Search

This paper presents policy document analysis as practical tool that can be put to valuable use by educational leaders and can also be adopted as a research method. Educational leaders are at the forefront of policy interpretation and consequently need knowledge and skills that enable them to analyse policy as part of their work in developing, implementing and reviewing organisational policy. They need to be able to look behind the policy to know what forces brought it into being; to tap into policy history to know how it was constructed; and most importantly, evaluate the way it is working to achieve its stated purposes. The analysis of policy documents is also an established and appealing qualitative research method, especially for students engaged in postgraduate research associated with educational leadership and policy studies because policy documents offer background insights into understanding educational problems in both research and practice. In this paper advantages and disadvantages associated with using documentary analysis as a qualitative research method are outlined and practical document analysis tools and approaches are presented.

This paper delves into the innovative use of the potluck, or "pa'ina," as a metaphor to reimagine a research approach aimed at fostering collective understanding between non-Indigenous knowledge seekers and Indigenous knowledge guardians in Indigenous contexts. By embracing the broader context of research, this metaphor strives to create a dialogical, relational, and ethical space for knowledge seekers to engage with knowledge guardians, promoting a reciprocal and respectful relationship. Central to this metaphor is the recognition of the insider/outsider binary and the need to transcend it. Indigenous knowledge is often guarded and restricted, granted access based on relationships and shared experiences. Understanding the complexity of these socio-spatial relationships is crucial for researchers to navigate respectfully. The metaphor also draws from the Oceanic concept of "va/va/wa," signifying the space between entities and the importance of maintaining harmony and balance within relationships. This relational space between the self and the other allows for transformative encounters and meaningful connections. To navigate this third space, researchers must undergo introspective reflexive exercises to understand their situationality and how it influences their research. Knowledge seekers must unsettle their histories, understand context, listen to the stories of others, create shared understanding, and launch new relationships that are centered on respect and reciprocity. Throughout the research process, the metaphor of "pa'ina" encourages researchers to be active participants, nurturing relationships with communities they seek knowledge from and reflecting upon their role within it. The "pa'ina" metaphor offers a transformative approach for Western academia to critically examine its historical impact on Indigenous communities and embrace a more respectful and inclusive research paradigm. By centering Indigenous voices and building meaningful relationships, this third space provides an opportunity for collaborative and sustainable research for the benefit of all stakeholders involved.

Teaching and learning research in higher education, often referred to as the Scholarship of Teaching and Learning (SoTL), is still relatively novel in many academic contexts compared to the mainstay of disciplinary research. One indication of this is the challenges those who engage in SoTL report in terms of how this work is valued or considered credible amongst disciplinary colleagues and in the face of institutional policies and practices. This paper moves beyond the literature that describes these specific challenges to investigate how 23 experienced SoTL researchers from five different countries understood the notion of credibility in relationship to their SoTL research and how they went about developing credibility for their work. Semistructured interviews were facilitated and analyzed using inductive analysis. Findings indicate that notions of credibility encompassed putting SoTL research into action and building capacity and community around research findings, as well as gaining external validation through traditional indicators such as publishing. SoTL researchers reported a variety of strategies and approaches they were using, both formal and informal, to develop credibility for their work. The direct focus of this paper on "credibility" of SoTL work as perceived by experienced SoTL researchers, and how they go about developing credibility, is a distinct contribution to the discussions about the valuing of SoTL work.

In this paper, we consider the implications of a commitment to acknowledging the role of context within a research practice partnership. We outline the approach to doing so within a design-based research intervention with 42 schools across three Pacific Island countries to improve literacy learning and language development. In doing so, the paper identifies context as a central concern for student and teacher learning, for schools as organisations and for intervention implementation. We draw on theories of context from each of these research bases to consider how aid interventions can best contribute to enhancing student learning outcomes across varied student populations in a way that is contextually appropriate, and builds sustainable local capability for ongoing improvement. In considering these concerns we argue for the potential of a design-based research approach, based on the Learning Schools Model (McNaughton, Lai, Jesson & Wilson, 2013) to incorporate "co-design" of the intervention. We exemplify how the process of jointly designing the content and implementation within preset phases of implementation is possible in ways that draw on the varied expertise of in-country and external partners. The focus on collective knowledge building, collective problem solving and sharing practice within trusting relationships is considered to foster capacity for sustained adaptation and improvement at local levels. We believe such an approach is relevant to the challenges faced by Pacific Island Ministries of Education and their aid donor partners in designing effective interventions for learning improvement.

The move to focus on Pacific indigenous research methodologies and methods is a complex yet ongoing experience for researchers of Pacific heritage. The relational positionalities of Pacific researchers allow a move away from a dual or binary perspective of one's research responsibilities to a more fluid understanding of what it means to do research by, for, with Pacific communities. This paper highlights the diverse experiences of three Pacific researchers taking into consideration heritage connections, socio-cultural backgrounds and research contexts. We utilise talanoa as a method of engagement, reflexivity, and sharing of our experiences with Tongan, Samoan and Fijian communities. We argue that talanoa as a Pacific research method enables the diverse layers of experiences that take into particular consideration our connections to land, people and knowledges in the diaspora.

In March 2004, Stephen Ball and others presented a symposium at the conference of the British Educational Research Association (BERA) on the necessity of theory in educational research. Like Ball, I have observed that theory, not just social theory, is a difficult space and one that divides researchers (those comfortable with theory and those less so), within educational research. It is an aspect of educational research training that rarely receives the attention essential for "quality" educational research. In the context of the contemporary research assessment exercises, it is worth reflecting on the relationship between research informed by social theory and expectations of quality and impact. In this paper I revisit the argument made by Ball and others for the necessity of theory, and discuss its role in framing research questions, informing analysis, and promoting reflexivity on the significance and relevance of research. I illustrate this process by discussing the ways theory can assist in the generation of research agendas and questions. I conclude the paper with an example of how a team of educational researchers from Australia, UK and New Zealand have made use of social theory to inform an Australian Research Council (ARC) funded project investigating the recontextualisation of health knowledge in schools. (Contains 1 endnote.)

A number of researchers have done extensive work on ontologies, epistemologies and pedagogies in relation to Pasifika research, but little on methodologies. Vaioleti describes talanoa as a phenomenological research approach which is ecological, oral and interactive. Halapua's article Talanoa Process: The Case of Fiji (2008) emphasises talanoa as a potential model for conflict resolution following Fiji's coup in the year 2000. Recently, talanoa as a research methodology has become widely used in the Pacific research arena. It has been defined by scholars as creating meaning out of nothing or simply to talk, gossip, share or chat about nothing. 'Talaloto' -a research methodology that I introduce and outline in this article is closely related in many ways to talanoa. While talanoa is the co-construction of knowledge/ideas by two or more people, talaloto is a person's testimony of constructed knowledge or lived experiences. There is a scarcity of information on this traditional practice yet like talanoa it is rooted in Tongan oral tradition. This paper foregrounds talaloto as a traditional cultural practice and it explains its use as a research methodology. It is hoped that more researchers will consider using this method in the future, recognising its place within Pasifika methodologies and its ability to generate rich and authentic data.

Teacher agency (TA) has been increasingly supported as an influential factor for teacher professional learning, school improvement and sustainable educational change. Previous studies, however, feature a variety of discrepancies in their conceptualisation and approaches to examining teacher agency. A systematic review is essential to map the field, refine our understanding of the concept and inform relevant stakeholders of useful insights for policy making and further research. After being screened against a number of inclusion criteria, 104 empirical studies were selected to be included in this review. Thematic analysis was adopted for the data analysis of these papers. Findings indicate an imbalance in geographical, theoretical, methodological and thematic distributions in previous studies. Six major themes were identified from the literature: (1) TA enactment, (2) the role of teacher cognition, (3) influential factors, (4) implementing professional development interventions, (5) TA outcomes and (6) TA change trajectory. TA can be extrapolated in terms of its source, enactment and outcomes. Teachers' capacities, implementation strategies, and contextual factors jointly determine the achievement of their professional agency. A conceptual framework for accounting teacher agency holistically is proposed and implications for relevant stakeholders are discussed.

This paper presents data generated during a semester-long programme to support international students from countries in Melanesia and Asia embarking on masters research in education in a New Zealand university. All were scholarship recipients. The researcher-and facilitator-of the programme, was interested in documenting and understanding the nature of the students' experience as they planned and wrote research proposals. The process of developing a research proposal, as one of the early stages of "becoming" a researcher, highlighted a number of challenges for the six case study students. The challenges are viewed from a transition or "resituation" perspective (Eraut in "Stud Contin Educ" 26(2): 247-74, 2004, 2008) rather than an adjustment one. A resituation perspective assumes that students brought with them "personal expertise, practical wisdom and tacit knowledge" (Eraut 2008, p. 42) which needed to be reconciled with what was demanded of them by different aspects of the research planning process. The resituation challenges experienced by the students included situating a perceived problem or issue in the research literature; reconciling personal research goals with the limitations of one's own agency as a researcher; integrating new learning with research goals; and reconciling the new role or identity as a researcher with the previous role as colleague or community member. The paper presents a case for providing a context for postgraduate students in which explicit recognition of what they bring to the research task, and acknowledgement of the resituation challenges can take place.

This article considers the role of research in disentangling an increasingly complex relationship between literacy policy and practice as it is emerging in different local and national contexts. What are the tools and methodologies that have been used to track this relationship over time? Where should they best focus attention now? In answering these questions this paper will consider three different kinds of research perspectives and starting points for enquiry: 1. Policy evaluation. The use of a range of quantitative research tools to feed policy decision-making by tracking the impact on pupil performance of different kinds of pedagogic or policy change (Organisation for Economic Co-operation and Development [OECD], 2010). 2. Co-construction and policy translation. This has for some time been a central preoccupation in policy sociology, which has used small-scale and context specific research to test the limits to the control over complex social fields that policy exercises from afar (Ball, 1994). Agentic re-framings of policy at the local level stand as evidence for the potential to challenge, mitigate or re-order such impositions. 3. Ethnographies of policy time and space. Ethnographic research tools have long been used to document community literacy practices, and in training their lens on the classroom have sought to focus on the potential dissonance between community and schooled practices. It is rarer to find such research tools deployed to explore the broader policy landscape. In the light of debate within the field, part of the purpose of this article is to examine how ethnographic research tools might be refined to study how policy from afar reshapes literacy practices in the here and now. (Brandt and Clinton, 2002). (Contains 1 table.)

Health professionals are attracted to the flexibility of the virtual classroom for their on-going education. Recent studies have documented the differences in pedagogy between Internet based learning online and the traditional classroom setting, but few have investigated student health professionals' transitional process while engaged in online learning. The purpose of this mixed methods evaluation study was to document students' experience of a six month online research methods paper (unit). Specifically it explores factors that influenced student transition to online pedagogy and successful completion of the paper. Descriptive qualitative and quantitative analyses were applied to 230 student evaluations and 1720 emails collected over a four year period. The findings supported those of previous studies; the main reasons students study online is the flexibility it offers (87%) and the ability to study without taking time off work (72%). The student experiences were captured in the overarching theme "from enduring to enjoying". A teacher who works within a collaborative team, engages students early with interactive skill acquisition learning activities, and is responsive to online students' unique needs, can successfully facilitate students through the virtual classroom transitional phases: from "virtual paralysis" to "engagement" to "getting into it" to "surprised enjoyment". Without strategies in place, however, teachers risk being overwhelmed by the onslaught of student emails, with the allotted teacher-student contact time slip sliding away. (Contains 1 table and 1 figure.)

This paper is targeted primarily at doctoral students and others considering hermeneutics as a research strategy. Research using hermeneutics was carried out with occupational therapy educators and clinicians in Australia, New Zealand, Canada, and the UK. A total of 53 participants engaged in focus groups and individual interviews over a one-year. The paper explores hermeneutics as a credible, rigorous and creative strategy to address aspects of professional practice that similarly need to be flexible, adaptable to particular needs, and justifiable in the contexts of evidence-based as well as client-centred practice. The hermeneutic study produced A Model of Professional Practice Judgment Artistry (Paterson, 2003) which is briefly described and the connections. (Contains 2 tables, 2 figures, and 1 footnote.)

This paper discusses the need for multi-cultural methodologies that develop knowledge about the maternity experience of migrant women and that are attuned to womens maternity-related requirements under multi-cultural conditions. Little is known about the transition to parenthood for mothers in a new country, particularly when the country is New Zealand. This paper will challenge the positivist hegemony of previously completed research on migrant women by reflecting on my own experience as a researcher grounded in a broadly-based, pluralistic set of critical epistemologies that allowed me to uncover the issues and contexts that impacted on the experience of migrant women. It concludes by proposing that, where research occurs with minority groups, multiple research strategies are incorporated in order to prevent the reproduction of deficiency discourses. (Contains 1 footnote.)

This paper describes the theoretical foundations of an online course to teach clinical educators how to convert a traditional face-to-face course for either flexible or distance delivery. We describe the design research approach to the creation of the course and the pedagogical theory behind the course development. We also present the details of the research project that we will be running including the rationale for the research, the research hypothesis and the research methodology. In concluding we give a brief outline of our experience of teaching the course for the first time. (Contains 3 tables and 10 figures.)

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]

Linda Tuhiwai Te Rina Smith--Maori researcher, educator, and activist--discusses key moments in the journey toward decolonization of Maori education, the impact of her book about decolonizing research methodologies, the concept of postcolonialism, challenges to the sustainability of social and educational change, disrupting the power relation between teacher and learner, making room for Indigenous pedagogies, and collaboration between Indigenous and non-Indigenous researchers. (SV)

Objective: Professional sport occupies a prominent cultural position in societies across the globe and commercial organisations make use of this to promote their products. The present scoping review explores existing academic literature on the relationship between professional sports clubs and food and drink marketing and considers how this relationship may impact upon the public's health.Design: The scoping review searched six databases. Experts were also consulted. Records written in languages other than English were excluded. We also excluded records relating to mega events (e.g. Olympics, Football World Cup) and alcohol marketing, because of the attention already given to these.Setting: Professional sports clubs.Results: We identified 18 166 titles, reviewed 163 abstracts and read twenty-six full texts. We included six papers in the review. Four were from Australia and New Zealand. The Australasian literature focused largely on the marketing of foods and beverages to children and the potential impact on consumption. Single papers from researchers in Turkey and the USA were identified. The Turkish paper analysed shirt sponsorship in football leagues internationally and showed food and beverage (including alcohol) companies were the most common sponsors. The US paper examined a mixed reaction to a football team named after an energy drink.Conclusions: Commercial relationships between professional sports clubs and Big Food corporations have largely eluded scrutiny in much of the world. The current review highlights the lack of public health research on these relationships. Research exploring the interdependent commercial practices of food and drink companies and professional sports clubs is urgently needed. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Rural Medicine (Wolters Kluwer India Pvt Ltd) is the property of Wolters Kluwer India Pvt Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article presents a description of a specific Indigenous research methodology, Kaupapa Māori Research (KMR), followed by a discussion of the potential contribution that KMR and other Indigenous frameworks make toward understanding and addressing widespread mental health inequities affecting the world's Indigenous peoples. The contribution of existing qualitative KMR to the fields of health and mental health in New Zealand is discussed, and innovative approaches employed within these studies will be outlined. This paper describes the utility of KMR methodology which informed the development of qualitative interviews and the adaptation of an analytic framework used to explore the impact of systems on the experiences of Māori (the Indigenous peoples of New Zealand) with bipolar disorder (BD). This paper adds to others published in this journal that describe the value, inherent innovation, and transformative potential of KMR methodologies to inform future qualitative research with Indigenous peoples and to enact systemic change. Transformation is achieved by privileging the voices of Māori describing their experiences of mental health systems; presenting their expert critique to those responsible for the design and delivery of mental health services; and ensuring equal weight is given to exploring the clinical, structural and organizational changes required to achieve health equity. It is proposed that this approach to research praxis is required to ensure that studies do not perpetuate institutional racism, which requires close adherence to Indigenous research priorities and partnership with Indigenous peoples in all steps of the research process. [ABSTRACT FROM AUTHOR]

In 2020, the New Zealand (NZ) Parliament voted to decriminalise abortion. Although NZ's abortion law formally opposes sex selective abortions, there is considerable complexity in the gender politics of 'choice' and 'agency' in multi-ethnic societies, and interpretations of reproductive rights for ethnic minority women and for the girl child, respectively. This paper explores these complexities through the perspectives of reproductive and maternity care practitioners who are situated at the interface of legal systems, health service provision, and delivery of culturally sensitive care. Thirteen practitioners were interviewed as part of this study. The analysis highlights strains in framings of 'reproductive choice' (underpinned by western liberal notions of rights) and 'gender equality' (abortion rights that acknowledge the complexity of cultural son-preference) for ethnic minority women. These tensions are played out in three aspects of the post-reform landscape: (a) everyday practice and accountability; (b) consumerism and choice; (c) custodianship and gender rights. The findings point to the limitations in operationalising choices for ethnic women in health systems wherein trust deficit prevails, and cultural dynamics render complex responses to abortion. They also highlight reconfigurations of client-expert relationships that may have implications for practitioners' abilities to advocate for ethnic women's rights against cultural influences. [ABSTRACT FROM AUTHOR]

Background: Pacific people living in New Zealand, Australia, United States, and the Pacific region continue to experience a disproportionately high burden of long-term conditions, making culturally contextualised behaviour change interventions a priority. The primary aim of this study was to describe the characteristics of behaviour change interventions designed to improve health and effect health behaviour change among Pacific people.Methods: Electronic searches were carried out on OVID Medline, PsycINFO, PubMed, Embase and SCOPUS databases (initial search January 2019 and updated in January 2020) for studies describing an intervention designed to change health behaviour(s) among Pacific people. Titles and abstracts of 5699 papers were screened; 201 papers were then independently assessed. A review of full text was carried out by three of the authors resulting in 208 being included in the final review. Twenty-seven studies were included, published in six countries between 1996 and 2020.Results: Important characteristics in the interventions included meaningful partnerships with Pacific communities using community-based participatory research and ensuring interventions were culturally anchored and centred on collectivism using family or social support. Most interventions used social cognitive theory, followed by popular behaviour change techniques instruction on how to perform a behaviour and social support (unspecified). Negotiating the spaces between Eurocentric behaviour change constructs and Pacific worldviews was simplified using Pacific facilitators and talanoa. This relational approach provided an essential link between academia and Pacific communities.Conclusions: This systematic search and narrative synthesis provides new and important insights into potential elements and components when designing behaviour change interventions for Pacific people. The paucity of literature available outside of the United States highlights further research is required to reflect Pacific communities living in New Zealand, Australia, and the Pacific region. Future research needs to invest in building research capacity within Pacific communities, centering self-determining research agendas and findings to be led and owned by Pacific communities. [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: The purpose of this paper is to examine the competition between accounting sustainability assurance providers (ASAPs) and non-accounting sustainability assurance providers (NASAPs), and how this competition influences the institutionalization of the evolving field of sustainability assurance. Design/methodology/approach: An interpretivist research methodology, guided by an institutional work perspective, is used to analyze interviews with 15 SAPs and 35 sustainability reporting managers (SRMs) in Australia and New Zealand. Findings: ASAPs prefer to use International Standard on Assurance Engagements 3000 (ISAE3000), because it is well recognized in the profession, adheres to ASAPs' regulatory requirements, and mirrors their financial audit methodologies. This preference influences ASAPs' institutional work as they compete against NASAPs and how they institutionalize sustainability assurance. ASAPs' institutional works include presenting sustainability assurance as similar to a financial audit, arguing in support of a single provider for financial audits and sustainability assurance, and undermining NASAPs and their preferred sustainability assurance standard, AA1000 Assurance Standard (AA1000AS), by appealing to senior management. In comparison, NASAPs promote AA1000AS as a specialist standard among SRMs, emphasizing the standard's sustainability enhancing qualities and its flexibility, while discrediting ASAPs and ISAE3000 as out of touch with sustainability objectives. Research limitations/implications: A new conceptual model is constructed that can be used in institutional work research. Practical implications: The accounting profession is encouraged to consider more flexible, innovative methods in new assurance markets. This involves using new assurance standards as well as developing specialist standards for new forms of assurance. Regulation over sustainability assurance could be helpful, but regulators should be careful not to stifle competition in this evolving field. Originality/value: This paper examines how competition between ASAPs and NASAPs influences the institutionalization of sustainability assurance. The paper offers a new model for the analysis of institutional work, which could be used by researchers, new insights into the emerging field of sustainability assurance, as well as a figure and discussion that clarifies the broader implications of the findings. [ABSTRACT FROM AUTHOR]

An increasing number of countries have, or are moving towards, reforming cannabis policies. New Zealand is also moving in this direction and the government will hold a referendum on the legalization of recreational cannabis in September 2020. To inform imminent public and political discussions it is important to understand how current cannabis use is controlled. Research suggests that cannabis law has been ineffective in NZ. Internationally, informal controls, rather than the law, have been found to shape cannabis use by creating a threshold for normalization, but the attitudes shaping this threshold are unknown. This study aimed to examine drug acceptability attitudes, specifically students' attitudes towards the illegal use of cannabis and their attitudes towards peers who abstain, sometimes use, or are heavy users of cannabis, to identify the factors that control cannabis use. Using a mixed methods approach, university students recruited their peers (N = 535) to complete a pen and paper survey investigating perceptions towards 3 cannabis user prototypes (abstainers, moderate users, heavy users), concern for legality of cannabis use, and the integration of cannabis into the student culture (perceptions of peers' use, ease of acquisition, and availability). Perceptions of peers' lifetime and regular use were 82% and 38.5%, respectively. Participants rated cannabis as easy to acquire and likely to be available at a typical student social occasion. The majority stated that the law does not deter use (92.7%); participants perceived the law to be soft and that they are unlikely to get caught. Participants' descriptions of the 3 cannabis user prototypes revealed a threshold for normalization. For instance, abstaining was perceived to be associated with positive attributes (such as being studious), linked to being less sociable, and linked to being less likely to be judged. Moderate use of cannabis was perceived to be normal and sociable. Heavy use was perceived to be associated with having negative attributes, such as being addicted, unhealthy, and an underachiever, and negative drug labels. Our findings revealed that cannabis use is not controlled by the law, but by informal thresholds of control. Moderate cannabis use is accepted whereas heavy cannabis use is not. We extended research by identifying the attitudes shaping these thresholds, in particular that negative outcomes associated with heavy use deters the normalization of this behavior. We argue that policy must be informed by, and build on, these informal controls. The negative perceptions associated with heavy use also raise concerns regarding the well-being of heavy users, and coupled with the ineffectiveness of cannabis law, lend support towards a health model for regulating cannabis. Furthermore, insights into the negative perceptions associated with heavy use could inform health interventions on the types of concerns that will resonate with users. [ABSTRACT FROM AUTHOR]

Background: The management of prediabetes in the community setting is a global priority. We evaluated the feasibility of a 6-month multilevel practice nurse-led prediabetes dietary intervention which involved goal setting. The aim of this paper is to explore the weight loss goals and strategies reported by participants to achieve their weight loss goals as recorded by practice nurses, and report on factors that influenced dietary behaviours. Methods: This study used a convergent mixed-methods design. A six-month pragmatic non-randomised pilot study with a qualitative process evaluation was conducted in two neighbouring provincial cities in New Zealand. A structured dietary intervention delivered by practice nurses was implemented in four practices in 2014–2016. Content analysis of the text and descriptive statistics were used to analyse the data. Results: One hundred and fifty seven people with prediabetes were enrolled (85 intervention, 72 control). The intervention group lost a mean 1.3 kg more than the control group (p <.0.001). The majority of the intervention group indicated either a high level of readiness (n = 42, 53%) or some readiness (n = 31, 39%) to make food changes. The majority of weight loss goals aligned with clinical guidelines (between 5 and 10% of body weight). While just over half (n = 47, 55%) demonstrated weight loss at the end of the six month period, the majority of participants did not achieve their predetermined weight loss goal (n = 78, 83%). Gender, ethnicity and budget were not related to weight loss at six months. Readiness to change and reported challenges to making dietary changes were related to weight loss at six months. Negative factors or set-backs included sporadic adherence to diet due to other health problems, change in context or environment and coping with ill health, most notably stress and low mood. Conclusions: The data relating to weight loss and dietary goals provided insight into the challenges that people faced in making dietary changes for weight loss across a six month period. Simplifying goal setting to those goals with the greatest potential clinical impact or the greatest significance to the person, in a socially supportive environment, may increase the success of goal achievement. Trial registration: ANZCTR ACTRN1261500080656. Registered 3 August 2015 (Retrospectively registered). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366560&isReview=true [ABSTRACT FROM AUTHOR]

Background: Lone parents and their children experience higher than average levels of adverse health and social outcomes, much of which are explained by high rates of poverty. Many high income countries have attempted to address high poverty rates by introducing employment requirements for lone parents in receipt of welfare benefits. However, there is evidence that employment may not reduce poverty or improve the health of lone parents and their children.Methods: We conducted a systematic review of qualitative studies reporting lone parents' accounts of participation in welfare to work (WtW), to identify explanations and possible mechanisms for the impacts of WtW on health and wellbeing. Twenty one bibliographic databases were searched. Two reviewers independently screened references and assessed study quality. Studies from any high income country that met the criteria of focussing on lone parents, mandatory WtW interventions, and health or wellbeing were included. Thematic synthesis was used to investigate analytic themes between studies.Results: Screening of the 4703 identified papers and quality assessment resulted in the inclusion of 16 qualitative studies of WtW in five high income countries, USA, Canada, UK, Australia, and New Zealand, covering a variety of welfare regimes. Our synthesis found that WtW requirements often conflicted with child care responsibilities. Available employment was often poorly paid and precarious. Adverse health impacts, such as increased stress, fatigue, and depression were commonly reported, though employment and appropriate training was linked to increased self-worth for some. WtW appeared to influence health through the pathways of conflict and control, analytical themes which emerged during synthesis. WtW reduced control over the nature of employment and care of children. Access to social support allowed some lone parents to manage the conflict associated with employment, and to increase control over their circumstances, with potentially beneficial health impacts.Conclusion: WtW can result in increased conflict and reduced control, which may lead to negative impacts on mental health. Availability of social support may mediate the negative health impacts of WtW. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The prevalence of long-term health conditions (LTCs) continues to increase and it is normal for people to have several. Lifestyle is a core feature of the self-management support given to people with LTCs, yet it seems to fail to meet their needs. From a larger study exploring the experiences of this group, this paper reports on the role of food and mealtimes, and the effect of the nutritional advice on the lives of people with several LTCs. METHODS: The experiences of 16 people with several advanced LTCs were explored using multiple qualitative case studies. Over an 18-month period, contact with participants included monthly conversations, two longer, semi-structured interviews and one interview with their primary care clinicians. The data were analysed inductively using thematic analysis. RESULTS: There was profound social, psychological and cultural significance of food to the participants. These aspects of food were then described using the Whare Tapa Wha model of health. The approach to food and nutrition participants experienced in health care was closely associated with conventional weight management. They found this advice largely irrelevant and therefore ineffective. DISCUSSION: The pressure people with several LTCs experience during clinical encounters has perverse effects on wellbeing and reinforces an overall sense of failure. This research challenges the assumption that all people have the will, agency and income to follow the advice they receive about nutrition and exercise. Considering people's needs using the Whare Tapa Wha model of health offers clinicians a framework to re-conceptualise the core features of self-management support and provide realistic, compassionate care that will optimise the quality of life for people with multiple LTCs. [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. The value of family health history as a means to understanding health risk has been long known. Its value in a precision medicine context is also now becoming apparent. General practitioners (GPs) are considered to play a key role in the collection, and investigation, of family health history, but it remains widely reported as being both poorly and infrequently undertaken. Little is known about this practice in Aotearoa New Zealand (NZ). Aim. This study aimed to explore current practices in relation to the ascertainment of family health history, with a view towards precision medicine. Methods. Semi-structured interviews were conducted with 10 GPs recruited from one urban area of NZ. The interviews were subjected to a thematic analysis. Results. Family health history information was used to varying degrees in four areas - risk ascertainment, patient engagement with a diagnosis, social context and building relationships. Patient cultural considerations were rarely mentioned. Reliability of information provided by patients, resource constraints, context driven consults and electronic health record limitations are potential indicators of current limits of family health history. Discussion. Our findings present a baseline of current practice and echo larger studies from overseas. As precision medicine is not yet routine, a unique opportunity exists for consideration to be given to establishing specific roles within the NZ health system to enable equitable practice of, and subsequent health gains from, the use of family/whānau health history information as part of precision medicine. [ABSTRACT FROM AUTHOR]

INTRODUCTION: During the coronavirus disease 2019 (COVID-19) pandemic lockdown in New Zealand in March 2020, there was a rapid shift to virtual consultations in primary care. This change was supported by system adjustments to enable electronic transmission of prescriptions without a handwritten signature if they met certain security criteria. International research suggests potential for unintended consequences with such changes, so it is important to understand the effect on professional practice in New Zealand general practice and community pharmacy. AIM: The purpose of this study was to undertake a preliminary exploration of the experiences of New Zealand general practitioners and community pharmacists when prescriptions are transmitted electronically directly from prescriber to pharmacy. METHODS: Semi-structured interviews with a purposive sample of four pharmacists and four general practitioners gathered qualitative data about their experiences of the shift to electronic transmission of prescriptions. Participants' perceptions of effect on professional workflow, interprofessional interactions between general practitioners and pharmacists, and interactions with patients were explored. Interviews were audio-recorded, and the data analysed thematically using an inductive approach. RESULTS: Four themes were identified: workflow transformation; mixed impact on interactions with patients; juggling timing and expectations; and new avenues for interprofessional communication (with some cul-de-sacs). DISCUSSION: Both general practitioners and pharmacists experienced transformational changes to workflow. This was positive for general practitioners due to saved time and increased work flexibility. Pharmacists noted potential benefits but also some challenges. To fully reap teamwork benefits, more work is needed on managing the timing issues and patient expectations, and to refine the new modes of communication between health-care practitioners. [ABSTRACT FROM AUTHOR]

Background: Drowning is a significant public health issue, with females accounting for one third of global drowning deaths. The rate of female drowning has not decreased within high-income countries and presentations to hospital have increased. This scoping review aimed to explore adult female unintentional drowning, including risk factors, clinical treatment and outcomes of females hospitalised for drowning.Methods: A systematic search of the literature following the PRISMA-ScR framework was undertaken. The databases OVID MEDLINE, Embase, CINAHL, OVID Emcare, Web of Science, Informit and Scopus were accessed. Study locations of focus were Australia, Canada, New Zealand, the United Kingdom, and the United States. Studies from January 2003 to April 2019 were included. The quality of evidence of included studies was assessed using GRADE guidelines.Results: The final search results included 14 studies from Australia (n = 4), Canada (n = 1), New Zealand (n = 1), United States (n = 6), United Kingdom (n = 1), and one study reporting data from both Australia and United States. Nine studies reported risk factors for female drowning including age, with the proportion of female drowning incidence increasing with age. Although females are now engaging in risk-taking behaviours associated with drowning that are similar to males, such as consuming alcohol and swimming in unsafe locations, their exposure to risky situations and ways they assess risk, differ. Females are more likely to drown from accidental entry into water, such as in a vehicle during a flood or fall into water. This review found no evidence on the clinical treatment provided to females in hospital after a drowning incident, and only a small number of studies reported the clinical outcomes of females, with inconsistent results (some studies reported better and some no difference in clinical outcomes among females).Conclusion: Adult females are a group vulnerable to drowning, that have lacked attention. There was no single study found which focused solely on female drowning. There is a need for further research to explore female risk factors, the clinical treatment and outcomes of females hospitalised for drowning. This will not only save the lives of females, but also contribute to an overall reduction in drowning. [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]

INTRODUCTION: Routinely following an evidence-based clinical pathway of care for bacterial sexually transmitted infections (STIs) such as chlamydia or gonorrhoea is important to help reduce the spread of infections, prevent reinfections and avoid associated health complications. AIM: To develop an easy-to-use tool for routine use by primary care clinicians to ensure best practice management of patients tested for and diagnosed with chlamydia or gonorrhoea. METHODS: The tool (a MedTech Advanced Form) was developed in consultation with seven primary care clinicians and included different tabs for use during the STI care pathway (testing, treatment, advice, partner notification and follow up) with clickable links to relevant online resources. The tool was trialled over 3 months by 19 clinicians in three Wellington primary care clinics - two youth health and a student health service. Outcome measures were frequency of use, completeness of fields related to best practice care and clinician acceptance of the tool (from focus group feedback). RESULTS: The tool was used for approximately one in four patients who were tested during the trial period, with 'forgetting' reported as the mostcommonreason for non-use. Clinician views about the tool were favourable, with most indicating they would like to continue use and would recommend it to colleagues. Documentation of best practice care was excellent; fields to record reasons for testing, discussion of sexual history, provision of treatment and advice given were used for most patients for whom the form was completed. CONCLUSIONS: Inclusion of this STI management tool in the electronic patient records system appeared to improve primary care clinicians' delivery and documentation of best practice sexual health care at a practice level. Wider use of a modified version of this tool could facilitate more comprehensive best practice management of bacterial STIs. [ABSTRACT FROM AUTHOR]

Objectives: To investigate and compare estimates of the longevity of dental treatment, expectations for free remedial treatment, and attitudes about formal dental warranties among dentists, students, and patients. Materials and methods: This is a mixed-method cross-sectional questionnaire survey with convenience sampling from dentists, dental students, and patients in New Zealand. A questionnaire was distributed to New Zealand dentists (n = 28) and final-year dental students (n = 27). A separate questionnaire was provided to patients in a university dental clinic (n = 43). Mann-Whitney U, Chi-square and Pearson Correlation, and Binary logistic regression tests were used to test for differences between groups and correlations amongst variables. Qualitative data were analysed thematically. Results: Dentists believed that their posterior composite resin restorations would last longer (p = 0.014), would remediate failed crowns for longer (p = 0.002) and would provide longer crown warranties (p = 0.003) compared to students. Patients had higher expectations for restoration longevity and free remediation for failed treatment. Students were generally more willing to provide warranties. Crowns were perceived to be the most warrantable, while endodontic treatment was the least warrantable. Recall attendance, mechanical failure, and adequate oral hygiene were commonly proposed as warranty conditions for restorations and crowns. There was little consensus about complete dentures and endodontic treatment. Conclusions: There are significant disparities between the expectations of patients and clinicians regarding treatment longevity and free remediation times. Clinicians, in general, are willing to provide free remediation within a specified time frame, except for endodontic treatment, but are hesitant to provide formal dental warranties. [ABSTRACT FROM AUTHOR]

Introduction. Delayed diagnosis of gut disease is a continuing problem, variously attributed to a range of patient, doctor, and health system factors. Gut disease often begins with indeterminate gut behaviours that are hard to classify. Aim. This study aimed to investigate delayed diagnosis from the point of view of the patient, or prospective patient. How gut and gut disease was understood, what might prompt them to seek care, and their experiences of seeking care. Methods. Using a qualitative design, we interviewed 44 people in New Zealand. Thirty-three had a diagnosis of gut disease, and 11 did not, though some of the patients in this latter group had symptoms. Results. Some participants had a smooth trajectory from first noticing gut symptoms to diagnosis. However, a subgroup of 22 participants experienced long periods of troublesome gut behaviours without a diagnosis. For this subgroup of 22 participants, we found people struggled to work out what was normal, thus influencing when they sought health care. Once they sought health care, experiences of that care could be frustrating, and achieving a diagnosis protracted. Some who remained undiagnosed felt abandoned, though had developed strategies to self-manage. Discussion. Indeterminate gut behaviours remain complex to deal with and it can difficult for both patients and doctors to assess when a symptom or group of symptoms need further investigation, watchful waiting or the use of other supportive strategies. Effectively communicating with healthcare staff can be a significant problem and there is currently a gap in support for patients in this regard. [ABSTRACT FROM AUTHOR]

Introduction. In Aotearoa New Zealand (NZ), there is inequity in rates of neural tube defects (NTDs). Among Maaori, NTD occur in 4.58/10 000 live births, and for Pacific peoples, it is 4.09/10 000 live births; this is compared to 2.81/10 000 live births for non-Maaori, non-Pacific peoples. Aim. To describe self-reported pre-pregnancy folic acid supplementation and to determine the association between pregnancy intendedness, ethnicity, parity, maternal age, care provider and pre-pregnancy folic acid supplementation. Methods. Secondary analysis of postpartum survey data collected at Te Whatu Ora Te Toka Tumai and Counties Manukau birthing facilities in 2020 was conducted. Descriptive analyses explored pregnancy intendedness and self-reported folic acid use by demographic variables. Multivariable logistic regression explored independent associations between demographic variables and folic acid use among intended pregnancies. Results. In total, 398 participants completed the survey. The response rate was (140/149) 94% at Counties Manukau and (258/315) 82% at Te Toka Tumai. Pre-pregnancy supplementation was reported by 182 of 398 participants (46%). Use was higher among those who intended their pregnancy (151/262, 58%) compared to those who were 'pregnancy ambivalent' (9/33, 27%) or did not intend to become pregnant (22/103, 21%). Factors independently associated with supplementation among intended pregnancies included: 'Other ethnicity' (European, Middle Eastern, Latin American, African) compared to Maaori (aOR 5.3 (95% CI 1.3, 21.8)), age =30 years compared to <30 years (aOR 2.1 (1.0, 4.1)), and private obstetrician compared to midwifery care (aOR 4.2 (1.6, 10.9)). Discussion. Low rates of pre-pregnancy folic acid supplementation exist in Auckland with significant ethnic disparity. Mandatory fortification of non-organic wheat is important, but supplementation is still recommended to maximally reduce risk. [ABSTRACT FROM AUTHOR]

Background: This paper reports the quantitative outcomes of a mixed-methods pilot study of the characteristics and demographics of chiropractic practices and patients in Western Australia. Methods: This was a mixed-methods data transformation model (qualitative to quantitative) pilot study. A non-random sample of chiropractic practices across Western Australia was recruited and data collected anonymously from consecutive new patients using an online platform. Data covered practice and patient demographics and characteristics, alongside quality of life measures. A descriptive quantitative analysis characterised the sample, and the patient population was stratified by main reason for presentation to compare characteristics according to the presence of secondary complaints. Odds ratios were calculated to estimate the odds of a secondary complaint for various combinations of main complaints, from univariate logistic regression models. Results: Of the 539 registered practitioners in WA in July 2014, 33 agreed to participate, from 20 different practices. Ten participating practices provided data on 325 adult new patients. The recruited practices (metropolitan n = 8, regional n = 2) had a positive response rate of 79.7% (n = 301 metropolitan and = 24 regional patients), mean age 36.3 years (range 18-74) (53.2 % female). Spinal problems were reported as the main reason for consultation by 67 % and as secondary reasons by 77.2 % of patients. People presented primarily for health maintenance or a general health check in 11.4 %, and as a secondary reason 14.8 %. There were 30 % of people below societal norms for the SF-12 Physical Component Score (mean 47.19, 95 % CI; 46.27-48.19) and 86 % for the Mental Component Score (mean 36.64, 95 % CI; 35.93-37.65), Pain Impact Questionnaire mean scores were 54.60 (95 % CI; 53.32-55.88). Conclusions: Patients presented to chiropractors in Western Australia with a fairly wide range of conditions, but primarily spinal and musculoskeletal-related problems. A significant proportion of patients had associated, or found to be at risk of, depression. Consequently, there are responsibilities and opportunities for chiropractors with respect to providing care services that include health promotion and well-being education related to musculoskeletal/spinal and mental health. This pilot study supports the feasibility of a future confirmatory study where the potential role of chiropractors in spinal/musculoskeletal health management may be explored. Trial registration: ACTRN12616000434493: Australian New Zealand Clinical Trials Registry (ANZCTR), Registered 5 April 2016, First participant enrolled 01 July 2014 Retrospectively Registered. [ABSTRACT FROM AUTHOR]

Background: Waiting lists for treatment are common in outpatient and community services, Existing methods for managing access and triage to these services can lead to inequities in service delivery, inefficiencies and divert resources from frontline care. Evidence from two controlled studies indicates that an alternative to the traditional "waitlist and triage" model known as STAT (Specific Timely Appointments for Triage) may be successful in reducing waiting times without adversely affecting other aspects of patient care. This trial aims to test whether the model is cost effective in reducing waiting time across multiple services, and to measure the impact on service provision, health-related quality of life and patient satisfaction.Methods/design: A stepped wedge cluster randomised controlled trial has been designed to evaluate the impact of the STAT model in 8 community health and outpatient services. The primary outcome will be waiting time from referral to first appointment. Secondary outcomes will be nature and quantity of service received (collected from all patients attending the service during the study period and health-related quality of life (AQOL-8D), patient satisfaction, health care utilisation and cost data (collected from a subgroup of patients at initial assessment and after 12 weeks). Data will be analysed with a multiple multi-level random-effects regression model that allows for cluster effects. An economic evaluation will be undertaken alongside the clinical trial.Discussion: This paper outlines the study protocol for a fully powered prospective stepped wedge cluster randomised controlled trial (SWCRCT) to establish whether the STAT model of access and triage can reduce waiting times applied across multiple settings, without increasing health service costs or adversely impacting on other aspects of patient care. If successful, it will provide evidence for the effectiveness of a practical model of access that can substantially reduce waiting time for outpatient and community services with subsequent benefits for both efficiency of health systems and patient care.Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12615001016527 . Approved 15/9/2015. [ABSTRACT FROM AUTHOR]

Introduction: The Department of General Practice and Primary Health Care at the University of Auckland is considering developing a Master of Primary Health Care (MPHC) programme. Masters level study entails considerable investment of both university and student time and money. Aim: To explore the views of potential students and possible employers of future graduates to discover whether there is a market for such a programme and to inform the development of the programme. Methods: Semi-structured interviews were conducted with 30 primary health care stakeholders. Interviews were digitally recorded, transcribed and analysed using a general inductive approach to identify themes. Findings: Primary care practitioners might embark on MPHC studies to develop health management and leadership skills, to develop and/or enhance clinical skills, to enhance teaching and research skills, or for reasons of personal interest. Barriers to MPHC study were identified as cost and a lack of funding, time constraints and clinical workload. Study participants favoured inter-professional learning and a flexible delivery format. Pre-existing courses may already satisfy the post-graduate educational needs of primary care practitioners. Masters level study may be superfluous to the needs of the primary care workforce. Conclusions: Any successful MPHC programme would need to provide value for PHC practitioner students and be unique. The postgraduate educational needs of New Zealand primary care practitioners may be already catered for. The international market for a MPHC programme is yet to be explored. [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]

INTRODUCTION: Primary health care is critical, particularly in rural areas distant from secondary care services. AIM: To describe the development of Coast to Coast Health Centre (CTCHC) at Wellsford, north of Auckland, New Zealand and reflect on its achievements and ongoing challenges. METHODS: Interviews were conducted with staff and management of CTCHC and with other health service providers. Surveys of staff and a sample of enrolled patients were undertaken. Numerical data on service utilisation were obtained from the practice and from national datasets. RESULTS: The CTCHC provides a wide range of services, including after-hours care, maternity and radiology, across a network of electronically connected sites, as well as interdisciplinary training for a range of health students. General practitioner (GP) recruitment is problematic and nursing roles have been expanded. Staff report positively on the work environment. Consultation rates are higher than in comparable practices, especially consultations with nurses. Rates of hospital admission are relatively low. The development of the CTCHC was assisted by formation of a local primary health organisation (PHO) and by recognition by the local district health board (DHB). Issues with poor coordination of local services, and less service provision than is characteristic in urban areas, remain. Contracting processes with the DHB were complex and time-consuming. The merging of the local PHO into a larger PHO within the Waitemata DHB catchment inhibited progression towards more complete locality planning. DISCUSSION: A dedicated and locally controlled provider was able to generate a more than usually complete community health service for Wellsford and area. [ABSTRACT FROM AUTHOR]