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

Crisis intervention services for people experiencing psychological distress and suicidal ideation are frequently described by the people accessing them as failing to meet their needs. This paper reports a prominent finding from a realist evaluation of Taranaki Retreat—a charitable, non‐clinical organisation in New Zealand, which offers free respite for people experiencing acute distress. Using qualitative methods, the study aimed to move beyond vague notions regarding the helpfulness of respite, to a deeper understanding of the contextual factors and mechanisms which generate outcomes for such an intervention. Participant observation, focus groups with staff, semi‐structured interviews with service users, and analysis of service users' case notes were conducted over a six‐month period in 2018. The most prominent finding from the study related to 'genuine care'—care which is interpreted by the recipient as being motivated by a genuine desire to help. We present this finding as to the central mechanism in a wider programme theory developed through the realist evaluation study. We also present five key features of the care participants were offered at Taranaki Retreat which contributed to their common interpretation regarding the motivations behind this care. Upon considering the centrality of this mechanism we conclude that, in designing crisis interventions, greater consideration should be given to how the intervention can demonstrate genuine care. Having highlighted the ways in which the structure of charitable organisations appears conducive for interpretations of genuine care, we further conclude that the provision of comprehensive crisis intervention by charitable organisations should be further explored and supported. [ABSTRACT FROM AUTHOR]

Primary health is at the forefront of efforts to address health inequities. Effective primary health care keeps people well and improves longevity and quality of life. The persistence of health inequities, particularly between Indigenous peoples and non‐Indigenous peoples globally, suggests that there is a need to strengthen policy and practise. Unique to Aotearoa (New Zealand) is te Tiritio Waitangi, a treaty negotiated in 1840 between the British Crown and hapū (Māori [Indigenous] subtribes). This treaty is foundational to public policy in Aotearoa and requires the Crown (New Zealand government) to uphold a set of responsibilities around protecting and promoting Māori health. This paper examines to what extent Primary Health Organisations are upholding te Tiritio Waitangi. The study utilises data from a nationwide telephone survey of public health providers conducted in 2019–2020 recruited from a list on the Ministry of Health website. This paper focuses on data about te Tiriti application from 21 Primary Health Organisations from a sample size of thirty. Critical te Tiriti analysis, an emerging methodology, was used to assess to what extent the participating primary health organisations were te Tiriti compliant. The critical te Tiriti analysis found poor to fair compliance with most elements of te Tiriti but good engagement with equity. Suggestions for strengthening practise included examining relationships with Māori, utilising a planned approach, structural mechanisms, normalising Māori world views and consistency in application. The onus needs to be on non‐Māori to contribute to the cultural change and power‐sharing required to uphold te Tiriti. Critical te Tiriti analysis is a useful methodology to review te Tiriti compliance and could be used in other contexts to review alignment with Indigenous rights and aspirations. [ABSTRACT FROM AUTHOR]

Chronic pain is common in older people. However, little is known about how pain is experienced in residents of retirement villages ('villages'), and how pain intensity and associations are experienced in relation to characteristics of residents and village living. We thus aimed to examine pain levels, prevalence and associated factors in village residents. The current paper is a cross‐sectional analysis of baseline data from the 'Older People in Retirement Villages' study in Auckland, New Zealand. Between July 2016 and August 2018, 578 village residents were interviewed face‐to‐face by gerontology nurse specialists, using interRAI Community Health Assessment (CHA) and customised survey. We used a validated pain scale and multivariable logistic regression analyses adjusted for pre‐specified confounders. Residents' median age was 82 years; 420 (73%) were female; 270 (47%) exhibited/reported daily pain, and in 11% this was severe. After controlling for confounders, daily pain was positively associated with self‐reported arthritis (OR = 3.88, 95% CI = 2.57–5.87), poor/fair self‐reported health (OR = 3.19, 95% CI = 1.29–7.93), having no health clinic on‐site (OR = 1.76, 95% CI = 1.10–2.83), and minimal fatigue (diminished energy but completes normal day‐to‐day activities) (OR = 1.77, 95% CI = 1.11–2.81). Similar associations were observed for levels of pain. We conclude that levels of pain and prevalence of daily pain are high in village residents. Self‐reported arthritis, self‐reported poor/fair health, no health clinic on‐site and minimal fatigue are all independently associated with a higher risk of daily pain and with levels of pain. This study suggests potential opportunities for villages to better provide on‐site support to decrease prevalence and severity of pain for their residents, and thus potentially increase wellbeing and quality‐of‐life, though as we cannot prove causality, more research is needed. [ABSTRACT FROM AUTHOR]

Shortly after the COVID‐19 pandemic reached Aotearoa New Zealand, stringent lockdown measures lasting 7 weeks were introduced to manage community spread of the virus. This paper reports the findings of a qualitative study examining how lockdown measures impacted upon the lives of nurses, midwives and personal care assistants caring for community‐based patients during this time. The study involved nationwide surveys and in‐depth interviews with 15 registered nurses employed in community settings, two community midwives and five personal care assistants. During the lockdown, nurses, midwives and personal care assistants working in the community showed considerable courage in answering their 'call to duty' by taking on heightened care responsibilities and going 'the extra mile' to help others. They faced significant risks to personal and professional relationships when they were required to take on additional and complex responsibilities for community‐based patients. Despite the hypervigilant monitoring of their personal protective equipment (PPE), the need to safeguard family and community members generated considerable stress and anxiety. Many also faced personal isolation and loneliness as a result of lockdown restrictions. Moreover, the negative impacts of experiences during lockdown often continued to be felt once restrictions had been lifted, inflecting life during periods in which community transmission of COVID‐19 was not occurring. This article makes five core service delivery and policy recommendations for supporting community‐based nurses, midwives and personal care assistants in respiratory disease pandemics: acknowledging the crucial role played by community‐based carers and the associated stress and anxiety they endured by championing respect and compassion; demystifying the 'heroism' or 'self‐sacrifice' projected onto care workers; the timely provision of adequate protective equipment; improving remuneration, with adequate provision for time off; and regular counselling, peer support groups and education on work‐life balance delivered by support workers in recognition of stressors arising from these complex and isolated working conditions. [ABSTRACT FROM AUTHOR]

Māori health providers emerged in Aotearoa/New Zealand in the 1980s as a mechanism to achieve self‐determination for Māori communities. However, the contracts funding Māori health providers limit expressions of self‐determination and fail to reflect Te Tiriti O Waitangi, the founding treaty of Aotearoa/New Zealand. Significant health reforms are proposed in Aotearoa/New Zealand, including the creation of a Māori Health Authority that will commission services from Māori health providers. This paper aims to critique the government contracts provided to Māori health providers in the light of the health reforms. A discourse analysis was undertaken on contracts held by a Māori health provider. The study was informed by a Kaupapa Māori congruent methodology that centralised Māori knowledge. The contractural language utilised a variety of discursive techniques that ultimately limit the power of Māori health providers. These discursive techniques included the redefinition of Māori concepts of self‐determination, the use of rhetoric that was not matched by action, reshaping Māori health priorities to reflect the funders' priorities and the application of a deficit lens to Māori health issues. The discursive techniques present in these contracts is consistent with previous work demonstrating a failure of funders to centralise Māori knowledge and ways of being. Success of the proposed health reforms and the Māori Health Authority should require dismantling of non‐Māori ways of commissioning and contracting, otherwise there is the continued risk of discriminatory contracting practices limiting the expression of self‐determination for Māori health providers. [ABSTRACT FROM AUTHOR]

The aim of this paper is to present the psychological strengths we identified from interviews with community dwelling older adults. Data for this paper is drawn from participants in a community dwelling older adult study. The latter involved qualitative in‐depth interviews with the participants exploring their well‐being. All participants were community dwelling and living in a region in the North Island of New Zealand. Interviews took place between March 2017 to September 2017. Thirty‐seven older adults between the ages of 66–99 took part in semi‐structured interviews and all interviews were audio‐recorded. Interviews ranged from 1 to 3 hr. Analysis was informed by the Values in Action Character strengths framework. We were able to identify strengths within the VIA conceptual framework comprising; cognitive strengths, emotional strengths, social and community strengths, protective strengths and transcendental strengths. Throughout this study we found that participants experienced difficulties in identifying and talking about their strengths. In many ways this may reflect participants' strength of humility, demonstrating modesty in talking about themselves. This study has highlighted the challenges older adults experienced in identifying their own strengths. However, the study has demonstrated how narratives can be one way of uncovering psychological strengths with older adults. In particular, these findings highlight the range of strengths, for example, bravery, gratitude, hope, humour, kindness, perseverance, spirituality, that older adults have and give a voice in highlighting these. However, more practical ways of making strength‐based practices workable in daily practice, for example, in clinical assessment and health promotion programs are required. [ABSTRACT FROM AUTHOR]

Studies on domestic violence in ethnic minority communities highlight that social norms, family structures and cultural practices are among the key triggers of violence against women. Not surprisingly, most antiviolence interventions in these communities aim to redeem women from the oppressive features of these cultures. More recently, however, emergent scholarship advocates mobilising, rather than erasing, culture within existing anti-violence strategies. This paper explores the nature of culturally informed interventions used by front-line workers. It presents the findings of a small-scale qualitative study in Aotearoa/New Zealand, where around 13% of the population are currently deemed to be from minority ethnic communities. Interviews and one focus group were conducted with nine practitioners - including social workers, counsellors and the police - in Hamilton, Aotearoa in 2013-2014. Based on thematic analysis, the paper identifies two core strands: (a) the distinctive profile of ethnic violence and (b) the strategies that mobilise culture in antiviolence interventions. Specifically within the former strand, it was found that violence in the ethnic community was distinctive for the following reasons: the heightened sense of stigma surrounding disclosure and the consequent silence by women who suffer from it; the lack of trust in authority; and the fear of conventional safety plans necessitating longer time periods for rapport-building. Among the strategies that mobilise culture, the study found that practitioners used a family approach; engaged men in their interventions, at times reinforcing gendered roles; utilised micro-interventions; and deployed cultural tropes, especially around spirituality, as a strategy. The conclusion points to the gap between interventions that challenge and mobilise cultures. While anecdotally, the latter are perceived to be relevant and effective in antiviolence interventions, there is need for a fuller assessment and better codification of these strategies within the training of practitioners who work in these communities. [ABSTRACT FROM AUTHOR]

There is a growing interest in English-speaking jurisdictions, including Australia, North America, Canada, the United Kingdom and New Zealand, about the prevention of sexual abuse perpetrated by children against other children. The aim of this review was to identify opportunities for research, policy and practice which could enhance the prevention agenda relating to the perpetration of sexual abuse by children through conducting a Critical Interpretive Synthesis. Eleven electronic databases were searched in the period from 22 April to 23 May 2013 and included: SocINDEX, Social Services Abstracts, Applied Social Sciences Index and Abstracts, Family and Society Studies Worldwide, Project Muse, PsychINFO, Family and Society Plus, Jstor, Expanded Academic ASAP, Web of Science and Google Scholar. Key individual journals were also searched, including Child Abuse and Neglect and the Journal of Interpersonal Violence, as well as the grey literature. The search was guided by the research question: How could the prevention agenda relating to sexual abuse perpetrated by children be enhanced? The systematic literature search yielded 3323 titles, and 34 of these papers were included in the final synthesis. The authors identified five domains operating in the evidence base: characteristics, causes, communications, interventions and treatments. A synthesising construct emerged from the review: prevention-enhancing interactions. This construct referred to the potential for enhancing the prevention agenda which exists as the evidence domains interact with one another, and with the public health model of prevention. The authors consider this review to be a timely contribution to the current agenda pertaining to sexual abuse perpetrated by children. It provides researchers, policy makers and practitioners in the field with an evidence-informed conceptualisation of opportunities for enhancing prevention work. [ABSTRACT FROM AUTHOR]

Identification of factors which influence health after a cardiovascular disease (CVD) event will assist with reducing the high health and economic burden of CVD. We undertook a systematic review to investigate the association between social health (lower social isolation, higher social support and lower loneliness) and health and well‐being after a CVD event among people living in Australia and New Zealand. Four electronic databases were systematically searched until June 2020. Two reviewers undertook title/abstract screen. One reviewer undertook full‐text screen and data extraction. A second author either independently extracted or checked data. Narrative thematic analysis was undertaken. Of the 752 unique records retrieved, 39 papers from 29 studies met our inclusion criteria. Included studies recruited between 10 and 1,455 participants, aged 12–96 years, and the majority were male. Greater social health was consistently associated with better mental health outcomes (lower depressive symptoms, anxiety symptoms and psychological distress). Lower social isolation and higher social support were associated with the extent to which patient needs were being met. Living situation was not associated with mental health outcomes, and being married or living with someone was associated with greater medication adherence. Our systematic review demonstrates that greater social health is associated with better mental health outcomes and met patient needs among cardiac patients. As partner status and living status did not align with social isolation and social support findings in this review, we recommend they not be used as social health proxies when assessing health outcomes among CVD patients. Our review highlights the need for more research focused on women and the importance of gender‐disaggregated reporting. Further assessment is required to evaluate whether loneliness is associated with health and well‐being outcomes after a CVD event. [ABSTRACT FROM AUTHOR]

The development of antiretroviral ( ARV) drugs to treat HIV has turned what was once a death sentence into a chronic disorder. However, a focus on absence of disease in the form of an undetectable viral load and the dismissal of the so-called 'cosmetic' complications of the disease ignores perceptions of health and well-being of those living with HIV. Facial lipoatrophy is a stigmatising side effect of treatment for HIV as it betrays the presence of the virus within the body. The study took a longitudinal qualitative approach, interviewing 11 people twice over a period of 1 year on their experience of living with HIV. Two participants were given cameras and asked to take photos which represented what it was like for them to live with this condition and were interviewed four times at four monthly intervals. This paper looks at one man's struggle to conceal or veil his facial lipoatrophy. His story is presented in the form of 'selfies' and extracts from in-depth interviews. It tells of an emotional (ongoing) journey of frustration, anger, excitement, depression and resignation which had a profound effect on his sense of social and psychological well-being. This suggests a more holistic approach to treating people living with HIV is needed. While an undetectable viral load is indeed vital, it should not be seen as the only essential outcome of treatment. [ABSTRACT FROM AUTHOR]

This paper explores older people's views, experiences and sources of bereavement support following the death of a spouse, family member or other significant individual. Telephone interviews were conducted with 28 bereaved older adults recruited from the Brief Risk Identification Geriatric Health Tool trial participants in three geographically diverse District Health Boards in New Zealand. Analysis adhered to the principles of grounded theory and followed the National Centre for Social Research 'Framework' approach. Findings indicate that family and friends play a fundamental role supporting older bereaved adults, both emotionally and practically. Existing community-based organisations were identified as an important source of support following bereavement. Despite the emotional, financial and practical challenges associated with bereavement, the majority of participants questioned the role of, need for and value of formal bereavement support services. Instead, study participants cited a combination of being older and previous life experiences as factors that had enabled them to cope with these largely 'expected' events. Moreover, they demonstrated considerable resilience in managing the emotional and practical changes associated with loss and bereavement. This study poses a challenge to the argument that the growing secularisation of society has led to an increase in the use of professional bereavement services over more 'traditional' forms of support, such as family, friends and community and religious organisations. The paper highlights the value of adopting a public health-based approach as a way of optimising bereavement support via the use of existing community organisations previously known to older people. This is particularly important in those countries where the provision of bereavement support is limited due to resource constraints. [ABSTRACT FROM AUTHOR]

This paper addresses the challenge reported in the research literature of providing adequate accounts of service quality and value to multiple stakeholders. Rather than starting with a particular accountability practice, we examine the accounts of complex service delivery and results from the perspective of five key stakeholder groups. The case study at the empirical centre of this research is a small New Zealand non-profit organisation that provides community-based wraparound casework to young people, and their families, with multiple and complex needs. This paper reports on data collected during 2009-2012 through interviews with five key stakeholders of this service: the young people, the caseworkers, the co-providers, the managers and the funders. Drawing on translation theory, the different points of reference and the consequential shifts in focus, content and meaning within the multiple stakeholder accounts are traced. The findings show that while each stakeholder group brings a unique point of reference to the service delivery, there are degrees of overlap in the focus and content of the accounts. This is particularly evident in the 'relationship' dimension. While overlaps may exist, points of invisibility are also revealed. Accountability tensions can be traced directly to these points of invisibility. As a result of this analysis, it is argued that more explicit attention to the impact of multiple stakeholders at the level of epistemology provides a mechanism for addressing some of the tensions routinely raised. [ABSTRACT FROM AUTHOR]

Worldwide, a growing burden of health and social issues now affect young people. Interagency collaboration and the "integration" of health and social care services are advocated to address the increasingly complex needs of at‐risk youth and to reduce barriers to accessing care. In New Zealand, Youth‐One‐Stop‐Shops (YOSSs) provide integrated health and social care to young people with complex needs. Little is known about how YOSSs facilitate collaborative care. This study explored the collaboration between YOSSs and external agencies between 2015 and 2017 using a multiple case study method. This paper reports qualitative focus group and individual interview data from two of four case sites including six YOSS staff and 14 external agency staff. Results showed participants regarded collaboration as critical to the successful care of high needs young people and were positive about working together. They believed YOSSs provided effective wraparound collaborative care and actively facilitated communication between diverse agencies on behalf of young people. The main challenges participants faced when working together related to the different "world views" and cultures of agencies which can run contrary to collaborative practice. Despite this, some highly collaborative relationships were apparent and staff in the different agencies perceived YOSSs had a lead role in co‐ordinating collaborative care and were genuinely valued and trusted. However without the YOSS involvement, collaboration between agencies in relation to young people was less frequent and rarely went beyond limited information exchange. Establishing and maintaining trusting interpersonal relationships with individual staff was key to successfully negotiating agency differences. The study confirms that collaboration when caring for young people with high needs is complex and challenging, yet agencies from diverse sectors value collaboration and see the YOSS integrated wraparound approach as an important model of care. [ABSTRACT FROM AUTHOR]

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

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

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

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

The needs of refugees and the struggles on the part of service providers to address this diverse population have received limited attention within the academic literature. This paper profiles Hauora o Puketapapa/Roskill Union and Community Health Centre (HoP), which is a non-profit, community owned and operated health clinic designed to deliver accessible, affordable and appropriate primary health care services to low-income groups in the Mt Roskill area of Auckland, New Zealand. The clinic's locality has undergone considerable demographic change over recent years with the arrival of refugees from diverse backgrounds. This situation has resulted in new sets of health needs and expectations which need to be addressed. The study took place in 2002–2003 and employed qualitative methods. In-depth interviews with community representatives, clinic users and health service staff members revealed that refugees face considerable barriers in accessing and utilising health services. Similarly, we found that health practitioners face the daunting task of endeavouring to meet these needs in an effective and culturally appropriate manner within a limited funding environment. We conclude that, despite these challenges, HoP has successfully established itself as a well-regarded place of primary health care. In so doing, it has strengthened the capacity of the local community to respond to the changing policy environment. However, long-term sustainability issues remain unless resourcing issues are adequately addressed. [ABSTRACT FROM AUTHOR]

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

This paper explores the views of healthcare staff regarding the provision of culturally appropriate palliative care for Māori, Pacific Island and Chinese elders living in Auckland, New Zealand. The ageing population is culturally and ethnically diverse and, along with other developed countries experiencing high levels of migration, the challenge is balancing the rise in numbers of older people from different ethnic and cultural groups with end-of-life care, which reflects personal values and beliefs. Two joint interviews and ten focus groups were conducted with eighty staff across a range of primary, secondary and speciality care settings in 2010. The findings demonstrated that participants viewed the involvement of family as fundamental to the provision of palliative care for Māori, Pacific Island and Chinese elders. For Māori and Pacific Islanders, healthcare staff indicated the importance of enabling family members to provide 'hands-on' care. The role of family in decision-making was fundamental to the delivery of and satisfaction with care for older Chinese family members. Care staff highlighted the need to be cognisant of individual preferences both within and across cultures as a fundamental aspect of palliative care provision. The role of family in 'hands-on' palliative care and decision-making requires care staff to relinquish their role as 'expert provider'. Counter to the prioritisation of autonomy in Western health-care, collective decision-making was favoured by Chinese elders. Providing families with the requisite knowledge and skills to give care to older family members was important. Whilst assumptions are sometimes made about preferences for end-of-life care based on cultural values alone, these data suggest that care preferences need to be ascertained by working with family members on an individual basis and in a manner that respects their involvement in palliative care provision. [ABSTRACT FROM AUTHOR]

Healthcare systems have a vested interest in employing work-ready graduates. The challenge for universities is to find ways to provide workplace learning that incorporates student education and high quality patient care. Inland areas of Australia, similar to other rural locations globally, experience additional challenges including a relatively high incidence of ill health, increasing demand for health services, chronic workforce shortages and ageing of the existing rural health workforce. In this paper, we conceptualise and describe the research findings related to context from a consultative enquiry into university clinics conducted in 2008. Interview participants were drawn from twenty university clinics in Australia and New Zealand. A consistent theme throughout the interviews was tensions that arose between the role of education and healthcare provision within university clinics. Many interview participants described ways they managed these tensions to meet the expectations of students, educators and the community. The patient supply is the most critical factor in the context of university clinic operations. It is vital to both the educator and the healthcare provider roles. In inland areas with sparse populations a number of strategies, such as outreach clinics, hospital or health centre- based clinics and multi-disciplinary sites, will have to be developed if university clinics are to operate effectively for students and patients. [ABSTRACT FROM AUTHOR]

We have previously reported a preliminary taxonomy of patient error. However, approaches to managing patients’ contribution to error have received little attention in the literature. This paper aims to assess how patients and primary care professionals perceive the relative importance of different patient errors as a threat to patient safety. It also attempts to suggest what these groups believe may be done to reduce the errors, and how. It addresses these aims through original research that extends the nominal group analysis used to generate the error taxonomy. Interviews were conducted with 11 purposively selected groups of patients and primary care professionals in Auckland, New Zealand, during late 2007. The total number of participants was 83, including 64 patients. Each group ranked the importance of possible patient errors identified through the nominal group exercise. Approaches to managing the most important errors were then discussed. There was considerable variation among the groups in the importance rankings of the errors. Our general inductive analysis of participants’ suggestions revealed the content of four inter-related actions to manage patient error: Grow relationships; Enable patients and professionals to recognise and manage patient error; be Responsive to their shared capacity for change; and Motivate them to act together for patient safety. Cultivation of this GERM of safe care was suggested to benefit from ‘individualised community care’. In this approach, primary care professionals individualise, in community spaces, population health messages about patient safety events. This approach may help to reduce patient error and the tension between personal and population health-care. [ABSTRACT FROM AUTHOR]

Discrimination against people with experience of mental illness is a recognised problem, and there is a lack of information in New Zealand regarding the nature of this discrimination. The Like Minds, Like Mine project is a New Zealand initiative to combat the stigma and discrimination associated with mental illness. This paper reports on a study undertaken as part of this initiative, and describes the nature of discrimination that people with experience of mental illness face in New Zealand. A written survey was undertaken with people with experience of mental illness from throughout New Zealand, using a mixture of qualitative and quantitative questions. This questionnaire was distributed throughout the country in 2003, using a variety of distribution methods, and 785 responses were received and analysed from people self-identifying as having experienced mental illness. Respondents reported discrimination in all areas of their lives. The most commonly reported areas were discrimination by friends and family (59%), a fear of being discriminated against (46%), and discrimination in looking for employment (34%) and mental health services (34%). Discrimination can limit the participation of people with experience of mental illness in our society. We all need to examine our own attitudes and behaviours and take responsibility for discrimination. [ABSTRACT FROM AUTHOR]

The present paper investigates what keeps doctors ‘in place’ in New Zealand rural communities and what prompts their departure from practice. The study is based on in-depth interviews conducted with nine overseas-trained medical practitioners within rural areas in New Zealand during 2004. A thematic analysis was undertaken. The resulting narratives reveal the unintended circumstances under which respondents often arrived in their rural communities, as well as some of the ‘pull’ factors which a more relaxed rural lifestyle offers. Recurring themes relating to the attractiveness of place include community loyalty and the enjoyment of ‘fully practicing medicine’. Themes which corroded the attractiveness of place included ‘entrapment’, lack of choice in secondary schooling, restricted spousal employment opportunities, the lack of cultural and entertainment activities, and difficulties accessing continuing medical education. The authors conclude that addressing the question of what makes ‘place’ attractive to overseas-trained general practitioners in rural New Zealand requires an understanding of place as context rather than mere location. [ABSTRACT FROM AUTHOR]

Abstract The present paper examines the relationship between deprivation and changing patterns of public hospital admissions in Christchurch, New Zealand, between 1992 and 1997, during a time of economic restructuring and rapid change in the health sector. The total set of admissions into Christchurch Hospital was geocoded according to the meshblock domicile of each patient. Domiciles were classified into 10 decile categories using the NZDep91 and NZDep96 measures of deprivation. Regression analysis was used to measure changes in the relationship between deprivation and different types of admissions. Differences between admission rates for people living in the most and least deprived areas increased over time, especially following the implementation of the 1993 health reforms. This was most marked for younger adults (ages = 25–44 years), day patients, and especially, acute day patients, ambulatory-care-sensitive admissions and re-admissions. The average length of stay also varied by deprivation and appeared to be an important cause of the increasingly high rate of re-admissions. On average, patients from more affluent areas are hospitalised longer than low-income patients, although the differences narrow over time. The results suggest that the widening social gap in hospitalisation rates is a result of the effects of poverty and problems of access to primary care. However, more research on different admission pathways and causes of admissions for different patients from different parts of the city is needed to confirm these observations. [ABSTRACT FROM AUTHOR]

This paper examines the issue of targeting primary health-care benefits in favour of low-income recipients and other high users of health care. Specifically we examine the New Zealand case where, despite the introduction of such benefits in 1992, financial barriers appear to remain a significant determinant of utilization. We address this issue through a case study conducted in the city of Christchurch. Through a survey-based research design, we seek to determine the extent to which price barriers remain important by comparing patient utilization of a free community health clinic (n = 202) with a low-income control sample of patients who continue to use conventional (for New Zealand) fee-for-service providers (n = 148). We found that a large proportion of respondents delayed seeking care because of cost. Further, for respondents using the fee-for-service providers, levels of use were not related to need, whereas at the free clinic there was an inverse relationship between income and consultation rates. We conclude that if a universality of benefits is not possible, then there is a need for better targeting of primary care benefits. We believe there is a danger in such initiatives being evaluated primarily in terms of their validity as funding mechanisms, rather than in terms of their success in meeting the health-care needs of the disdavantaged. [ABSTRACT FROM AUTHOR]

This paper provides a regional commentary on the progress of deinstitutionalization in an era of restructuring in New Zealand. The commentary focuses on the Waikato region, where the transition to community-based psychiatric care has been underway since the announcement of the closure of Tokanui Hospital in 1993. We use media reports to construct a narrative illuminating the distinctive threads of alternative discourse on the re-placing of people with mental health problems and sites of treatment ‘into the community’. Our interpretation of this local narrative is cast against a series of backdrops: firstly, we provide an abbreviated history of deinstitutionalization in New Zealand; secondly, we examine mental health care as a sector within a rapidly evolving health system; and, thirdly, we reflect on the implementation of community mental health care in a re-regulated civil society. We argue that the effective implementation of community care has been hampered by the lack of concerted policy in the mental health care sector, by a fiscal squeeze on the health care system and by the impingement of non-health care legislation (the Commerce Act, the Privacy Act and the Resource Management Act) on the local expression and management of community care. In the Waikato narrative, we also identify administrative practices that have recast people with mental health problems as criminals and re-established prisons as the site of treatment. We conclude that the media in New Zealand have a role that extends beyond simply reporting on events. Indeed, the media act as a reflexive conduit; journalists interpret issues and through their ‘stories’ help to shape the course of events. [ABSTRACT FROM AUTHOR]

Young people are known to face challenges when accessing healthcare and generally have low rates of health service utilisation. Use of telehealth might be one way to improve access, but evidence is needed from young people as to how acceptable it is. This online survey of 15‐ to 25‐year olds in the greater Wellington region of New Zealand sought young people's views on telehealth (phone and videocalls) as a means of accessing primary care. The survey included both forced‐choice questions and free‐text options. We report here on the free‐text data from open‐ended questions that were qualitatively analysed using template analysis. A total of 346 participants took part between August 6 and September 21, 2021, of whom 60% were female, 12% Māori (indigenous) ethnicity, and 38% had used telehealth methods of consulting previously. Analysis was undertaken of the free‐text comments that were provided by 132 participants (38%). Although those contributing comments described both benefits and drawbacks to using telehealth, more drawbacks were cited, with specific examples given to illustrate a range of concerns and potential limitations of telehealth including privacy, communication difficulties and compromised quality of care. Participants thought telehealth could be used successfully in specific situations, for example by people concerned about leaving the house due to anxiety, illness or being immunocompromised and for simple consultations or when the person knows exactly what they need. Respondents expressed a strong desire to be offered the choice between in‐person and telehealth consultations. Providing young people with a choice of consultation mode together with clear information about all aspects of a telehealth consultation is important if clinicians want young people to engage with this method of primary care service delivery. [ABSTRACT FROM AUTHOR]

Within the context of an ageing population and the added challenges posed by COVID‐19, the need to optimise palliative care management in the community – the setting where a significant proportion of people prefer to die – cannot be underestimated. To date, there has been a dearth of research exploring community palliative care delivery during the pandemic. This study aimed to explore the impact of and response to COVID‐19 for hospice community services in Aotearoa/New Zealand. Eighteen structured interviews were conducted (10 February–18 August 2021) with healthcare professionals from sixteen purposively sampled community hospices from New Zealand regions according to the number of COVID‐19‐positive patients per 100,000 inhabitants (low, medium and high) with oversampling of high prevalence areas. Two overarching themes emerged 'challenges' and 'adaptations'. Each theme had several subthemes related to service delivery in communication, visiting, allied health team collaboration and volunteer services. Adaptations involved adjusting official health advice to the local context, increased use of telehealth, reducing infection risk during in‐home visits through triaging of cases, division of the workforce into teams and repurposing volunteers' services. Despite these adaptations, challenges remained, including increased workload pressures for staff and an absence of the human touch for patients and families. Implications for hospice practice and recommendations for future research are discussed. Governments must acknowledge the essential contribution of hospice to the COVID‐19 pandemic and ensure that these services are incorporated into the healthcare system response. [ABSTRACT FROM AUTHOR]

The objective of this study was to understand how participants referred to a childhood obesity intervention programme prefer to receive health information, and secondly, to determine acceptability of digital technologies such as a social media platform or IT application for programme engagement. This study includes a subset of interviews (n = 64) of a wider study of the barriers and facilitators of engagement in a multidisciplinary healthy lifestyle programme for childhood obesity, based in Taranaki, Aotearoa/New Zealand. The topics of health information and social media and/or app use were covered in 53 and 30 interviews, respectively. Participants were parents and caregivers of children and adolescents referred to the programme, and interviews were mostly conducted in family homes. Findings showed that participants consulted a range of people, places and resources for information about their health, notably the internet, health professionals, and family and friends. Participants reported using the internet to complement or supplement information from health professionals. A strong relationship with health professionals built on trust was important. Use of digital technologies such as an IT application or social media platform for engagement with the programme was generally acceptable, with the caveat that this did not replace face‐to‐face communication with their primary care provider. In conclusion, the high usage of digital sources of health information requires accurate and reliable information. Digital technologies such as IT applications or social media platforms may have a role in terms of supplementing the patient journey; however, the importance of in‐person communication and an ongoing relationship with a health professional or practice remains paramount. [ABSTRACT FROM AUTHOR]

In many countries across the world, older people are one of the groups most vulnerable to loneliness. Community‐based responses are well placed to support and enhance pre‐existing coping strategies in older people. However, the evidence base of these responses remain scattered and obscured, particularly in relation to their design and reasons behind their success. In this systematic review, we focus on qualitative studies on community‐based responses to loneliness among older people to learn how these responses work in practice with in‐depth details. At the end of a systematic searching and screening process, 17 studies conducted in five countries (Australia, Canada, New Zealand, Spain and the UK) published in English were selected and reviewed initially in October 2020 and then updated at the end of August 2021. Three themes were identified as being most valuable to addressing loneliness in a specific community, namely, autonomy, new social connections, and belonging. These interventions were also employed according to three primary considerations: what the community lacked, how that community experienced loneliness, or a combination of both. Several implications for policymakers and future research emerged, urging future interventions to take a more contextual approach that encompasses community‐level considerations before establishing a user‐led and tailored setting that facilitates social engagement. [ABSTRACT FROM AUTHOR]

The traditional competency frameworks for coaches, the International Coaching Federation (ICF) and the European Mentoring and Coaching Council (EMCC) disregard the differences in expertise required among the diverse professions that may provide coaching. A recent systematic review has identified competencies specific to health professionals who health coach. There are increasing workload pressures in primary care; pharmacists can potentially shift to the greater provision of health promotion services, such as health coaching. The provision of such services needs to be underpinned by competency frameworks, which support the role of pharmacists as health coaches. This analysis identifies the competency gaps for pharmacists if they are to take on the role of health coaching. The enabling competencies of health coaches were compared to the competency frameworks of pharmacists from Australia (AUS), Canada (CAN), New Zealand (NZ), the United Kingdom (UK) and the United States of America (USA). Correlations between the international pharmacist competency frameworks and the competencies enabling health coaching showed that entry to practice pharmacists from AUS, CAN and NZ all require training enabling the health coaching competency 'demonstrates confidence', whereas competency frameworks for pharmacists from both the UK and the USA included all competencies required to health coach. Although pharmacists from the countries examined had most of the competencies required to health coach, gaps within the international pharmacist competency frameworks were apparent, university curricula addressing these gaps would equip entry to practice pharmacists with the knowledge and understanding to confidently provide emerging professional pharmacy services such as health coaching. [ABSTRACT FROM AUTHOR]

A growing body of research indicates both positive and negative effects of grandparent childcare; effects that are largely dependent upon the context and intensity of the care are required. Here, we suggest that context to be inclusive of cultural background. Drawing on the indigenous methodological framework, talanoa, the views of 13 Pacific Island grandparents in relation to themes of grandparent childminding are explored, as well its proximity to perceptions of elder abuse. A cultural analysis reveals that traditions specific to the Pacific way of life may lead to increased risk of prolonged childcare. The participants in this study felt that prolonged childminding deprived them of time which could be used to benefit them and their community in the long run. It was viewed as a form of disrespect, as older people are revered and held in high regard in decision making activities from the Pacific worldview. The participants embraced their roles as the knowledge holders of cultural treasures; responsible for teaching children and grandchildren their genealogy and language, and for upholding the protocols of their cultural heritage. However, they felt their contributions were not reciprocated nor valued, but instead exploited. [ABSTRACT FROM AUTHOR]

The objective of this research was to explore social connectedness and associations with self‐perceived health amongst older adults in New Zealand at a population level. The data for this analysis were derived from the 2016 Health and Lifestyle Survey, a nationally representative survey administered via face‐to‐face interviews. The findings from this analysis of 1,374 respondents, all of whom were over the age of 55 years, highlight that being female, belonging to older age groups (above 70 years), being employed full‐time or part‐time, connecting online with known people, considering cultural connections to be important and not feeling isolated from others are significantly and positively associated with positive self‐perceived health. The findings underscore the resilience potential of older adults and importance of social connectedness for positive health and well‐being. In addition, the findings reveal target areas that would benefit by intervention and support by health professionals and policy makers. [ABSTRACT FROM AUTHOR]

There has been growing recognition of the harmful consequences of loneliness for health and well‐being, and the need for community intervention, particularly in times of global crisis such as the Covid‐19 pandemic with its imperatives of distancing, isolation, and quarantine. Social capital and a sense of social cohesion are known to have roles in buffering against the effects of adverse life circumstances. Our study sought to investigate the association of a range of social attitudes and activities – as proxies for social capital – with loneliness while taking into account socio‐demographic factors. We undertook a national survey on a stratified random sample of the New Zealand (NZ) adult population aged 18+ in 2017 (n = 1,358), data from which included the requisite variables. The prevalence of loneliness was highest in young adults (18–30), falling with age until a slight rise in older people (76+). Loneliness was associated with socio‐demographic factors, being more prevalent in the more disadvantaged groups: the deprived, Māori (the indigenous people of NZ), the non‐partnered, and the less educated. Controlling for these socio‐demographic factors, pro‐social attitudes (that is towards political efficacy, trust in others, not feeling exploited, or being committed to family) and participation in social activities (that is being employed or being involved in recreation groups) – were protective against loneliness. Our study supports asset‐based approaches to tackling loneliness – with implications for health and social care – that emphasise mobilising existing social resources, building social capital, and raising social cohesion in our communities. Such intervention on loneliness would help to prevent and ameliorate its detrimental consequences for public health. [ABSTRACT FROM AUTHOR]

A generalist–specialist model of palliative care is well established as a framework for the provision of community care in resource‐rich countries. However, evidence is lacking regarding how the model is experienced by family carers and the extent to which access to both generalist and specialist palliative care is equitable. A cross‐sectional postal survey was undertaken to explore bereaved family's experiences of generalist palliative care and its intersection with hospice services in the last 3 months of life. A modified version of the Views of Informal Carers—Evaluation of Services survey was sent to 4,778 bereaved family. Data were collected between February 2017 and October 2018. Chi‐square was utilised to identify factors that impacted on experiences of generalist palliative care; analysis of free text data comprising 45,823 words was undertaken using a directed content analysis approach. Eight hundred and twenty‐six questionnaires were returned (response rate = 21%). Seventy per cent of people (n = 579) spent some time at home in the last 3 months prior to death. People who received support from hospice were more likely to receive support from multiple other services. Those who received no community services were less likely to feel supported by their general practitioner, less likely to spend the last 2 days of life or die at home. Feeling supported had a strong association with services working well together, being involved in decision‐making and being aware of the poor prognosis. The provision of palliative care is complicated by a lack of integration with specialist palliative care and may be the basis of continuing inequities in the provision of community care at the end of life. The assumption at a policy level that "generalists" are willing and able to play a key role in palliative care provision needs to be further challenged. [ABSTRACT FROM AUTHOR]

Volunteering is a way for people to develop meaningful relationships within a social group and can lead to the building of social capital, from which both individuals and the wider group can benefit in the form of enhanced well‐being. This study aimed to explore and describe the impact of volunteering on the volunteer coordinators and volunteers themselves in the eastern suburbs of Christchurch, New Zealand, an area particularly impacted by the devastating earthquakes in the period 2010/2011. Data were collected via semi‐structured interviews with volunteer coordinators and volunteers (n = 35; 16 men, 19 women) from November 2018 to mid‐January 2019. Thematic analysis of data highlighted a key theme of Creating and strengthening valued community connections, with subthemes of Personal growth, Community connections and Role of coordination. The key theme illustrated how formal volunteering created effort and opportunities towards the strengthening of personal and community connectedness. Our study demonstrates the importance of social connection for both individual and community well‐being, emphasises the important role of "champions" in facilitating the building of bridging and bonding relationships between individuals and communities, and suggests a role for healthcare professionals to prescribe volunteering as a way to improve individual health and well‐being outcomes. [ABSTRACT FROM AUTHOR]

The objective of this qualitative study in New Zealand was to investigate how general practitioners and patients discuss chronic pain in consultations. Chronic pain is a complex condition that defies many commonsense understandings. It is challenging to manage and patients can come to conclude that there is an empathy deficit. To our knowledge most, if not all, studies on this topic have recruited participants whose main presenting complaint is chronic pain. Forms of chronic pain are relatively common in the population and we thought it likely that at least some discussions may be rendered invisible via these recruiting practices. The study analysed data from the Applied Research on Communication in Health repository of audio transcripts and video‐recorded consultations collected from a range of studies on a variety of topics, none of which were about chronic pain specifically. We searched the 256 transcripts looking for key words that might indicate that pain was at least part of the consultation. This yielded a large number of potentially relevant transcripts. These transcripts were assessed and reduced to 18 by excluding those that were about non‐physical pain or pain that was expected to resolve relatively quickly. A medical specialist in chronic pain reviewed the resulting 18 and excluded two further transcripts giving us a final sample of 16. We conducted in‐depth analysis of these consultations. Rather than confirming an empathy deficit, we found a much more complex deployment of empathy in the space where the two complex systems of chronic pain and general practice meet. These findings highlight the utility of analysing data originally generated for other purposes, with permission, and in a practical sense, highlight the importance of understanding empathy as highly contextual in 'real world' practice. [ABSTRACT FROM AUTHOR]

Māori (Indigenous people of New Zealand [NZ]) experience inequitable health outcomes compared to non‐Māori, across the spectrum of clinical care, including those relating to medicines. Internationally, pharmacist‐facilitated medicines review services have been shown to benefit older adults. Despite national policies calling for the increased implementation of these services, NZ data relating to them remain limited, and these services may increase disparities between Māori and non‐Māori. There are currently no medicines review services developed specifically for Māori older adults. The current study aims to elicit stakeholder views of current and potential pharmacist services to help inform the development of a pharmacist‐facilitated medicines review service for community‐dwelling Māori older adults. Kaupapa Māori theory was applied within this qualitative research. Purposive sampling was used to recruit participants who were involved in providing, planning, funding developing or culturally supporting health services in Waitematā District Health Board, Auckland, NZ. Data were collected in semi‐structured interviews and in a focus group and analysed using reflexive thematic analysis. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative research. Eleven participants took part in the research in one focus group (n = 4) and seven semi‐structured interviews, conducted between November 2018 and March 2019. Three main themes were generated: (a) moving out of the shadows – claiming pharmacists' unique role within a healthcare whānau (family); (b) 'give them the power to be able to ask' – upholding the mana (self‐esteem, pride, standing) and autonomy of kaumātua (Māori older adults) and (c) rights versus realities – reimagining pro‐equity Māori health services within the constraints of the colonial health system. The right of Māori to experience equitable health outcomes needs to be included in policy and also operationalised in relation to medicines review services through improved utilisation of pharmacist skills and improving Māori older adults' autonomy and control. [ABSTRACT FROM AUTHOR]

In New Zealand, as in other industrialised societies, an ageing population has led to an increased need for palliative care services. A cross‐sectional postal survey of bereaved carers was conducted in order to describe both bereaved carer experience of existing services in the last 3 months of life, and to identify factors associated with overall satisfaction with care. A self‐complete questionnaire, using a modified version of the Views of Informal Carers – Evaluation of Services (VOICES) instrument was sent to 4,778 bereaved carers for registered deceased adult (>18yrs) patients in one district health board (DHB) for the period between November 2015 and December 2016. Eight hundred and twenty‐six completed questionnaires were returned (response rate = 21%). The majority of respondents (83.8%) rated their overall satisfaction with care (taking all care during the last 3 months into account), as high. However, satisfaction varied by care setting. Overall satisfaction with care in hospice was significantly higher compared to other settings. Additionally, patients who died in hospice were more likely to be diagnosed with cancer and under 65 years of age. The factors associated with overall satisfaction with care in the last 2 days of life were: caregiver perceptions of treatment with dignity and respect; adequate privacy; sufficient pain relief and decisions in line with the patient's wishes. A more in‐depth exploration is required to understand the quality of, and satisfaction with, care in different settings as well as the factors that contribute to high/low satisfaction with care at the end‐of‐life. [ABSTRACT FROM AUTHOR]

Older adults living alone in the community with no immediate family network or support are referred in the literature as 'elder orphans'. The grey literature has a growing emphasis on the importance of supporting this vulnerable group, particularly with health and social care. However, there is a dearth of empirical research on 'elder orphans', and definitions remained semantically complicated and unknown to the public, healthcare professionals and those being referred as elder orphans. This research explored the views of older adults on the use of the terminology 'elder orphans', and the implications of using the terminology in health and social care systems. A descriptive qualitative approach through face‐to‐face interviews of 11 older adults was undertaken in Auckland, New Zealand in October 2018. Narratives were analysed using thematic analysis. Two themes were identified from the analysis of interview data. The first theme was 'realistic and practical term', which emphasised the participants' impression of the term 'elder orphan' resonating to themselves with great relevance to their current and future situations. The second theme is 'visibility and vulnerability', which highlighted participants' both positive and ambivalent views on the use of the terminology in healthcare settings. The participants viewed this terminology as beneficial to alerting care services, and in promoting awareness among healthcare providers. Older adults from the study, who are living alone without immediate family networks and support self‐identified themselves as 'elder orphans' through a gradual realisation of their current and anticipated social situations. The use of the term within healthcare was considered and preferred by the participants to be used contextually, and targeted towards appropriate health and social care services within and outside hospital‐care settings. [ABSTRACT FROM AUTHOR]

Social networks are informal relationships often with social ties and voluntary or mandatory obligations that can positively support a patient with multimorbidity. This exploratory study sought insights into the social networks of New Zealand people with multimorbidity and also the work of those nominated as providing significant support. Ten participants were recruited from general practice as part of an education programme in which health professional students discussed living with multimorbidity and completed a social network template together with patients. Each patient nominated an individual from their social network whom they considered provided significant support. A researcher interviewed each supporter about their experience of providing support, and their view of the patient's social network. Significant supporters included three classified as 'lay' supporters (sister, wife and daughter) and seven classified as 'professional' supporters (exercise physiologist, general practitioners, nurse, medical specialists). The activities described by supporters was classified according to Vassilev et al.'s expansion of Corbin and Strauss's 1985 classification of work in chronic illness, including the categories of "illness," "everyday" and "emotional" work. Irrespective of whether supporters were lay or professional, they gave examples of each category. While this is expected of lay supporters, it is not expected of professional supporters who are typically viewed as undertaking illness work. Lay supporters described a complex array of activities sometimes impacting on their own personal well‐being, making them more akin to meeting the formal definition of being a carer, while professional supports gave objective yet professionally invested descriptions. The work of lay and professional supporters is complementary in the provision of support for those with multimorbidity. Consideration should be given to the role of lay supporters and to their own needs if they are to be able to sustain their support work with patients. [ABSTRACT FROM AUTHOR]

Healthcare support workers face challenging situations in their day‐to‐day work but may have minimal training on how to deal with such incidents. Although staff training is often recommended as an essential part of any comprehensive approach for preventing and managing workplace violence, there is paucity of evidence on the content and effectiveness of such training. This study aimed to evaluate the effect of an intervention (communication skills training) to reduce the experience of aggression for healthcare support workers. A two arm, cluster randomised, single‐blinded, controlled trial among healthcare support workers in nongovernmental organisations (NGOs) and District Health Boards (DHBs) in New Zealand was conducted. The trial was conducted across 14 NGOs and DHB in Otago, Southland, and Auckland regions of New Zealand. One hundred and twenty‐seven participants were randomised to one of two groups. Both the intervention (communication skills) and control condition (mindfulness) were group‐based, fully scripted, and structured training interventions that consisted of four once weekly workshops that were facilitated by one of two nonclinical facilitators. Measurements of perceived aggression, psychological well‐being, and distress and communication competence were taken pre‐, post‐, 3 months' post‐, and 6 months' postintervention. There was a significant drop in the rate of aggression over time with a mean score and standard deviation of 10.37 (9.169) at baseline dropping to 6.07 (6.923) for the Perception of Patient Aggression Scale‐New Zealand across both intervention and control. Equivalent results were noted with increased psychological well‐being and communication competence and decreased distress with both interventions. This was sustained at 6 months' follow‐up. However, the between groups effect did not demonstrate a statistically significant difference between the intervention and control groups. Both mindfulness and communication skills training can reduce the experience of aggression reported by healthcare support workers. [ABSTRACT FROM AUTHOR]

The demographic ageing of New Zealand society, as elsewhere in the developed world, has dramatically increased the proportion of older people (aged 65 years and over) in the population. This has major policy implications for the future organisation of social care. Our objective was to test the effects on social care use, first, of putative changes in the overall disability profile of older people, and second, of alterations to the balance of their care, i.e. whether it was community-based or residential. In order to undertake these experiments, we developed a microsimulation model of the later life course using individual-level data from two official national survey series on health and disability, respectively, to generate a synthetic version which replicated original data and parameter settings. A baseline projection under current settings from 2001 to 2021 showed moderate increases in disability and associated social care use. Artificially decreasing disability levels, below the baseline projection, only moderately reduced the use of community care (both informal and formal). Scenarios implemented by rebalancing towards informal care use moderately reduced formal care use. However, only moderate compensatory increases in community-based care were required to markedly decrease the transition to residential care. The disability impact of demographic ageing may not have a major negative effect on system resources in developed countries like New Zealand. As well as healthy ageing, changing the balance of social care may alleviate the impact of increasing demand due to an expanding population of older people. [ABSTRACT FROM AUTHOR]

With the future focus on palliative and end-of-life care provision in the community, the role of the general practice team and their relationship with specialist palliative care providers is key to responding effectively to the projected increase in palliative care need. Studies have highlighted the potential to improve co-ordination and minimise fragmentation of care for people living with palliative care need through a partnership between generalist services and specialist palliative care. However, to date, the exact nature of this partnership approach has not been well defined and debate exists about how to make such partnerships work successfully. The aim of this study was to explore how general practice and specialist palliative care team (SPCT) members view their relationship in terms of partnership working. Five focus group discussions with general practices and SPCT members ( n = 35) were conducted in 2012 in two different regions of New Zealand and analysed using a general inductive approach. The findings indicate that participants' understanding of partnership working was informed by their identity as a generalist or specialist, their existing rules of engagement and the approach they took towards sustaining the partnership. Considerable commitment to partnership working was shown by all participating teams. However, their working relationship was based primarily on trust and personal liaison, with limited formal systems in place to enable partnership working. Tensions between the cultures of 'generalism' and 'specialism' also provided challenges for those endeavouring to meet palliative care need collaboratively in the community. Further research is required to better understand the factors associated with successful partnership working between general practices and specialist palliative care in order to develop robust strategies to support a more sustainable model of community palliative care. [ABSTRACT FROM AUTHOR]

Organisational culture has been shown to impact on resident outcomes in residential aged care ( RAC). This is particularly important given the growing number of residents with high palliative care needs. The study described herein (conducted from January 2013 to March 2014) examined survey results from a convenience sample of 46 managers, alongside interviews with a purposively selected sample of 23 bereaved family members in order to explore the perceptions of organisational culture within New Zealand RAC facilities in one large urban District Health Board. Results of the Organisational Culture Assessment Instrument ( OCAI) completed by managers indicated a preference for a 'Clan' and the structured 'Hierarchy' culture. Bereaved family interviews emphasised both positive and negative aspects of communication, leadership and teamwork, and relationship with residents. Study results from both managers' OCAI survey scores and next of kin interviews indicate that while the RAC facilities are culturally oriented towards providing quality care for residents, they may face barriers to adopting organisational processes supportive of this goal. [ABSTRACT FROM AUTHOR]

Despite the benefits of advance care planning ( ACP), international research has suggested that in pluralistic and multicultural societies such as New Zealand, significant differences exist in the uptake of ACP between European-based populations and other cultural groups [Crawley (2005)]. The purpose of this study was to therefore explore the views of generalist palliative care providers in both the community and hospital settings regarding the barriers to ACP adoption as well as methods to increase knowledge about ACP among Māori, Pacific and Asian cultural groups within New Zealand society. Eleven individual interviews, two joint interviews and three focus groups were conducted with health and social care professionals with a wide range of knowledge and experience in palliative care. Challenges were related to a number of issues based on culture, including family decision-making style, a need to 'do everything' and a reluctance to discuss issues surrounding dying and death. Suggestions to increase the knowledge of ACP included techniques to improve information access and the utilisation of shared norms and values to assist with discussions between Māori, Pacific and Asian health professionals and their patients and families/whānau. Findings indicate a need for more family/whānau-centred models of ACP, addressed much earlier in the healthcare process and within the community setting. [ABSTRACT FROM AUTHOR]

Ageing in place initiatives that aim to keep older people out of hospitals and rest homes and in their own homes for longer have been at the forefront of aged care policy since the early 1990s. The success of these policies depends largely on the availability of a suitable home environment, a supportive social network and regular assessment to detect changes in the older person's health status and needs for support. The BRIGHT Trial was a randomised control trial investigating the effectiveness of introducing case finding in primary care settings to detect unmet need and risk of disability among older people. We used baseline questionnaire data collected in 2008-2009 from 3753 community-dwelling older people to estimate and describe use and need for additional personal assistance. Logistic regression was used to identify the most important predictors of reporting some need for support and unmet need. Eighty-one per cent of participants required support with at least one instrumental activity of daily living. Sixty-six per cent were meeting their needs with the support they were currently receiving. Unmet need was most frequently reported for heavy housework (65%) and light housework (53%). While spouses, family members and friends were the main providers of support for light housework, meal preparation, shopping, finances and transportation, paid staff most frequently provided personal care and heavy housework assistance. Reporting mobility difficulty ( OR = 3.5), identifying as a care provider ( OR = 1.7) and being female ( OR = 1.9) were all significant predictors of some need for assistance as well as unmet need for assistance ( OR = 2.5, 1.7 and 1.7 respectively). The findings highlight the importance of regular needs assessment for older people living in the community particularly, given the reliance on spousal support for the majority of activities. [ABSTRACT FROM AUTHOR]

Comprehensive geriatric assessment ( CGA) is considered the cornerstone of good practice, as it identifies need across multiple domains such as social, physical and psychological. The interRAI home care ( interRAI- HC), probably the most well-researched and supported community-based CGA has been implemented globally, often at considerable expense. Policy-makers, managers and clinicians anticipate significant gains in health outcomes following such investment; however, the implementation of CGA is often undertaken in the absence of community service development. This study sought to compare the inter RAI- HC with an existing CGA [the Support Needs Assessment ( SNA)] in community-dwelling older people. A randomised controlled trial was undertaken from January 2006 to January 2007 comparing the interRAI- HC and the SNA in 316 people (65+) referred for assessment of needs with follow-up at 1 and 4 months. Outcomes included health-related quality of life, physical function, social support, cognitive status, mood and health service usage as well as identified need. The study found that significantly more support needs were identified using the interRAI- HC compared to the SNA. More social and carer support were recommended by SNA and more rehabilitation and preventive health screens were recommended by interRAI- HC. Despite these differences, the mean healthcare use was similar at 4 months, although interRAI- HC participants had more Emergency Department presentations and hospital admissions. No statistically significant differences between groups were reported in terms of outcomes. In conclusion, the interRAI- HC was found to identify more unmet support needs than the SNA though resulted in no favourable outcomes for the older person or their carer. The study highlights the need to invest attention around the service context to maximise outcomes based on identified needs. [ABSTRACT FROM AUTHOR]