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Item Open Access The governance of local health systems in the era of Sustainable Development Goals: Reflections on collaborative action to address complex health needs in four country contexts(BMJ, 2019) Schneider, Helen; Zulu , Joseph Mumba; Mathias, Kaaren; Cloete , Keith; Hurtig , Anna-KarinThis analysis reflects on experiences and lessons from four country settings - Zambia, India, Sweden and South Africa - on building collaborations in local health systems in order to respond to complex health needs. These collaborations ranged in scope and formality, from coordinating action in the community health system (Zambia), to a partnership between governmental, non-governmental and academic actors (India), to joint planning and delivery across political and sectoral boundaries (Sweden and South Africa). The four cases are presented and analysed using a common framework of collaborative governance, focusing on the dynamics of the collaboration itself, with respect to principled engagement, shared motivation and joint capacity. The four cases, despite their differences, illustrate the considerable challenges and the specific dynamics involved in developing collaborative action in local health systems. These include the coconstruction of solutions (and in some instances the problem itself) through engagement, the importance of trust, both interpersonal and institutional, as a condition for collaborative arrangements, and the role of openly accessible information in building shared understanding. Ultimately, collaborative action takes time and difficulty needs to be anticipated. If discovery, joint learning and developing shared perspectives are presented as goals in themselves, this may offset internal and external expectations that collaborations deliver results in the short term.Item Open Access Empowering community control over alcohol availability as a suicide and self-harm prevention measure: Policy opportunity in Aotearoa New Zealand(Elsevier BV, 2022) Boden , J; Hetrick S, S; Bowden, N; Fortune, S; Marek, Lukas; Theodore, R; Ruhe, T; Kokaua, J; Hobbs, MattOne of the most pressing issues in public health in Aotearoa New Zealand (NZ) is our rate of suicide and self-harm, particularly among young people.1,2 The 2018 New Zealand Government Inquiry into Mental Health and Addiction recognised the challenge of reducing these rates, and raised the important issue of the role of alcohol and other substance use in increasing suicide risk.Item Open Access Telehealth-delivered naturalistic developmental behavioural intervention with and without caregiver acceptance and commitment therapy for autistic children and their caregivers: Protocol for a multi-arm parallel group randomised clinical trial(BMJ, 2023) McLay, Laurie; Emerson, Lisa-Marie; Waddington H; van Deurs, Jenna; Hunter J; Blampied, Neville; Hāpuku, Aaron; Macfarlane, Sonja; Bowden N; Van Noorden L; Rispoli MIntroduction Timely access to early support that optimises autistic children's development and their caregiver's mental health is critical. Naturalistic developmental behavioural interventions (NDBIs) and acceptance and commitment therapy (ACT) are evidence-based supports that can enhance child learning and behaviour, and adult well-being, respectively. The traditional face-to-face delivery of these approaches is resource intensive. Further, little is known about the benefit of parallel child-focused and caregiver-focused supports. The aims of this trial are to evaluate the effectiveness and social validity of telehealth-delivered, caregiver-implemented, child-focused NDBI and caregiver-focused ACT when delivered alone and in parallel, on autistic children's social communication and caregiver well-being. Methods and analysis The study will use a randomised, single-blind clinical trial with three parallel arms: NDBI; ACT and ACT+NDBI. We will recruit a minimum of 78, 2-5-year-old autistic children and their families throughout Aotearoa New Zealand. Support will be delivered over 13 weeks using a combination of culturally enhanced web-based modules and online group coaching. Primary outcome variables include children's social communication/engagement with their caregiver as well as caregiver stress and will be evaluated using a repeated measures multivariate analysis of variance. Outcome variables are assessed at baseline (before randomisation), immediately postparticipation and at 3-month follow-up. Ethics and dissemination The trial is approved by the Health and Disability Ethics Committee (2022 FULL 12058). The findings of this trial will be disseminated through peer-reviewed journals and national and international conference proceedings regardless of the magnitude/direction of effect. Additionally, data will be shared with stakeholder groups, service providers and health professionals. Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN12622001134718).Item Open Access Effect of Indian clubbell exercises on cricket fast bowlers’ shoulder kinematics(2023) Walter, Sibi; Moltchanova, Elena; Petersen, CarlBackground: The glenohumeral joint’s rotational range of motion (ROM) and muscle strength are essential to execute the cricket bowling action. Performing shoulder rotation exercises may increase the rotator cuff muscle strength and rotational ROM. Objectives: The aim of this study was to test the effect of a six-week exercise programme on shoulder rotational ROM and muscle strength. Methods: Twenty-one healthy male cricket fast bowlers were recruited, ranked and pair-matched on initial shoulder rotator muscle strength and assigned to either a shoulder exercise (SE) group or cricket training (CT) only group. The SE group incorporated Indian clubbell exercises in addition to their cricket training. Results: Bowlers in both groups displayed a large increase on the dominant shoulder’s internal rotation (IR) ROM, but only the SE group’s bowlers displayed ROM improvements (p<0.001) bilaterally for both internal and external rotation. The CT group’s fast bowler’s non-dominant shoulder IR ROM significantly decreased (p=0.02) during the six weeks. Between groups, only the SE group’s bowler’s internal rotator muscle strength improved (p<0.001) bilaterally. The observed kinematic changes were statistically significantly greater at a 5% level for the SE group’s bowlers (bilateral internal rotators muscle strength, non-dominant shoulder IR ROM and horizontal adduction ROM). Conclusion: Maintenance of the shoulder’s rotational ROM and muscle strength is vital for a fast bowler. Cricket bowlers who perform regular clubbell exercises might increase their shoulder’s ROM and internal rotator cuffs’ muscle strength, which may aid in stabilising their glenohumeral joint while bowling.Item Open Access Developing relevant community mental health programmes in North India: Five questions we ask when co-producing knowledge with experts by experience(BMJ, 2023) Pillai , Pooja; Rawat , Meenal; Jain S, Sumeet; Martin , Rachelle Anne; Shelly K, Kakul; Mathias, KaarenKnowledge co-production can improve the quality and accessibility of health, and also benefit service users, allowing them to be recognised as skilled and capable. Yet despite these clear benefits, there are inherent challenges in the power relations of co-production, particularly when experts by experience (EBE) are structurally disadvantaged in communication skills or literacy. The processes of how knowledge is co-produced and negotiated are seldom described. This paper aims to describe processes of co-production building on the experiences of EBE (people with lived experience of psychosocial or physical disability), practitioners and researchers working together with a non-profit community mental health programme in North India. We describe processes of group formation, relationship building, reflexive discussion and negotiation over a 7-year period with six diverse EBE groups. Through a process of discussion and review, we propose these five questions which may optimise co-production processes in communities: (1) Who is included in co-production? (2) How can we optimise participation by people with diverse sociodemographic identities? (3) How do we build relationships of trust within EBE groups? (4) How can we combine psychosocial support and knowledge co-production agendas in groups? and (5) How is the expertise of experts by experience acknowledged?Item Open Access Trajectories of Successful Aging Among Older Adults in Aotearoa New Zealand(SAGE Publications, 2023) Fasoro A; Maddocks, Wendy; Barnett P, Pauline; Basu, ArindamSuccessful aging was defined as having no multimorbidity, high functional capacity, active life engagement, and good health-related quality of life. This study analyzed data from 1433 older adults who were followed up for 12 years across seven waves from the New Zealand Health, Work and Retirement study by examining the trajectories of successful aging. Latent growth curve modeling was used to assess the growth factors of successful aging trajectories of older adults. The mean successful aging score was 3.53 (range: 0–6) in 2006 and linearly declined by 0.064 units every year. Those with higher successful aging scores at baseline had a slower decline. Successful aging scores were lower among females, Māori, and those aged 65 years and above at baseline. The findings from this study suggest that gender and ethnic inequalities play significant roles in successful aging among older adults in New Zealand.Item Open Access Nurse Anaesthetists in the First World War(2023) Maddocks, WendyItem Open Access Improving mental ill-health with psycho-social group interventions in South Asia-A scoping review using a realist lens.(Public Library of Science (PLoS), 2023) Mathias, Kaaren; Jain , Sumeet; Fraser , Robert; Davis , Meghan; Kimijima-Dennemeyer , Rita; Pillai , Pooja; Deshpande , Smita N.; Wolters , Maria; Nalecz HThis scoping review aimed to synthesise current evidence related to psycho-social groups as part of community-based mental health interventions in South Asia. We used a realist lens to pay attention to the contexts and mechanisms supporting positive outcomes. We included studies published from January 2007 to February 2022 that: were based in communities in South Asia, included a group component, reported on interventions with a clear psychosocial component, targeted adults and were implemented by lay community health workers. Two reviewers extracted data on intervention components, groups and facilitators, participant demographics and enabling contexts, mechanisms and outcomes. Expert reference panels including people with lived experience of psycho-social disability, mental health professionals and policy makers confirmed the validity and relevance of initial review findings. The review examined 15 interventions represented by 42 papers. Only four interventions were solely psycho-social and nearly all included psychoeducation and economic support. Only 8 of the 46 quantitative outcome measures used were developed in South Asia. In a context of social exclusion and limited autonomy for people with psychosocial disability, psychosocial support groups triggered five key mechanisms. Trusted relationships undergirded all mechanisms, and provided a sense of inclusion, social support and of being able to manage mental distress due to improved skills and knowledge. Over time group members felt a sense of belonging and collective strength meaning they were better able to advocate for their own well-being and address upstream social health determinants. This led to outcomes of improved mental health and social participation across the realms of intrapersonal, interpersonal and community. Psychosocial groups merit greater attention as an active ingredient in community interventions and also as an effective, relevant, acceptable and scalable platform that can promote and increase mental health in communities, through facilitation by lay community health workers.Item Open Access Adoptee activism: I am not your “child for all purposes”.(2022) Blake, Denise; Ahuriri-Driscoll, Annabel; Sumner , BarbaraIn this article, we, three adoptee scholars, share collectively our experiences of adoption while engaging in activism that contests adoption practices. We apply autoethnographic and re!exive strategies to unpack our shared conversation in order to foreground the plight of adoptees and o"er insight into adoption and the importance of the current law reform in Aotearoa New Zealand. We draw on a model of adoptee consciousness to frame the complexity of our ‘lived experience’ and activism. In doing this we outline some of the challenges we face as adoptees because adoption, as a human-rights injustice, is largely misunderstood, overlooked, or ignored. To begin, however, it is necessary to outline the history of closed stranger adoption in Aotearoa New Zealand with the purpose of providing context.Item Open Access Recognition of mind and body interactions in New Zealand counselling education and practice(2023) Belton R; Taylor M; Barraclough, ShaneeUsing mixed-method surveys and case study interviews, thirty emerging and experienced counsellors were queried on the mind–body interactions of bodyoriented psychotherapies, nutrition, and physiological conditions relative to counselling education and practice. Participating counsellors did not consider their counselling education covered these areas well, particularly in bodyoriented psychotherapies and nutrition with only 30% and 20% of participants respectively affirmative. Counsellors reported mixed confidence in knowledge and referral competency around nutritional and physiological health interactions with mental wellbeing. Counsellors generally (97%) did not consider body-oriented psychotherapies alternative and 100% indicated they would consider future professional development in this area. The Māori health model Te Whare Tapa Whā is endorsed in Aotearoa New Zealand counselling education. This holistic wellbeing model recognises mind–body interactions. However, this research indicates inconsistent and often negligible mind–body interaction knowledge is taught in Aotearoa New Zealand counselling education.Item Open Access A ‘forgotten’ whakapapa: historical narratives of Māori and closed adoption(Informa UK Limited, 2023) Ahuriri-Driscoll, Annabel; Blake D; Potter H; McBreen K; Mikaere AThe era of closed stranger adoption is a significant part of Aotearoa New Zealand’s social and colonial history; some 80,000 children were legally adopted between the years 1955–1985. Māori children constituted a considerable proportion of these legal adoptions, although little attention has been given to their experiences. The relative silence surrounding this phenomenon exists alongside narratives of colonisation and a professed abhorrence by Māori to closed adoption practice, producing a narrative discrepancy. This article aims to understand and account for some of the discrepancies in public narratives by providing an accurate historical account of engagement with the 1955 Adoption Act and its 1962 amendments from a Māori perspective, and unpacking the legal, political, social and cultural aspects from a historical experience. The complexities and nuances of settler colonialism are highlighted, as well as the effects for Māori adoptees of not being publicly and historically narrated–forgotten subjects. Glossary of Māori words: Aotearoa: the Māori name for New Zealand; hapū: kinship group, clan, sub-tribe; iwi: kinship grouping, tribe; korero: to tell, say, speak, talk (verb); speech, narrative, story, discussion (noun); Māori: normal, usual, natural, common or ordinary, used to refer to indigenous New Zealanders; mokopuna: grandchild/grandchildren, descendant; Ngāpuhi: the people or tribal grouping of the Northland region; Pākehā: New Zealanders of European origin; tamariki: child/children; Te Tiriti o Waitangi: the Māori text of the Treaty of Waitangi, the founding document which enabled British settlement of Aotearoa; tikanga: culture, customs, traditions; whakapapa: genealogy, lineage, descent (noun); to place in layers (verb); whanau: family; whanaungatanga: relationship, kinship; whāngai: customary child placement, literal meaning to feed, nourish or nurture.Item Open Access Item Open Access What innovative practices and processes are used to deliver psychosocial care in India? A qualitative case study of three non-profit community mental health organisations(Elsevier BV, 2023) Srinivasan V; Jain S; Kwon W; Bayetti C; Cherian AV; Mathias, KaarenThe global mental health field seeks to close the “treatment gap” for mental illness in low-and middle-income countries by scaling evidence-based interventions. The evidence base has often bypassed psychosocial interventions by local organizations who do not fit a biomedical approach to evidence building. In India, non-profit mental health organizations are addressing care gaps through novel approaches that emphasise social recovery and inclusion. This study seeks to better understand the nature and dynamic of this innovation by examining what was working well in the practices and processes of three such community mental health care organizations. A comparative case approach was chosen for its strength as an exploratory means for inductive theory building. Three case organizations in Kerala, West Bengal and Uttarakhand states were selected based on their diverse socio-cultural and health systems settings. Qualitative data was collected in 2018-20, to examine their practices and processes using mixed methods and data sources including interviews, focus groups, participant observation and document analysis. Common strategies observed across the three organizations, included engaging community, prioritising beneficiaries, co-opting resources, devolving care, reorganising communication and recovery and integration. These strategies were further categorized into three domains: constructing a sustainable resource base, managing knowledge and redefining meanings. In contrast with conventional problem-solving approaches, these cases used an approach that built on assets and strengths using inclusive governance which enabled coordination of the community health system. This study concludes that these organizations incorporate reflexive practice and two-way flows of knowledge to enable them to address complex social determinants of mental health by: modifying processes relating to place, relations, and processes of care; challenging existing distribution of power in biomedical care models and redefining ways of scaling innovations in health systems.Item Open Access Self-report measures of parental psychosocial functioning did not predict further maltreatment of children involved with child protection services: A small cohort study(2023) Schluter P; Tarren-Sweeney M; Whitcombe-Dobbs, SarahAim: This prospective study explored whether self-report measures of parenting self-efficacy, mood, anxiety, stress, emotional regulation or substance use were useful in predicting subsequent notifications of harm to Child Protection Services (CPS). Methods: CPS-involved parents living in Christchurch, New Zealand were recruited to the study, all of whom retained the custody of their youngest child at the time of assessment. Comprehensive data regarding the aforementioned constructs, along with demographic data, were gathered during a baseline assessment. Notifi cations of harm were prospectively retrieved from the national child protection database. Methods of analysis included logistic regression and Receiver Operating Characteristics (ROC) analyses. Results: No individual psychological constructs, nor cumulative risk scores, were found to be associated with notifications of harm among the study sample (N = 26). The Area Under the Curve (AUC) values ranged from 0.49 to 0.65, indicating that these scores generally performed no better than chance. Two background factors predicted CPS notifications, namely: having more children and the parent reporting a personal history of neglect. Conclusion: Self-report measures of mood, emotional regulation, parenting self-efficacy and substance use are unlikely to be useful for PCA when conducted in the context of child protection casework or court assessments.Item Open Access Preventing Bullying in Preschool-Age Children: Predictors of Defending Behaviour(2023) Blakely-McClure S; Kamper-DeMarco K; Swit, CaraUnderstanding the factors that motivate defending behaviour from an early age is crucial in informing effective intervention in bullying. However, relatively little is known about the social, emotional, and cognitive factors that predict young children’s involvement in defending behaviour. This study investigated the concurrent role of social (i.e. relational and physical aggression, prosocial behaviour, positive peer interactions, and peer rejection), emotional (i.e. anger, empathy), and cognitive (i.e. social withdrawal, inhibitory control, and attention) predictors of defending behaviour in early childhood (N =87, M age=46.74 months, SD=10.13, 56% males). Children were recruited from kindergartens located in three diverse socioeconomic communities in the South Island of New Zealand. The findings of a series of hierarchical regressions showed that, after controlling for age, lower levels of social withdrawal predicted higher levels of defending behaviour. For older children (≥46.7 months), empathy was a strong predictor of defending behaviour. Defending behaviour was positively associated with age; however, no differences were found in teacher reports of boys’ and girls’ use of defending. Implications for early prevention, intervention, and future research directions are discussed.Item Open Access Effect of Clubbell Exercises on Shoulder Kinematics in Female Handball Players(Australian International Academic Centre, 2023) Daneshfar A; Petersen C; Noel Walter, Sibi BoycottBackground: Clubbells were popular shoulder exercise equipment used during the 17-18th centuries. Currently there is a resurgence in the use of clubbells to strengthen the shoulder rotators, but there are no studies to prove their effectiveness on shoulder kinematics. Therefore, this study aimed to find out if clubbell exercises had any effect on glenohumeral rotational range of motion (ROM) and shoulder rotator strength. Methods: Using a randomised control study design, female handball athletes (n=15) were voluntarily recruited and were assigned randomly to either a handball training only group (HT) (n = 8, age 25±7 y, height 1.77 ± 0.11m, mass 76 ± 15 kg,) or a shoulder exercise group (SE) (n = 7, age 27±8 y, height 1.78 ± 0.12m, mass 79 ± 15 kg). The SE group underwent an exercise programme (8 weeks, 3 days/week, 20 min/day) using clubbells. The ROM and muscle strength were assessed at baseline and at the end of weeks 2, 4, 6 and 8. Results: After eight weeks, comparison between groups showed that the SE group’s dominant arm internal rotators muscle strength improved (28±5 to 33±7 Nm) significantly (p0.05). Within the SE group, internal rotation ROM, internal rotators, and external rotators muscle strength all significantly (p0.05) improved. Conclusions: Clubbell exercises increases internal rotation ROM and shoulder rotators muscle strength. Therefore, it is suggested that handball athletes could use clubbell exercises to improve their shoulder rotational ROM and strengthen the shoulder rotators whereby reducing shoulder injury risk.Item Open Access Strengths of family carers: Looking after a terminally ill adult under 65 years of age(2022) James M; Reid, KateINTRODUCTION: To learn of a terminal illness is devastating at any age. How much more so when it occurs in early or mid-adulthood, when people are busy with family and career goals. Those facing death when under 65 years of age are a group whose voice is virtually invisible in the palliative caregiving literature. Yet one in every five people die in Aotearoa New Zealand before 65 years of age. For Maori, almost half will die under the age of 65. METHODS: This qualitative descriptive research involved semi-structured interviews with eight bereaved family carers focusing on the carer’s experience of living with their spouse during their final illness. FINDINGS: Analysis of the research narratives revealed the strengths of love, hope, family, teamwork and resilience in navigating these experiences. CONCLUSION: In order to support holistic care for those who are receiving palliative care, this research advocates for strength-based assessments to support carers during the illness of their family member. This gives a different lens to the caregiving narrative which has, as its focus, the growth of human potential as well as enabling partnerships between palliative care practitioners and family carers.Item Open Access The future of Māori health is here – The 2022 Aotearoa New Zealand health reforms(Elsevier BV, 2022) Ahuriri-Driscoll A; Kawa DT; Lovell, Sarah; MacDonald, Lindsey Te Ata o Tū; Mathias, KaarenThe formal launch of Te Aka Whai Ora, the new Maori Health Authority, on 1 July 2022 marks one of the most significant health system changes in Aotearoa’s recent history. The new authority joins a suite of newly created central government institutions including Te Whatu Ora (Health NZ), and Whaikaha (Ministry of Disabled People). The Hauora Maori Ministerial Advisory Committee was also created to be positioned alongside a slimmed down Manatu Hauora (Ministry of Health) focused on stewardship and incorporating a re-established Public Health Agency. Replacing the community consultation elements of the country’s disestablished District Health Boards will be new Iwi Maori Partnership Boards. Significantly, Te Tiriti o Waitangi (Te Tiriti, the Maori text of the Treaty of Waitangi) forms the basis of the health reforms, framing both the problems to be addressed and the solutions.Item Open Access Is the Parwarish parenting intervention feasible and relevant for young people and parents in diverse settings in India? A mixed methods process evaluation(BMJ, 2022) Nayak P; Singh P; Pillai P; Goicolea I; Mathias, KaarenObjective To assess the feasibility, acceptability and relevance of the Parwarish, a positive parenting intervention (adapted from PLH-Teens) in three diverse settings in India. Design This mixed methods study used the Medical Research Council framework for process evaluations of complex interventions. Setting This study was set in disadvantaged communities in urban Agra, rural Uttar Pradesh and tribal Jharkhand in India. Participants Data were collected from 86 facilitators, implementers, parents and teens who participated in the Parwarish intervention among 239 families. Intervention Couples from target communities facilitated groups of parents and teens over the 14-module structured, interactive Parwarish intervention which focused on building communication, reducing harsh parenting and building family budgeting skills. Outcome measures We assessed relevance, acceptability and feasibility of the intervention using mixed methods. Qualitative data collected included semistructured interviews and focus group discussions with implementers, facilitators, parents and young people who were transcribed, translated and thematically analysed to develop themes inherent in the data. Quantitative data which assessed attendance, fidelity to the intervention and facilitator training and coaching were analysed descriptively. Results Findings were grouped under the three domains of facilitation, community engagement and programme support with the following seven themes: (1) community-based facilitators increased contextual validity of the intervention; (2) gender relations were not only influenced by Parwarish implementation but were also influenced and transformed by Parwarish; (3) facilitator responsiveness to group concerns increased participation; (4) participation gathered momentum; (5) Parwarish's strong core and porous periphery allowed adaptations to local contexts; (6) technology that included Skype and WhatsApp enhanced implementation and (7) critical reflection with community trained coaches strengthened facilitation quality and programme fidelity. Conclusion This study found Parwarish engaging, feasible and acceptable in three diverse, low-income communities, although constrained by patriarchal gender relations. It paves the way for larger-scale implementation in other South Asian settings.Item Open Access Participatory mental health interventions in low-income and middle-income countries: a realist review protocol(BMJ, 2022) Heap CJ; Jennings HM; Mathias K; Gaire H; Gumbonzvanda F; Gumbonzvanda N; Gupta G; Jain S; Maharjan B; Maharjan R; Maharjan SM; Mahat P; Pillai P; Webber M; Wright J; Burgess R; Mathias, KaarenIntroduction The launch of the Movement for Global Mental Health brought long-standing calls for improved mental health interventions in low-and middle-income countries (LMICs) to centre stage. Within the movement, the participation of communities and people with lived experience of mental health problems is argued as essential to successful interventions. However, there remains a lack of conceptual clarity around € participation' in mental health interventions with the specific elements of participation rarely articulated. Our review responds to this gap by exploring how € participation' is applied, what it means and what key mechanisms contribute to change in participatory interventions for mental health in LMICs. Methods and analysis A realist review methodology will be used to identify the different contexts that trigger mechanisms of change, and the resulting outcomes related to the development and implementation of participatory mental health interventions, that is: what makes participation work in mental health interventions in LMICs and why? We augment our search with primary data collection in communities who are the targets of global mental health initiatives to inform the production of a programme theory on participation for mental health in LMICs. Ethics and dissemination Ethical approval for focus group discussions (FGDs) was obtained in each country involved. FGDs will be conducted in line with WHO safety guidance during the COVID-19 crisis. The full review will be published in an academic journal, with further papers providing an in-depth analysis on community perspectives on participation in mental health. The project findings will also be shared on a website, in webinars and an online workshop.