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Williams L, Henry C, Simcock B, Amataiti T, Perelini O, Filoche S. 'It's not a solution to keep telling me to lose weight!' Exploring endometrial cancer survivors' experiences of nutrition and well-being advice: A qualitative study. Aust N Z J Obstet Gynaecol 2024. [PMID: 39242357 DOI: 10.1111/ajo.13875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 08/11/2024] [Indexed: 09/09/2024]
Abstract
AIMS The aim was to explore Endometrial cancer (EC) survivors' experiences of being offered nutrition and well-being advice. METHODS This qualitative study was conducted at two tertiary centres in Aotearoa New Zealand. Semi-structured conversations with people who had completed treatment for EC in the past 12 months were undertaken to explore how they were offered nutrition and well-being advice as part of standard follow-up care. Interviews were analysed using reflexive thematic analysis. RESULTS Fifteen people of Pacific, Māori and European ethnicity participated. Five themes were derived: (i) isolation and vulnerability, (ii) importance of language, (iii) inconsistent availability and relevance of nutrition and well-being information, (iv) competing priorities and influences and (v) holistic and culturally responsive support. People often experienced judgement associated with their weight as part of their care, with limited understanding of their lived realities. Nutrition and well-being advice was not widely available or accessible, and people had to explicitly ask for it. Social and environmental factors were barriers to making changes to health behaviours. A need for culturally safe holistic care was identified. CONCLUSION Enhancing survivorship after EC is ultimately premised on providing culturally safe and responsive care. Expanding workforce training in communication around high weight as well as education and self-assessment of cultural safety could enable aspects of this. A holistic care program could facilitate wider access to nutrition and well-being advice and better meet the needs of this population.
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Affiliation(s)
- Linda Williams
- Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
| | - Claire Henry
- Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
| | - Bryony Simcock
- Department of Gynaecology, Christchurch Hospital, Te Whatu Ora, Waitaha Christchurch - Health New Zealand, Christchurch, New Zealand
| | - Tutangi Amataiti
- Allied Health, Te Whatu Ora (Health New Zealand) - Capital, Coast and Hutt Valley, Wellington, New Zealand
| | - Olivia Perelini
- Oncology Service, Te Whatu Ora (Health New Zealand) - Te Toka Tumai, Auckland, New Zealand
| | - Sara Filoche
- Department of Obstetrics, Gynaecology & Women's Health, University of Otago, Wellington, New Zealand
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Williams L, Henry C, Simcock B, Filoche S. Increasing incidence of endometrial cancer in Aotearoa New Zealand: Health professionals' perspective. Aust N Z J Obstet Gynaecol 2024; 64:114-119. [PMID: 37737531 DOI: 10.1111/ajo.13751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/27/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND The incidence of endometrial cancer is globally increasing. Aotearoa New Zealand is no exception with a 59% increase in cases over that last ten years. AIMS We report a sub-set of themes which pertain to provider reflections of rising endometrioid-type endometrial cancer incidence in individuals with high weight. MATERIALS AND METHODS Fifteen semi-structured interviews with healthcare professionals experienced in providing care to women with endometrial cancer were audio-recorded and transcribed. Interviews were analysed using reflexive thematic analysis. RESULTS Two main themes emerged: (1) concerns for the future; and (2) impact on fertility and treatment options. Healthcare professionals discussed rising incidence in younger people and a need for increased awareness about the association of excess weight as a risk factor for developing the disease. The concern extended to workforce and equipment shortfalls of meeting the needs of individuals with higher weight, which subsequently influenced treatment options, health outcomes and survivorship. CONCLUSIONS Rising incidence of endometrial cancer in individuals with high weight presents multiple chances for inequitable access and health outcomes over the care continuum for endometrial cancer. Action is required to address incidence, awareness, access to equitable and inclusive treatment, and survivorship.
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Affiliation(s)
- Linda Williams
- Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
| | - Claire Henry
- Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
| | - Bryony Simcock
- Department of Gynaecology, Christchurch Hospital, Te Whatu Ora: Waitaha Christchurch - Health New Zealand, Christchurch, New Zealand
| | - Sara Filoche
- Department of Obstetrics, Gynaecology & Women's Health, University of Otago, Wellington, New Zealand
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Sivak L, Reilly R, Lockton J, Treloar C, Roe Y, McKetin R, Butt J, Ezard N, Winkenweder H, Ward J. Psychosocial stress and methamphetamine use: A mixed-methods study of intersectional stigma and Aboriginal and Torres Strait Islander methamphetamine use. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 121:104189. [PMID: 37708599 DOI: 10.1016/j.drugpo.2023.104189] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/09/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Regular methamphetamine use can cause a range of physical, psychological and social harms. Stigma is one factor that impacts engagement and successful completion of treatment. In Australia, Aboriginal and Torres Strait Islander people who regularly use methamphetamine experience multiple stigmas, which further compounds access to treatment and quality of life. This paper explores the cumulative and compounding effects of participating in a stigmatised activity such as illicit drug use in relation to the stigma experienced by Aboriginal and Torres Strait Islander people as a population marginalised through colonisation. METHODS Ten sites nationally participated in a cross-sectional survey measuring a range of factors including psychosocial stress in methamphetamine users. The survey sample size was 734, with 59% identifying as Aboriginal and Torres Strait Islander (n = 433). In addition, a total of 147 mainly Aboriginal and Torres Strait Islander people who use methamphetamine, community and family members, and service providers took part in a total of 19 focus groups and 7 interviews. RESULTS Aboriginal and Torres Strait Islander participants experienced multiple psychosocial stressors at significantly higher rates than non-Indigenous participants. These stressors include diminished access to health care (33%), experiences of racism (34%), grief and sorrow (39%), worry for family (46%), and child welfare experiences (46%). The qualitative findings highlight the cumulative impact of historical, political and social stressors on an already stigmatised population. CONCLUSIONS The findings of this unique analysis demonstrate the disruptive impact of methamphetamine use on the lives of those who use methamphetamines and their family members. They also illustrate challenges, such as stigma, that may confront those seeking assistance for drug-related issues. Aboriginal and Torres Strait Islander community involvement is necessary to provide support and education for the individual, the family, and the community as a whole. Stigma reduction is therefore a worthy target for intervention.
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Affiliation(s)
- Leda Sivak
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Australia.
| | - Rachel Reilly
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Australia; School of Psychology, University of Adelaide, Australia
| | - Jane Lockton
- School of Psychology, University of Adelaide, Australia
| | - Carla Treloar
- Centre for Social Research in Health and the Social Policy Research Centre, University of New South Wales, Australia
| | - Yvette Roe
- Molly Wardaguga Research Centre, Charles Darwin University, Australia
| | - Rebecca McKetin
- National Drug and Alcohol Research Centre, University of New South Wales, Australia
| | - Julia Butt
- School of Arts and Humanities, Edith Cowan University, Australia
| | - Nadine Ezard
- National Drug and Alcohol Research Centre, University of New South Wales, Australia
| | | | - James Ward
- Poche Centre for Indigenous Health, University of Queensland, Australia
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Anoop V, Sreelakshmi S. Public discourse and sentiment during Mpox outbreak: an analysis using natural language processing. Public Health 2023; 218:114-120. [PMID: 37019026 DOI: 10.1016/j.puhe.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 02/01/2023] [Accepted: 02/21/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES Mpox has been declared a Public Health Emergency of International Concern by the World Health Organization on July 23, 2022. Since early May 2022, Mpox has been continuously reported in several endemic countries with alarming death rates. This led to several discussions and deliberations on the Mpox virus among the general public through social media and platforms such as health forums. This study proposes natural language processing techniques such as topic modeling to unearth the general public's perspectives and sentiments on growing Mpox cases worldwide. STUDY DESIGN This was a detailed qualitative study using natural language processing on the user-generated comments from social media. METHODS A detailed analysis using topic modeling and sentiment analysis on Reddit comments (n = 289,073) that were posted between June 1 and August 5, 2022, was conducted. While the topic modeling was used to infer major themes related to the health emergency and user concerns, the sentiment analysis was conducted to see how the general public responded to different aspects of the outbreak. RESULTS The results revealed several interesting and useful themes, such as Mpox symptoms, Mpox transmission, international travel, government interventions, and homophobia from the user-generated contents. The results further confirm that there are many stigmas and fear of the unknown nature of the Mpox virus, which is prevalent in almost all topics and themes unearthed. CONCLUSIONS Analyzing public discourse and sentiments toward health emergencies and disease outbreaks is highly important. The insights that could be leveraged from the user-generated comments from public forums such as social media may be important for community health intervention programs and infodemiology researchers. The findings from this study effectively analyzed the public perceptions that may enable quantifying the effectiveness of measures imposed by governmental administrations. The themes unearthed may also benefit health policy researchers and decision-makers to make informed and data-driven decisions.
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Shaming: A Concept Analysis. ANS Adv Nurs Sci 2023; 46:E16-E28. [PMID: 36066340 DOI: 10.1097/ans.0000000000000434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nurses in a variety of settings frequently use behavior modification strategies to promote health behavior change. Shaming is one such behavior modification tool, but its use in nursing is poorly understood. A concept analysis using Walker and Avant's method was performed. After an extensive literature review, a conceptual definition of shaming is proposed and defining attributes, antecedents, and consequences are presented. Shaming is also differentiated from related concepts often used synonymously such as stigmatization and incivility. Shaming as a behavior modification strategy is incongruous with nursing values and its utilization in nursing warrants further investigation.
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Teeth are for chewing: a critical review of the conceptualisation and ethics of a controversial intraoral weight-loss device. Br Dent J 2021; 231:675-679. [PMID: 34893725 DOI: 10.1038/s41415-021-3680-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 09/30/2021] [Indexed: 01/10/2023]
Abstract
We are a diverse collective of researchers who are committed to improving the health and wellbeing of marginalised individuals. This article is a response to, and critique of, the DentalSlim Diet Control research. This device revises a controversial 1970s weight-loss technology connected to poor health outcomes, which is indicative of a culture that consistently promotes harm to fat and other marginalised communities.We address the historical context in which unruly bodies, particularly fat, and Indigenous bodies have been the site of unethical investigation conducted under the auspices of medical research. Existence outside the normative white, male, cis physical ideal demands regulation, and disciplinary measures. We demonstrate how Brunton et al.'s research is underpinned by anti-fat attitudes and assumptions which impose this punitive physical intervention onto healthy people in a way that should not be acceptable in medical research.Further, we address a range of harms, giving attention to Māori and to individuals with eating disorders, along with issues of research integrity. We argue that no ethics committee should have approved this research, no academic journal should have published it, and no member of the dental and medical community should promote or prescribe this device.
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Wild CEK, Wynter LE, Triggs CM, Derraik JGB, Hofman PL, Anderson YC. Five-year follow-up of a family-based multidisciplinary program for children with obesity. Obesity (Silver Spring) 2021; 29:1458-1468. [PMID: 34370401 DOI: 10.1002/oby.23225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/15/2021] [Accepted: 04/25/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study aimed to determine 5-year outcomes from a 12-month, family-based, multidisciplinary lifestyle intervention program for children. METHODS This study was the 5-year follow-up of a randomized clinical trial comparing a low-intensity control group (home-based assessments) with a high-intensity intervention group (assessments plus weekly sessions) in New Zealand. Participants were aged 5 to 16 years with BMI ≥ 98th centile or > 91st centile with weight-related comorbidities. The primary outcome was BMI standard deviation score (BMISDS). Secondary outcomes included various health markers. RESULTS Of the 199 children included in the study at baseline (47% who identified as Māori, 53% who identified as female, 28% in the most deprived quintile, mean age = 10.7 years, mean BMISDS = 3.12), 86 completed a 5-year assessment (43%). BMISDS reduction at 12 months was not retained (control = 0.00 [95% CI: -0.22 to 0.21] and intervention = 0.17 [95% CI: -0.01 to 0.34]; p = 0.221) but was greater in participants aged <10 years versus >10 years at baseline (-0.15 [95% CI: -0.33 to 0.03] vs. 0.21 [95% CI: 0.03 to 0.40]; p = 0.008). BMISDS trajectory favored participants with high attendance (p = 0.013). There were persistent improvements in water intake and health-related quality of life in both groups as well as reduced sweet drink intake in the intervention group. CONCLUSIONS This intervention, with high engagement from those most affected by obesity, did not achieve long-term efficacy of the primary outcome. Attendance and age remain important considerations for future interventions to achieve long-term BMISDS reduction.
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Affiliation(s)
- Cervantée E K Wild
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child & Youth Health, School of Medicine, University of Auckland, Auckland, New Zealand
- Tamariki Pakari Child Health and Wellbeing Trust, New Plymouth, New Zealand
| | - Lisa E Wynter
- Department of Pediatrics, Taranaki District Health Board, New Plymouth, New Zealand
| | - Christopher M Triggs
- Department of Statistics, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child & Youth Health, School of Medicine, University of Auckland, Auckland, New Zealand
- Tamariki Pakari Child Health and Wellbeing Trust, New Plymouth, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Yvonne C Anderson
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child & Youth Health, School of Medicine, University of Auckland, Auckland, New Zealand
- Tamariki Pakari Child Health and Wellbeing Trust, New Plymouth, New Zealand
- Department of Pediatrics, Taranaki District Health Board, New Plymouth, New Zealand
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Hilder J, Gray L, Stubbe M, Duncan S, Dowell AC. 'Water dripping on a stone': a feasibility study of a healthy weight management conversation approach in routine general practice consultations. Fam Pract 2021; 38:246-252. [PMID: 33184641 DOI: 10.1093/fampra/cmaa122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Primary health care has an important role to play in the management of weight and yet discussions of healthy weight management do not occur optimally, indicating a need for simple tools and training in brief weight counselling. The 'FABS' approach (focusing on four topic areas: Food, Activity, Behaviour and Support) was developed to address this. OBJECTIVES To explore the feasibility of the 'FABS' approach within routine general practice consultations and its effectiveness in facilitating healthy weight conversations. METHOD The FABS approach was run for a trial period in five New Zealand general practices. The approach entailed staff training, the addition to the practice patient management system of a template outlining potential topics for discussion and a patient handout. GPs were asked to use the approach with any adult patient with a body mass index of over 28 kg/m2. A descriptive analysis of anonymized quantitative practice data was conducted, with limited qualitative data from an online clinician questionnaire and interviews with GPs and patients. RESULTS Over 4 months, the template was opened 862 times by 27 clinicians in 830 patient consultations. All FABS topics were raised at least once. Physical activity was raised most frequently, followed by two food-related topics. There was variation between practices and between GPs. GPs tended to raise more topics within a single consultation than the training recommended. The limited clinician survey results and patient interviews also indicated positive responses to the approach. CONCLUSIONS It is possible to provide an infrastructure for healthy weight conversation approaches within general practice so that patients receive supportive and consistent messages on a regular basis. General practice is an appropriate setting for this due to the ongoing relationships with patients and team-based approach, but there is a need for effective training and education to ensure appropriate and effectively delivery.
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Affiliation(s)
- Jo Hilder
- Department of Primary Health Care and General Practice, University of Otago Wellington, Wellington, New Zealand
| | - Lesley Gray
- Department of Primary Health Care and General Practice, University of Otago Wellington, Wellington, New Zealand
| | - Maria Stubbe
- Department of Primary Health Care and General Practice, University of Otago Wellington, Wellington, New Zealand
| | | | - Anthony C Dowell
- Department of Primary Health Care and General Practice, University of Otago Wellington, Wellington, New Zealand
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Batal M, Chan HM, Fediuk K, Ing A, Berti P, Sadik T, Johnson-Down L. Associations of health status and diabetes among First Nations Peoples living on-reserve in Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2021; 112:154-167. [PMID: 34181230 PMCID: PMC8239104 DOI: 10.17269/s41997-021-00488-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 01/28/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Our objective is to describe self-reported health status, prevalence of diabetes and obesity and their associations in participants from the First Nations Food, Nutrition and Environment Study (FNFNES) in order to identify possible correlates of health in First Nations adults. METHODS FNFNES is a participatory study with First Nations Peoples living on reserve lands south of the 60th parallel. Health and diabetes were self-reported, and prevalence of obesity was evaluated. Socio-demographic and lifestyle factors and traditional food (TF) activities were investigated for associations with health parameters. RESULTS High prevalence rates of overweight/obesity (78-91%) and diabetes (19% age-standardized prevalence) were found. Smoking rates were high and physical activity was low. In multivariable analyses, obesity was associated with region, income source, age, gender, smoking and self-reported health; diabetes and lesser self-reported health were associated with obesity and lower education. Diabetes was strongly associated with lesser self-reported health and weakly associated with being a smoker. CONCLUSION We have identified possible correlates of health in this population that can help to better understand the underlying concerns and identify solutions for First Nations and their partners. We urge governments and First Nations to address the systemic problems identified with a holistic ecosystem approach that takes into consideration the financial and physical access to food, particularly TF, and the facilitation of improved health behaviour. New mechanisms co-developed with First Nations leadership should focus on supporting sustainable, culturally safe and healthy lifestyles and closing the gaps in nutrition and food insecurity.
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Affiliation(s)
- Malek Batal
- Département de nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, CP 6128 succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada.
- Centre de recherche en santé publique de l'Université de Montréal et du CIUSS du Centre-sud-de-l'Île-de-Montréal (CReSP), 7101 Avenue du Parc, Montréal, QC, H3N 1X7, Canada.
| | - Hing Man Chan
- Department of Biology, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada
| | - Karen Fediuk
- Department of Biology, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada
- First Nations Food, Nutrition and Environment Study, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada
| | - Amy Ing
- Département de nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, CP 6128 succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada
| | - Peter Berti
- HealthBridge Foundation of Canada, 1 Nicholas Street, Suite 1004, Ottawa, ON, K1N 7B7, Canada
| | - Tonio Sadik
- Assembly of First Nations, 55 Metcalfe Street, Suite 1600, Ottawa, ON, K1P 6L5, Canada
| | - Louise Johnson-Down
- Département de nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, CP 6128 succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada
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Anderson YC, Wild CEK, Hofman PL, Cave TL, Taiapa KJ, Domett T, Derraik JGB, Cutfield WS, Grant CC, Willing EJ. Participants' and caregivers' experiences of a multidisciplinary programme for healthy lifestyle change in Aotearoa/New Zealand: a qualitative, focus group study. BMJ Open 2021; 11:e043516. [PMID: 33980517 PMCID: PMC8118004 DOI: 10.1136/bmjopen-2020-043516] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Child and adolescent obesity continues to be a major health issue internationally. This study aims to understand the views and experiences of caregivers and participants in a child and adolescent multidisciplinary programme for healthy lifestyle change. DESIGN Qualitative focus group study. SETTING Community-based healthy lifestyle intervention programme in a mixed urban-rural region of Aotearoa/New Zealand. PARTICIPANTS Parents/caregivers (n=6) and children/adolescents (n=8) who participated in at least 6 months of an assessment and weekly session, family-based community intervention programme for children and adolescents affected by obesity. RESULTS Findings covered participant experiences, healthy lifestyle changes due to participating in the programme, the delivery team, barriers to engagement and improvements. Across these domains, four key themes emerged from the focus groups for participants and their caregivers relating to their experience: knowledge-sharing, enabling a family to become self-determining in their process to achieve healthy lifestyle change; the importance of connectedness and a family-based programme; the sense of a collective journey and the importance of a nonjudgemental, respectful welcoming environment. Logistical challenges and recommendations for improvement were also identified. CONCLUSIONS Policymakers need to consider the experiences of participants alongside quantitative outcomes when informing multidisciplinary intervention programmes for children and adolescents affected by obesity.Trial registration number Australian New Zealand Clinical Trials Registry (ANZCTR):12611000862943; Post-results.
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Affiliation(s)
- Yvonne C Anderson
- Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Cervantée E K Wild
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Starship Children's Health, Auckland, New Zealand
| | - Tami L Cave
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | | | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Starship Children's Health, Auckland, New Zealand
| | - Cameron C Grant
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
- Starship Children's Health, Auckland, New Zealand
| | - Esther J Willing
- Kōhatu-Centre for Hauora Māori, University of Otago, Dunedin, New Zealand
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Domingo A, Spiegel J, Guhn M, Wittman H, Ing A, Sadik T, Fediuk K, Tikhonov C, Schwartz H, Chan HM, Batal M. Predictors of household food insecurity and relationship with obesity in First Nations communities in British Columbia, Manitoba, Alberta and Ontario. Public Health Nutr 2021; 24:1021-1033. [PMID: 32366338 PMCID: PMC8025097 DOI: 10.1017/s1368980019004889] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 10/20/2019] [Accepted: 11/21/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To further understandings of household food insecurity in First Nations communities in Canada and its relationship with obesity. DESIGN Analysis of a cross-sectional dataset from the First Nations Food, Nutrition and Environment Study representative of First Nations communities south of the 60th parallel. Multivariate logistic regression was used to assess associations between food insecurity and sociodemographic factors, as well as the odds of obesity among food-insecure households adjusting for sociodemographic characteristics. SETTING Western and Central Canada. PARTICIPANTS First Nations peoples aged ≥19 years. RESULTS Forty-six percent of First Nations households experienced food insecurity. Food insecurity was highest for respondents who received social assistance; had ≤10 years of education; were female; had children in the household; were 19-30 years old; resided in Alberta; and had no year-round road access into the community. Rates of obesity were highest for respondents residing in marginally food-insecure households (female 56·6 %; male 54·6 %). In gender-specific analyses, the odds of obesity were highest among marginally food-insecure households in comparison with food-secure households, for both female (OR 1·57) and male (OR 1·57) respondents, adjusting for sociodemographic variables. For males only, those in severely food-insecure (compared with food-secure) households had lower odds of obesity after adjusting for confounding (OR 0·56). CONCLUSIONS The interrelated challenges of food insecurity and obesity in First Nations communities emphasise the need for Indigenous-led, culturally appropriate and food sovereign approaches to food security and nutrition in support of holistic wellness and prevention of chronic disease.
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Affiliation(s)
- Ashleigh Domingo
- Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo, Waterloo, ONN2L 3G1, Canada
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BCV6T 1Z3, Canada
| | - Jerry Spiegel
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BCV6T 1Z3, Canada
| | - Martin Guhn
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BCV6T 1Z3, Canada
| | - Hannah Wittman
- Faculty of Land and Food Systems, Centre for Sustainable Food Systems, University of British Columbia, Vancouver, BCV6T 1Z4, Canada
| | - Amy Ing
- Département de Nutrition, Faculté de Médecine, Université de Montréal, Montréal, QCH3T 1A8, Canada
| | - Tonio Sadik
- Environment, Assembly of First Nations, Ottawa, ONK1P 6L5, Canada
- School of Sociological and Anthropological Studies, University of Ottawa, Ottawa, ONK1N 6N5, Canada
| | - Karen Fediuk
- First Nations Food, Nutrition and Environment Study, University of Ottawa, Ottawa, ON, Canada
| | - Constantine Tikhonov
- Environmental Public Health Division, First Nations and Inuit Health Branch, Indigenous Services Canada, Ottawa, ON, Canada
| | - Harold Schwartz
- Environmental Public Health Division, First Nations and Inuit Health Branch, Indigenous Services Canada, Ottawa, ON, Canada
| | - Hing Man Chan
- Department of Biology, University of Ottawa, Ottawa, ONK1N 6N5, Canada
| | - Malek Batal
- Département de Nutrition, Faculté de Médecine, Université de Montréal, Montréal, QCH3T 1A8, Canada
- Centre de recherche en santé publique (CReSP), 7101 Avenue du Parc, Montreal, QCH3N 1X7, Canada
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McKerchar C, Lacey C, Abel G, Signal L. Ensuring the right to food for indigenous children: a case study of stakeholder perspectives on policy options to ensure the rights of tamariki Māori to healthy food. Int J Equity Health 2021; 20:67. [PMID: 33639956 PMCID: PMC7910759 DOI: 10.1186/s12939-021-01407-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The United Nations Convention on the Rights of the Child confirms a child's right to adequate food, and to the highest attainable standard of health. For indigenous children, these rights are also recognised in the UN Declaration on the Rights of Indigenous Peoples. However, Indigenous children endure higher rates of obesity and related health conditions than non-indigenous children, including in Aotearoa New Zealand (NZ). For indigenous tamariki (Māori children) in NZ, high levels of obesity are interconnected with high rates of food insecurity. Therefore there is a need for action. This study aimed to investigate policy options that would safeguard the rights of indigenous children to healthy food. We explored with key stakeholder's policy options to ensure the rights of indigenous children to healthy food, through a case study of the rights of tamariki. METHODS Interviews were conducted with 15 key stakeholders, with experience in research, development or delivery of policies to safeguard the rights of tamariki to healthy food. Iterative thematic analysis of the transcripts identified both deductive themes informed by Kaupapa Māori theory and literature on rights-based approaches and inductive themes from the interviews. RESULTS The analysis suggests that to ensure the right to adequate food and to healthy food availability for tamariki, there needs to be: a comprehensive policy response that supports children's rights; an end to child poverty; food provision and food policy in schools; local government policy to promote healthy food availability; and stronger Māori voices and values in decision-making. CONCLUSIONS The right to food for indigenous children, is linked to political and economic systems that are an outcome of colonisation. A decolonising approach where Māori voices and values are central within NZ policies and policy-making processes is needed. Given the importance of food to health, a broad policy approach from the NZ government to ensure the right to adequate food is urgent. This includes economic policies to end child poverty and specific strategies such as food provision and food policy in schools. The role of Iwi (tribes) and local governments needs to be further explored if we are to improve the right to adequate food within regions of NZ.
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Affiliation(s)
- Christina McKerchar
- Department of Population Health, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand.
| | - Cameron Lacey
- Māori/Indigenous Health Institute, University of Otago, PO Box 4345, 8140, Christchurch, New Zealand
| | - Gillian Abel
- Department of Population Health, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
| | - Louise Signal
- Department of Public Health, University of Otago, PO Box 7343, Wellington, South Wellington, 6242, New Zealand
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Kidd J, Cassim S, Rolleston A, Chepulis L, Hokowhitu B, Keenan R, Wong J, Firth M, Middleton K, Aitken D, Lawrenson R. Hā Ora: secondary care barriers and enablers to early diagnosis of lung cancer for Māori communities. BMC Cancer 2021; 21:121. [PMID: 33541294 PMCID: PMC7863263 DOI: 10.1186/s12885-021-07862-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 01/31/2021] [Indexed: 12/02/2022] Open
Abstract
Background Lung Cancer is the leading cause of cancer deaths in Aotearoa New Zealand. Māori communities in particular have higher incidence and mortality rates from Lung Cancer. Diagnosis of lung cancer at an early stage can allow for curative treatment. This project aimed to document the barriers to early diagnosis and treatment of lung cancer in secondary care for Māori communities. Methods This project used a kaupapa Māori approach. Nine community hui (focus groups) and nine primary healthcare provider hui were carried out in five rural localities in the Midland region. Community hui included cancer patients, whānau (families), and other community members. Healthcare provider hui comprised staff members at the local primary healthcare centre, including General Practitioners and nurses. Hui data were thematically analysed. Results Barriers and enablers to early diagnosis of lung cancer were categorised into two broad themes: Specialist services and treatment, and whānau journey. The barriers and enablers that participants experienced in specialist services and treatment related to access to care, engagement with specialists, communication with specialist services and cultural values and respect, whereas barriers and enablers relating to the whānau journey focused on agency and the impact on whānau. Conclusions The study highlighted the need to improve communication within and across healthcare services, the importance of understanding the cultural needs of patients and whānau and a health system strategy that meets these needs. Findings also demonstrated the resilience of Māori and the active efforts of whānau as carers to foster health literacy in future generations. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-07862-0.
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Affiliation(s)
- Jacquie Kidd
- School of Clinical Sciences, Faculty of Environmental and Health Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand
| | - Shemana Cassim
- Waikato Medical Research Centre, Division of Arts, Law, Psychology and Social Sciences, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand.
| | - Anna Rolleston
- The Centre for Health, PO Box 13068, Tauranga, 3141, New Zealand
| | - Lynne Chepulis
- Waikato Medical Research Centre, Division of Arts, Law, Psychology and Social Sciences, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | - Brendan Hokowhitu
- Te Pua Wananga ki te Ao Faculty of Māori and Indigenous Studies, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | - Rawiri Keenan
- Waikato Medical Research Centre, Division of Arts, Law, Psychology and Social Sciences, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | - Janice Wong
- Waikato District Health Board, Waikato Hospital, Private Bag 3200, Hamilton, 3240, New Zealand
| | - Melissa Firth
- Waikato Medical Research Centre, Division of Arts, Law, Psychology and Social Sciences, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | - Karen Middleton
- Waikato District Health Board, Waikato Hospital, Private Bag 3200, Hamilton, 3240, New Zealand
| | - Denise Aitken
- Lakes District Health Board, Rotorua Hospital, Private Bag 3023, Rotorua Mail Centre, Rotorua, 3046, New Zealand
| | - Ross Lawrenson
- Waikato Medical Research Centre, Division of Arts, Law, Psychology and Social Sciences, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
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Cyr M, Riediger N. (Re)claiming our bodies using a Two-Eyed Seeing approach: Health-At-Every-Size (HAES®) and Indigenous knowledge. Canadian Journal of Public Health 2021; 112:493-497. [PMID: 33410123 DOI: 10.17269/s41997-020-00445-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 10/26/2020] [Indexed: 01/09/2023]
Abstract
We originally proposed a study to examine changes in disparities in "obesity" between Indigenous and non-Indigenous Canadian populations, as called for in the Truth and Reconciliation Commission, Article 19 (2015), which calls for ongoing monitoring of disparities in health outcomes. Instead, we questioned the importance of reducing the prevalence of "obesity" as a health goal for Indigenous peoples. This critical commentary provides an overview of Canadian Indigenous populations' weight, its relationship with health outcomes, and weight stigma and discrimination, using an Indigenous feminist lens. We introduce the applicability of a Two-Eyed Seeing approach utilizing a Health-At-Every-Size (HAES®) model and Indigenous ways of knowing, as a starting point, to understand weight, health, and our bodies. A new paradigm is needed to identify and close health gaps as noted in Article 19 of the Truth and Reconciliation Calls to Action (2015). We respectfully call upon health professionals and public health bodies to acknowledge the harm of weight stigma and discrimination in their practice and policies, and we encourage Indigenous peoples to (re)claim and (re)vitalize body sovereignty.
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Affiliation(s)
- Monica Cyr
- Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, 209 Human Ecology Building, Winnipeg, MB, R3T 2N2, Canada.
| | - Natalie Riediger
- Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, 209 Human Ecology Building, Winnipeg, MB, R3T 2N2, Canada.,Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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15
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Anderson YC, Wynter LE, O'Sullivan NA, Wild CEK, Grant CC, Cave TL, Derraik JGB, Hofman PL. Two-year outcomes of Whānau Pakari, a multi-disciplinary assessment and intervention for children and adolescents with weight issues: A randomized clinical trial. Pediatr Obes 2021; 16:e12693. [PMID: 32959996 DOI: 10.1111/ijpo.12693] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/26/2020] [Accepted: 06/04/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine whether 12-month BMI SDS reductions persisted at 24 months in a multi-disciplinary assessment and intervention program for children and adolescents with obesity, and whether secondary outcomes improved. METHODS This was a community-based 12-month RCT in Aotearoa/New Zealand. Eligible participants were aged 5 to 16 years with BMI ≥98th centile or BMI >91st centile with weight-related comorbidities. The low-intensity control received comprehensive home-based baseline assessments and advice, and 6-monthly follow-up. The high-intensity intervention received the same assessments and advice, but also weekly multidisciplinary sessions. Primary outcome was BMI SDS at 12 months. Secondary outcomes included cardiovascular and metabolic markers. RESULTS 121 participants (60% of participants at baseline) were assessed at 24 months. BMI SDS reduction at 12 months was lost at 24 months in the modified intention-to-treat analysis [Control -0.03 (95%CI -0.14, 0.09) and Intervention -0.02 (-0.12, 0.08); P = .93]. However, sweet drink intake was reduced, water intake increased, and there were improvements in cardiovascular fitness in the high-intensity intervention. ≥70% attendance in the high-intensity intervention resulted in a persistent BMI SDS reduction of -0.22 after 24 months (95%CI -0.38, -0.06). CONCLUSIONS This trial was negative in terms of primary outcome at 24 months. However, high engagement led to sustained treatment effect, and there were multiple improvements in health measures.
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Affiliation(s)
- Yvonne C Anderson
- Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand.,Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Lisa E Wynter
- Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand
| | - Niamh A O'Sullivan
- Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand
| | | | - Cameron C Grant
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand.,Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Tami L Cave
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start - National Science Challenge, University of Auckland, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
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16
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Valdez LA, Garcia DO. Hispanic Male Recruitment into Obesity-Related Research: Evaluating Content Messaging Strategies, Experimental Findings, and Practical Implications. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2020; 42:85-93. [PMID: 33356864 DOI: 10.1177/0272684x20982598] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hispanic men have the highest prevalence of overweight and obesity among men in the U.S. Current research is lacking to inform best practices to engage Hispanic men in obesity-related research. The purpose of this work was to evaluate messaging strategies to engage Hispanic men in obesity-related research. Outreach took place in an outdoor marketplace in Southern Arizona, US. Messaging strategies (fear appeal/arousal, positive masculinity, and spousal convergence) identified in formative research were utilized. Two six-foot standing banners displayed content messages and infographics in both English and Spanish. Trained bilingual and bicultural staff collected health information survey cards that elicited self-reported demographic information and health concerns. Four aspects of recruitment were evaluated: volume, efficiency, community representation, and primary health concerns. A comparative analysis was conducted in the fall of 2016 to determine the effectiveness of each messaging strategy. 387 survey cards were collected, 221 were from Hispanic men. Obesity, diabetes, and cancer were identified as the most pertinent health concerns. Fear appeal yielded 209 completed surveys, followed by 110 for positive masculinity, and 68 for spousal convergence. Fear appeal/arousal and positive masculinity content messaging were effective approaches to engage Hispanic males in research, preventive and treatment efforts. Findings warrant replication as there is potential for confounding seasonal effects.
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Affiliation(s)
- Luis A Valdez
- Department of Health Promotion and Policy, University of Massachusetts, Amherst, United States
| | - David O Garcia
- Department of Health Promotion Sciences, University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, United States
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Abstract
Objective: The objective of the current study was to identify challenges of making and sustaining healthy lifestyle changes for families with children/adolescents affected by obesity, who were referred to a multicomponent healthy lifestyle assessment and intervention programme in Aotearoa/New Zealand (NZ). Design: Secondary qualitative analysis of semi-structured interviews. Setting: Taranaki region of Aotearoa/NZ. Participants: Thirty-eight interviews with parents/caregivers (n 42) of children/adolescents who had previously been referred to a family-focused multidisciplinary programme for childhood obesity intervention, who identified challenges of making healthy lifestyle changes. Participants had varying levels of engagement, including those who declined contact after their referral. Results: Participant-identified challenges included financial cost, impact of the food environment, time pressures, stress, maintaining consistency across households, independence in adolescence, concern for mental health and frustration when not seeing changes in weight status. Conclusions: Participants recognised a range of factors that contributed towards their ability to make and sustain change, including factors at the wider socio-environmental level beyond their immediate control. Even with the support of a multidisciplinary healthy lifestyle programme, participants found it difficult to make sustained changes within an obesogenic environment. Healthy lifestyle intervention programmes and families’ abilities to make and sustain changes require alignment of prevention efforts, focusing on policy changes to improve the food environment and eliminate structural inequities.
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Came HA, Herbert S, McCreanor T. Representations of Māori in colonial health policy in Aotearoa from 2006-2016: a barrier to the pursuit of health equity. CRITICAL PUBLIC HEALTH 2019. [DOI: 10.1080/09581596.2019.1686461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- H. A. Came
- School of Public Health and Psychosocial Health, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - S. Herbert
- Te Kupenga Hauora Māori, University of Auckland, Auckland, New Zealand
| | - T. McCreanor
- Te Rōpū Whāriki, Massey University, Auckland, New Zealand
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