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Item 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, AlexYoung 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.Item Open Access Co-design of digital mental health support for autistic youth with co-occurring anxiety : a qualitative inquiry.(2024) Gray, HollyAutism 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.Item Open Access Collisions in junior rugby: Incidence, magnitude, and their effect on cognition and neurological integrity(2024) Henley, Stefan JohnRugby 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.Item Open Access Menstruation in the military: stories of gender and periods in the New Zealand Army.(2024) Gagnon, ElyseBackground: 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.Item 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 ArohaHuman 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.Item Open Access Childhood predictors for later service use in those with depression and anxiety.(2024) Herry, OceaneThe 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.Item Open Access Parents’ Perspectives on Technoference and Non-Technological Interruptions to Parent-Child Interactions: A Mixed-Methods Study.(2024) Johnstone, Sasha MichelleDigital 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.Item Open Access Long-term effects of Vipassana Meditation as taught by S. N. Goenka : a qualitative study.(2024) Babchuk, AlonBackground. 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.Item Open Access The influence of parentification on mental health help-seeking behaviours : a phenomenological study.(2024) Malagayo, NikkiParentification 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.Item Open Access Forms and functions of aggression in preschool-age children: the roles of executive function and emotion understanding(2024) Pavlov, SmrutiThis 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.Item Open Access Youth experiences of using a crisis text line.(2024) Stace, AliciaThere 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.Item 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, JessicaIntroduction 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.Item Open Access Parental love withdrawal and relational aggression in preschool age children : the role of normative beliefs about relational aggression.(2024) Lawerance, PreethiParental 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.Item Open Access Intergenerational parenting and wellbeing of Pacific families in Aotearoa | New Zealand: a strengths-based quantitative investigation.(2024) Saunders Bowen, DeborahIntergenerational 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.Item Open Access Navigating a tunnel without sight: the experiences of children of parents with mental illness (COPMI) in Aotearoa New Zealand(2023) George, NatashaChildren 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.Item Open Access A Private Universe: What does spirituality mean and is appropriate support being provided for people in hospital?(2024) Woodhouse, ColinIn 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?Item Open Access Exploring the heart health knowledge among newly diagnosed cardiac patients in Aotearoa New Zealand: A convergent mixed methods inquiry(2023) Short, Kylie AnneBackground: 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.Item Open Access Developing a Kaupapa Māori science education programme focused on microplastics, plastic pollution and sustainability.(2023) Feltham, GraceThis 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.Item Open Access Patients’ decision making when experiencing possible acute coronary syndrome : a retrospective exploratory study(2023) Maria, RoonaCoronary 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.Item Open Access Access to primary healthcare and ambulatory care sensitive hospitalisations in the Maldives.(2023) Mohamed Ellwood, FazeelaAmbulatory care sensitive hospitalisation (ACSH) for hypertension, diabetes, chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD), and asthma is a growing problem globally and in the Maldives. Ideally, these hospitalisations are avoidable with people's ability to access primary healthcare (PHC) services in a timely and effective manner. Even though PHC is provided free of charge across all inhabited islands, the rates of ACSH in the country surpass those of many other nations. While the literature acknowledges many factors that contribute to access to PHC services and the risk of ACSH, no previous studies have examined these factors in the context of a small, dispersed island nation like the Maldives. The Maldives differs due to the country's distinctive geographical layout that stretches up to 1192 tiny islands surrounded by sea. Therefore, this research marks the first endeavour to examine these factors in such a unique context, providing new insights and filling an existing gap in the scientific literature. Methods: A cross-sectional study was conducted to examine whether individuals with less trust in the PHC providers, low levels of transportation satisfaction, and more travel time to reach the PHC provider had low levels of self-reported access to PHC services. Data were collected through a cross-sectional survey involving 806 participants from 24 islands within eight atolls of the Maldives. The participants were recruited using convenience sampling. From the cross-sectional survey, participants for a case-control study were selected, focussing on hospitalisation outcomes in a ratio of 1:1. A total of 337 cases and 337 controls were selected. This case-control study was undertaken to determine whether those with low levels of self-reported access to PHC had a higher risk of ACSH. Results: The multivariate analysis of the cross-sectional study confirmed the hypothesis regarding the relationship between less trust in PHC providers and low level of self-reported access to PHC services (adjusted odds ratio: AOR=2.986, 95% CI 1.477-6.036). However, no statistically significant association was observed for transportation and travel time when adjusted for individual characteristics and contextual factors. The results indicated that a range other factors contributed to the complexity of self-reported access to PHC services, including self-rated health status (AOR=2.108, 95% CI 1.108-4.009), patient knowledge (AOR=14.242, 95% CI 6.467-31.364), past experience (AOR=2.987, 95% CI 1.400-6.372), and PHC availability (AOR=1.953, 95% CI 1.013-3.766). Furthermore, the results of the multivariate analysis disproved the hypothesis of the case-control study that the risk of ACSH would be higher among individuals with a low level of self-reported access to PHC services. Nevertheless, this study identified a diverse array of statistically significant factors that increased the risk of ACSH in the Maldives. These factors encompassed presence of diabetes (AOR=1.927, 95% CI 1.054-3.526), CHF (AOR=11.892, 95% CI 2.755-51.339), COPD (AOR=5.572, 95% CI 1.218-25.484), and asthma (AOR=8.010, 95% CI 2.494-25.726), past experience in visiting a PHC provider (AOR=2.624, 95% CI 1.380-4.987), PHC availability (AOR=2.302, 95% CI 1.314-4.033), trust in the PHC provider (AOR=3.530, 95% CI 1.847-6.744), and transportation satisfaction (AOR=2.376, 95% CI 1.330-4.244). Conclusion: The findings of this study emphasise the need for comprehensive healthcare reforms, both at the micro and macro levels, in the Maldives. The pivotal strategies should aim to improve PHC access and reduce ACSH risks, with a particular focus on high-risk groups. Key areas of focus comprise fostering trust, enhancing patient experience, providing adequate health-related information, improving the availability of PHC services and vital medications, and developing and implementing an efficient transportation infrastructure.