Browsing by Author "Kidd J"

Now showing 1 - 9 of 9
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    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.
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    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.
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    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.
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    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.
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    Inequalities between Māori and non-Māori men with prostate cancer in Aotearoa New Zealand.
    (Pasifika Medical Association Group (PMAG) previously New Zealand Medical Association (NZMA), 2020-09-04) Egan R; Kidd J; Lawrenson R; Cassim S; Black S; Blundell R; Bateman J; Broughton J
    Māori experience poorer health statistics in terms of cancer incidence and mortality compared to non-Māori. For prostate cancer, Māori men are less likely than non-Māori men to be diagnosed with prostate cancer, but those that are diagnosed are much more likely to die of the disease than non-Māori men resulting in an excess mortality rate in Māori men compared with non-Māori. A review of the literature included a review of the epidemiology of prostate cancer; of screening; of access to healthcare and of treatment modalities. Our conclusion was that there are a number of reasons for the disparity in outcomes for Māori including differences in staging and characteristics at diagnosis; differences in screening and treatment offered to Māori men; and general barriers to healthcare that exist for Māori men in New Zealand. We conclude that there is a need for more culturally appropriate care to be available to Māori men.
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    ‘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.
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    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.
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    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.
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    Using vignettes about racism from health practice in Aotearoa to generate anti-racism interventions
    (John Wiley & Sons Ltd on behalf of Health and Social Care in the Community, 2022-11) Kidd J; Came H; McCreanor T
    Racism is a key modifiable determinant of health that contributes to health inequities in Aotearoa and elsewhere. Experiences of racism occur within the health sector for workers, patients and their whānau (extended family) every day. This paper uses stories of racism from nurses – reworked into vignettes – to examine the dynamics of racism to generate possible micro, meso and macro anti-racism interventions. A critical qualitative design was utilised, informed by kaupapa Māori approaches. The five vignettes in this paper were sourced from a pair of caucused focus groups with nine senior Māori (Indigenous peoples of Aotearoa) and Tauiwi (non-Māori) nurses held in Auckland Aotearoa in 2019. The vignettes were lightly edited and then critically analysed by both authors to identify sites of racism and generate ideas for anti-racism interventions. The vignettes illustrate five key themes in relation to racism. These include (i) mono-cultural practice, (ii) everyday micro-aggressions; (iii) complexity and the costs of racism, (iv) Pākehā (white settler) privilege and (v) employment discrimination. From analysing these themes, a range of evidence-based micro, meso and macro-level anti-racism interventions were derived. These ranged from engaging in reflective practice, education initiatives, monitoring, through to collective advocacy. Vignettes are a novel way to reveal sites of racism to create teachable moments and spark reflective practice and more active engagement in anti-racism interventions. When systematically analysed vignettes can be utilised to inform and refine anti-racist interventions. Being able to identify racism is essential to being able to effectively counter racism.