title: Obesity Management in Rural New Zealand General Practice from Healthcare Professional and Client Perspectives

authors: Norman, Kimberley

subjects: Obesity

abstract: Obesity is a health issue which currently affects over 34% of New Zealand (NZ) adults. Obesity, if left unchecked, leads to further physical and psychosocial health complications and an overall poor quality of life. People living in rural communities, high deprivation areas, as well as Indigenous Māori and Pacific Island populations in NZ, experience significant obesity health inequities and have a high-risk of developing obesity. General practice clinicians are positioned to be ‘best suited’ to deliver effective obesity healthcare in their practice, however, despite weight management intervention options being available through general practice, the obesity rates have continued to rise in the last 30 years. This suggests that there are potentially barriers to achieving a healthy weight in this context.
The aim of this research thesis is to understand the experiences with, and barriers to, effective obesity management in general practice from clinician and client perspectives to identify areas of improvement in the future.
This research thesis examines obesity healthcare in NZ general practice using a sequential explanatory mixed method research design in three parts. Firstly, a literature review study was conducted as a baseline point to identify the efficacy of any weight management interventions that are available in general practice. Secondly, a quantitative exploratory survey was conducted with Waikato region general practitioners (GP’s). Lastly, interviews with rural clinicians (GPs, nurses, and Indigenous Māori health professionals) and clients (patients engaging with rural general practice) were then conducted to understand the more in-depth perspectives of any barriers experienced with delivering, or engaging with, obesity management in general practice.
The experiences of both clinicians and clients were found to be complex and nuanced, with each participant having a unique experience with obesity management. Concepts such as effective yet inaccessible weight management interventions, interventions not suitable for sociocultural health needs, conflicting nutritional guidelines, lack of rural general practice systemic support, the unique and time consuming nature of obesity ‘treatment’, complications with the role of a clinician in obesity management, stigma or power imbalances in the general practice context, social determinants of health, the obesogenic environment, privatised weight management programmes and the individualised nature of sociocultural norms were found to be significant to effective obesity management.
This research thesis identified that the positioning of general practitioners as ‘best suited’ for delivering effective obesity healthcare in their practice was questionable. Potentially, the clinician role is better suited as a supportive one to an obesity health specialist who can meet the more holistic needs of a client when it comes to weight management. The current health model generates difficulties for clinicians to deliver comprehensive healthcare for such a complex and individualised health issue. Future research should look to develop weight management options that are suitable for rural and indigenous health needs to improve quality of life for clients and reduce health inequities. In addition, wider critical reflection on the current obesity healthcare model and the feasibility of a more specialist service outside general practice is warranted.

text: Obesity Management in Rural New Zealand General Practice from Healthcare Professional and Client Perspectives Obesity is a health issue which currently affects over 34% of New Zealand (NZ) adults. Obesity, if left unchecked, leads to further physical and psychosocial health complications and an overall poor quality of life. People living in rural communities, high deprivation areas, as well as Indigenous Māori and Pacific Island populations in NZ, experience significant obesity health inequities and have a high-risk of developing obesity. General practice clinicians are positioned to be ‘best suited’ to deliver effective obesity healthcare in their practice, however, despite weight management intervention options being available through general practice, the obesity rates have continued to rise in the last 30 years. This suggests that there are potentially barriers to achieving a healthy weight in this context.
The aim of this research thesis is to understand the experiences with, and barriers to, effective obesity management in general practice from clinician and client perspectives to identify areas of improvement in the future.
This research thesis examines obesity healthcare in NZ general practice using a sequential explanatory mixed method research design in three parts. Firstly, a literature review study was conducted as a baseline point to identify the efficacy of any weight management interventions that are available in general practice. Secondly, a quantitative exploratory survey was conducted with Waikato region general practitioners (GP’s). Lastly, interviews with rural clinicians (GPs, nurses, and Indigenous Māori health professionals) and clients (patients engaging with rural general practice) were then conducted to understand the more in-depth perspectives of any barriers experienced with delivering, or engaging with, obesity management in general practice.
The experiences of both clinicians and clients were found to be complex and nuanced, with each participant having a unique experience with obesity management. Concepts such as effective yet inaccessible weight management interventions, interventions not suitable for sociocultural health needs, conflicting nutritional guidelines, lack of rural general practice systemic support, the unique and time consuming nature of obesity ‘treatment’, complications with the role of a clinician in obesity management, stigma or power imbalances in the general practice context, social determinants of health, the obesogenic environment, privatised weight management programmes and the individualised nature of sociocultural norms were found to be significant to effective obesity management.
This research thesis identified that the positioning of general practitioners as ‘best suited’ for delivering effective obesity healthcare in their practice was questionable. Potentially, the clinician role is better suited as a supportive one to an obesity health specialist who can meet the more holistic needs of a client when it comes to weight management. The current health model generates difficulties for clinicians to deliver comprehensive healthcare for such a complex and individualised health issue. Future research should look to develop weight management options that are suitable for rural and indigenous health needs to improve quality of life for clients and reduce health inequities. In addition, wider critical reflection on the current obesity healthcare model and the feasibility of a more specialist service outside general practice is warranted.

year: 2024

title: Housing quality, health and whānau wellbeing

authors: Kukutai, Tahu

abstract: Shelter is a basic human need (Maslow 1943) and access to housing is a fundamental human right. A house is more than a physical dwelling that offers shelter; for many, it is a space that provides structure and meaning, and relates to feelings, emotions, memories and experiences, whether raising a whānau or discovering newfound independence. 
For Māori, the multi-layered concept of kāinga is broader still. Literally meaning ‘village’, kāinga is a home space where identity, whakapapa and whenua come together (Henare 2014). Kāinga is where individuals and whānau can sustain and care for themselves and others through practices of whanaungatanga (connecting with kin) and manaakitanga (acts of reciprocal caring). 
Kāinga is also closely related to the concept of tūrangawaewae, denoting a sense of physical and spiritual belonging or attachment to a place. Kāinga and tūrangawaewae thus share similarities with the meaning of home but mean much more than simply ‘being housed’ (Brown 2017). 
While housing and housing quality form only part of what it means to be ‘at home’, access to a warm, dry, safe, secure and watertight house is a basic right for all whānau and tamariki. 
In this section, we focus on the relationships between housing quality, health and wellbeing to better understand the extent of housing quality issues that whānau Māori face, and how housing quality, in turn, affects health and wellbeing. To our knowledge, this is the first nationally representative study that focuses specifically on Māori assessments of housing quality. It does so using data from the Māori Social Survey Te Kupenga.

text: Housing quality, health and whānau wellbeing Shelter is a basic human need (Maslow 1943) and access to housing is a fundamental human right. A house is more than a physical dwelling that offers shelter; for many, it is a space that provides structure and meaning, and relates to feelings, emotions, memories and experiences, whether raising a whānau or discovering newfound independence. 
For Māori, the multi-layered concept of kāinga is broader still. Literally meaning ‘village’, kāinga is a home space where identity, whakapapa and whenua come together (Henare 2014). Kāinga is where individuals and whānau can sustain and care for themselves and others through practices of whanaungatanga (connecting with kin) and manaakitanga (acts of reciprocal caring). 
Kāinga is also closely related to the concept of tūrangawaewae, denoting a sense of physical and spiritual belonging or attachment to a place. Kāinga and tūrangawaewae thus share similarities with the meaning of home but mean much more than simply ‘being housed’ (Brown 2017). 
While housing and housing quality form only part of what it means to be ‘at home’, access to a warm, dry, safe, secure and watertight house is a basic right for all whānau and tamariki. 
In this section, we focus on the relationships between housing quality, health and wellbeing to better understand the extent of housing quality issues that whānau Māori face, and how housing quality, in turn, affects health and wellbeing. To our knowledge, this is the first nationally representative study that focuses specifically on Māori assessments of housing quality. It does so using data from the Māori Social Survey Te Kupenga.

year: 2018

title: From piles to tiles: designing for overview and control in case handling systems

authors: Blomkvist, Stefan

subjects: computer science

abstract: Poor overview and control of workload in electronic case handling systems is a potential health risk factor which affects the users. Case handling systems must therefore be designed to give the users a better overview and maximum control over their workload. In an earlier study, we developed a prototype interface for managing cases, based on the piles metaphor. This paper introduces a second prototype, which is designed to incorporate the findings of an evaluation of the piles metaphor prototype. In this second prototype cases are visualized as “tiles”, reflecting the number and complexity of the cases. This paper also describes some the results of the evaluation of the tiles prototype.

text: From piles to tiles: designing for overview and control in case handling systems Poor overview and control of workload in electronic case handling systems is a potential health risk factor which affects the users. Case handling systems must therefore be designed to give the users a better overview and maximum control over their workload. In an earlier study, we developed a prototype interface for managing cases, based on the piles metaphor. This paper introduces a second prototype, which is designed to incorporate the findings of an evaluation of the piles metaphor prototype. In this second prototype cases are visualized as “tiles”, reflecting the number and complexity of the cases. This paper also describes some the results of the evaluation of the tiles prototype.

year: 2004