, female, older, and most were actively engaged in managing their health. FINDINGS: Four themes were identified: issues with current information provision; preferences for content; format; and sources of health information. These themes are described in the paper, using illustrative quotes from consumer participants. CONCLUSION: This study indicates that consumers have varied health information needs. Health professionals cannot assume that consumers all have the same health literacy skills. The ideal is to provide personalised, relevant information in a manner the consumer can understand, within the current time constraints in practice. Health professionals can support consumers in their use of different strategies to ensure their health information needs are expressed and met. [ABSTRACT FROM AUTHOR]

Introduction. Maternal vaccination against influenza and pertussis protects mothers and babies from severe disease and is recommended and funded in Aotearoa New Zealand. Despite this, maternal vaccination uptake is low, varies by region and is inequitable, with Māori and Pacific māmā (mothers) less likely to receive vaccination. Aim. To determine what interventions currently exist to support and encourage maternal vaccination against influenza and pertussis and what changes and interventions could be implemented to improve coverage, with a focus on Māori and Pacific hapū māmā (pregnant mothers). Methods. Interviews with six participants with diverse roles in the vaccination workforce were conducted. Participants were involved in education, certification and supporting vaccinators, high-level strategising, and vaccination. Interviews aimed to determine what interventions currently exist for hapū māmā, what changes need to be made to improve coverage and how Māori and Pacific people have been specifically engaged. Qualitative data analysis was used to determine themes. Results. Participants identified that interventions must focus on prioritising and emphasising the importance of maternal vaccination, promoting collaboration and innovation, making interventions accessible, and empowering Māori- and Pacific-driven avenues to vaccination. To create positive foundations, participants identified the importance of building and maintaining trust and affording mothers’ time and autonomy in vaccination. Discussion. Healthcare professionals need to proactively engage hapū māmā about vaccination and collaborate in service delivery. Interventions must be suitably accessible and allow for the autonomy of hapū māmā over vaccination decisions. Equity should be considered at the foundation of vaccine interventions to improve the accessibility of vaccines to all communities. [ABSTRACT FROM AUTHOR]

Introduction. A handful of reports detail efforts to redesign traditional hospital gowns to address common concerns related to patient comfort and privacy for big bodied patients. Results suggest that improving gown design has the potential to improve both the patient and carer experience and satisfaction of care. Aim. This study aimed to ascertain the utility of gowns purposely designed for big bodied patients (named Xcellent Gowns) from a staff perspective. Methods. Qualitative semi-structured interviews were conducted in 2022 with 14 hospice staff members. Interview transcripts were uploaded to DedooseTM. Data were analysed utilising reflexive thematic analysis according to a six-phase process including data familiarisation, iterative data coding, and theme development and refinement. Results. The qualitative analysis of the interview data identified four main themes: (1) the gown experience, (2) fit-for-purpose, (3) love and dignity, (4) design principles. Each theme is presented and discussed with illustrative quotes from participants’ interview transcripts. Discussion. The perspectives of the staff participants in this study confirm research findings from other healthcare settings, that the patient and carer experience may be improved through focused redesign of this vital item of patient clothing. [ABSTRACT FROM AUTHOR]

Purpose: Vocational rehabilitation (VR) involves complex skills, and often inter-disciplinary teams need to work effectively to meet the needs of stakeholders. Research highlights important influences on effective teamwork, including funding systems, team structure, policies and procedures, and effects of professional hierarchies. This qualitative study aimed to explore these issues in-depth including how factors interact to produce problems and solutions. We focused on identifying challenges and opportunities for VR teams working in the Aotearoa-New Zealand context which may also be transferrable to other settings. Methods: Qualitative descriptive instrumental case study involving focus groups and interviews with two VR teams (n = 14). Teams worked in musculoskeletal injury and were geographically diverse. Reflexive thematic analysis was used to analyse the data. Results: Analysis constructed three overarching themes: Having the Power, Being Human, and VR is Not for Everyone. Achieving trusting relationships within the team was paramount. This was achieved through seeing everyone as equal, and as human. Equality within the team was particularly important for professionals that occupied different positions of power in a wider professional hierarchy. VR specialist skills (experience and postgraduate qualifications) were often under-recognised, leading them to have little power in VR decision making processes. VR professionals also experienced competing demands between client needs and business drivers. Conclusion: Findings offer detail of processes teams engage in to create effective team relationships and manage systemic factors to facilitate positive outcomes. Additionally, findings highlight opportunities in decision-making processes for VR medical certification that may increase job satisfaction and better utilize skills and expertise. [ABSTRACT FROM AUTHOR]

In 2020, a government-funded healthy school lunch program was introduced in a quarter of New Zealand schools, selected due to high levels of socio-economic barriers. This study assesses the impact of the introduction of the school lunch program from family (whānau), student and school principal perspectives. Across four schools, we conducted five focus groups (two with secondary students and three with family members) and four school principal interviews. Participating schools represented a range of contexts: primary and secondary, schools with cooks in on-site kitchens and schools receiving meals delivered by external caterers. Thematic analysis was used to develop themes describing the health, wellbeing and nutritional impact of the program. Family participants were 82% Indigenous Māori and self-identified as having 'borderline' (73.5%) or no financial security (8.8%). Seven positive impact themes were identified: improved food security, enhanced equity, increased appreciation of healthy foods for students, enhanced mana (wellbeing) for all, reduced financial hardship/stress for families, opportunities for nutritional learning and recognition that appreciation and uptake happen over time. Four negative impact themes were identified: low uptake that created food waste, perception that healthy food is not palatable for students, lack of knowledge of the program and loss of agency for students. This is the largest intervention in nutrition and food security for children implemented in New Zealand since the 1930's. The first 2 years have offered wellbeing and financial benefits for students and families, particularly when school environments promote uptake. More involvement of students and family members in the program planning is essential. [ABSTRACT FROM AUTHOR]

Objective: Over 34% of New Zealand (NZ) adults are classed as obese, which reduces quality of life for many individuals. Those living in rural areas, high‐deprivation communities, and indigenous Māori populations are more likely to experience obesity and related co‐morbidities than other cohorts. General practice is positioned as most suitable to deliver effective weight management health care; however, little is understood about the rural general practitioner (GP) experience in NZ, despite having the majority of patients at high risk of developing obesity. The aim of this study was to investigate rural GP perspectives on barriers to delivering weight management. Design: Qualitative descriptive design guided by Braun and Clarke (2006) using semi‐structured interviews and analysed using deductive reflexive thematic approach. Setting: Rural Waikato general practice which has significant rural, Māori and high‐deprivation communities. Participants: Six rural Waikato GPs. Results: Three significant themes were identified: communication barriers, rural health care barriers, and social and cultural barriers. GPs reported not wanting to jeopardise the doctor‐patient relationship by discussing weight. GPs felt unsupported by the health system through lack of rurally appropriate obesity intervention options, funding and resources. The unique rural lifestyle and health needs were reportedly not understood at the wider health system level, making the role of a rural GP working in high‐deprivation communities more difficult. Additional barriers to delivering effective weight management included factors outside the clinical practice such as obesity stigma, an obesogenic environment and sociocultural factors shaping rural patients' lives. Conclusion: Rural GPs have a lack of weight management referral options that are considered effective for their patients, as the options available reportedly do not cater for their patients' unique rural health needs. GPs position addressing the individualised and complex weight management health issue as challenging. Navigating stigma, wider sociocultural issues, and limited intervention options were difficult and found to be questionable to achieve in a short 15‐min consult. There is a need for rural health support in the form of funding, staff (indigenous and non‐indigenous), and rurally feasible resources to improve health outcomes and reduce inequity. Effective primary care weight management strategies need to be appropriate for high‐deprivation rural communities, including tailored, affordable and reliable interventions that GPs can offer patients if future weight management efforts are to be successful in this space. [ABSTRACT FROM AUTHOR]

Delivery of interprofessional education (IPE) initiatives for pre-licensure students is increasingly the norm in health and social care training programmes. This collaborative form of education relies on teachers from various disciplines joining together to facilitate IPE. When IPE programmes first start, goodwill often prevails and facilitators are keen to take part. But as time goes on, retaining the IPE facilitator workforce is challenging. Research was undertaken to explore the experience of IPE facilitators who were part of a New Zealand university-based ten year old IPE programme. The research used a qualitative survey approach. Responses were received from 29% of all those invited to participate. Closed questions were collated and free-text survey responses analyzed using Template Analysis. Three themes and one integrative theme were identified. Themes include facilitators who are recognized, facilitators who are confident, and facilitators who are inspired. Themes were mediated by macro, meso and micro level forces. The cross-cutting integrative theme showed IPE facilitators experienced individual tipping points, with the potential to influence their continued involvement. These tipping points need to be recognized and addressed by those in senior level positions (macro-governance and meso-management), to ensure IPE facilitators continue and IPE programmes remain sustainable. [ABSTRACT FROM AUTHOR]

Introduction: Delivery of end-of-life care for severe chronic obstructive pulmonary disease (COPD) has been hampered by an unpredictable disease trajectory and poor integration of health care and social services. Objective: To critically explore the perspectives, values, and experiences of stakeholders in COPD end-of-life healthcare services in a large district in Aotearoa New Zealand. Design: Focus groups analysed utilising critical theory and Actor-Network Theory. Methods: Stakeholders in end-of-life COPD healthcare services were purposively sampled from a large healthcare network in Canterbury, Aotearoa New Zealand to participate in seven focus groups (bereaved carers, community-based health professionals, non-Māori, non-Pacific patients, and support people (two groups), Māori patients, supporters and health professionals, Pacific patients, support people and health professionals, and hospital-based health professionals). Participants discussed end-of-life care services for people with COPD. Transcripts were coded utilising descriptive and structural coding to develop themes related to provision of quality care. Participants were positioned as experts. We considered how the themes arising supported and disrupted the healthcare network for end-of-life COPD. Results: Five themes related to quality of care for end-of-life COPD were identified: compassion, competence, community, commitment, and collaboration. The absence of any of these five themes required for quality care led to power imbalances within healthcare systems. Power inequities created disconnection among stakeholders which then disrupted commitment, community, and collaboration. A dysfunctional healthcare network impeded compassion between stakeholders and did not support their competence, leading to lower quality care. All five themes were identified as essential to delivery of high-quality end-of-life care in COPD. Conclusion: Stakeholders' perspectives of end-of-life care for COPD identified of core features of a health system network that enabled or impeded the actions of stakeholders and allocation of resources to provide quality care. [ABSTRACT FROM AUTHOR]

Aim: We aimed to explore current approaches to assessing professionalism in dietetics education in Australia and New Zealand, and asked the questions what is working well and what needs to improve? Method: We employed a qualitative interpretive approach and conducted interviews with academic and practitioner (workplace‐based) educators (total sample n = 78) with a key stake in dietetics education across Australia and New Zealand. Data were analysed using team‐based, framework analysis. Results: Our findings suggest significant shifts in dietetics education in the area of professionalism assessment. Professionalism assessment is embedded in formal curricula of dietetics programs and is occurring in university and placement settings. In particular, advances have been demonstrated in those programs assessing professionalism as part of the programmatic assessment. Progress has been enabled by philosophical and curricula shifts; clearer articulation and shared understandings of professionalism standards; enhanced learner agency and reduced power distance; early identification and intervention of professionalism lapses; and increased confidence and capabilities of educators. Conclusions: These findings suggest there have been considerable advances in professionalism assessment in recent years with shifts in practice in approaching professionalism through a more interpretivist lens, holistically and more student‐centred. Professionalism assessment in dietetics education is a shared responsibility and requires further development and transformation to more fully embed and strengthen curricula approaches across programs. Further work should investigate strategies to build safer learning cultures and capacity for professionalism conversations and in strengthening approaches to remediation. [ABSTRACT FROM AUTHOR]

The burden of health inequities borne by Indigenous peoples can be overwhelming, especially when mothers and newborns' lives are at stake and health services seem slow to invest in responsiveness. In Aotearoa (New Zealand), urgent action is required to eliminate persistent systemic inequities for Māori (Indigenous) whānau (family collectives that extend beyond the household). This Kaupapa Māori (by Māori, for Māori) qualitative study aimed to explore the views of health practitioners identified as champions by whānau of preterm Māori infants. Ten health practitioners were interviewed and asked about their involvement with the whānau, their role in explanations and communication, and their thoughts on whānau coping. Interview data were analysed using interpretative phenomenological analysis. Three superordinate themes were identified: working together in partnership, a problem shared is a problem halved, and sacred space. Collaboration between health practitioners and with whānau was important to the champions and central to their goal of enabling whānau autonomy. This was built on a foundation of connectivity, relationships, and a full appreciation that childbirth is a sacred time that is potentially disrupted when an infant is born prematurely. The values- and relationship-based practices of these champions protected and uplifted whānau. They showed that health practitioners have important roles in both the elimination of inequities and the sustaining of Māori self-determination. This championship is an exemplar of what culturally safe care looks like in day-to-day practice with Māori and is a standard that other health practitioners should be held to. [ABSTRACT FROM AUTHOR]

Background: In Aotearoa/New Zealand (NZ) general practices diagnose and manage pre-diabetes. This work is important as it has the potential to delay or prevent the onset of Type 2 Diabetes (T2DM), reduce NZ's health inequities, and the burden that T2DM places on health care services. However, no study has previously examined how this work routinely occurs in NZ. Methods: Two case studies of practices serving ethnically and socio-economically diverse populations, followed by cross-case analysis. Results: The NZ health care context including funding mechanisms, reporting targets, and the disease centred focus of care, acted together to dis-incentivise and de-prioritise pre-diabetes care in general practices. The social determinants of health differentially influenced patients' ability to engage with and respond to pre-diabetes care, significantly impacting this work. Differing perspectives about the significance of pre-diabetes and gaps in systematic screening practices were identified. Interventions used were inconsistent and lacked comprehensive ongoing support. Conclusions: Complex multi-layered factors impact on pre-diabetes care, and many of the barriers cannot be addressed at the general practice level. The practice serving the most disadvantaged population who concurrently have higher rates of pre-diabetes/T2DM were more adversely affected by the barriers identified. [ABSTRACT FROM AUTHOR]

This study applied a fa'afaletui cultural lens to an exploratory qualitative study examining Samoan families' experiences and engagement with a person‐centred care model employed in specific mental health services in Aotearoa. Six semi‐structured talanoa group discussions with families who had been previously or currently engaged with mental health services. In addition, a local stakeholder group was recruited to guide stages of the fa'afaletui. A total of 13 individual participants from six families participated. Participants consisted of four mothers, two fathers, five sisters, one son, and one husband. Five themes were identified: (i) Fa'atuatua ile Atua; Spiritual faith in God; (ii) It is a hush hush topic; stigma of mental illness; (iii) We are in the dark with our communication and dealings with the services; (v) Practice what you preach; clinical service delivery misaligned with the model of care; and (vi) Alofa (love) and fa'aaloalo (respect); enablers of positive experience. The findings overall highlight spirituality and religion as core to a Samoan's faith to foster resilience and healing when facing adverse mental health events with their family members. In addition, the need to build up capacity for Pacific staffed specialist services and Pacific model to achieve equity and holistic care for Samoans and other Pacific populations at risk of adverse mental health outcomes are recommended. [ABSTRACT FROM AUTHOR]

Background: Decreasing oral intake is common towards the end of life and a potential source of distress and concern for patients, relatives, whānau and clinicians. This paper provides insight to inform practice regarding clinicians' perceptions, practices, responses and communication with patients and their companions regarding declining oral intake towards the end of life. Methods: In this qualitative study ten specialist palliative care staff participated in semi-structured interviews. Qualitative thematic analysis was used to analyse the data. Findings: Three themes were identified: declining oral intake was a natural part of the dying process; responding empathetically; and clinicians described specific aims and ways regarding communication. Conclusion: Insight into clinicians' endeavours to manage declining oral intake and support the wellbeing of patients, families, and whānau can inform practice. However the perspectives of family, whānau and health professionals continue to show significant variation regarding the communication given and received around declining oral intake towards the end of life. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Research supports talking about death outside the end-of-life context. Benefits include allaying death anxiety to increased engagement in health promotion interventions. Nonetheless, the focus on death conversations remains centred on the imminently dying. This qualitative study investigated New Zealanders' perspectives on the value of, opportunities for, and barriers to death conversations in primary healthcare. METHODS: Twenty-one participants were interviewed. Participants were young older adults (54-65 years) not receiving palliative care or diagnosed with a terminal illness. Most were women who identified ethnically as New Zealand European. An immersion-crystallisation approach to thematic development was used to accommodate the multidisciplinary research framework. RESULTS: Four core themes were identified: 'a need to talk about death'; 'the role of the GP'; 'broaching the topic'; and 'media'. CONCLUSION: A cultural silence on death has rendered both the medical and lay community insufficiently prepared for frank and meaningful engagement with the topic, exacerbated by restricted consultation timeframes. The ease of death conversations may be facilitated by taking a family-centred approach, using community organisations and settings, and harnessing conversation entry points provided by the media. Future research should aim to develop tailored resources and frameworks to support general practitioners' meaningful engagement with the topic of death both within and outside of the end-of-life context. [ABSTRACT FROM AUTHOR]

This study aimed to explore the experiences of civil rights of disabled children receiving physiotherapy in New Zealand. As yet there is limited attention given to this topic in rehabilitation literature. We conducted a qualitative study that drew on the fields of childhood studies and disability studies to address the study aim. Seven disabled children who used local physiotherapy services (aged between four and 14 years) were interviewed using child-centered methods. In addition, their parents were interviewed individually, and eight rehabilitation professionals and disability advocates took part in a focus group discussion. Interpretive thematic analysis was used to analyze findings. The participating disabled children all appreciated being informed about physiotherapy, but had individual preferences regarding involvement in decision making. They described positive and negative influences on their experiences, but indicated they may not have been asked by adults about these. Parents, professionals and advocates described that attempting to promote a positive experience for children is constrained by understandings regarding the purposes and practices of physiotherapy. Our findings suggest it is important to get an understanding of individual children's views and preferences regarding physiotherapy in order to promote opportunities for choice, control and satisfaction. In this way physiotherapists can ensure disabled children's civil rights are realized in practice. [ABSTRACT FROM AUTHOR]