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This thesis explored the use of training healthcare staff in non-pharmacological, biopsychosocial approaches to supporting people living with dementia. This is a vital area of research due to the increasing prevalence of dementia and people living with dementia requiring long-term support worldwide (World Health Organisation, [WHO], 2017). Furthermore, national guidelines recommend the use of psychosocial approaches to managing behavioural and psychological symptoms of dementia (BPSD), prior to pharmacological intervention. Therefore, it is important to understand their effectiveness and applicability into everyday clinical practice. Paper one is a systematic review of fifteen studies that trained long-term care staff to use psychosocial approaches and investigated the impact upon their confidence and proficiency to work with people living with dementia. The results suggest that psychosocial approaches can improve staff confidence and proficiency, particularly when training focused upon supporting those with BPSD. However, there were methodological weaknesses across the literature and not all studies concluded positive findings. This research has important clinical implications because improving staff confidence and proficiency can improve their quality of care, and ultimately quality of life for people living with dementia requiring long-term support. Paper two is a qualitative study exploring the views of thirteen community healthcare professionals that have been trained to use a biopsychosocial approach to managing BPSD. Findings suggested that healthcare professionals valued learning about this approach to their practice and even deemed it effective in meeting the needs of their service users, improving carer attitudes and reducing BPSD. There were barriers however to implementation in practice, such as professional priorities, needing quicker approaches and collaborative working, resulting in instances when the approach was not deemed effective. Clinical implications include raising awareness and providing evidence of the usefulness of biopsychosocial approaches in managing BPSD and improving care for people living with dementia, as well as suggestions of how to facilitate application within community teams. Paper three provides a critical appraisal of both papers, including strengths and limitations of the thesis, as well as overall personal reflections on the research process.

In traditional Hawaiian society, the konohiki were a specialized class of chiefs appointed by the Aliʻi Nui (high chiefs) to steward their land, water and human resources. Their self-sustaining and holistic methods of land and resource stewardship became known as the Konohiki System. The System’s principles were governed by the ancient Hawaiian Kapu religion and based on cultural values of Mālama ʻĀina – the deep familial ties and reciprocal stewardship between the ʻĀina (land and environment), the Akua (deities) and kanaka (man). To date, the konohiki’s history remains fragmented, insufficient, and lacking the Hawaiian perspective. This thesis is the first comprehensive, focused study on the konohiki utilizing a wider range of Hawaiian-language primary sources mainly from 19th century Hawaiian-language newspapers, published in 1834-1948, and the 1848 Māhele land records. These sources uncover invaluable Hawaiian cultural, historical and ancestral knowledge, and provide new information that changes the complex and often misunderstood historiography of the konohiki.