title: Trust and gender in patient-practitioner relationships

authors: FitzPatrick, Mary

abstract: This research investigates the phenomenon of patient trust in primary health care providers. Using the qualitative methodology of Memory Work, this research draws largely on social constructionism to understand gendered 'lived' experiences of trust within the patient-practitioner relationship. The central question of this research, then, was: How do male and female patients describe and perceive their experience, both positive and negative, of trust in primary health care practitioners (PHCPs)? Following the Memory Work method, two groups of participants, one comprising four men, the other five women, independently wrote detailed narratives of their lived experiences of trust. These experiences were evoked by agreed 'trigger' topics that each group felt explored and represented trust within the patient-practitioner relationship. The participants then came together as a group to discuss and analyse the individual narratives for the 'common' sense or the social aspects of the experiences common to the group, and the processes used to make sense of them. Both the women's research group and the men's research group met for five sessions, each session lasting at least three hours. Between them the research participants wrote 43 individual narratives (two absences) and generated more than 30 hours of recorded group work. From their written descriptions and verbal discussions of their individual narratives, this research describes and explains the trust that these participants experienced, and explores the meaning that these men and women themselves ascribe to trust in various health care service contexts. Specifically, Memory Work facilitated the participants' own understanding of how their individual experiences of trust have been constructed by the self, and the social processes of gender on self. 
This research worked at two levels of analysis and interpretation (textual and crosssectional), examining the experiences both within and between the men and women in the study. A number of common themes were found to be critical to patient trust for these women and men showing important gender differences in how trust is lived and understood within the patient-practitioner relationship. The themes that the women use to make sense of their trust in PHCPs are: Vulnerability, Knowledge, Affirmation, Voice, Clinical Skills, Responsiveness, Professional Confidence, Thoroughness, Acceptance, Personal Connection, Honesty, Empathy, Reciprocity, Safety, and Empowerment. Collectively the men develop the following themes: Risk, Evidence, Autonomy, Personal Connection, Clinical Skills, Professionalism, Empathy, Friendliness, 'Reading' Skills, Honesty, Reciprocity, and Alliance. Finally, the discussion elaborates the participants' theorising by connecting it to existing marketing literature. The research finds that there are both profound relational and social dimensions to trust in this service context. Trust is understood as a relational phenomenon through the heuristic device of the 'She' /'He', 'Other', and 'They'. 
This research extends the relationship marketing literature by developing a deep understanding of the phenomenon of trust from the patients' perspective, and the interconnections between this trust and gender as it is lived in health care service contexts. These insights provide a sound base for implementing improvements to current health care practice that are valued by the patient, and therefore have immediate practical relevance for health care practitioners, health care policy makers, and patients. This research also contributes academically by establishing a new way of analysing and interpreting relational phenomena such as trust.

text: Trust and gender in patient-practitioner relationships This research investigates the phenomenon of patient trust in primary health care providers. Using the qualitative methodology of Memory Work, this research draws largely on social constructionism to understand gendered 'lived' experiences of trust within the patient-practitioner relationship. The central question of this research, then, was: How do male and female patients describe and perceive their experience, both positive and negative, of trust in primary health care practitioners (PHCPs)? Following the Memory Work method, two groups of participants, one comprising four men, the other five women, independently wrote detailed narratives of their lived experiences of trust. These experiences were evoked by agreed 'trigger' topics that each group felt explored and represented trust within the patient-practitioner relationship. The participants then came together as a group to discuss and analyse the individual narratives for the 'common' sense or the social aspects of the experiences common to the group, and the processes used to make sense of them. Both the women's research group and the men's research group met for five sessions, each session lasting at least three hours. Between them the research participants wrote 43 individual narratives (two absences) and generated more than 30 hours of recorded group work. From their written descriptions and verbal discussions of their individual narratives, this research describes and explains the trust that these participants experienced, and explores the meaning that these men and women themselves ascribe to trust in various health care service contexts. Specifically, Memory Work facilitated the participants' own understanding of how their individual experiences of trust have been constructed by the self, and the social processes of gender on self. 
This research worked at two levels of analysis and interpretation (textual and crosssectional), examining the experiences both within and between the men and women in the study. A number of common themes were found to be critical to patient trust for these women and men showing important gender differences in how trust is lived and understood within the patient-practitioner relationship. The themes that the women use to make sense of their trust in PHCPs are: Vulnerability, Knowledge, Affirmation, Voice, Clinical Skills, Responsiveness, Professional Confidence, Thoroughness, Acceptance, Personal Connection, Honesty, Empathy, Reciprocity, Safety, and Empowerment. Collectively the men develop the following themes: Risk, Evidence, Autonomy, Personal Connection, Clinical Skills, Professionalism, Empathy, Friendliness, 'Reading' Skills, Honesty, Reciprocity, and Alliance. Finally, the discussion elaborates the participants' theorising by connecting it to existing marketing literature. The research finds that there are both profound relational and social dimensions to trust in this service context. Trust is understood as a relational phenomenon through the heuristic device of the 'She' /'He', 'Other', and 'They'. 
This research extends the relationship marketing literature by developing a deep understanding of the phenomenon of trust from the patients' perspective, and the interconnections between this trust and gender as it is lived in health care service contexts. These insights provide a sound base for implementing improvements to current health care practice that are valued by the patient, and therefore have immediate practical relevance for health care practitioners, health care policy makers, and patients. This research also contributes academically by establishing a new way of analysing and interpreting relational phenomena such as trust.

year: 2004

title: The effects of varying intensity cultivation on soil quality in a maize cropping system

authors: McKay, Emily Grace

abstract: Maize is the primary crop grown on arable land in the Waikato region, predominantly established on Allophanic soils due to their well-drained and resilient properties. Full cultivation (FC) is universally adopted in cropping systems and associated with increased soil aeration and successful seed establishment, however, has been shown to reduce soil quality through declines in soil organic matter (SOM) and soil structure. SOM (TC & TN) decline and aggregate stability are considered important indicators of soil quality in cropping systems as they pose the greatest risk to long term productivity and profitability. Soil degradation can be reduced through conservation tillage such as no-till (NT) and strip-till (ST). Previous studies have investigated the effect of cultivation intensity on soil quality and consistently found that NT systems have greater carbon (C) levels and aggregate stability at the soil surface than higher intensity cultivation systems. 

The main aim of this thesis was to determine whether there were significant differences in soil quality between varying intensity cultivation systems (FC, ST, NT) on Allophanic soils in the Hamilton Basin. Further aims were to determine whether differences in the inherent soil properties of the Horotiu silt loam and Bruntwood silt loam would influence the soil quality within the study area, and to identify whether soil quality was influenced by an interaction between cultivation intensity and soil type. 

Twelve plots with four replicates of each cultivation treatment were sampled and soil quality measured using seven soil quality indicators (total C (TC), total nitrogen (TN), mineralisable nitrogen (N), soil pH, Olsen P, bulk density (BD), and macroporosity (MP)) and three additional cropping indicators (aggregate stability, penetration resistance, and visual soil assessment). Mechanically driven cores for TC and TN analysis were taken from 0 – 7.5 cm, 7.5 – 15 cm, and 15 – 30 cm. Significant differences in TC, TN, and aggregate stability in the top 10 cm were detected between cultivation treatments (p < 0.05). NT was shown to be the most beneficial cultivation for a maize cropping system, indicated by significantly greater TC (3.98 %), TN (0.41 %), and aggregate stability (0.97 mm, MWD) at the soil surface than higher intensity cultivation systems (For FC; TC = 3.56 %, TN = 0.37 %, aggregate stability = 0.62 mm). Additionally, significant differences in TC and TN were found between soil types, where Horotiu silt loam had significantly greater TC and TN (e.g. for 0 – 10 cm; Horotiu: TC = 4.02 %, TN = 0.42 %; Bruntwood TC = 3.52 %, TN = 0.36 %). There were also significant differences in aggregate stability, MP, and BD between soil types, where the Horotiu silt loam had higher aggregate stability (0.82 mm, MWD), MP (14 %) and lower BD   (0.96 t m-3) and Olsen P (82.9 μg g-1) than the Bruntwood silt loam (Aggregate stability = 0.73 mm, MP = 12 %, BD = 1.05 t m-3, Olsen P = 105.5 g g-1). Where there were interactions between cultivation intensity and soil type, significant differences were detected in aggregate stability and penetration resistance, where the Horotiu silt loam under NT had higher aggregate stability (1.07 mm, MWD) and penetration resistance (2.00 MPa) than all other combinations. Conversely, the Bruntwood silt loam under FC had the lowest aggregate stability (0.55 mm, MWD) and penetration resistance (1.63 MPa). 

Many of the soil quality values in the study area fell below or exceeded target ranges set for cropping systems, regardless of cultivation treatment or soil type. This is due to the intensive nature of cropping systems, use of heavy machinery, removal during harvest, and poorly defined target ranges. This study highlights how differences in inherent soil properties between two soil types within the same soil order can greatly influence soil quality. Previous data showed cultivation intensity did not significantly influence maize yield at this stage in the trial.  This research therefore suggests NT systems result in higher SOM content and greater aggregate stability and therefore may be a more suitable cultivation system for continuous maize cropping without decreasing productivity or profitability.

text: The effects of varying intensity cultivation on soil quality in a maize cropping system Maize is the primary crop grown on arable land in the Waikato region, predominantly established on Allophanic soils due to their well-drained and resilient properties. Full cultivation (FC) is universally adopted in cropping systems and associated with increased soil aeration and successful seed establishment, however, has been shown to reduce soil quality through declines in soil organic matter (SOM) and soil structure. SOM (TC & TN) decline and aggregate stability are considered important indicators of soil quality in cropping systems as they pose the greatest risk to long term productivity and profitability. Soil degradation can be reduced through conservation tillage such as no-till (NT) and strip-till (ST). Previous studies have investigated the effect of cultivation intensity on soil quality and consistently found that NT systems have greater carbon (C) levels and aggregate stability at the soil surface than higher intensity cultivation systems. 

The main aim of this thesis was to determine whether there were significant differences in soil quality between varying intensity cultivation systems (FC, ST, NT) on Allophanic soils in the Hamilton Basin. Further aims were to determine whether differences in the inherent soil properties of the Horotiu silt loam and Bruntwood silt loam would influence the soil quality within the study area, and to identify whether soil quality was influenced by an interaction between cultivation intensity and soil type. 

Twelve plots with four replicates of each cultivation treatment were sampled and soil quality measured using seven soil quality indicators (total C (TC), total nitrogen (TN), mineralisable nitrogen (N), soil pH, Olsen P, bulk density (BD), and macroporosity (MP)) and three additional cropping indicators (aggregate stability, penetration resistance, and visual soil assessment). Mechanically driven cores for TC and TN analysis were taken from 0 – 7.5 cm, 7.5 – 15 cm, and 15 – 30 cm. Significant differences in TC, TN, and aggregate stability in the top 10 cm were detected between cultivation treatments (p < 0.05). NT was shown to be the most beneficial cultivation for a maize cropping system, indicated by significantly greater TC (3.98 %), TN (0.41 %), and aggregate stability (0.97 mm, MWD) at the soil surface than higher intensity cultivation systems (For FC; TC = 3.56 %, TN = 0.37 %, aggregate stability = 0.62 mm). Additionally, significant differences in TC and TN were found between soil types, where Horotiu silt loam had significantly greater TC and TN (e.g. for 0 – 10 cm; Horotiu: TC = 4.02 %, TN = 0.42 %; Bruntwood TC = 3.52 %, TN = 0.36 %). There were also significant differences in aggregate stability, MP, and BD between soil types, where the Horotiu silt loam had higher aggregate stability (0.82 mm, MWD), MP (14 %) and lower BD   (0.96 t m-3) and Olsen P (82.9 μg g-1) than the Bruntwood silt loam (Aggregate stability = 0.73 mm, MP = 12 %, BD = 1.05 t m-3, Olsen P = 105.5 g g-1). Where there were interactions between cultivation intensity and soil type, significant differences were detected in aggregate stability and penetration resistance, where the Horotiu silt loam under NT had higher aggregate stability (1.07 mm, MWD) and penetration resistance (2.00 MPa) than all other combinations. Conversely, the Bruntwood silt loam under FC had the lowest aggregate stability (0.55 mm, MWD) and penetration resistance (1.63 MPa). 

Many of the soil quality values in the study area fell below or exceeded target ranges set for cropping systems, regardless of cultivation treatment or soil type. This is due to the intensive nature of cropping systems, use of heavy machinery, removal during harvest, and poorly defined target ranges. This study highlights how differences in inherent soil properties between two soil types within the same soil order can greatly influence soil quality. Previous data showed cultivation intensity did not significantly influence maize yield at this stage in the trial.  This research therefore suggests NT systems result in higher SOM content and greater aggregate stability and therefore may be a more suitable cultivation system for continuous maize cropping without decreasing productivity or profitability.

year: 2020

title: The TOHU framework: Sensing and interpreting tohu to heal from trauma

authors: McLachlan, A

subjects: Environment

abstract: This hypotheses article presents understandings and practices of tohu (signs) in the personal, eco-environmental, and spiritual wellbeing of Māori. Tohu can be observed in the natural, social, physical, or spiritual environment, and within a Māori worldview provide important ways of understanding and responding to phenomena. Wānanga (shared dialogue and debate) were held with seven Māori clinical psychologists from He Paiaka Tōtara (Māori Psychologist Network) and two mātauranga Māori specialists to explore their experiences, knowledge, and perspectives about tohu, with their insights collected through online information sharing. Our wānanga goals were to inform the creation of a therapeutic framework to address patu ngākau, psychological and spiritual trauma experienced by Māori. The results identified that tohu are located within the person and their environment, and the importance of exploring how tohu are interpreted. We propose a TOHU acronym as a framework for understanding and addressing the multifaceted impacts of patu ngākau.

text: The TOHU framework: Sensing and interpreting tohu to heal from trauma This hypotheses article presents understandings and practices of tohu (signs) in the personal, eco-environmental, and spiritual wellbeing of Māori. Tohu can be observed in the natural, social, physical, or spiritual environment, and within a Māori worldview provide important ways of understanding and responding to phenomena. Wānanga (shared dialogue and debate) were held with seven Māori clinical psychologists from He Paiaka Tōtara (Māori Psychologist Network) and two mātauranga Māori specialists to explore their experiences, knowledge, and perspectives about tohu, with their insights collected through online information sharing. Our wānanga goals were to inform the creation of a therapeutic framework to address patu ngākau, psychological and spiritual trauma experienced by Māori. The results identified that tohu are located within the person and their environment, and the importance of exploring how tohu are interpreted. We propose a TOHU acronym as a framework for understanding and addressing the multifaceted impacts of patu ngākau.

year: 2024