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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]

New Zealand is a peaceful nation, but ongoing political tensions and inequities between Māori (the indigenous peoples of New Zealand) and Pākehā (the majority group of Europeans) persist as a result of its colonial history. Identifying ways to redress the enduring legacy of colonialism are therefore of critical importance. Accordingly, this paper examines data from 7017 Māori, as well as 37,233 Pākehā, to examine the impact of regional-level Pākehā warmth towards Māori on Māori support for progressive collective action. Results reveal that Pākehā warmth towards Māori varies markedly across 257 regional wards (regional units created for New Zealand electoral purposes). Moreover, multilevel modelling demonstrates that Pākehā warmth towards Māori at the region-level correlates positively with Māori identity and political efficacy at the individual level which, in turn, both correlate positively with collective action support. Collectively, these results demonstrate the impact of the broader social climate on social change, while identifying a previously-unknown facilitator of collective action support (namely, a broader context of warmth towards structurally disadvantaged groups). [ABSTRACT FROM AUTHOR]

Introduction. Uptake of maternal vaccinations (MVs) is suboptimal in Aotearoa New Zealand, particularly for Māori. Aim. To describe Māori women’s journeys regarding maternal pertussis and influenza vaccinations and explore influences on uptake. Methods. Semi-structured interviews were conducted in Waikato, Aotearoa New Zealand, with pregnant or recently pregnant Māori women, and separately with Māori healthcare professionals (HCPs) to understand women’s decisions regarding MVs and enablers and barriers to uptake. Results. Nine women and nine HCPs were interviewed. Verbal communications from midwives, general practice and pharmacy strongly influenced women’s journeys. Women’s decisions appeared largely straight-forward, with influences including awareness, knowledge, underlying beliefs and previous MVs. Enablers for MV uptake included HCPs’ discussions, pro-vaccination beliefs, and accessibility. Barriers for MV uptake included poverty (and transport), lack of awareness, insufficient knowledge of benefits, late presentation to the midwife and other commitments or challenges in the women’s lives affecting prioritisation of the vaccine. Misconceptions, seasonality, and lower HCP emphasis impaired influenza vaccination uptake. Discussion. With multiple barriers to accessing MVs, HCPs who see pregnant women are the primary resource to improve awareness, knowledge, and access through kōrero (discussions) with the woman and, where possible, being able to administer the vaccinations. These HCPs need to be well-informed, aware of likely concerns women may have and how to address them, encourage these discussions and preferably be trusted. [ABSTRACT FROM AUTHOR]

Background Many public health experts have claimed that elimination strategies of pandemic response allow 'normal social life' to resume. Recognizing that social connections and feelings of normality are important for public health, this study examines whether, and for whom, that goal is realized, and identifies obstacles that may inhibit its achievement. Methods Thematic analysis of narratives obtained via a qualitative cross-sectional survey of a community cohort in Aotearoa | New Zealand. Results A majority of participants reported that life after elimination was 'more or less the same' as before the pandemic. Some became more social. Nevertheless, a sizeable minority reported being less social, even many months after elimination. Key obstacles to social recovery included fears that the virus was circulating undetected and the enduring impact of lockdowns upon social relationships, personal habits and mental health. Within our sample, old age and underlying health conditions were both associated with a propensity to become less social. Conclusions Elimination strategies can successfully allow 'normal social life' to resume. However, this outcome is not guaranteed. People may encounter difficulties with re-establishing social connections in Zero-COVID settings. Measures designed to overcome such obstacles should be an integral part of elimination strategies. [ABSTRACT FROM AUTHOR]

Our study with 71 children aged 6-14 living in New Zealand and Samoa, provides a new child-centred perspective on transnational diasporic families. We use the Pacific concept vā to frame the study, in which children's transnational-kinship connections reflect relational rather than physical approaches to space. Familial habitus surpasses spatial habitus as children's primary reference point. For diasporic children, family keeps alive their sense of Pacific Island belonging. Transnational kinship ties give Pacific children additional resilience in adapting to unknown futures. [ABSTRACT FROM AUTHOR]

Background and Objectives: Gay and bisexual men (GBM) are deferred from donating blood in many countries. Perceptions by GBM that blood donor deferral policies are unjustifiably discriminatory, especially due to advances in HIV prevention, could contribute to non‐compliance and need to be understood. We explore blood donation interest and history among GBM and attitudes towards donor deferral policies for the first time in New Zealand (NZ). Materials and Methods: Data from a cross‐sectional online survey of GBM in NZ were examined. We constructed three groups: (1) never donated blood and not interested; (2) never donated but expressed interest; and (3) previously donated blood. We tested these for association with demographic and behavioural variables, as well as attitudes towards blood donation policy. Results: A total of 607 GBM were eligible for the study, of whom 32.9% reported having donated blood previously, 44.3% had never donated blood but expressed interest and 22.7% expressed no interest in donating. Among previous donors, a third (8.6% of the total sample) reported non‐compliance with the deferral policy. Most participants found the 12‐month deferral policy to be too strict (81.8%), unfair (75.4%) and homophobic (68.8%). Conclusion: We estimate that, for the first time in NZ, almost 10% of the sample did not report compliance with the 12‐month deferral policy for men who have sex with men (MSM). Negative attitudes towards the deferral policy were common and could potentially increase the risk to the blood supply if compliance reduces. Further work is needed to inform a deferral policy that is accepted by GBM while maintaining the safety of NZ's blood supply. [ABSTRACT FROM AUTHOR]

As psychosocial factors have been recognised as significant predictors of the recovery trajectory from chronic back pain, the 34-item Back Pain Attitudes Questionnaire (Back-PAQ) was developed based on themes obtained from patient interviews, but previous psychometric analyses with a general population sample revealed uncertainty around the factor structure of the instrument. To provide more detailed information about the psychometric properties of the Back-PAQ when used with participants from the general population and also to test the internal validity of the tool for use with General Practitioners (GPs). After applying partial-credit Rasch analysis with a sample of participants from the general population (n = 600), a replication analysis was conducted with a sample of GPs (n = 184). This approach permitted examination of sample-specific personal factors for differential item functioning. Subtests were used to differentiate between local dependency due to underlying dimensionality from local dependency due to method effects. A unidimensional fit to the Rasch model was achieved after 14 misfitting items had been deleted. The final 20-item solution also fit with a sample of 184 GPs. In both cases, the Back-PAQ-20 demonstrated good reliability (PSI ≥ 0.80), with no evidence of differential item functioning by personal factors. The ordinal-to-interval conversion algorithms presented here further enhance the precision of the scale and permit analysis of Back-PAQ-20 scores using parametric statistics. The present study provided evidence for valid and reliable assessment of the back pain recovery beliefs of both users as well as providers of health services. Psychosocial factors have been recognised as significant predictors of the recovery trajectory from chronic back pain. The 34-item Back Pain Attitudes Questionnaire (Back-PAQ) was developed based on themes obtained from patient interviews, but previous psychometric analyses with a general population sample revealed uncertainty around the factor structure of the instrument. The 20-item version of the Back Pain Attitudes Questionnaire (Back-PAQ) is shown here to have strong psychometric properties for administration with users and providers of health services. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has disrupted all aspects of life and may raise particular fears for people with rheumatic disease. There is a need for research on fears and perceived risk of SARS‐CoV‐2 so as to understand the impact on wellbeing and inform service provision. Objectives: The aim of this study was to examine the correlates of COVID‐19 fears and perceived risk of SARS‐CoV‐2 among people with rheumatoid arthritis or ankylosing spondylitis. Design: A cross‐sectional survey design was applied in Aotearoa New Zealand in the period after initial nationwide lockdowns. Method: An online survey was completed from July to September 2020 by 126 individuals with rheumatoid arthritis (n = 96) or ankylosing spondylitis (n = 30) who had previously been recruited to the Patient Opinion Real‐Time Anonymous Liaison (PORTAL) study in 2015 or 2018. The survey included demographics and health information as well as measures of COVID‐19 fears and experiences, functional disability and fatigue‐related disability. Results: Fears about COVID‐19 were higher among younger participants, those who had been tested for SARS‐CoV‐2, and those who experienced more flares over the initial lockdown. Perceived risk of SARS‐CoV‐2 infection was also higher among individual who had been tested for SARS‐CoV‐2 and those taking biologic medications. Conclusion: Fears about COVID‐19 and perceived risk of infection are related to age, health and medications among individuals with rheumatoid arthritis or ankylosing spondylitis. These findings inform how health professionals can help address the concerns of particular groups of people with rheumatic disease by providing relevant information about the ongoing effects of the pandemic. [ABSTRACT FROM AUTHOR]

Recent pre-pandemic research suggests that living wages can be pivotal for enhancing employee attitudes and subjective wellbeing. This article explores whether or not the present COVID-19 pandemic is impacting pivotal links between living wages and employee attitudes and subjective wellbeing, with replication indicating robustness. Twin cohorts each of 1,000 low-waged workers across New Zealand (NZ), one pre- (2018), and one present-pandemic (2020) were sample surveyed on hourly wage, job attitudes, and subjective wellbeing as linked to changes in the world of work associated with the pandemic (e.g., job security, stress, anxiety, depression, and holistic wellbeing). Using locally estimated scatter-point smoothing, job attitudes and subjective wellbeing scores tended to pivot upward at the living wage level in NZ. These findings replicate earlier findings and extend these into considering subjective wellbeing in the context of a crisis for employee livelihoods and lives more generally. Convergence across multiple measures, constructs, and contexts, suggests the positive impacts of living wages are durable. We draw inspiration from systems dynamics to argue that the present government policy of raising legal minimum wages (as NZ has done) may not protect subjective wellbeing until wages cross the living wage Rubicon. Future research should address this challenge. [ABSTRACT FROM AUTHOR]

Building public trust and willingness to vaccinate against COVID-19 is as important as developing a safe and effective vaccine to contain the pandemic. Based on the theory of planned behaviour and trust heuristic, this study tests factors associated with COVID-19 vaccination intentions using a national sample survey of the New Zealand public (N = 1040). Results show that while trust in health experts, Prime Minister Jacinda Ardern, and mass media are significantly associated with COVID-19 vaccine intention, affective attitude, and cognitive attitude partly mediate this relationship. Findings can help inform theory and practice of health campaigns to increase COVID-19 vaccine uptake. Trusted sources communicating information that addresses prevailing vaccine concerns are likely to increase public enthusiasm for COVID-19 vaccination. [ABSTRACT FROM AUTHOR]

Understanding employability for Māori, the Indigenous peoples of Aotearoa New Zealand (NZ), is an under researched area. The dominant Western culture, structures and practices in university and industries within NZ have obscured Māori presence and limited Māori student's expression of their own cultural identity. The current employment environment in NZ is starting to appreciate and recognize the contribution of Māori values and principles in the workplace. The demand for Maori employees competent in tikanga (Māori protocols) and Te Reo (Māori language, one of three official languages of NZ) is on the rise. We highlight the need to explore ways to change Higher Education and work-integrated learning (WIL) to better enable and encourage students to explore their cultural identity and add value into the workplace by bringing their 'whole selves' and their 'superpower'. This study adopted a case study methodology to examine employability from a Māori perspective. [ABSTRACT FROM AUTHOR]

To understand how suspected suicides are investigated in New Zealand we conducted a thematic analysis of in-depth interviews with coroners. Coroners identified the inquisitorial nature of the coronial system and coroners' wide powers of jurisdiction as key strengths of the system. Important influences in key areas of coronial decision making in cases of suspected suicides included; the need for more evidence – especially to determine intent, and family factors, including therapeutic jurisprudence. Coroners identified lack of follow up and monitoring of recommendations, poorly resourced coronial training and the personal impact of suicides as challenges of working in the coronial system. [ABSTRACT FROM AUTHOR]

For older people gardens may be paradoxical sites. Whilst gardening is associated in multiple ways with wellbeing and health, gardens may also become a source of frustration and worry as ageing bodies limit gardening activities. Yet determination remains. However, little of the well-established body of work on gardens and old age includes people in advanced age. In this paper, we draw on interviews with Māori and non-Māori 85-90-year olds in Aotearoa, New Zealand, focusing on how they talk about their wellbeing in relation to past, present, and future experiences of home gardening. Our research shows home gardens and gardening figure prominently and positively in the narratives of people in advanced age. Most of our participants described themselves as active gardeners; most also lived with multimorbidity, sometimes severe and complex. Applying positioning theory, we examine how our participants connect gardens and gardening to identity; connectedness; and adaptation and renegotiation of health and wellbeing in ageing bodies. Home gardens are 'more than therapeutic'; while they are protective of health and wellbeing, they are also enabling places for the expression and performance of agency in advanced age. These understandings have practical implications for supporting wellbeing amongst those in advanced age. • Gardening links to health & well-being, but may also cause frustration & worry. • We explore home gardening of people in advanced age including older indigenous people. • Most participants identified as active gardeners; most lived with multimorbidities. • They related gardening to identity, connectedness, & expressing agency in very old age. • Home gardens protect health & are enabling places; they are therapeutic and more. [ABSTRACT FROM AUTHOR]

Disabled young people have lower levels of participation in community life than nondisabled peers across a number of domains, including sporting activities, with profound implications for health, wellbeing and life course opportunities. Playing sport is a defining feature of identity for many young people in Aotearoa/New Zealand. Participation in sporting activities provides opportunities to develop competencies, to have fun and to compete, while also providing a sense of inclusion and peer group belonging. However, despite policies promoting inclusion of disabled young people in school and club sport, ableist attitudes and practices still function to exclude individuals who do not fit able-bodied norms. Drawing on recent 'assemblage thinking' in health and cultural geography, this paper explores the material, social and affective dimensions of 'enabling' and 'disabling' sporting assemblages, drawing on interviews with 35 disabled young people (12–25 years), parents and key informants. Many reported instances of demoralising exclusion in mainstream sporting activities. Some turned to adaptive sporting codes, designed for inclusion. In our exploration of participants' embodied experiences of enabling and disabling assemblages we employ assemblage theory to examine how social, affective and material forces and processes converge to either enable or constrain participation in local sporting activities. We close with a brief assessment of the implications of our analysis for ongoing efforts to promote inclusion for disabled youth in physical activity. • Disabled young people have lower sports participation levels than non-disabled peers. • Ableist attitudes and practices frequently exclude those who do not fit able-bodied norms. • Ableist attitudes produce social, cultural and physical barriers to participation. • Disability-specific sports can enable experiences of pleasure, freedom and inclusion. • Assemblage thinking has helped identify forces that enable/constrain participation. [ABSTRACT FROM AUTHOR]

This research examines the impact of digitized and digital indigenous knowledge collections (D‐IKC) on cultural knowledge transmission, social connections, and cultural identity through semi‐structured interviews with 8 users of D‐IKC in New Zealand. The participants acknowledged that D‐IKC brought about many benefits, including the surfacing of otherwise hidden or inaccessible cultural heritage. Concerns around digital access, digital competency, and responsiveness to cultural values need to be thoughtfully addressed nevertheless. Use of D‐IKC had impact not only at an individual level but also at a social‐community level. We highlight several traditional cultural values related to D‐IKC use that are not embodied in existing value‐impact frameworks. This research also found that the intersection and interactions among individual needs, cultural expectations, and norms and affordances around the digital information environments concerned were nuanced and multifaceted. These facets must be incorporated into the stewardship of knowledge collections. We also observed "digital knowledge sharing in the wild"—knowledge transmission that transpired and in some cases led to creation of knowledge resources that materialized outside the bounds of the originating repositories and institutions. Further studies into such self‐organized knowledge transmission/sharing phenomena can lead to valuable insights to inform and shape the curation and design of D‐IKC. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Pacific populations in New Zealand are aging, but little is known in the health-care environment about their experiences with cognitive impairment. AIM: The aim was to explore the needs of Pacific peoples affected by age-related cognitive decline from the perspectives of health-care providers. METHODS: Six health-care service providers from organisations focused on Pacific patients were interviewed to determine services available to aged Pacific peoples, access, and whether they met Pacific people's needs. RESULTS: Three areas of concern were identified by all participants: access to services; getting a diagnosis; and communication and language. Many experienced a lack of information and poor access to services. Diagnosis of cognitive impairment was frequently made difficult by inconsistent access to general practitioners in lower socio-economic areas. Communication was hindered by poor access to information in Pacific languages. DISCUSSION: Common themes noted by all participating health-care providers indicated the needs of aged Pacific people experiencing cognitive decline were often not being met. [ABSTRACT FROM AUTHOR]

Bronchiectasis is a chronic respiratory disease that impacts significantly on quality of life for those who have it. There is a paucity of literature exploring the perspectives of children and young people. The aim of this study was to examine the day-to-day life experience of a group of young people with bronchiectasis. A qualitative study using semi-structured interviews explored fifteen young people's perspectives of life with bronchiectasis. Key themes were identified using an inductive iterative approach through constant comparative analysis guided by Thorne's interpretive description. Life with bronchiectasis was conceptualized by participants as "Pretty Normal". This consisted of two co-existing life views which represented how young people balanced the ups and downs of adolescence while learning to accommodate the demands of living with bronchiectasis. Three key thematic elements "sore and tired", 'life interrupted and "looking after self", influenced and challenged these two views of life. Young people with bronchiectasis portray life as being the same as their peers. Despite this, they recognized that the symptoms, interruptions, and self-management responsibilities led them to find ways of coping and integrating their experience into a new and modified view of normal. [ABSTRACT FROM AUTHOR]

Animal therapy has been shown to have both physiological and psychological benefits for older people, including improvements in outlook and social interaction. Volunteer-led animal visitation programmes are common within residential aged care facilities in New Zealand. Visits by animals and handlers are intended to improve the quality of life of people in residential care. Very little research has been conducted on the informal animal visitation programmes typical in care facilities in New Zealand. This project examined the experience of animal therapy in two residential aged care homes that receive animal visits from an animal welfare organisation. In-depth interviews were conducted with seven older people about their experiences of the programme and analysed using narrative analysis. Three overarching narratives were identified: animal therapy as a fleeting pleasure, residential care as a sad environment, and identity outside residential care as highly valued. Older people in residential care do value animal therapy, but it is narrated as a fleeting pleasure, rather than having a long-lasting or far-reaching impact on the daily experience of residential care. In some ways, the structure of the animal therapy programme may underscore the challenges to everyday autonomy and identity experienced in residential aged care. These findings can be used to develop animal visiting programmes which recognise the importance of a valued social identity in later life. [ABSTRACT FROM AUTHOR]

Objective. Effective clinical governance can improve delivery of health outcomes. This exploratory study compared perceptions of clinical governance development held by registered health professionals employed by two different but interrelated health organisations in the broader New Zealand (NZ) health system. Most staff in public sector healthcare service delivery organisations (i.e. District Health Boards (DHBs)) are registered health professionals, whereas these clinical staff represent a small minority (5%) in social insurance organisations (i.e. the Accident Compensation Corporation (ACC)). Given these different contexts, comparison of results from three surveys of clinical governance perceptions identified key learnings for the development of clinical governance. Methods. The Clinical Governance Development Index (CGDI) was administered to registered health professional staff in NZ DHBs and ACC, at different time points. The data were explored, compared and reported. Results. Responses to survey items completed by NZ DHB staff and registered health professionals employed by ACC were compared. For each administration, there was a similar profile of positive responses across the seven CGDI items. The 2020 ACC survey results for one item were clearly different. This item asked about perceptions of full and active involvement in organisational processes and decision making (i.e. clinical engagement). Conclusions. Perceptions of registered health professionals working in the NZ public sector delivering health services were compared with those held by staff employed by a NZ social insurer predominantly commissioning and influencing care. The results indicated similar levels of clinical governance development. Clinical governance development in the ACC context can benefit from clear communication, building strong supporting structures and greater management-clinical provider partnerships. Clinical governance development drives health outcomes and regular measurement of developmental progress can provide momentum. There is room across the NZ health system to raise awareness and leverage clinical governance to deliver improved health outcomes. [ABSTRACT FROM AUTHOR]

Background: Changes in pharmacy models of care, services and funding have been occurring internationally, moving away from the traditional dispensing role to more extended patient-facing roles utilising pharmacists' clinical skills. This study aimed to identify the extended services offered by community pharmacy in Aotearoa New Zealand and the barriers and facilitators to extended services provision. The study is unique in that it includes intern (pre-registration) pharmacists.Methods: An online survey, conducted in 2018, of all pharmacists and intern (pre-registration) pharmacists working in a community pharmacy. Data were analysed using descriptive statistics and regression analyses.Results: The results are based on replies from 553 community pharmacists and 59 intern pharmacists (response rate: 19 and 26% respectively). Both pharmacists (83%) and interns (85%) want to work at the top of their scope of practice. Wide variation exists in the specific services individual pharmacists offer. Most pharmacists were accredited to supply the emergency contraceptive pill (95%), sildenafil for erectile dysfunction (86%) and trimethoprim for uncomplicated urinary tract infection (85%). Fewer were able to immunise (34%) or to supply selected oral contraceptives (44%). Just under a quarter could provide a Medicines Use Review (MUR) or Community Pharmacy Anticoagulation Management Service (CPAMS). Of the pharmacists not already accredited, 85% intended to gain accreditation to supply selected oral contraceptives, 40% to become vaccinators, 37% to offer CPAMS and 30% MUR. Interns expressed strong interest in becoming accredited for all extended services. Poisson regression analyses showed key factors supporting the likelihood of providing extended services were owner and management support and appropriate space and equipment. Being excited about the opportunities in community pharmacy, having employer funding and time for training and sufficient support staff were also statistically significant.Conclusions: Pharmacists need time and a supportive management structure to enable them to deliver extended services. Health policy with a greater strategic emphasis on funding services and pharmacist training, and developing technician support roles, will help to minimise or eliminate some of the barriers to role expansion both in Aotearoa New Zealand and internationally. [ABSTRACT FROM AUTHOR]

Former quota refugees are known to have higher health and social care needs than the general population in resettlement countries. However, migrants with a refugee-like background (refugee-like migrants) in New Zealand are not currently offered systematic government-sponsored induction or health services. This study explored the experiences of New Zealand health and social care providers in general practice. Staff at two Wellington region general practices with known populations of refugee-like migrants and former quota refugees were approached to participate in an exploratory qualitative study. Semistructured audio-recorded interviews and focus groups were undertaken. Deductive and inductive analyses were used to identify key themes. Twelve interviews were undertaken with professionals with backgrounds in clinical pharmacy, cross-cultural work, general practice medicine, primary care nursing, reception and social work. Key themes from the interviews were communication challenges, organisational structure and teamwork, considerations to best meet core health and support needs, and the value of contextual knowledge. Healthcare workers perceived many similarities between working with refugee-like migrants and working with former quota refugees. Even though communication challenges were addressed, there were still barriers affecting the delivery of core health and support services. Primary care practices should focus on organisational structure to provide high-quality, contextually informed, interprofessional team-based health and social care. Migrants, especially family members of former refugees, may have similar health and social experiences to former refugees. Health and social care professionals should take these experiences into account when planning and providing care. Little is known about how professionals specifically interact with such migrants, so we examined the experiences of primary care professionals, finding key themes for successful care. This expands on research into the health of former refugees, emphasising the importance of also considering the health needs of migrating family. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study aimed to explore the experiences and perceptions of nursing home staff and residents of unauthorised covert administration of medication. Prior studies identify that covert medication administration (crushing medication to administer in food or drink) is common in nursing home settings. Still, few recognise that this practice may occur without consultation or clinical authorisation. Design: An exploratory qualitative study was conducted with nursing home staff and residents as part of a more extensive mixed‐methods study on medication omissions and clinical decision‐making. Methods: We conducted a qualitative study using focus groups and semi‐structured interviews across four geographical areas in New Zealand to better understand nursing home staff and residents' experiences and perspectives on covert administration. Semi‐structured interviews took place with 11 Clinical managers/leads and one senior Registered Nurse; role specific focus groups were held with Registered Nurses (n = 6), Health Care Assistants (n = 14), and Residents (n = 12). Data were analysed using thematic analysis. Findings: Participants described covert administration as a practical option if a nursing home resident refused medication but recognised it was a deception that carried ethical and clinical risks, particularly when unauthorised. Participants felt that unauthorised covert administration stemmed from doubts about residents' competence and the competing demands staff face during medication administration. Staff, who typically relied on advice from their pharmacies around which medications were safe to crush, expressed a need for more education. Conclusions and Implications for practice: This study provides evidence that unauthorised covert administration of medications is an ongoing practice, using New Zealand nursing homes as an example. The results emphasise that nursing home staff and residents are aware that this practice carries ethical and clinical risks and requires a certified process to legitimise its authorised form. [ABSTRACT FROM AUTHOR]