Massey Research Online - Browsing by Author "Keenan R"

Browsing by Author "Keenan R"

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Are patients with type 2 diabetes in the Waikato District provided with adequate education and support in primary care to self-manage their condition? A qualitative study.
(CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners, 2024-03) Crosswell R; Norman K; Cassim S; Papa V; Keenan R; Paul R; Chepulis L; Stokes T
Introduction In Aotearoa New Zealand (NZ), type 2 diabetes (T2D) is predominantly managed in primary care. Despite established guidelines, patients are often suboptimally managed, with inequitable health outcomes. To date, few NZ studies have evaluated the primary care management of T2D at the time of diagnosis. Aim This study aims to explore patients' the provision of education and delivery of care to patients at the time of diagnosis, which is a crucial time in the disease trajectory. Methods Participants were recruited from a Māori health provider in the Waikato District, and diagnosed with T2D after January 2020. Patients were texted a link to opt into a survey (larger study) and then registered interest by providing contact details for an interview (current study). Semi-structured interviews were conducted and were audio recorded, transcribed, and thematically analysed. Results In total, 11 participants aged 19-65 years completed the interviews (female n = 9 and male n = 20); the comprised Māori (n = 5), NZ European (n = 5) and Asian (n = 1) participants. Three overarching themes were identified, including: (1) ineffective provision of resources and education methods; (2) poor communication from healthcare practitioners; and (3) health system barriers. Discussion Evidently, there are difficulties in primary care diabetes mellitus diagnosis and management. Improvements could include locally relevant resources tailored to patients' experiences and cultural identities. Utilising whānau support and a non-clinical workforce, such as health navigators/kaiāwhina, will drastically address current workforce issues and assist patient self-management. This will allow improved diagnosis experiences and better health outcomes for patients and whānau.
Barriers and facilitators to colorectal cancer diagnosis in New Zealand: a qualitative study
(BioMed Central Ltd, 2020-10-01) Blackmore T; Norman K; Kidd J; Cassim S; Chepulis L; Keenan R; Firth M; Jackson C; Stokes T; Weller D; Emery J; Lawrenson R
Background New Zealand (NZ) has high rates of colorectal cancer but low rates of early diagnosis. Due to a lack of understanding of the pre-diagnostic experience from the patient’s perspective, it is necessary to investigate potential patient and health system factors that contribute to longer diagnostic intervals. Previous qualitative studies have discussed delays using The Model of Pathways to Treatment, but this has not been explored in the NZ context. This study aimed to understand the patient experience and perception of their general practitioner (GP) through the diagnostic process in the Waikato region of NZ. In particular, we sought to investigate potential barriers and facilitators that contribute to longer diagnostic intervals. Methods Ethical approval for this study was granted by the New Zealand Health and Disability Ethics Committee. Twenty-eight participants, diagnosed with colorectal cancer, were interviewed about their experience. Semi-structured interviews were audio recorded, transcribed verbatim and analysed thematically using The Model of Pathways to Treatment framework (intervals: appraisal, help-seeking, diagnostic). Results Participant appraisal of symptoms was a barrier to prompt diagnosis, particularly if symptoms were normalised, intermittent, or isolated in occurrence. Successful self-management techniques also resulted in delayed help-seeking. However if symptoms worsened, disruption to work and daily routines were important facilitators to seeking a GP consultation. Participants positively appraised GPs if they showed good technical competence and were proactive in investigating symptoms. Negative GP appraisals were associated with a lack of physical examinations and misdiagnosis, and left participants feeling dehumanised during the diagnostic process. However high levels of GP interpersonal competence could override poor technical competence, resulting in an overall positive experience, even if the cancer was diagnosed at an advanced stage. Māori participants often appraised symptoms inclusive of their sociocultural environment and considered the impact of their symptoms in relation to family. Conclusions The findings of this study highlight the importance of tailored colorectal cancer symptom communication in health campaigns, and indicate the significance of the interpersonal competence aspect of GP-patient interactions. These findings suggest that interpersonal competence be overtly displayed in all GP interactions to ensure a higher likelihood of a positive experience for the patient.
Barriers to Diabetes Self-Management in a Subset of New Zealand Adults with Type 2 Diabetes and Poor Glycaemic Control
(Hindawi Limited, 2021) Chepulis L; Morison B; Cassim S; Norman K; Keenan R; Paul R; Lawrenson R
Background. Despite the fact that there is an increasingly effective armoury of medications to treat diabetes, many people continue to have substantially elevated blood glucose levels. The purpose of this study was to explore what the barriers to diabetes management are in a cohort of people with diabetes and poor glycaemic control. Methods. Qualitative semistructured interviews were carried out with 10 people with diabetes who had known diabetes and a recent HbA1c of >11.3% (100 mmol/mol) to explore their experiences of barriers to diabetes self-management and glycaemic control. Results. Barriers to diabetes management were based around two key themes: biopsychosocial factors and knowledge about diabetes. Specifically, financial concerns, social stigma, medication side effects, and cognitive impairment due to hyperglycaemia were commonly reported as barriers to medication use. Other barriers included a lack of knowledge about their own condition, poor relationships with healthcare professionals, and a lack of relevant resources to support diet and weight loss. Conclusion. People with diabetes with poor glycaemic control experience many of the same barriers as those reported elsewhere, but also experience issues specifically related to their severe hyperglycaemia. Management of diabetes could be improved via the increased use of patient education and availability of locally relevant resources.
Co-opting or Valuing the Indigenous Voice Through Translation? A Decision for Research Teams
(Wilf Malcolm Institute of Educational Research, 2019) Kidd J; Cassim S; Rolleston A; Keenan R
Although te reo Māori is an official language of Aotearoa New Zealand, translation of research material such as information sheets, consent forms and questionnaires into te reo Māori remains highly variable. Translation tends to occur in research projects where Māori lead the work and that exclusively focus on Māori communities and topics. Translations are not offered or undertaken as a matter of course for all research. As a team of Māori and Indigenous researchers working within the health sector, we believe that there are important questions that need to be explored around the practice of using Indigenous languages, rich in similes and metaphors, to convey English/Western concepts/constructs/ideologies. In this paper, we draw on the story of one project to deconstruct and challenge the hegemonic terms through which translation of research material occurs. We explore the messages that translated material sends to potential research participants. We contend that the choice about whether to translate research material into te reo Māori is one that should be undertaken within a robust decision-making framework that considers the reasons for a translation and its impact on the participants. Translation should not be undertaken primarily to attract Māori participants, but should reliably signal that the research is being undertaken in a way that honours a Māori worldview.
Hā Ora: Reflecting on a Kaupapa Māori Community-Engaged Co-design Approach to Lung Cancer Research
(Waakebiness-Bryce Institute for Indigenous Health, Dalla Lana School of Public Health, University of Toronto, 25/01/2021) Kidd J; Cassim S; Rolleston A; Keenan R; Lawrenson R; Sheridan N; Warbrick I; Ngaheu J; Hokowhitu B
Co-designed research is gaining prominence within the health care space. Community engagement is a key premise of co-design and is also particularly vital when carrying out kaupapa Māori research. Kaupapa Māori describes a “by Māori, for Māori” approach to research in Aotearoa/New Zealand. This article discusses the research process of Hā Ora: a co-design project underpinned by a kaupapa Māori approach. The objective was to explore the barriers to early presentation and diagnosis of lung cancer, barriers identified by Māori. The team worked with four rural Māori communities, with whom we aimed to co-design local interventions that would promote earlier diagnosis of lung cancer. This article highlights and unpacks the complexities of carrying out community- engaged co-design with Māori who live in rural communities. In particular, we draw attention to the importance of flexibility and adaptability in the research process. We highlight issues pertaining to timelines and budgets, and also the intricacies of involving co-governance and advisory groups. Overall, through this article, we argue that health researchers need to prioritise working with and for participants, rather than on them, especially when working with Māori communities.
Hā Ora: secondary care barriers and enablers to early diagnosis of lung cancer for Māori communities
(BioMed Central Ltd, 2021-02-04) Kidd J; Cassim S; Rolleston A; Chepulis L; Hokowhitu B; Keenan R; Wong J; Firth M; Middleton K; Aitken D; Lawrenson R
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.
‘Look, wait, I’ll translate’: refugee women’s experiences with interpreters in healthcare in Aotearoa New Zealand
(CSIRO Publishing on behalf of La Trobe University, 2022-05-09) Cassim S; Kidd J; Ali M; Abdul Hamid N; Jameel D; Keenan R; Begum F; Lawrenson R
This study aimed to explore refugee women's experiences of interpreters in healthcare in Aotearoa, New Zealand (NZ). Semi-structured interviews were conducted with nine women who arrived in NZ as refugees. Analysis involved a ‘text in context’ approach. An iterative and interpretive process was employed by engaging with participant accounts and field notes. The various meanings behind participants' experiences were unpacked in relation to the literature and the broader socio-cultural contexts in which these experiences occurred. Findings highlighted issues with professional and informal interpreters. These issues included cost, discrepancies in dialect, translation outside appointments, and privacy. Findings indicate ethical and practical implications of using interpreters in healthcare for refugee women. A step to achieving equitable healthcare for refugee women in New Zealand entails putting in place accessible and robust communicative infrastructure.
Patient and carer perceived barriers to early presentation and diagnosis of lung cancer: a systematic review
(BioMed Central Ltd, 2019-01-08) Cassim S; Chepulis L; Keenan R; Kidd J; Firth M; Lawrenson R
Background Lung cancer is typically diagnosed at a late stage. Early presentation and detection of lung cancer symptoms is critical to improving survival but can be clinically complicated and as yet a robust screening method for diagnosis is not available in routine practice. Accordingly, the barriers to help-seeking behaviour and diagnosis need to be considered. This review aimed to document the barriers to early presentation and diagnosis of lung cancer, based on patient and carer perspectives. Methods A systematic review of databases was performed for original, English language articles discussing qualitative research on patient perceived barriers to early presentation and diagnosis of lung cancer. Three major databases were searched: Scopus, PubMed and EBSCOhost. References cited in the selected studies were searched for further relevant articles. Results Fourteen studies met inclusion criteria for review. Barriers were grouped into three categories: healthcare provider and system factors, patient factors and disease factors. Conclusions Studies showed that the most frequently reported barriers to early presentation and diagnosis of lung cancer reported by patients and carers related to poor relationships between GPs and patients, a lack of access to services and care for patients, and a lack of awareness of lung cancer symptoms and treatment. Addressing these barriers offers opportunities by which rates of early diagnosis of lung cancer may be improved.
Seen but unheard: navigating turbulent waters as Māori and Pacific postgraduate students in STEM
(Taylor and Francis, 9/08/2022) McAllister T; Naepi S; Walker L; Gillon A; Clark P; Lambert E; McCambridge AB; Thoms C; Housiaux J; Ehau-Taumaunu H; Connell CJW; Keenan R; Thomas K-L; Maslen-Miller A; Tupaea M; Mauriohooho K; Puli'uvea C; Rapata H; Nicholas SA; Pope R-N-A-R; Kaufononga SAF; Reihana K; Fleury K; Camp N; Carson GMR; Kaulamatoa JL; Clark ZL; Collings M; Bell GM; Henare K; Reiri K; Walker P; Escott K-R; Moors J; Wilson B-J; Laita OS; Maxwell KH; Fong S; Parata R; Meertens M; Aston C; Taura Y; Haerewa N; Lawrence H; Alipia T
The experiences of Māori and Pacific postgraduate students in STEM (Science, Technology, Engineering and Mathematics) offer insights into how universities, particularly science faculties, currently underserve Māori and Pacific people. This article shares the experiences of 43 current or past postgraduate students at New Zealand universities. Collectively, our stories offer insight into how representation, the white imprint, space invaders/stranger making, and institutional habits, specifically operate to exclude and devalue Māori and Pacific postgraduates in STEM. We provide new understandings of the white imprint (rewarding and incentivising white behaviour), where Māori and Pacific postgraduates were prevented from being their authentic selves. Importantly, this research documents how Māori and Pacific postgraduates experience excess labour because of institutional habits. This research also provides insight into how the science funding system results in superficial and unethical inclusion of Māori and Pacific postgraduates. Our stories provide persuasive evidence that the under-representation of Māori and Pacific in STEM will not be addressed by simply bolstering university enrolments. Instead, our stories highlight the urgent requirement for universities to change the STEM learning environment which continues to be violent and culturally unsafe for Māori and Pacific postgraduates.
The experiences of refugee Muslim women in the Aotearoa New Zealand healthcare system
(Taylor and Francis Group, 2022-03) Cassim S; Ali M; Kidd J; Keenan R; Begum F; Jamil D; Abdul Hamid N; Lawrenson R
This study explores the experiences of refugee Muslim women as they accessed and navigated the healthcare system in Aotearoa New Zealand (NZ). A case-oriented approach was used, where semi-structured interviews were carried out with nine Muslim women who arrived in NZ as refugees. Interviews were carried out in 2020, in Hamilton, NZ. Analysis involved a ‘text in context’ approach which employed an iterative and interpretive process, by engaging with participant accounts and field notes to unpack the various meanings behind the experiences of the participants in relation to the literature as well as the broader socio-cultural contexts in which these experiences occurred. The findings of this research identified various structural barriers to accessing healthcare such as cost and issues with interpreters, as well as instances of othering in the healthcare settings experienced by refugee Muslim women. In order to tackle inequity in the health system, structural and institutional barriers need to be addressed first, to prompt other levels of othering and discrimination to reduce over time.

Browsing by Author "Keenan R"

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