Transdisciplinary stakeholder understandings of antimicrobial resistance: An integrative approach in Aotearoa New Zealand

OBJECTIVE

Antimicrobial resistance (AMR) is a complex public health issue, with a range of influences across human, animal, and environmental health. Given the complexity of the problem, the diversity of stakeholders, and the failure of current policies to curb AMR worldwide, integrative approaches are needed to identify effective actions. Underpinned by systems thinking and One Health principles, this qualitative study explored how diverse AMR experts in Aotearoa New Zealand perceive the main drivers and effects of AMR.

METHODS

Semi-structured interviews with clinical, academic, policy, community, and industry representatives were designed to elicit mental models of the causes and outcomes of AMR across dimensions.

RESULTS

Thematic analysis revealed contrasting understandings of AMR causes across four domains: food-producing animals (livestock), healthcare, community, and environment. AMR was often framed as a problem of individual behaviour, despite many implicit references to underlying structural economic influences. The politics of collaboration was a further major underlying theme. The interviews highlighted fundamental connections between AMR and other complex issues, including poverty and environmental pollution.

IMPLICATIONS FOR PUBLIC HEALTH

This study brings together the understandings of AMR of transdisciplinary stakeholders, providing some immediate insights for policy makers and setting the foundation for developing a collaborative system model of AMR as a basis for decision-making.

Mental health promotion practice in Aotearoa New Zealand: findings from a qualitative study

Mental health promotion (MHP) is integral to improving the overall health and well being of individuals, communities, and populations. However, knowledge and reporting about MHP which occurs throughout Aotearoa New Zealand (NZ) is limited. This article reports findings from a qualitative study that sought to understand NZ health promotion practitioners' (HPPs) MHP practice. Semi-structured interviews were undertaken with 15 HPPs employed at various health promotion organizations. Thematic analysis of interview transcripts identified three key themes. Two themes (planning and evaluation) related to practice directly and included various subthemes: needs assessment; principles/approaches/frameworks; operationalizing equity and te Tiriti o Waitangi; collaborative approaches; planning for evaluation; process evaluation domination; and evaluation challenges. The third theme related to the context of practice and encompassed various system influences restricting HPPs from practising as they wished. These were represented in four subthemes: contractual agreements; field fragmentation; in the shadows of mental ill-health and workforce capacity. Study findings highlight several opportunities to improve MHP practice in NZ. Most pertinently, the need for system-level action to address the factors restricting HPPs' practice.

National Sporting Organisation Policies: A health promotion opportunity?

The objective was to identify whether National Sporting Organisations (NSOs) have policy documentation on healthy behaviours (smokefree, sun-protection, healthy food/beverages, and alcohol) and, for organisations with such documentation, whether this is in-line with current scientific evidence of past best practice in cancer prevention.

METHODS

This cross-sectional policy analysis study was performed September - December 2018 in New Zealand. A content analysis was undertaken using NSO policy documents matched against a framework of key indicators for best practice within health behaviours of interest. Data analysis of the policy process was undertaken through key informant telephone interviews with NSO staff using semi-structured qualitative interviews.

RESULTS

Of 96 NSOs, nearly half (49%) mentioned smokefree at least once in one of their policy documents, and 47% had an alcohol policy, although in both instances the policies lacked comprehensiveness. Two NSOs had a reasonably comprehensive sun protection policy. Seventeen had at least one specific nutrition policy/guideline. The contents of the latter were primarily related to short-term athletic performance rather than non-communicable disease prevention, specifically promoting hydration during sports participation, and food and nutrition to support sporting performance. Two NSOs had policies relating to the promotion of health food/nutrition more widely. For some NSOs the lack of health-related policies was not a conscious choice but just not considered previously. Other NSOs reported they lacked resources or had other priorities.

CONCLUSIONS

Although this study clearly demonstrates that many NSOs lack adequate health-related policies, this is not necessarily a conscious choice, but the result of a lack of resources, other priorities, or just that they had not considered developing policies in these areas. A number expressed support for these types of policies although it was apparent that some, particularly smaller NSOs would require assistance in policy template development. It seems probable that the development of health-related policies will only occur if partner agencies become involved.

Accounts of bullying on Twitter in relation to dentofacial features and orthodontic treatment

Social media offers an accessible resource for gaining valuable insights into the social culture of bullying. The purpose of this study was to qualitatively analyse Twitter posts for common themes relating to dentofacial features, braces and bullying. Twitter's database was searched from 2010 to 2014 using keywords relevant to bullying, teeth and orthodontics. Two investigators assessed the Twitter posts, and selected those that conveyed the experiences or opinions of bullying victims. The posts were qualitatively analysed using thematic analysis. Of the 548 posts screened, 321 were included in the final sample. Four primary categories relating to 'dental-related bullying' were identified: (i) morphological features, (ii) psychological and psychosocial impact, (iii) coping mechanisms and (iv) the role of family. Bullied individuals reported a diverse range of psychological impacts and coping mechanisms. Secondary categories were also identified. Family members, for example, were found to play both a contributory and mediatory role in bullying. In summary, social media can provide new and valuable information about the causal factors and social issues associated with oral health-related bullying. Importantly, some coping mechanisms may mitigate the negative effects of bullying.

Is New Zealand water fluoridation justified?

Public health programmes extend beyond the clinical context and focus on measures that affect the lives of large subgroups or the population as a whole. An example of this is community water fluoridation (CWF), the altering of fluoride levels in the water supply with the aim of preventing the initiation and slowing the progression of dental caries lesions for the benefit of entire populations. Despite the unfeasibility of randomised controlled trials of CWF, a large volume of evidence is available on the topic. However, CWF remains a polarising and keenly contested issue. CWF is also an intervention where it is difficult to provide everyone affected with a choice. The Nuffield Council on Bioethics is an independent body that examines and reports on ethical questions, and they have provided a useful ethical framework for considering CWF via the 'stewardship' model. This commentary aims to discuss each of the public health aims and how they can be applied and weighed to reach a justified position about CWF.

Impact evaluation of a farm safety awareness workshop in New Zealand

OBJECTIVE

Farming is a hazardous occupation, with high rates of injury and death. FarmSafe, a whole-country approach, sought to address work-related injury on New Zealand sheep, beef, and dairy farms. More than 10 000 farmers participated in 630 workshops held over two years. This short communication presents the results of an impact evaluation of the FarmSafe Awareness Workshop (FSAW) in its first two years of operation.

METHODS

All FSAW participants completed, and received credit for, formal educational assessments. Pass rates were used to assess safety knowledge, and a quasi-experimental design with intervention and comparison groups was applied to assess attitudes, safety behaviors, and environmental determinants of injury.

RESULTS

An intervention (N=111) and two comparison groups (C1, N=409, and C2, N=78) completed before and after questionnaires. At follow-up, the intervention group (IG) showed a small improvement in attitudes toward safety (IG=79.3, C1=77.4; C2=77.4, P=0.035), but there were no differences between groups for personal safety practice or the safety environment of the farm. However, if a respondent registered their interest in the workshop, but a different person from the same farm attended, there was some improvement in the safety of the farm environment score.

CONCLUSION

Well-conducted safety training tailored to farmers was still not enough to change safety practice. Future interventions may be more likely to achieve progress if they are comprehensive, include environmental and enforcement features, and target more than one participant per farm.

Adults with intellectual disability: a mixed-methods investigation of their experiences of dental treatment under general anaesthetic

OBJECTIVES

This study aimed to explore the experiences of dental care under general anaesthesia in adults with an intellectual disability.

METHODS

The study used an explanatory mixed-methods design. In the initial quantitative phase of the study, a clinical audit of oral health services provided for adults with intellectual disabilities was carried out for individuals who underwent a general anaesthetic (GA) for dental treatment at Christchurch Hospital during a 5-year period. In a qualitative second phase, fifteen semi-structured interviews were carried out for 13 individuals with an intellectual disability to investigate the experience and perceptions of individuals with an intellectual disability (and caregivers and guardians) relating to their oral health care.

RESULTS

The majority of the treated patients lived in care, and many had severe medical problems. Most had both restorative treatment and tooth extractions carried out under GA. Their major concern was anxiety associated with the dental visits. Support people/ guardians shared this concern, and played a vital role in helping to manage this anxiety. Many of the latter had difficulty identifying dental problems in their charges, and they often relied on detection of changes in the individual's behaviour or demeanour. The time spent waiting in waiting rooms for treatment was a frequently reported cause of stress.

CONCLUSIONS

As a group, these individuals present challenges for the provision of oral health care, given their severe disability and medical conditions, and many require a high level of support for daily activities. When dental treatment is required, a GA is often necessary in order to carry it out. The management of anxiety was a key issue for the patient group and support people play a vital role in helping to manage this anxiety, and achieve a successful visit. There is potential to improve the service with a multidisciplinary approach to coordinate other health services during treatment episodes, reduced time spent in waiting rooms, and improved waiting room layout.

A qualitative analysis of orthodontic-related posts on Twitter

OBJECTIVE

To investigate the content of orthodontic-related Twitter posts in order to improve our understanding of orthodontic patients' perceptions and treatment experiences.

MATERIALS AND METHODS

Some 131 consecutive posts were collected from Twitter over a 5-day period. Twitter's advanced-search function was used to limit the sampling frame to New Zealand. The posts were qualitatively analyzed for themes using discourse analysis.

RESULTS

Four main themes were identified: (1) excitement about getting braces off, (2) problems with braces, (3) positive comments about braces, and (4) negative comments about braces. Various language tools and symbols were often used to convey different degrees of emotion. The present study explores these themes and discusses how they relate to modern-age orthodontics.

CONCLUSION

This is the first study to qualitatively analyze orthodontic-related posts in the social media era. Our findings suggest that orthodontic patients use social media sites such as Twitter to convey positive and negative feelings about braces.

Ukaipō niho: the place of nurturing for oral health

OBJECTIVES

To report on oral-health-related characteristics, beliefs, and behaviours among participants in a randomised control trial of an intervention to prevent early childhood caries (ECC) among Māori children, and to determine whether there were any systematic differences between the intervention and control groups at baseline.

DESIGN

Baseline measurements from a randomised control trial (involving 222 pregnant Māori women allocated randomly to either Intervention or Delayed groups) which is currently underway.

SETTING

The rohe (tribal area) of Waikato-Tainui.

METHODS

Self-report information collected on sociodemographic characteristics, pregnancy details, self-reported general and oral health and health-related behaviours, and oral health beliefs.

RESULTS

Other than those in the Delayed group being slightly older, on average, there were no significant differences between the two groups. Some 37.0% were expecting their first child. Most reported good health; 43.6% were current smokers, and 26.4% had never smoked. Only 8.2% were current users of alcohol. Almost all were dentate, and 57.7% described their oral health as fair or poor. One in six had had toothache in the previous year; 33.8% reported being uncomfortable about the appearance of their teeth, and 27.7% reported difficulty in eating. Dental service-use was relatively low and symptom-related; 78.9% needed to see a dentist. Overall, most of the sample believed that it was important to avoid sweet foods, visit dentists and to brush the teeth, while about half thought that using fluoride toothpaste and using floss were important. Some 38.2% felt that drinking fluoridated water was important. Oral-health-related fatalism was apparent, with 74.2% believing that most people usually get dental problems, 58.6% believing that most people will need extractions at some stage, and that most children eventually get dental caries.

CONCLUSIONS

Mothers' important role in nurturing the well-being of the young child includes the protection and maintenance of the growing child's oral health (or ukaipo niho). The findings provide important insights into Māori mothers' oral health knowledge, beliefs and practices.

Reducing disease burden and health inequalities arising from chronic disease among indigenous children: an early childhood caries intervention in Aotearoa/New Zealand

BACKGROUND

Maaori are the Indigenous people of New Zealand and do not enjoy the same oral health status as the non-Indigenous majority. To overcome oral health disparities, the life course approach affords a valid foundation on which to develop a process that will contribute to the protection of the oral health of young infants. The key to this process is the support that could be provided to the parents or care givers of Maaori infants during the pregnancy of the mother and the early years of the child. This study seeks to determine whether implementing a kaupapa Maaori (Maaori philosophical viewpoint) in an early childhood caries (ECC) intervention reduces dental disease burden among Maaori children. The intervention consists of four approaches to prevent early childhood caries: dental care provided during pregnancy, fluoride varnish application to the teeth of children, motivational interviewing, and anticipatory guidance.

METHODS/DESIGN

The participants are Maaori women who are expecting a child and who reside within the Maaori tribal area of Waikato-Tainui.This randomised-control trial will be undertaken utilising the principles of kaupapa Maaori research, which encompasses Maaori leadership, Maaori relationships, Maaori customary practices, etiquette and protocol. Participants will be monitored through clinical and self-reported information collected throughout the ECC intervention. Self-report information will be collected in a baseline questionnaire during pregnancy and when children are aged 24 and 36 months. Clinical oral health data will be collected during standardised examinations at ages 24 and 36 months by calibrated dental professionals. All participants receive the ECC intervention benefits, with the intervention delayed by 24 months for participants who are randomised to the control-delayed arm.

DISCUSSION

The development and evaluation of oral health interventions may produce evidence that supports the application of the principles of kaupapa Maaori research in the research processes. This study will assess an ECC intervention which could provide a meaningful approach for Maaori for the protection and maintenance of oral health for Maaori children and their family, thus reducing oral health disparities.

TRIAL REGISTRATION

Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12611000111976.

The importance of 'student voice' in dental education

Although much published school and higher education research have established a strong conceptual foundation for eliciting student feedback, this element is relatively poorly developed in dental education research. This paper examines 'student voice' as a conceptual/theoretical framework and justification for attending to students' perspectives in dental education. The aims of this review paper were: to explore the concept of student voice, including some pragmatic considerations and key critiques of listening to student feedback; to critically analyse key debates about the importance of a research focus on student perceptions using themes from the seminal and contemporary educational literature on student voice from the school, higher and dental educational sectors; to identify gaps in the dental education literature in relation to students' perceptions of their learning, and highlight some practical implications drawn from the 'student voice' literature for dental education; and to assist dental educational researchers in developing a strong rationale for listening to student voice in dental educational institutions. This paper is intended to assist dental educational researchers in justifying future research projects which require eliciting dental student feedback/perceptions.

The importance of 'student voice' in dental education

Although much published school and higher education research have established a strong conceptual foundation for eliciting student feedback, this element is relatively poorly developed in dental education research. This paper examines 'student voice' as a conceptual/theoretical framework and justification for attending to students' perspectives in dental education. The aims of this review paper were: to explore the concept of student voice, including some pragmatic considerations and key critiques of listening to student feedback; to critically analyse key debates about the importance of a research focus on student perceptions using themes from the seminal and contemporary educational literature on student voice from the school, higher and dental educational sectors; to identify gaps in the dental education literature in relation to students' perceptions of their learning, and highlight some practical implications drawn from the 'student voice' literature for dental education; and to assist dental educational researchers in developing a strong rationale for listening to student voice in dental educational institutions. This paper is intended to assist dental educational researchers in justifying future research projects which require eliciting dental student feedback/perceptions.

Effective and ineffective supervision in postgraduate dental education: a qualitative study

INTRODUCTION

Research suggests that students' perceptions should be considered in any discussion of their education, but there has been no systematic examination of New Zealand postgraduate dental students' learning experiences. This study aimed to obtain in-depth qualitative insights into student and graduate perceptions of effective and ineffective learning in postgraduate dental education.

METHODS

Data were collected in 2010 using semi-structured individual interviews. Participants included final-year students and graduates of the University of Otago Doctor of Clinical Dentistry programme. Using the Critical Incident Technique, participants were asked to describe atleast one effective and one ineffective learning experience in detail. Interview transcripts were analysed using a general inductive approach.

RESULTS

Broad themes which emerged included supervisory approaches, characteristics of the learning process, and the physical learning environment. This paper considers students' and graduates' perceptions of postgraduate supervision in dentistry as it promotes or precludes effective learning. Effective learning was associated by participants with approachable and supportive supervisory practices, and technique demonstrations accompanied by explicit explanations. Ineffective learning was associated with minimal supervisor demonstrations and guidance (particularly when beginning postgraduate study), and aggressive, discriminatory and/or culturally insensitive supervisory approaches.

CONCLUSION

Participants' responses provided rich, in-depth insights into their reflections and understandings of effective and ineffective approaches to supervision as it influenced their learning in the clinical and research settings. These findings provide a starting point for the development of curriculum and supervisory practices, enhancement of supervisory and mentoring approaches, and the design of continuing education programmes for supervisors at an institutional level. Additionally, these findings might also stimulate topics for reflection and discussion amongst dental educators and administrators more broadly.

Improving the quality of educational strategies in postgraduate dental education using student and graduate feedback: findings from a qualitative study in New Zealand

INTRODUCTION

Research suggests that students' perceptions should be considered in any discussion of their education. However, to date, there has been no systematic examination of New Zealand postgraduate dental students' learning processes in both the research and clinical settings. This study aimed to obtain in-depth qualitative insights into student and graduate perspectives of effective and ineffective learning experiences during their postgraduate dental education.

METHODS

Data were collected in 2010 using semi-structured individual interviews. Participants included 2010 final-year students and 2009 graduates of the University of Otago Doctor of Clinical Dentistry programme. Using the Critical Incident Technique, participants were asked to describe at least one effective and one ineffective learning experience in detail. Interview transcripts were analysed using a general inductive approach.

RESULTS

Broad themes which emerged included supervisory approaches, characteristics of the learning process and characteristics of the physical learning environment. The focus of this article is to report and discuss the learning processes that participants identified as promoting and precluding effective learning experiences in the clinical and research settings. Students and graduates in the study had largely similar perspectives of learning processes likely to result in effective clinical and research learning. These included self-directed and collaborative learning; timely, constructive and detailed feedback with directions for further improvement; and discreet clinical feedback. Learning processes that precluded effective learning included unsupported and isolated learning, delayed and overly critical/destructive feedback and open criticism in the clinical context.

CONCLUSION

The in-depth findings of this study contribute to the scientific literature that identifies learning process characteristics which facilitate effective learning from New Zealand postgraduate students' and graduates' perspectives. Additional cross-sectional and longitudinal studies (both qualitative and quantitative) would lead to a better understanding of what constitutes effective teaching in postgraduate dental education.

An exploratory study of pregnant women's knowledge of child oral health care in New Zealand

BACKGROUND

To be maximally effective, oral health preventive strategies should start at birth. There appear to be few reports on pregnant women's knowledge of oral health care for their developing children.

OBJECTIVES

This exploratory study assessed Dunedin expectant mothers' knowledge of the oral health care of their future children.

METHODS

A questionnaire was developed to assess expectant mothers' knowledge of child oral health and appropriate prevention strategies. Three public Lead Maternity Carer (LMC) organisations and 30 private individual LMCs were asked to distribute the questionnaire to their clients attending appointments during a one-month period. Questions focused on the mother's knowledge of oral health practices for their future children, including oral hygiene and access to dental care.

RESULTS

Fewer than half of the participants thought they had enough information about their child's oral health needs. One-quarter thought that toothbrushing should not start until after two years of age. The majority thought their child should not be seen by a dental professional until this age, while one-fifth did not think their child should be seen until four years old. Poorer child oral health knowledge was found in first-time mothers, younger women, those from low-SES groups, and those who were not New Zealand (NZ) Europeans.

CONCLUSIONS

A substantial number of participants were unaware of how to provide appropriate oral health care for their children despite the available information. This lack of awareness needs to be taken into account when designing oral health promotion strategies for parents of very young children.

A qualitative investigation of specialist orthodontists in New Zealand: part 2. Orthodontists' working lives and work-life balance

BACKGROUND

Orthodontics is the most widely practised form of specialist dentistry in New Zealand. To date, no known qualitative research has been published examining the work-life balance of practitioners. The aim of this study was to investigate the working lives and work-life balance of NZ orthodontists in order to generate an understanding of the reality of orthodontic specialist practice and its effects on orthodontists' professional and personal lives.

METHODS

Semi-structured interviews were conducted involving 19 practising orthodontists (four females, 15 males; mean age 50 years) from throughout New Zealand and selected for maximum variation in the sample. Transcribed interviews were analysed for themes using an applied grounded theory approach.

RESULTS

A core category of 'practising orthodontist' was derived, and related themes were grouped under the sub-categories of: (a) NZ orthodontic specialist practice; (b) NZ specialist orthodontists; and (c) Work-life balance. The present paper reports on the final sub-category. Themes emerging from the work-life sub-category were further divided into two sub-themes of 'work' and 'life'. Themes in the 'work' subgroup included time off, injuries and illness, regrets, personality traits, job stress and criticism, establishing a practice, peer support and contact, and success in orthodontics. Themes in the 'life' sub-group were personal development, family life, life balance and interests outside work, and financial security.

CONCLUSIONS

This was the first qualitative investigation of the orthodontic profession in New Zealand. The findings provided a valuable insight into the working lives of New Zealand orthodontists and effects on their day-today lives. It will be revealing and interesting to observe how the modernisation of orthodontic practice will affect the work-life balance of New Zealand orthodontists in the future.

A qualitative investigation of specialist orthodontists in New Zealand. Part 1. Orthodontists and orthodontic practice

BACKGROUND

Current knowledge of orthodontic practice is largely anecdotal and the lack of systematic knowledge can create barriers to better identifying the factors that make a successful orthodontist. The aim of this study was to investigate the routine practising lives of New Zealand orthodontists in order to generate an understanding of the reality of orthodontic specialist practice and its effects on their professional and personal lives.

METHODS

Semi-structured interviews were conducted involving 19 practising orthodontists (four females, 15 males; mean age 50 years) throughout New Zealand.Transcribed interviews were analysed for themes using an applied grounded theory approach.

RESULTS

A core category of 'practising orthodontists' was derived, and related themes were grouped under the sub-categories of: (a) NZ orthodontic specialist practice; (b) NZ specialist orthodontists; and (c) work-life balance. The present paper reports on the first two subcategories. Themes elucidated under the specialist practice sub-category included modernisation, changing social norms, practice arrangement, branch practice, staffing, competition, legislation, advertising, the future and the provision of orthodontics by non-specialists. Themes in the orthodontic specialist sub-category were prior experience, postgraduate training, recent graduates, reasons for specialising, generational differences, females in orthodontics, NZ and overseas practice, the ageing profession and the prospect of an orthodontist shortage.

CONCLUSIONS

This investigation has shed light on orthodontists and the practice of orthodontics in New Zealand and determined aspects rarely discussed in the current or previous literature. It will be valuable to observe how orthodontists and orthodontic practice continue to evolve in response to changes in NZ society.

An exploratory study of the acceptability of delivering oral health information in community pharmacies

OBJECTIVE

The community pharmacy is an accessible service which, with further training and support, could be used to deliver oral health messages. This is important especially for those with systemic diseases such as diabetes mellitus and cardiovascular disease, where the oral environment may have a negative impact. This qualitative study assessed the feasibility of pharmacists delivering oral health messages in community pharmacies.

DESIGN AND METHODS

Semi-structured interviews were conducted with 49 pharmacists in Dunedin and Auckland, New Zealand, with a focus on the pharmacists' current knowledge, attitudes and possibilities for providing oral health information to patients with diabetes and cardiovascular disease.

FINDINGS

There is potential for community pharmacists to provide oral health information to patients, dependent on the approach of the pharmacist and the patient response. The majority of pharmacists agreed that providing oral health advice was within their role; however, few did so proactively. They highlighted a lack of available resources relating to oral health and systemic disease. Further training relating to oral health and systemic disease would be necessary to provide the knowledge to support any resources. The preferred option by pharmacists for such training was an evening course or workshop.

Obtaining health information from farmers: interviews versus postal questionnaires in a New Zealand case study

PURPOSE

To compare the effectiveness of interviewer-led and postal surveys in gathering adequate health data for occupational health programmes among farmers.

METHODS

Two cross-sectional studies of farmers from southern New Zealand were conducted. Farms were randomly selected from the public land valuation roll and all farmers and farm workers invited to participate in the farmers' health study. First, 477 farms were invited to participate in an interviewer administered questionnaire and health check; and second, a further 432 farms were selected and invited to participate in a self-administered postal survey. Both groups completed the same questionnaire.

RESULTS

The response for the interviewer-led and postal surveys was 65.4 % and 51.6 % respectively. The 2 groups differed demographically, with fewer young farm workers in the postal survey, but were similar in all areas of health information collected, except that men in the interviewer-led survey were significantly more likely to have a psychological disturbance than men in the postal survey (chi ( 2 ) =5.06, df=1, p=0.024).

CONCLUSIONS

Despite the interviewer-led survey having a higher response rate, the postal survey produced similar health data, which is adequate for planning occupational health programmes for farmers. Extra effort should be made to recruit younger farm workers in future research.