Health: Theses and Dissertations

Permanent URI for this collection

https://ir.canterbury.ac.nz/handle/10092/103244

Browse

Now showing 1 - 20 of 327

Open Access
Competence assessment practice in the Bachelor of Nursing programmes in Aotearoa New Zealand.
(2024) Borren, Joanne
The assessment of clinical competence is an essential feature of pre-registration health practitioner programmes. In New Zealand, Bachelor of Nursing programmes are the main pathway to registration as a nurse. A final competence assessment at the end of the third year is required for the award of the degree and for application for entry to practice as a registered nurse. The aim of this study was to investigate the assessment of clinical competence in the undergraduate BN programmes in Aotearoa New Zealand to identify current competence assessment practices. At the commencement of this research in 2018, the Bachelor of Nursing (BN) 3-year degree qualification was offered at 17 tertiary institutions in Aotearoa New Zealand, each of which has developed their own method and process of assessing the clinical competence of nursing students undertaking clinical practicums. A multi-phase mixed-methods research design was undertaken in three phases. The first phase of the research was qualitative and involved key-informant interviews with participants from nine institutions offering the BN programme in Aotearoa New Zealand. The second phase was quantitative, and a survey was sent to nursing student, preceptor and clinical lecturer participants. There was a total of 708 responses to the surveys. The third and final phase was qualitative and 15 semi-structured interviews were conducted with nursing students, clinical lecturers and preceptors. As far as can be determined, this research is the only study that has been conducted nationally or internationally that engages a mixed-methods methodology to investigate competence assessment practice from the view of nursing students, clinical lecturers and preceptor participants. The research includes a focus on features of the competence assessment of nursing students that are unique to the Aotearoa New Zealand context, including students’ ability to demonstrate application of the principles of the Treaty of Waitangi | Te Tiriti o Waitangi in their practice. A methodological contribution to the research environment is the development of the Competence Assessment in Nursing Education Joint Display; an original conceptualisation that drew on findings from the three participant groups to identify meta-inferences. This research provides evidence that supports a standardised competence assessment structure for undergraduate nursing programmes nationally that is designed to adequately meet the needs of the developing nursing student. Despite nursing programmes being audited against the Nursing Council of New Zealand (NCNZ) Education Standards, this research has identified a gap between what is required of nursing programmes in Aotearoa New Zealand and what is occurring in practice to support the competence assessment of nursing students.
Open Access
Raising transgender, non-binary and gender questioning children and adolescents : the experiences of parents in Aotearoa New Zealand.
(2024) Johnston, Amy
This thesis explores the experiences of parents of transgender children in Aotearoa New Zealand. Overseas research shows parents experience a range of emotions raising their transgender child. Parents of transgender children can also experience gender minority stress and discrimination. Despite difficulties, some parents demonstrate love, acceptance and support for their transgender child. Family support and acceptance is a key factor in the mental wellbeing and positive outcomes for transgender children and adolescents. Therefore, it is important to understand how to remove barriers and challenges for these parents in order for them to best support their children. This qualitative study had two aims. First, to explore experiences parents regard as a barrier or challenge in their day-to-day life raising their children. Second, to explore experiences parents had that were affirming and positive for them. Seven parents participated in the study — the participants all lived in Aotearoa New Zealand and are currently raising transgender, non-binary, or gender questioning children. Semi-structured interviews were used to collect stories of parents’ lived experiences. Themes developed from reflexive thematic analysis fit generally into a negative or positive category. Themes in the negative were: (1) the impact of others on the parenting experience, and (2) difficult emotions are part of this journey. Themes in the positive were: (1) walking alongside me (2) not on this journey alone, and (3) clearing the pathway. Parents’ experiences revealed how systemic cisnormative gender beliefs create barriers, while challenging cisnormativity via unconditional love, accepting diversity, and respect contributes to positive, affirming interactions. It is my hope that the findings from this study can assist other parents of gender diverse children on their parenting journey. Further, I hope findings can positively contribute to the knowledge of service providers and others involved with parents of gender diverse children.
Open Access
Virtual reality-exergaming in rehabilitation of people with multiple sclerosis.
(2024) Moeinzadeh, Amir
Introduction and Overview of Thesis: Multiple sclerosis (MS) is a chronic neurodegenerative disease characterised by diverse physical and cognitive symptoms. This thesis investigates how virtual reality (VR)-exergaming as an innovative intervention can enhance the effectiveness of MS rehabilitation strategies, considering both scientific evidence and perceptions of people with MS (PwMS). This includes a comprehensive assessment of the intervention’s potential, its practical implementation, and its alignment with the needs and expectations of the end-users. Methodology: Employing a framework for developing complex interventions, this research integrates a systematic review, qualitative insights, and a feasibility study. This approach, guided by the Medical Research Council (MRC) framework, allows for a comprehensive exploration of VR-exergaming’s potential in MS rehabilitation. A patient-centred approach was integral to the research, ensuring iterative feedback and development across the three phases. The mixed-methods design allowed for a thorough investigation of both quantitative and qualitative dimensions, with a focus on key feasibility domains such as usability, recruitment, and adherence. The methodology was based on principles from rehabilitation science, understanding how people adopt new technologies, and focusing on patient needs. This ensured a well-rounded approach to developing and evaluating the intervention. Studies: 1. Systematic Review: This review examined the comparative impacts of VR-exergaming and conventional exercise on MS rehabilitation. Searching databases like EMBASE, PubMed, and Scopus, it identified 10 eligible studies with a total of 486 participants from an initial pool of 239 articles. Key findings indicated that VR-exergaming showed benefits in improving balance, upper limb function, and cognitive processing speed, though results varied across studies. While VR-exergaming often enhanced engagement and adherence, the impact on fatigue and psychological well-being was mixed. Some studies suggested VR-exergaming might be more effective for specific outcomes, such as balance and cognitive speed, but further research is needed to clarify these effects. This review provides a comprehensive synthesis of existing evidence on VR-exergaming for MS, offering valuable insights into its potential effectiveness compared to conventional exercise, while also highlighting the need for more standardised, large-scale trials. 2. Qualitative Study: This study explored the perceptions of PwMS regarding immersive VR-exergaming using Meta Quest 2. Through thematic analysis of interviews with six participants, key themes emerged around the enjoyment of physical activity, the desire for rehabilitation methods improving cognition and alleviating fatigue, and the positive yet mixed experiences with immersive VR-exergaming, considering concerns like cost and comfort. The study highlighted the importance of personalising VR experiences to enhance user engagement and promote long-term adherence. Participants consistently emphasised the value of rehabilitation methods that are both enjoyable and motivating. The study effectively captured the lived experiences of PwMS, offering rich insights into their attitudes, perceived barriers, and facilitators concerning VR-exergaming adoption, including concerns about cost and comfort. 3. Feasibility Study: Investigating the feasibility of an immersive VR-exergaming system, this study involved a single-arm trial with nine participants over 4 weeks. Results indicated high participants’ satisfaction, usability, and adherence (100%), with significant improvements in upper limb function and fatigue reduction, but no significant change in processing speed cognition tests. The study underlined the feasibility of conducting larger clinical trials to evaluate the efficacy of immersive VR-exergaming in MS rehabilitation, particularly in improving hand function, fatigue, and cognition. Adhering to the CONSORT extension for pilot and feasibility trials, the study ensured a rigorous evaluation of key outcomes, including recruitment and retention rates, intervention acceptability, and usability. Key practical aspects, such as adherence and participant safety, were effectively managed throughout the trial. Application of these results will prove beneficial to the design of more extensive trials targeting better understanding of the long-term benefits and broader applicability of VR-exergaming in MS rehabilitation. Conclusion: The thesis demonstrates VR-exergaming’s significant potential in MS rehabilitation, offering substantial benefits over traditional methods. Two key strengths of this thesis were the iterative learning approach, where the outcomes of each study informed the next, and its patient-centred aspect, emphasising the importance of aligning rehabilitation strategies with PwMS’ needs and preferences. This approach ensures that the development of VR-exergaming interventions is grounded in real-world patient needs and preferences, paving the way for personalised, effective MS rehabilitation solutions. Future research should continue to optimise these interventions, focusing on patient-centred experiences and advanced technology integration. Long-term studies are also needed to assess the sustained benefits of VR-exergaming and its potential impact on disease progression and quality of life for PwMS.
Open Access
Developing a practical talent identification and development model for track sprint cycling.
(2024) Cullinane, Fionn
Track sprint cycling is an Olympic sport with 8 potential medals; however, New Zealand lacks a clear development pathway for track sprint cycling. The identification and development of talent is complex, dynamic, non-linear, and multidimensional, and the proposed theoretical and conceptual models lack practical application within sport. By identifying the key performance characteristics of track sprint cycling, and how they develop can support evidence based decision making and optimise the development of aspiring track sprint cyclists. Therefore, the purpose of this thesis was to develop a practical talent identification and development model for track sprint cycling. This purpose was addressed through 4 objectives, 1. Develop a valid and reliable holistic testing battery for track sprint cycling. 2. Develop a method to correctly classify track cycling disciplines using the holistic testing battery. 3. Identify the key performance characteristics of track sprint cycling. 4. Assess the rate of change of the key performance characteristic, and how they relate to the development of track sprint cycling performance. The sample for this research (n = 51) was 33% of the population of track cyclists, and 56% of the track sprint cyclists competing within New Zealand. The sample ranged from development athletes to World Championship and Olympic medallists. Chapter 3 confirms the reliability of a portable isometric mid-thigh pull device and inertial ergometer. Chapter 4 presents a valid and reliable holistic testing battery for track sprint cycling. Chapter 5 provides a model which can correctly classify track cycling disciplines with an accuracy of 86%. Chapter 6 identifies maximal power, maximal torque, optimal cadence, and isometric peak force as key performance characteristics for track sprint cycling, which can be measured using the holistic testing battery. Chapter 7 consolidates the findings in Chapter 6, with maximal torque, optimal cadence, and isometric peak force supporting the development of track sprint cycling performance. Self-directed control and management was also identified as an additional key performance characteristic for the development of track sprint cycling performance. Chapter 8 presents a practical, holistic talent identification and development model for track sprint cycling. This thesis provides Cycling New Zealand, aspiring track sprint cyclists, and coaches with a practical approach to identify and develop the key performance characteristics critical for the development of track sprint cycling performance. This thesis also establishes a solid foundation for future longitudinal research to further understand the complex, dynamic, multidimensional and non-linear nature of talent in the context of track sprint cycling.
Open Access
The impact of endometriosis on young females in New Zealand : a qualitative study.
(2024) Biddick, Cloe
This study explored the lived experiences of young people with endometriosis and their families in New Zealand, giving a voice to their unique perspectives. Using a qualitative descriptive approach, nine participants shared their stories in semi-structured interviews. The data was analysed using Braun and Clarke’s thematic analysis framework. The results revealed significant impacts on the lives of these young people. Key themes included substantial effects on education, work, social relationships, family dynamics, interactions with the healthcare system, and psychological wellbeing. The study highlighted the need for improved understanding and support from healthcare practitioners, increased advocacy, and the importance of family support. However, the research also identified several limitations, including a small cohort size, lack of Māori participants, and the effects of COVID-19. This research contributes to the existing literature by filling a significant gap in understanding the experiences of young people in New Zealand with endometriosis. Future research is suggested to further explore the impact that living with endometriosis has on education and work, and the effects on mental health that are unique to youth, and what strategies could be implemented to support them. This study highlights the importance of giving a voice to adolescents and addressing the unique factors that affect their lives.
Open Access
“And now we’re asking them to teach this!” Middle leaders’ experiences of leading learning and teaching about pornography through relationships and sexuality education.
(2024) Michel-Smith, Alex
Young people today are growing up in an ever-changing world. Widespread availability and access to devices that entice them online have shifted the way that young people gather information. As a result, learning about pornography has increasingly become a key topic in school-based relationships and sexuality education (RSE) programmes in New Zealand. Despite pornography's increasing relevance for young people in RSE programmes, teachers continue to be uncomfortable and reluctant to cover the topic. At present, there is a lack of research regarding middle leaders' experiences of leading learning and teaching about RSE, therefore it is valuable to explore their capability and confidence to lead learning and include learning about pornography within their secondary RSE programmes. This qualitative research aimed to gain the current views of middle leaders' leadership practices in relation to teaching and learning about pornography to potentially add new knowledge to support more effective teaching, learning, and leadership practices in this area of RSE in New Zealand. Data was collected through semi-structured interviews with five middle leaders. The data provided rich and detailed accounts of middle leaders' experiences of leading learning and teaching about pornography through RSE as well as teaching the subject. Analysis was conducted using reflexive thematic analysis which ultimately resulted in the development of two findings chapters relating to: (I) teaching about pornography through RSE, and (II) leading learning. Findings Chapter I explores themes relating to confidence, time and the importance of building and maintaining collegial relationships. Findings Chapter II explores themes and subthemes relating to buy-in from schools, students and whānau, and leadership and school culture at all levels. This thesis highlights middle leaders’ passion and the importance they place on health education and RSE, despite grappling with ongoing challenges to their practice. Understanding middle leaders’ experiences of leading learning and teaching about pornography through RSE, allows us to identify the barriers, enablers, issues and approaches middle leaders are taking in relation to leading learning and teaching about pornography through RSE. Ultimately, providing young people with the knowledge and skills to navigate and engage with the online world safely and enhance their learning experiences in RSE.
Open Access
Co-design of digital mental health support for autistic youth with co-occurring anxiety : a qualitative inquiry.
(2024) Gray, Holly
Autism is a neurodevelopmental condition characterised by differences in social communication and behaviour. Estimates suggest that 1-2% of taiohi (youth) in Aotearoa New Zealand are Autistic. Autistic taiohi are at disproportionately high risk of experiencing mental health challenges, with anxiety being one of the most common co-occurring diagnoses. This has a significant effect on the daily functioning, social interactions, and overall quality of life of Autistic people. Unfortunately, the quality and accessibility of anxiety support services are suboptimal. Tāngata whaitakiwātanga (Autistic individuals) face many barriers to accessing mental health support and supports that are available have primarily been developed for non-Autistic youth. As a result, the needs of Autistic taiohi are not being met. Evidence shows that anxiety in Autistic taiohi can be effectively managed and treated with the right approach. Co-designed face-to-face support models, which involve input from Autistic individuals and their families, have demonstrated positive outcomes in managing anxiety. Additionally, dMH supports can provide an accessible and effective model for delivering these interventions by offering flexible and inclusive options. Digital supports refer to independently accessed supports that are delivered via technology (e.g., mobile apps, internet- and computer-based websites, or virtual reality). These supports include both self-directed and therapist-assisted supports. The current research sheds light on the preferences of anxious Autistic taiohi for dMH solutions, highlighting both desired and less favoured features. It underscores the importance of integrating co-design in developing dMH supports that effectively address the individual needs of Autistic taiohi in Aotearoa New Zealand, including accessibility, personalisation, and cultural relevance. The inclusion of culturally relevant content is essential for ethnic minorities, particularly Māori, to ensure that support is culturally sensitive and promotes self-identity. Findings highlight the need to integrate holistic approaches, such as Te Whare Tapa Whā, into dMH tools to address multiple dimensions of well-being among both Māori and non-Māori taiohi. Enhancing personalisation and semi-structured interviews designed to explore the perceived benefits and challenges of dMH and the design preferences for an anxiety-specific dMH tool. Data were analysed using reflexive thematic analysis (RTA). Tāngata whaitakiwātanga were involved at each phase of the research, including the design of research aims and interview questions, recruitment, and the interpretation of findings. This collaboration ensured that this thesis was representative of the perspectives of tāngata whaitakiwātanga and made sure their needs and preferences were explored in a non-pathologizing way. Three overarching themes were identified from the data: (Soke et al.) perceived benefits of dMH, (Soke et al.) perceived challenged of dMH, and (3) design preferences. Key perceived benefits included increased access to mental health support by overcoming barriers to accessing in-person support and an increase in self-understanding. Perceived challenges identified were associated with a lack of humanisation in dMH and the skill barriers experienced by potential end-users. Finally, important design preferences included an inclusive approach that integrated cultural considerations, app reminders and notifications, gamification, therapeutic content, features for connection, and crisis response capabilities. The current research sheds light on the preferences of anxious Autistic taiohi for dMH solutions, highlighting both desired and less favoured features. It underscores the importance of integrating co-design in developing dMH supports that effectively address the individual needs of Autistic taiohi in Aotearoa New Zealand, including accessibility, personalisation, and cultural relevance. The inclusion of culturally relevant content is essential for ethnic minorities, particularly Māori, to ensure that support is culturally sensitive and promotes self-identity. Findings highlight the need to integrate holistic approaches, such as Te Whare Tapa Whā, into dMH tools to address multiple dimensions of well-being among both Māori and non-Māori taiohi. Enhancing personalisation and accessibility in dMH tools is crucial for meeting individual needs, and can be achieved through customisable avatars, various communication formats (e.g, written/text, audio, voice memo), crisis management, progress tracking, and daily check-ins. Additionally, incorporating peer support into dMH may promote connections among Autistic taiohi who share similar experiences, which could benefit their wellbeing. The study also emphasizes the integration of gamified elements to enhance engagement and motivation, including virtual worlds with missions, reward systems, and mini games. Moreover, the research suggests that dMH should complement rather than replace traditional mental health services, which suggestions that a hybrid support model may be most beneficial. Overall, findings reiterate the need to improve access to appropriate and relevant anxiety supports that do not impose neurotypical expectations. Future research should continue to engage Autistic communities in developing and refining dMH interventions, exploring elements like gamification, crisis support, and cultural inclusion, and assessing their long-term effectiveness and user satisfaction.
Open Access
Collisions in junior rugby: Incidence, magnitude, and their effect on cognition and neurological integrity
(2024) Henley, Stefan John
Rugby union is a popular contact sport where high impact collisions frequently occur. High rates of concussion have been reported in the sport. Concern exists surrounding these rates, and regarding the overall brain health of those playing the game as repeated sub-concussive collisions may compromise rugby players’ neurological integrity. In response to this, wearable sensors are being increasingly used to measure the number and size of the head acceleration events experienced in sport, including rugby. Presently little objective data exist in this research space regarding adolescent rugby players. More research is justified in this population as adolescents make up the majority of those playing the game (76% in Aotearoa New Zealand). Moreover, adolescents may be at higher risk of concussion than adults, and the adolescent brain is still developing and may generally be more susceptible to injury. This thesis attempts to quantify head impact exposure of male adolescent players, and to gain an understanding of the effect of repeated head impact exposure on neurological integrity. Forty-one participants, aged 14-16, were recruited from two male under-16 rugby teams playing in the Ellesmere Rugby Sub-union: one team in the 2022 season, one team in the 2023 season. Thirty-nine participants underwent pre- and post-season MRI scanning, including T1-weighted structural imaging and high angular resolution diffusion imaging. Participants also completed pre- and post-season neuro-cognitive and conscious motor control assessments. Participants were fitted with HitIQ Nexus A9 instrumented mouthguards to record head acceleration events experienced during the season. All training sessions and games were video recorded to verify mouthguard data. Video verification and analysis of mouthguard data took place using Catapult Focus software. Post-season processing of MRI scans focused on within-subject analysis of pre- to post-season changes in white matter as measured by diffusion tensor imaging. Linear mixed models were used to investigate correlations between neurological changes and cumulative head impact loading recorded by the mouthguards. The results of the study quantified head acceleration events (HAEs) among male adolescent rugby players over a season. Although data were collected over two seasons, we report findings on one season per player. Head acceleration events (HAEs) were more frequent and intense in games than trainings, with playing position and acceleration type (linear vs. rotational) closely correlated. Most recorded HAEs were low in magnitude (< 15.5 g), with high magnitude events occurring 6.8% of the time. Five concussions were recorded in the study. Results from pre- and post-season MRI scans indicated a non-significant relationship between HAE exposure in one season of rugby and changes in white matter microstructure, including for those players exposed to a higher level of impact magnitude. Results from post-concussion MRI scans similarly found non-significant changes in white matter microstructure compared to baseline scans. Conclusions that can be drawn from the results include that collision incidence variability was influenced by contact disposition, while relative magnitude variability was influenced by impact mechanism, match action, and player technique. Headgear use decreased linear acceleration in direct HAEs. Major risk factors for concussion included high speed, poor anticipation, uncontrolled falling, and head-to-ground impact. Proper technique, especially in the tackle situation, and good anticipation reduced risk of high magnitude events. Pre- to post-season changes in neuro-cognitive assessments were non-significant, including for the concussion cohort. Results from structural and diffusion-based MRI scans suggest exposure to one season of rugby for healthy adolescent male players does not directly result in neurological compromise.
Open Access
Menstruation in the military: stories of gender and periods in the New Zealand Army.
(2024) Gagnon, Elyse
Background: Internationally, efforts to increase the representation of women in military forces persist despite stagnant gender ratios. While the past decade has seen notable and rapid progress in menstrual health and hygiene promotion, menstrual health research and initiatives have been predominately led by the Water, Sanitation and Hygiene (WASH) field (Wilson et al., 2021). In the limited body of research concerning menstruation within organizational settings, menstrual health is predominantly viewed as an individual concern, while systemic inequities remain unaddressed (Sommer et al., 2016; Nash, 2023). The management of menstruation in military environments is framed as essential for maintaining both individual and organizational operational effectiveness (Chua, 2020). Consistent with this lens, menstruation in military contexts has typically considered it a problem solvable through medical treatment and control (Keyser et al., 2020; Grindlay & Grossman, 2013, 2015; Powell-Dunford, 2003). While addressing hygiene and access to menstrual products is crucial, research is needed to understand women’s experiences of menstruation to address the aspects of organisational culture that perpetuate menstrual stigma. The specific aims of this study were to understand how women perceive and manage menstruation within the New Zealand Army, explore how women’s experiences of menstruation are negotiated within and shaped by the military environment, and add to our understanding of women’s menstrual experiences through the use of narrative interviews. Methods: This qualitative study collected data using narrative interviews with eighteen women currently serving in the New Zealand Army and nine key informants. Data were analysed using reflexive thematic analysis. Narrative research is a broad and varied methodology that puts stories and individual voices at the heart of the research. It leans on the complexity of stories to establish a greater understanding of a phenomenon or lived human experience (Lewis, 2017; Creswell, 2007). A qualitative study design and narrative methodology was chosen in part as it had the potential to challenge androcentrism, which recognizes the tendency to diminish women’s experiences. Through the lens of gendered organisational theory, narrative interviewing was used to explore personal narratives and construct an organisational narrative. Results: Women’s stories underscored their need to consistently prove their worth as soldiers whilst being highly visible as women. This constant need to justify their place in the military influenced how women managed their period and, underpins the three overarching themes identified from the narrative interviews: First, menstrual suppression was explored by most participants who described the convenience of not having their period in a military environment. Whether supressing their period or not, women’s stories highlighted their desire to fit in within the current military culture while also having control over their own body and decision-making. Second, the stigma of menstruation placed conversations on the subject at the margins of normative military culture. To maintain menstrual concealment and, more specifically, their place within a male-dominated culture, women’s stories described the additional load they carried in their daily tasks to maintain gendered expectations. Third, the framing of menstruation as a barrier to operational readiness creates a dilemma for women seeking reproductive health care. Used to minimising their menstruation, women struggled with self-advocacy to access the menstrual care they wanted from health providers. While exploring the unique element of operational readiness, findings suggest that care is conditional on the setting and career stage women’s bodies are found. Findings of key informant interviews reinforced the importance of gendered norms on women’s experiences in the military. Key informant interviews highlighted a growing awareness of the positive aspects of menstruation while demonstrating that the lack of institutional emphasis and education on menstrual wellbeing poses a challenge to fully embracing and incorporating this perspective into broader culture change. Conclusion: Using gendered organisational theory, this research examined menstruation as a vehicle to explore gendered interactions and structures within a military context. Participant stories elucidated how women’s embodied experiences of menstruation were mediated by the organisational norms of the military and, in turn, how menstruation influenced perceptions and attitudes towards women, highlighting their experience as ‘other’. We argue that gender equity cannot be achieved without addressing menstrual injustices embedded in the gendered environment that perpetuates menstrual stigma and regards menstruation as a barrier to operational readiness. This research concludes by highlighting the importance of fostering a cultural shift that normalises menstruation and addresses the deeper cultural norms embedded within military structures for true menstrual justice and gender equity to be achieved.
Open Access
“a new guilty thing you’re aware of but you don’t change” – seeking supportive smartphone habits for new mothers at the transition to parenthood: a mixed methods study
(2024) McCaleb, Miriam Aroha
Human infants are born altricial, dependent on their caregivers. Responsive, warm, ‘serve and return’ interactions with caregivers set developmental trajectories that benefit babies throughout their lifespans. A challenge to optimal infant development exists in the ‘absent presence’ brought about by unconscious parental engagement with smartphones. This phenomenon, also known as ‘technoference’, has been demonstrated to interfere with maternal sensitivity, a precursor to the formation of a secure attachment. This study sought to use co-created, evidence-based strategies to support new mothers in creating deliberate smartphone habits at the transition to parenthood. This study used a mixed methods methodology, with an experimental multiphase, exploratory sequential design. First, semi-structured feasibility and acceptability interviews with n=6 primiparous mothers supported co-creation of an Action Plan based intervention, also employing tangible tools to support mindful smartphone use. Next, a randomised control trial (RCT) was conducted which enrolled n=93 first-time pregnant women in their final trimester of pregnancy. These participants provided objective measures of their smartphone use (measured over seven days) and completed an online survey. Following random assignment, half of the women received the Action Plan and tools, and all women provided a second round of phone use (also measured over seven days) and survey data at around 6-8 weeks postpartum. Finally, n=6 purposively selected members of the intervention group participated in semi-structured evaluative interviews. In addition to the content analysis which provided intervention feedback, reflexive thematic analysis was used to develop a narrative of the women’s experiences of mothering with smartphone in hand. Phase one interviews yielded positive feedback and practical suggestions, which were enacted as was pragmatic. Results from the RCT revealed that during pregnancy, the invention group (n=47) had a mean phone use of 299 mins/day (range: 97, 574 mins/day) and 103 pickups/day (range: 29, 249 pickups/day), while postpartum the mean phone use was 312 mins/day (range: 59, 763 mins/day) and 117 pickups/day (range: 12, 310 pickups/day). For control mothers (n=46), they recorded a mean phone use of 293 mins/day (range: 132, 574 mins/day) and 94 pickups/day (range: 28, 189 pickups), while postpartum used their phone a mean of 331 mins/day (range: 101, 664 mins/day) and had 106 pickups/day (range: 50, 232 pickups/day). Neither intention-to-treat nor per-protocol analyses revealed any significant differences between groups in terms of primary measures of minutes onscreen per day, or number of phone unlocks/pickups (all p>0.05). There was also no pre- and post- partum difference within groups. Survey data were also not different between groups, with secondary analyses revealing results from the Mobile Phone Problem Use Scale, WHO-5, Likelihood to Use a Phone While Feeding, Maternal Distraction Questionnaire, and the Distraction in Social Relations and Use of Parent Technology scale all unchanged between groups. These data suggest that this intervention targeting individual behaviour change was ineffective and would likely require support at the familial, professional, and structural levels if it were to support undistracted care of new babies. For the postpartum interview data, Bronfenbrenner’s Bioecological Model was used as a tool for organising themes. This allowed for an exploration of women’s ideas as related to their relationships with themselves in the innermost concentric circle, followed by their micro-, meso-, and macrosystems. Themes spoke first to the notion that “everything’s new, and it’s all a bit stressful”, while considering smartphone use alongside the intimate relationships of the microsystem pointed to feeling like “you just wanna keep going on it, but you know you’re not meant to”. Women’s stories about interacting with the professional world were summarised by the theme title “I haven’t had anyone talk about tech use, at all”, and the outermost circle in Bronfenbrenner’s model led to stories of women’s interactions with their macrosystems, in this case including the World Wide Web. These stories were about ‘loving, hating, and loving to hate technology’ and dealt with the pleasures of instant communication, disdain of influencer (‘mumfluencer’) culture, and the overwhelm that accompanies information overload. Finally, stories pertaining to the concept of time were gathered in the name of the chronosystem, and these asked ‘whose time is this?’, considering ideas such as how their child’s future relationship with smartphones will be impacted by their parents’ current-day phone habits. Overall, the stories highlighted ambivalent and contradictory perspectives regarding smartphone use – phones were a source of comfort and stress; support and guilt. These data provide insight into how new mothers’ relationships with their smartphones describe a tool that is a distraction from, an accessory to, and a redefinition of, new motherhood. The critical pragmatist stance underpinning this work reinforces that persuasive technologies serving international companies’ shareholders should not be allowed unchallenged access to the attention of new parents. This is especially salient while their infants are in a stage of exuberant synaptogenesis. As such, this research exists in service of the family unit and in defence of the human potential of each infant. This study reveals that behaviour change strategies alone were not effective in changing new mothers’ smartphone habits at the transition to parenthood, reinforcing the need for families, professionals and policies that recognise the need for purposeful phone use in infants’ presence.
Open Access
Childhood predictors for later service use in those with depression and anxiety.
(2024) Herry, Oceane
The impact of mental health problems has been extensively researched in the literature through the different life stages, particularly because of its relation to difficulties in life trajectory. However, the research is limited on later treatment seeking and treatment outcome for depression and anxiety. The objectives of this study were to explore childhood predictors of treatment seeking for adult depression and anxiety; to investigate the patterns of mental health service utilisation in adulthood; and to examine the types of treatment used. This study used data from the Christchurch Health and Development study, a prospective longitudinal study involving 1265 participants recruited at birth. This current research utilised 5 waves of data, consisting of 1011 (496 men and 515 women) participants at age 21; 1003 (488 men and 515 women) participants at age 25; 987 (478 men and 509 women) participants at age 30; 962 (463 men and 499 women) participants at age 35; and 904 (431 men and 473 women) participants at age 40. At age 40, the sample consisted of 17.8% of individuals who identified as Māori and 82.2% as non-Māori. Participants were assessed for mental health problems, such as depression and anxiety, and treatment seeking at ages 21, 25, 30, 35 and 40 year assessments. The findings were that individuals, especially women, were more likely to seek treatment, especially as they aged. Individuals with depression were more likely to seek treatment than those with anxiety. The childhood determinants of later service use for depression were childhood adversity, identifying as female, higher neuroticism, identifying as non-Māori and higher paternal education. For anxiety, determinants were childhood adversity, identifying as female and higher neuroticism. When time-dynamic covariates were included, cannabis use disorder, alcohol use disorder and life stress became significant predictors of treatment seeking for depression. The results were similar for treatment seeking for anxiety except for alcohol use disorder which was not significant. In conclusion, individuals who identified as female, had exposure to childhood adversity, identified as non-Māori, had neuroticism as a personality trait, and whose fathers had higher education, were more inclined to seek treatment for their mental well-being. This research also found that accumulative factors such as experiencing alcohol and cannabis problems, and life stress may serve as contributing factors to seeking treatment, consistent with an allostatic load explanation.
Open Access
Parents’ Perspectives on Technoference and Non-Technological Interruptions to Parent-Child Interactions: A Mixed-Methods Study.
(2024) Johnstone, Sasha Michelle
Digital technology often interrupts parent-child interactions, and these interruptions, referred to as technoference, have been associated with a range of adverse outcomes for children and parents and the quality of their relationships. This project aims to explore parents’ qualitative perspectives regarding technoference and non-technological interference in scenarios involving parent-child interactions and examine how these perspectives relate to parents’ self-reported technoference frequency. Participants were 39 parents (97.4% female; M age = 36.94 years; SD = 4.97) of preschool-aged children (aged 2-5 years). Structured interviews were used to collect quantitative measures of parents’ technoference frequency, mobile phone distraction, and problematic media use. A scenario-based open-ended questionnaire developed for this study was used to ascertain parents’ perspectives on three situations involving different types of interruptions (externally-initiated technoference, self-initiated technoference, and non-technological interruption) to parent-child interactions. Parent reports of technoference frequency, mobile phone distraction and problematic media use aligned with findings in prior literature. Thematic analysis revealed four themes in how parents described their opinions on technoference and non-technological interruptions: (1) Actions parents take in response to interruptions, (2) Parents’ emotions, thoughts, and values and how these influence parents’ responses to interruptions, (3) Parents’ perceptions of children’s needs and how children feel and behave in response to interruptions, and (4) Strategies parents use to minimise the impact of interruptions. Similarities and differences in parents’ perceptions of the three interruption scenarios are discussed. Patterns in parents’ responses revealed associations between technoference frequency and parents’ perspectives on technoference. The findings suggest that parental technoference is considered normative behaviour and may be more disruptive to parent-child joint attention than non-technological interruptions.
Open Access
Long-term effects of Vipassana Meditation as taught by S. N. Goenka : a qualitative study.
(2024) Babchuk, Alon
Background. According to The Buddha’s teaching, mental reactions to bodily sensations are the source of mental negativities (including anxiety, hatred, greed, and jealousy). From this perspective, reducing mental reactions to bodily sensations will result in less mental negativities that make people miserable and, in turn, contribute to better well-being. It is believed that people are often unaware that their minds constantly react with craving and aversion to pleasant and unpleasant bodily sensations, respectively. These uncontrolled reactions lead to misery and suffering, mistakenly attributed to external events or internal thoughts and emotions. Traditionally, The Buddha's teaching has been found to be helpful in examining these processes and bringing them from unconscious to conscious levels of awareness Vipassana Meditation trains students to reduce and ultimately eradicate craving and aversion towards bodily sensations. Courses of Vipassana Meditation, as taught by S. N. Goenka, are practised worldwide and used in prison systems in several countries as a rehabilitation strategy. Globally, 10-day residential courses are offered in 238 centres and 138 non-centre locations. During the course, students learn to be continuously aware of the impermanent nature of bodily sensations without reacting. The 10-day courses are considered to be the beginning, as Vipassana Meditation is a way of living or a lifestyle intervention. When practised long-term, Vipassana Meditation is likely to lead to changes in the persona of the meditators. Peer-reviewed studies have examined the effects of Vipassana Meditation. Studies have used measures like questionnaires and physical indicators, including heart rate variability, EEG, and MRI, which may not provide an in-depth understanding of the effects. Furthermore, research examining the effects of practising long-term Vipassana Meditation is lacking. The current study was designed to address these limitations. It has examined the effects of Vipassana Meditation after practising it for long periods. It also has employed a phenomenological approach to develop an in-depth understanding of the meditators’ experiences of the effects of the practice on their lives. Participants and Methods. Semi-structured interviews were conducted with seven Vipassana meditators practising for at least eight years (on average 16 years) and residing in New Zealand. The interviews aimed to encapsulate the changes participants noticed within themselves after practising Vipassana Meditation and adopting it as a way of living. Data were analysed using Reflexive Thematic Analysis, a qualitative data analysis approach. Results. Participants were four females and three males. The average age was 50.1 years. The average number of years they have practised Vipassana Meditation was 16.5 years since their first course (range: 8-21 years). Analysis of their interview transcripts identified three main effects of the practice: positive traits were increased, negative traits were reduced, and participants gained insights regarding the nature of their minds and life. In addition to these effects, interviewees described how they practised Vipassana Meditation and embedded it into their daily lives. Finally, participants described the background of the period they took their first course, including life circumstances and previous meditation practices. Discussion and Conclusion. The current studies’ results validate the quantitative research findings on Vipassana Meditation. In general, previous research found positive effects on psychological well-being. The current research findings were in accordance with the literature. However, while most existing studies examined mental health-related variables, including anxiety and depression, the current research found benefits aligned with The Buddha’s teaching. Participants reported developing the Ten Pāramī (loving-kindness, wisdom, effort, equanimity, tolerance, generosity, morality, truthfulness, renunciation, and strong determination) and a reduction in taṇhā (craving and aversion). The current research has added a new perspective to the empirical knowledge base about the outcomes of Vipassana Meditation.
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. 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 experiences 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 study aimed 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.