Health: Theses and Dissertations

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Open Access
The influence of parentification on mental health help-seeking behaviours : a phenomenological study.
(2024) Malagayo, Nikki
Parentification is a change in parent-child relationships wherein a young child assumes roles and responsibilities typically reserved for parents. Empirical evidence shows that parentification can have potentially positive or negative impacts, including implications for child mental health and psychological distress (Borchet et al., 2022; Hendricks et al., 2021; Hooper et al., 2008; Schier et al., 2015). Accordingly, mental health research indicate that psychological distress among individuals continue to increase over time, particularly for young people (Sweeting et al., 2010). However, research which explore familial influences on psychological distress and subsequent mental health help-seeking is lacking. To fill gaps in research, this study attempts to better understand the influences of parentification, with particular regard to mental health help-seeking behaviours. Semi-structured interviews were conducted with eight participants with lived experiences of parentification. Findings from thematic analysis showed that identified themes belong to four categories of positive influences of parentification; negative influences of parentification; influences of parentification to seeking mental help or support; and a supplemental finding, responsibility. The main findings of this study suggest that parentified participants experience predominantly negative influences of parentification including for their mental health. The key finding relating to the influence of parentification on mental health help-seeking is that parentified participants seek help from professionals but also have difficulty asking for help, especially from their parents. The findings also suggest that while they do seek help from professionals, it is typically a last resort approach. The results from this study provides valuable insights on familial influences on mental health and help-seeking behaviours which may be informational for researchers and policymakers.
Open Access
Forms and functions of aggression in preschool-age children: the roles of executive function and emotion understanding
(2024) Pavlov, Smruti
This study adopted a multidimensional approach to investigate the relationships between children’s executive function, emotion understanding and forms and functions of aggression in children from five different preschools in Christchurch, New Zealand. The study aimed to explore potential gender differences within these relationships and to see which components of executive function and emotion understanding would be most predictive of different subtypes of aggression. Potential interactions between executive function and emotion understanding were also explored as predictors of aggression. One hundred and thirty-seven preschool-age children (61 boys and 77 girls) from 2 to 5 years of age (mean age = 3.9, SD = 0.73) completed inhibitory control and cognitive flexibility tasks and expressive and receptive emotion understanding tasks. Teachers completed questionnaires on children’s aggressive behaviours. Emotion understanding emerged as a significant predictor across aggression forms and functions. Distinct patterns were observed with lower receptive emotion understanding associated with reactive aggression and higher levels linked to proactive aggression. Lower receptive emotion understanding and higher inhibitory control predicted increased teacher- reported reactive relational aggression. This suggests there is a more intricate relationship between executive function, emotion understanding and aggression in preschool-age children that extends beyond a simple deficit-based explanation.
Open Access
Youth experiences of using a crisis text line.
(2024) Stace, Alicia
There is a global mental health crisis with youth aged 15 to 24 experiencing high levels of mental distress. Thus, adolescence is a critical developmental period in which to provide high-quality mental health interventions. With greater access to technology, Crisis Text Lines (CTLs) are frequently used by adolescents who are seeking support for their mental health. However, very few studies have examined youth’s perspectives on using these services. This phenomenological qualitative study will use semi-structured interviews to collect first-person perspectives from 16 to 18-year-olds about their experiences using a New Zealand-based mental health CTL within the previous 12 months. Data was analysed using inductive reflexive thematic analysis. Findings consisted of four main themes; the reasons why youth contact CTL services, youth experiences of helpful and unhelpful conversations, the significance of the therapeutic relationship, and youth suggestions for improvements of CTL services. The findings of this study will enhance our understanding of youth experiences of using a CTL. It may also have important implications for the development, delivery, and improvement of clinical services. Awareness and understanding of youth experience may also help to ensure CTL continues to benefit youth who use these services.
Open Access
Investigating the feasibility of a supervised, personalised exercise programme, during the first 12-months of primary treatment, for people with early stage breast or colon cancer, in a Christchurch, New Zealand clinical setting.
(2023) Allan, Jessica
Introduction Despite extensive evidence supporting the benefits of exercise for individuals undergoing cancer treatment and people living with and beyond cancer, exercise programmes are not currently provided at Christchurch Hospital. This study aimed to explore the feasibility of introducing a 12-week individualised exercise programme for individuals with early-stage breast or colon cancer in Christchurch, New Zealand. Methods A multi-method study assessed the feasibility of the 12-week supervised exercise intervention for people with early-stage breast or colon cancer. Feasibility was evaluated through process feasibility (recruitment, compliance, and adherence) and scientific feasibility (safety, description of dose response, and acceptability). Participants' feedback and field diary notes were analysed qualitatively. Results Process feasibility was established with a recruitment rate of 45%, compliance rate of 79%, and adherence rate of 89%. Scientific feasibility was supported by no serious adverse events and adherence to exercise guidelines. Participants reported benefits in emotional and physical health, along with programme acceptance and insights for programme improvement. Discussion The supervised and personalised exercise programme was feasible and accepted by participants, despite challenges posed by the COVID-19 pandemic. Recommendations include a community-based setting and a combined-exercise approach supported by an interdisciplinary team. Conclusions This study demonstrated feasibility for a 12-week exercise intervention for individuals with early-stage breast and colorectal cancer in Christchurch, New Zealand. A proposed interdisciplinary communitybased exercise programme would offer continued support and health benefits for people with cancer.
Open Access
Parental love withdrawal and relational aggression in preschool age children : the role of normative beliefs about relational aggression.
(2024) Lawerance, Preethi
Parental psychological control encompasses several dimensions, such as invalidation of feelings, shaming/disappointment, guilt induction, and love withdrawal. These parenting behaviours have been shown to influence young children’s aggressive behaviours, such as relational aggression (RA). Parental love withdrawal is similar to RA, where the threat is often directed towards the possibility of damaging social relationships. Social Learning Theory suggests that parental love withdrawal may be observed by children, and subsequently modelled in peer interactions as RA. Additionally, the Social Information Processing Model for aggressive behaviours posits that children turn to their memory for cognitive schemas to guide their behavioural choices. Exposure to parental love withdrawal is likely to impact children's belief behaviour pathways and their normative beliefs about relational aggression (NBRA). This study used data from a larger three-year longitudinal study called THRIVE and examined the association between parental love withdrawal and preschool age children’s (2-5 years) RA via NBRA. Parents participated in interviews regarding their parenting styles. Teacher reports were used to measure child RA, and children’s NBRA were assessed using hypothetical vignettes and a social cognitive interview. The results showed no significant associations between parental love withdrawal and children's RA. However, children more disapproving of RA showed significantly higher levels of RA. Similarly, older children were more likely to perceive RA as wrong, but also exhibited greater levels of RA compared to younger children. Older children with greater exposure to parental love withdrawal were more likely to be accepting of RA. Overall, the study highlights the nuances of the belief behaviour pathway in preschool children, and the need to examine different precursors and mechanisms of child RA.
Open Access
Intergenerational parenting and wellbeing of Pacific families in Aotearoa | New Zealand : a strengths-based quantitative investigation.
(2024) Saunders Bowen, Deborah
Intergenerational parenting practices shape societies. Positive parenting practices that endure over time instil health-promoting behavioural strategies within families and across wider populations. Indigenous Pacific cultures enhance positive parenting practices through shared values of relational connections to family, community, and homeland. However, it is unclear how emigration away from place of origin may impact a parent’s ability to nurture adaptive interpersonal behaviour strategies for resilient wellbeing. Within Aotearoa | New Zealand, evidence suggests that cultural connections, acculturation, and social inequalities each have implications for relational behaviours within Pacific families. Many families have less access to their heritage forms of social support and raise children in surroundings with distinctly different cultural norms than those experienced by predecessors from their homelands. Pacific youth and their families today are increasingly challenged by inequalities in health and overall wellbeing. Thus, the following question remains: how do intergenerational parenting practices impact next-generation behaviours, and what contextual factors influence their stability? This doctoral study examined the intergenerational parenting practices of Pacific families living in Aotearoa | New Zealand in the context of cultural change. It analysed how parenting practices influence next-generation behaviours and identified key social influences that promoted stability of intergenerational patterns. It aimed to improve understanding of the social determinants of positive parenting practices and youth wellbeing among Pacific mothers and their children participating in the Pacific Islands Families birth-cohort study. Methods This research analysed data that were prospectively collected over seven measurement waves from childbirth to age 14 years. A multi-level mixed effects modelling approach was applied to account for correlations within the repeated measures of participant responses. Relational behaviour patterns across three generations of Pacific families were examined to assess the stability of intergenerational parenting practices within this population. This involved the sequential study of three consecutive time phases of parenting influence along an intergenerational parenting developmental pathway: I) long-term effects of childhood parenting on current parenting practices; II) real-time effects between parent and child behaviours; and III) cumulative effects on adolescents’ self-concept development. At each phase, the effects of key social determinants were also assessed. Phase I examined associations between childhood parenting and current parenting practices of Pacific mothers of children aged two and four years. Maternal nurturance in childhood was the only type of recalled childhood parenting to have an enduring effect on current parenting practices. Mothers who recalled their maternal upbringing as often nurturing, rather than rarely, had significantly greater odds of frequent use of nurturing parenting practices with their children (adjusted odds ratio [AOR]: 1.6, 95% confidence interval [CI]: 1.1, 2.3). Having a higher level of education and greater familiarity with local cultural contexts were also associated with more frequent use of nurturing parenting practices. Low household incomes were associated with harsh disciplinary practices. In Phase II, analysis of current parent and child behaviours at six time-points between child ages two and 14 years revealed strongly associated behaviour patterns. In particular, the adjusted odds of age-appropriate development of prosocial behaviour between ages six and nine years was 20.9 (95% CI: 9.8, 44.5) for mothers who reported frequent use of optimal parenting practices compared to those reporting infrequent use. Additionally, optimal parenting practices had an inverse association with child internalising and externalising behaviours. Adverse parenting practices, including those typified by harsh discipline or low monitoring, were persistent risk factors for higher odds of internalising and externalising behaviours. Phase III explored the prevalence of positive self-concept among Pacific youth (between ages 11 to 12 years) and their associations with parenting practices as had been reported over the previous five measurement waves. Self-concept was measured in terms of youth-perceived social relations and general self-worth. Pacific youth self-concept dimensions of parental relations, peer relations, and self-esteem were perceived as positive by 90%, 67%, and 61% of all youth, respectively. Cumulative parenting practices were most strongly related to the youth self-concept dimension of peer-relational competency, having enduring effects on youth-perceived peer relations. Optimal parenting practices related to greater odds of youth describing positive peer relations, while adverse parenting practices had the reverse effect. This series of studies of Pacific maternal parenting practices found that positive intergenerational parenting practices persisted within the post-migration context. This was a novel finding within the PIF Study population. No continuity of negative intergenerational parenting was observed. The strong parent-child associations that were either both positive or both negative indicated that these behaviour patterns were bidirectionally reinforcing. They also related to youth-perceived quality of relations beyond the parent-child relationship. Maternal acculturation and higher education were protective factors for the relational wellbeing of both parent and child. The importance of maternal acculturation to optimal parenting practices and child behaviour development implies that trusted, proximal social support is vital to optimal parenting in the post-migration context. The need for sufficient material resources to support the healthy development of children was underscored by the risk of inadequate income to maladaptive parent and child behaviours. The strong associations between maternal and child behaviours seen throughout childhood suggest that wellbeing developmental trajectories for both parent and child could be improved through early detection of behavioural challenges and parenting support. These findings advocate for a public health focus on reducing mothers’ social isolation that may result from cultural and language barriers, inadequate economic resources, or other factors affecting parental self-efficacy. Targeted, culturally responsive parenting support could benefit those mothers who do not recall frequent maternal nurturing in their own upbringing and those mothers currently experiencing challenging child behaviours. Public health initiatives that complement parental efforts to transmit adaptive cultural knowledge for relational health could benefit current and future generations and enhance wellbeing across multilevel social systems. Further in-depth research with Pacific mothers and youth is recommended to gain direct insights into the specific contexts that boost their personal agency to promote relational health and wellbeing resilience.
Open Access
Navigating a tunnel without sight: the experiences of children of parents with mental illness (COPMI) in Aotearoa New Zealand
(2023) George, Natasha
Children of parents with mental illness (COPMI) grow up with either episodic or enduring mental illnesses within their parents that shape their childhood and impact their entire family. COPMI research is important to the field of child and family psychology as parental mental illness influences child development, parenting experiences, and family functionality. International research on the felt experience of COPMI and subsequent impacts are well-established in international research with a notable gap on the recent experiences of tertiary students and children in Aotearoa New Zealand who have not engaged with a COPMI service. The aim of the study was to investigate the childhood experiences among COPMI tertiary students in Aotearoa New Zealand. Participants were five female tertiary students who had grown up in Aotearoa New Zealand and had a parent who had received psychiatric care. Each participant completed a semi-structured interview about their childhood which was transcribed and analysed using reflexive thematic analysis. Three subsequent themes were inductively generated and held together by the metaphor of navigating a tunnel without sight to illustrate how the participants navigated their parent’s mental illness. Each theme had three subthemes which followed a chronological order of their experiences of going from in the dark, growing eyes that see, to lighting a spark. The theme in the dark captured family secrecy about mental illness, inadequate support, and feeling stuck and alone. Second, the theme of growing eyes that see described their journey towards understanding as they experienced hypervigilance, a desire to understand, and positive outcomes. The final theme lighting a spark illustrated the felt connection between the past and the present as the participants felt the impacts of parental mental illness on the family system, talking and education helped, and they had a desire for change. Ultimately, the childhood experiences of COPMI had a profound and long-term impact, providing motivation and inspiration amongst their ongoing loss, frustration, and difficulties. The implications are relevant for a range of people, such as COPMI and their families, practitioners, and policymakers, with avenues for future research that are outlined for researchers.
Open Access
A Private Universe: What does spirituality mean and is appropriate support being provided for people in hospital?
(2024) Woodhouse, Colin
In New Zealand, The Ministry of Health has a contract with the Inter-church Council for Hospital Chaplaincy (ICHC) to provide religious, pastoral, and spiritual support in all of the public hospitals. The ICHC is a Christian only organisation managed by a panel of 9 churches. All of the salaried chaplains are practicing Christians, many of them ordained ministers. All of the trained volunteers helping the chaplains are practicing Christians too. This is in contrast with the United Kingdom’s (UK’s) NHS where each hospital trust has control over its own chaplaincy budget. This puts the trusts in a position to employ the chaplains they feel they need to in order to provide appropriate religious, pastoral, and spiritual support for the service users. I knew that there was a consistently increasing proportion of non-religious people in Aotearoa/New Zealand but there had been no changes in the chaplaincy service since its inception. Spirituality is seen as a significant part of holistic health care both in the Māori health model Te Whāre Tapa Whā (Durie 1984 ) and by the World Health Organisation (Dhar 2014 ) . This importance of spiritual care made me wonder how can a hospital or the Ministry of Health claim to be providing holistic care without offering adequate and appropriate religious, pastoral, or spiritual support to the majority of the population?
Open Access
Exploring the heart health knowledge among newly diagnosed cardiac patients in Aotearoa New Zealand: A convergent mixed methods inquiry
(2023) Short, Kylie Anne
Background: Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide, accounting for 32% of global deaths (World Health Organization [WHO], 2021). In Aotearoa New Zealand, ischaemic heart disease stands as the primary cause of death among various demographic groups, with 175,000 people living with heart disease (Heart Foundation, 2023a). Secondary prevention, specifically cardiac rehabilitation, has been proven to reduce mortality rates and further cardiac events. However, the effectiveness of such programmes relies on patients’ comprehension. Aim: This research sought to investigate the current levels of understanding among individuals diagnosed with cardiovascular disease in Aotearoa New Zealand following their first engagement with acute cardiac hospital services. A tailored model for cardiac health education in acute care settings is proposed. Method: Employing a fixed convergent mixed methods research design, by nationally administering a previously validated questionnaire, across five prominent cardiac centres throughout the country, while also conducting focus groups and individual interviews in Canterbury. Results: The Aotearoa New Zealand knowledge scores obtained from the survey were parallel with international studies, indicating an overall ‘acceptable’ level of knowledge (63.04±13.38), with disparities associated with demographic characteristics such as prior educational levels, employment, smoking habits, age, and gender. Patients exhibited varying levels of knowledge across different aspects of cardiac health. Qualitative findings revealed that patients perceived good knowledge of risk factors but struggled with medication instructions and exercise guidelines. Both patients and healthcare professionals highlighted a lack of formal assessment of understanding during the inpatient period and a need for standardised approaches. Information overload emerged as a potential barrier to knowledge retention. Moreover, the study highlighted the interplay between cardiovascular disease and mental health. Mixed analysis revealed disparities and alignments between knowledge scores and acute cardiac patient and health care professionals’ insights, emphasising the impact of information overload on knowledge retention and the importance of mental health screening. Conclusion: Despite progress in reducing CVD rates, there is a need for acute hospital cardiac rehabilitation, as it remains a crucial connection to specialised cardiac healthcare. The study recommends a future model of acute education practice, including rapid knowledge assessment and mental health screening. Addressing these aspects can improve patient outcomes and contribute to the ongoing efforts to combat cardiovascular diseases.
Open Access
Developing a Kaupapa Māori science education programme focused on microplastics, plastic pollution and sustainability.
(2023) Feltham, Grace
This research explores the potential for creating a microplastics education programme which is centered in mātauranga Māori. The project utilizes Participatory Action Research and Kaupapa Māori Research Methods to create a culturally grounded science education initiative. Through a case study at Te Pā o Rākaihautū, this research found that actively connecting scientific topics to Te Ao Māori (the Māori world) promoted Māori student engagement and understanding of complex topics. This connection must be continually affirmed and made relevant to the local Indigenous context. Connection to Te Ao Māori through te reo Māori (the Māori language), and pūrākau (oral histories) not only creates a positive learning environment but also improves the robustness of environmental science research in Aotearoa. Research into microplastics and plastics pollution in Aotearoa would benefit greatly from an understanding of Te Ao Māori, and recognition of the responsibilities of Treaty Partners under Te Tiriti o Waitangi. Similarly, policies and government actions on reducing plastics pollution must acknowledge the unique role of Indigenous Peoples and Indigenous Knowledge in solving the plastics pollution crisis.
Open Access
Patients’ decision making when experiencing possible acute coronary syndrome : a retrospective exploratory study
(2023) Maria, Roona
Coronary Heart Disease (CHD) is one of the leading causes of death worldwide. In New Zealand CHD accounts for more than 15% of the annual mortality (Ministry of Health, 2018). Acute Coronary Syndrome (ACS) is an umbrella term used for Unstable Angina (UA), ST Elevation Myocardial Infarction (STEMI) and Non-ST Elevation Myocardial Infarction (NSTEMI). In this spectrum of disease, pre-hospital delay and decision making remains the main concern in accessing medical care in a timely manner to avoid negative outcomes in patients. This research identified a paucity of studies, especially qualitative studies in Aotearoa New Zealand to explore concerns related to this problem. Moreover, no studies expressly addressed pre-hospital decision delay and symptom experiences in residents of South Canterbury. This retrospective qualitative study aimed to explore the decision-making process for five participants from South Canterbury, when they experienced ACS. Semi-structured interviews were used to collect data from individual participants. The data was collected and recorded verbatim by the author and transcribed by a transcriber. Thematic analysis was used to analyse the transcribed data, which generated eight major and eleven subthemes. The study recognised various factors (personal, familial, cultural and educational) which led to the participants’ decision delay. The participants of this study experienced subtle and less intense symptoms which affected the interpretation of their symptoms as critical and thus delayed their calling for help. It is concluded from the findings of the study that pre-hospital delay and decision making remains as a major obstacle to seek immediate medical care. Thus, educating general public and high-risk patients and their family regarding possible typical and atypical symptoms of ACS could be helpful to assist in recognising when their symptoms are serious and when there is a need to call an ambulance immediately.
Open Access
Periodised strength and conditioning for short-sprint athletes in Sri Lanka : a mixed-methods study.
(2023) Sellathurai, Jeganenthiran
The distance covered by track and field athletes in short-sprint competitions ranges from 60 to 200 metres. Short-sprint coaches employ periodised training programmes in order to increase performance that incorporate strength training, plyometrics, and sprint practise. Periodised training methods are believed to be more successful than non-periodised (NP) programmes in improving overall performance of elite short-sprinters. Although periodisation has garnered popularity in the literature and sport science, its application to sprinting is limited in developing countries, particularly in Sri Lanka. Therefore, current research has mainly focused on periodised strength and conditioning (PSC) for short-sprint athletes in Sri Lanka; a developing country. Using a sequential exploratory mixed-method design, this thesis consists of four complimentary studies providing insight into how short-sprint coaches in Sri Lanka might structure and impact their athletes' short-sprint performance. The first phase of the explorative study (Study 1) revealed that coaches reported minimal or inadequate knowledge of periodised training and consequently, there did appear to be a gap between coach knowledge of periodised training, but additionally in regard to general training methodology; including aspect such as prescribing strength and speed training loads and, monitoring of training loads. Given the inadequate knowledge of periodised training highlighted by the first study, the second phase comprised of two separate but related concurrent 24-weeks quantitative studies. Experimental manipulations in Study 2 sought to examine the effects 24- weeks of periodised strength and conditioning among short-sprint athletes in Sri Lanka. Results indicated that participants who undertook PSC significantly improved in all the tests at mid-and post-testing (p < 0.05) compared to NP. As a result, PSC training appear beneficial for shortsprinters to maximise reserve capacity in sprint performances. Study 3 assessed the coach and athlete perceptions of the PSC programme concurrently with Study 2. Results indicated that the PSC programme is a fully applicable method for short-sprint athletes in Sri Lanka. As such, Study 4 sought to investigate coaches’ perceptions on the impact of a formal coach education (CE) setting designed to promote short-sprint coaches in Sri Lanka on their coaching practice. Finding revealed that coaches believed knowledge acquired through the CE programme influenced their coaching practices. Overall, the results of this mixed methods study attempt to increase the knowledge about, and application of, periodisation and training methods among Sri Lankan coaches in Sri Lanka, particularly among elite-level coaches working with short-sprint athletes, which likely would reflect the success of Sri Lankan short-sprinters in International competitions in the years to come.
Open Access
A comparison of three mind-body intervention packages to improve transdiagnostic symptoms associated with chronic stress exposure in children.
(2023) Hooper, Lee
Children who experience chronic stress have an increased risk of developing psychopathology, which can have deleterious effects on their social and emotional functioning. Effective treatment protocols exist that look to address the impact of chronic stress; however, these often involve interventions that are primarily targeted at behavioural and cognitive change. As a result, dysfunction of key biological mechanisms, such as the autonomic nervous system, may be overlooked, which can limit the efficacy of interventions that rely on cognitive control to regulate emotions. Mind-body interventions incorporate both top-down (cognitive) and bottom-up (emotional and somatic) processes, and may have beneficial effects on a range of transdiagnostic outcomes that are associated with chronic stress. This research evaluated the effectiveness of three different mind-body intervention packages on reducing transdiagnostic symptoms of chronic stress (in this instance, exposure to natural and man-made disasters) in 11 children aged between 9-12 years. Specifically, the impact of different combinations of heart rate variability biofeedback (and two associated breathing techniques), a social emotional programme, diaphragmatic breathing, and drumming were assessed on eight different measures: heart rate variability, posttraumatic stress symptoms, trait anxiety, anxiety sensitivity, emotion regulation and lability/negativity, wellbeing, hope levels, and positive behaviours. Three concurrent multiple baseline design studies and a qualitative thematic analysis were conducted. Quantitative data were analysed through visual analysis of multiple baselines graphs and modified Brinley plots, as well as through calculating reliable change, clinical significance, and effect size. These results suggested that the intervention packages involving biofeedback and the social emotional programme had stronger effects than the intervention package that involved drumming, and may have been more effective in contributing to decreases in negative symptomatology than increases in positive outcomes. Qualitative data were analysed through thematic analysis. These results suggested that all three interventions packages were deemed acceptable by the participants, and that the breathing techniques and the social emotional programme were considered the most helpful parts of the intervention. Overall, although the results revealed mixed findings, preliminary evidence suggests that the mind-body intervention strategies, particularly biofeedback, diaphragmatic breathing, and the social emotional programme, may be a useful stand-alone or adjunct treatment for chronic stress in children, particularly in reducing posttraumatic stress symptoms. In considering the need for accessible mental health services in Aotearoa New Zealand, as well as internationally, these strategies provide a viable alternative to current treatments and warrant further research to determine their effectiveness and efficacy.
Open Access
Muramura ana te ahi | A pedagogy of fire : ways to reconnect.
(2023) Berning, Hannah
Fires are an integral part of human history and have provided safety, cooking, warmth and a centre for social gatherings. However, fires are also linked to death, loss of biodiversity and habitat as well as massive carbon dioxide emissions. Many national and international reports highlight such environmental changes, that are interconnected to social inequity. They, at the same time, call for urgent actions and change. This thesis addresses fire. By looking at educational fire contexts, this research explores if fire can re-connect people and the environment, as well as connect Western and Indigenous Māori knowledges. In Aotearoa New Zealand, fire is linked to human arrival. Māori used to travel with fire which connects people to their homelands and other important places. Since colonisation, Indigenous views have been marginalised by Western approaches. Therefore, this research draws on He Awa Whiria (a braided river) methodological approach, which highlights the authority of both Western and Indigenous knowledge streams as they come together and interact. The research is theoretically grounded in whakapapa and critical theory. Additionally, He Awa Whiria is visible through two case studies: one shaped by predominantly Māori perspectives and one shaped by Western lenses. In the Western case study, participants were kaiako (teachers) and ākonga (students) from tertiary institutions, while in the other case study, the researcher went on a hikoi (journey) with a kaiako (Te Hurinui Karaka-Clarke) from Te Arawa (Māori tribe). The thesis uses reflexive thematic analysis for both data sets to interrogate and integrate the data. The stories identified in the data broaden Western understandings of fire, which are for example defined through the fire triangle (fuel, heat and oxygen); instead, the thesis argues that places with fire features and meanings should be included in outdoor education programmes. Further, fires reveal power dynamics that exist in places, fire regulations, pedagogical approaches and the teacher-student relationships. Importantly, findings show how fire enhances reflection, promotes inclusive conversations and develops feelings of belonging. Implications for sustainable (outdoor) education include a pedagogical framework considering learning around and through fire. This framework challenges oppressive, unsustainable practices and views. It argues that a pedagogy of fire in Aotearoa New Zealand should be place-responsive, skill-based, reflexive, engaged and bicultural.
Open Access
Positive video self-review of parent-infant interactions with adolescent mothers: exploring intervention feasibility and changes to interactive parenting behaviour, parenting self-efficacy, and mental health.
(2023) van Gerwen, Jennifer
A long history of research indicates that adolescent mothers are more likely to enter motherhood experiencing risk factors that may negatively impact developmentally supportive interactions with their child. One effective intervention for promoting developmentally supportive interactions is the use of parent coaching from video recorded parent-child interactions (known as video feedback; VF). However, like many parenting interventions, this approach may be perceived by adolescent mothers as too intrusive. This study explored an adaptation of VF called Positive Video Self-review of Parent-infant Interactions (PVSR-PI). PVSR-PI is based upon the principles of Video Self Modeling (VSM) and is distinct from VF approaches as it employs autonomous video self-review of only positive parent-infant interactions. This study examined the feasibility of the PVSR-PI, changes in observed parenting behaviour, parenting self-efficacy, maternal mental health, and mothers’ reflections on experiences of personal and relationship change with their infant over the course of the intervention. A single-case research design was employed with four mother-infant dyads recruited from a local Young Parents Programme (YPP), with three assigned to the intervention condition and one to a treatment as usual condition. Intervention engagement was very good and discourse around the acceptability of PVSR-PI was largely positive, offering preliminary support for feasibility. Data attributes restricted the interpretation of intervention effects or meaningful change for observed parenting behaviour, and no replication was seen across participants. Parenting self-efficacy increased for all intervention participants from pre-intervention to post-intervention, but did not meet reliable change criteria, and one mother experienced a clinically meaningful improvement in emotional closeness to her infant. At baseline, participants reported symptoms of depression, anxiety, and stress within a normal range, and idiosyncratic changes were seen, but none met reliable change criteria. Qualitative findings indicated that all mothers perceived some effects of the intervention on their thoughts about, and interactions with their child. Study findings are discussed in relation to previous video feedback and video self-modeling research and theory, alongside implications and recommendations for future research.
Open Access
An investigation into the effectiveness of psychosocial sleep interventions for children with cystic fibrosis.
(2023) Ballam, Kimberly
Cystic Fibrosis (CF) is an inherited and life-limiting chronic illness which affects multiple organs including the lungs and digestive system. CF can lead to many symptoms including chronic cough, poor weight gain and chest infections, which all vary in their intensity. Over the last two decades illness outcomes for those with CF have dramatically improved. Despite this, those with CF still experience significant challenges, including psychological, social and physiological difficulties, as well as a significant treatment burden. Sleep problems are a challenge commonly reported for children with CF at a higher rate than their healthy peers. Common sleep issues include sleep related breathing disorders, reduced total sleep time, lower sleep efficiency, increased frequency of arousals, and a longer duration of wakefulness after sleep onset. This is especially problematic as sleep problems are associated with increased severity of lung disease, low mood and decreased quality of life in those with CF. Research has found that children with CF can experience sleep problems resulting from non-respiratory factors, suggesting that their sleep difficulties may be amenable to psychosocial sleep interventions. Psychosocial sleep interventions are a category of interventions that focus on the underlying psychological or behavioural factors that impact sleep. These interventions can include cognitive behavioural techniques, sleep hygiene modifications, stimulus control techniques, sleep restriction, extinction procedures and relaxation strategies. Psychosocial sleep interventions have been found to be effective in improving sleep among typically developing children and children with neurodevelopmental disabilities, however, no research has explored the use of these interventions among children with CF. This thesis aims to investigate the use of psychosocial sleep interventions for children with CF and sleep problems through two studies. Study one involved a systematic review of the effectiveness and acceptability of psychosocial sleep interventions among children with various Chronic Health Condition(s) (CHC), including children with respiratory conditions, diabetes and epilepsy. The review identified 13 studies which investigated the use of behavioural strategies, cognitive behavioural therapy for insomnia and motivational based interviewing techniques. The overall findings from the review were promising, with 12/13 studies reporting at least some improvement in sleep outcomes across participants. Additionally, improvements were seen in daytime behaviours, quality of life and symptoms of depression and anxiety following sleep treatment. While promising, the findings of the review are limited due to the small number of studies focused on each CHC condition, as well as methodological limitations (e.g., limited experimental control). Despite these limitations, the use of psychosocial sleep interventions emerged as a promising avenue for future research. The findings of study one were used to inform study two. The aims of study two were to investigate the effectiveness of a psychosocial sleep intervention for a child with CF. Study two also aimed to investigate if any change in sleep would result in secondary improvements in the child and parent’s wellbeing, and if the intervention would be considered acceptable to the parents. Within this study a multi-component psychosocial sleep intervention was implemented with a five-year-old boy with CF who was experiencing problematic night waking (NW) and unwanted co-sleeping. The intervention involved three sequential phases, beginning with sleep/wake rescheduling, followed by the use of reinforcement and a social story, and finally modification to parental responses to NW. Following intervention, the frequency and duration of NW decreased significantly, which was maintained at six weeks follow up. Additionally small improvements were reported in his quality of life and daytime behaviour as measured using the Pediatric Quality of Life Inventory and Child Behavior Checklist administered pre- and post-intervention. Some improvements were also reported in parental sleep, however, few changes were observed in regard to parental emotional wellbeing and parental relationship quality using the Depression Anxiety and Stress Scales –21 and the Relationship Quality Index. The intervention was reported be highly effective and acceptable. Despite these promising findings, further replication is needed which builds upon the limitations in existing research, including this study.
Open Access
Parents of children with hyperactivity, impulsivity, and inattention: what do parenting programs contribute to parental wellbeing?
(2023) Taylor, Samantha
Hyperactivity, impulsivity, and inattention are patterns of behaviour that are interrelated, multidetermined, and characteristics of attention deficit hyperactivity disorder (ADHD), yet HII are not limited to people with ADHD. Parenting a child with hyperactivity, impulsivity, and inattention has been described by parents as a “stress-generating experience” as the associated behaviours can be difficult for parents to manage (Johnston & Chronis-Tuscano, 2014, p. 193). Parenting is a modifiable component of the child’s ecological context and central to the management of hyperactivity, impulsivity, and inattention in childhood. Parenting programs aim to promote positive parent-child relationships and developmental outcomes for children and are a recommended intervention for children with ADHD. The aim of this systematic review of randomized control trials was to establish what secondary benefits parenting programs have for the wellbeing of parents of children with elevated levels of hyperactivity, impulsivity, and inattention. A systematic search strategy was implemented in accordance with PRISMA guidelines. A total of 16,027 records were identified from six databases, trial registries and citation searches. After screening, 21 studies were included in the review. A total of nine parenting programs involving 1,323 parent participants were evaluated. While most parenting programs were likely to improve at least one-dimension parental wellbeing, either by reducing stress, depression, or anxiety, or by increase parents’ sense of competence or self-compassion, these effects were highly variable. The largest and most consistent effect found on any measure of parental wellbeing was a reduction in stress after completing Parent Child Interaction Therapy, Mindful Parenting, Triple P, Helping the Non-compliant Child or 1-2-3 Magic. The majority (85%) of between group findings were not significant. Thirteen constructs of parental wellbeing were measured by 16 different psychometric assessments. Implications and limitations are discussed, and recommendations made for future research.
Open Access
Student Experiences of E Tū Tāngata at School : a collaborative evaluation and pilot test of effects on school climate and student outcomes.
(2023) Fraser, Chloe
Schools are complicated developmental contexts, and many different aspects of the school environment can influence how students experience school life, interact with others, and generally feel within that environment. E Tū Tāngata is a new initiative within Aotearoa New Zealand that aims to address the country’s alarming mental health challenges, at a cultural level, by addressing the social norms and values associated with Tall Poppy Syndrome. Within schools, E Tū Tāngata aims to improve the school’s climate by shifting how students communicate and interact with one another through the promotion of three key mindsets – You Have Value, We Succeed Together, and Others Matter. This mixed-methods pilot study is one of the first attempts to evaluate the implementation and efficacy of E Tū Tāngata in a target school in Canterbury. This study had three aims: (a) to examine the psychometric properties of a retrospective survey of student experiences with E Tū Tāngata and hypothesised outcomes; (b) to examine how the school’s integration of the E Tū Tāngata mindsets is associated with students’ sense of belonging to the school, positive risk-taking behaviours, and response to failure; and (c) to investigate how students reflect on the changes they have experienced personally and seen within their classroom and school. Sixty-six students from years 6, 7, and 8 completed the survey. Psychometric testing found acceptable reliability for over half of the survey subscales and preliminary evidence for convergent validity, alongside a considerable need for redevelopment of other aspects of the survey. The vast majority of students evaluated the initiative positively and those who perceived better integration of the E Tū Tāngata mindsets also reported a greater sense of school belonging and connection to their peers. The results of this pilot test remain relatively consistent with the current literature on school climate and school belonging and provide preliminary support for E Tū Tāngata’s theory of change model. In light of the strengths and limitations of this pilot test, suggestions are made for future investigations into E Tū Tāngata, including opportunities for further survey development and evaluation strategies which should facilitate a better understanding of E Tū Tāngata’s effect on students and schools.
Open Access
You get better with age : wellbeing and health status assessment in older people.
(2022) Johnston, Robyn Marjorie
People aged 65 years and older are the fastest growing age group in New Zealand. By the mid-2070s, there are predictions that this age group is likely to comprise approximately one third of the population. Older people are encouraged to stay in their own homes within their community for as long as possible with support to encourage the extension of ageing in place. Currently around 14% of those aged 75 years or older, make the move into retirement villages. This is expected to increase. Little is known by retirement villages about the wellbeing and health of those who decide to live independently in these facilities. Predicting the need for a continuum of care is challenging. This research measured the wellbeing and health of older adults. It was situated in a critical realist paradigm, overlaid with an empathetic axiology. A focused literature review considered the impact on wellbeing from the aspects of living place, age, gender, health status and the 2010/2011 Canterbury earthquakes. Longitudinal studies used the Enlightenment Scale and the interRAI Community Health Assessment (CHA) to measure the wellbeing and health of one group of residents (n=120) living independently in one retirement village in Canterbury, New Zealand. The research was extended to incorporate two cross-section studies when initial results for wellbeing were found to be higher than anticipated. These additional studies included participants living independently from other retirement villages (n=115) and those living independently within the community (n=354). A total of 589 participants, aged 65 – 97 years old, completed the Enlightenment Scale across the four studies. Across the living places, wellbeing continued to significantly improve with age. The Enlightenment Scale was a useful measure of wellbeing with older adults. Participants in the longitudinal studies largely maintained a relatively good health status, showing little change over the study period of 15 months. Predictions for the need for a move to supportive care were not able to be made using the CHA. The health status of participants did not influence their level of wellbeing. The key finding of note is that the wellbeing score of older adults increases by 1.27 points per year, using the Enlightenment Scale, irrespective of where they live.
Open Access
The health benefits of trampolining.
(2022) Clement, Tāne
Trampolining is a common recreational activity, that is especially popular amongst children. The body of evidence investigating the health effects of trampolining on human physiology is very limited compared to other common modalities, such as running, rowing or biking. Therefore, the purpose of this series of studies was to expand the amount of literature using trampolining as the modality of choice. This thesis first comprehensively reviews the literature relating to physiology and trampolining. General methods used in the studies are then discussed. The next five chapters consist of the five studies that were published as a part of completing this thesis. Finally, the findings from each of the studies are summarised in the last chapter. In the first study, a model was developed which allows energy expenditure, on an app- equipped trampoline, to be calculated using only the input of the user’s mass. Participants were required to bounce on a trampoline while wearing a breath by breath analyser. This allowed the model to be validated by comparing the model’s estimated energy expenditure to the participant’s oxygen consumption, as measured by breath by breath analysis. This allows the intensity of bouncing on a trampoline to be easily calculated and measured. This method was used in every subsequent study, as it was a significant improvement to the quality of life, for the collection of data, for exercise on a trampoline. In the second study, energy consumption while bouncing on a trampoline was compared to energy consumption while running on a treadmill. Participants wore a breath by breath analyser and blood lactate was collected, while bouncing on a trampoline. Then in a second session, a week later, participants wore a breath by breath analyser and blood lactate was collected while running on a treadmill. This was to build on the findings of a previous study to see if they remained consistent. It was confirmed that trampolining and running had similar exercise profiles and the findings of the previous study were validated. In the third study, energy expenditure while bouncing on a trampoline was measured while altering the bouncing action. A variety of different bouncing actions were measured and it was discovered that altering the bouncing action did increase the energy expenditure. The model produced in the first study was then updated. This allowed a more accurate estimation of energy expenditure, while using the bouncing actions measured in the study. In the fourth study, a novel exercise protocol on a trampoline was investigated to assess whether it produced a positive change to various health markers. The novel protocol was designed to be very time efficient. Participants regularly exercised on a trampoline for 8 weeks. The novel protocol appeared to improve the participant’s fitness and vertical jump with as little as ten minutes of exercise per week. The fifth study investigated whether trampolining could be used as a novel treatment to improve body composition, cardiovascular fitness, bone density and stress urinary incontinence amongst parous women. Participants regularly exercised on a trampoline for 12 weeks. The treatment appeared to improve the participant’s pelvic floor strength and reduce the impact stress urinary incontinence had on their quality of life.