title: A walking stick in one hand and a chainsaw in the other: Patients’ perspectives of living with multimorbidity

authors: Signal, Louise

abstract: AIMS: Multimorbidity is common, yet there are major gaps in research, particularly among younger and indigenous populations. This research aimed to understand patients’ perspectives of living with multimorbidity. 

METHODS: A qualitative study of 61 people living with multimorbidity, 27 of whom were Māori and a third aged under 65, from urban and rural regions in New Zealand. Six focus groups and 14 interviews were conducted, recorded, transcribed and analysed. 
RESULTS: For many participants, living with multimorbidity disrupted their ‘normal’ lives, posing challenges in everyday activities such as eating and toileting, working and managing medications. Dealing with the health system posed challenges such as accessing appointments and having enough time in consultations. Cultural competency, good communication and continuity of care from healthcare providers were all valued. Participants had many recommendations to improve management, including a professional single point of contact to coordinate all specialist care. 
CONCLUSIONS: Living with multimorbidity is often challenging requiring people to manage their conditions while continuing to live their lives. This research suggests changes are needed in the health system in New Zealand and elsewhere to better manage multimorbidity thus improving patient’s lives and reducing costs to the health sector and wider society.

text: A walking stick in one hand and a chainsaw in the other: Patients’ perspectives of living with multimorbidity AIMS: Multimorbidity is common, yet there are major gaps in research, particularly among younger and indigenous populations. This research aimed to understand patients’ perspectives of living with multimorbidity. 

METHODS: A qualitative study of 61 people living with multimorbidity, 27 of whom were Māori and a third aged under 65, from urban and rural regions in New Zealand. Six focus groups and 14 interviews were conducted, recorded, transcribed and analysed. 
RESULTS: For many participants, living with multimorbidity disrupted their ‘normal’ lives, posing challenges in everyday activities such as eating and toileting, working and managing medications. Dealing with the health system posed challenges such as accessing appointments and having enough time in consultations. Cultural competency, good communication and continuity of care from healthcare providers were all valued. Participants had many recommendations to improve management, including a professional single point of contact to coordinate all specialist care. 
CONCLUSIONS: Living with multimorbidity is often challenging requiring people to manage their conditions while continuing to live their lives. This research suggests changes are needed in the health system in New Zealand and elsewhere to better manage multimorbidity thus improving patient’s lives and reducing costs to the health sector and wider society.

year: 2017

title: COVID-19 and blind spaces: Responding to digital (in)accessibility and social isolation during lockdown for blind, deafblind, low vision, and vision impaired persons in Aotearoa New Zealand

authors: Graham, Rebekah Sarah

abstract: In this chapter we, as Indigenous (Māori) and non-Indigenous (Pākehā) academics, practitioners, and disability advocates critically examine the experiences of people who are blind, deafblind, low vision and vision impaired (BLV) during the COVID-19 lockdown of Aotearoa New Zealand. We pay particular attention to the ways in which access (or lack thereof) to digital spaces facilitated experiences of social inclusion (and exclusion). Digital connectivity was heavily relied upon during lockdown in Aotearoa New Zealand to disseminate health information and to connect people socially. The use of digital technologies during lockdown extended the interpersonal space of the home beyond the physicality of the urban home people were confined to, drawing people together across the country and creating a sense of shared experience. However, these experiences were not shared equally across the citizenry. Conversations during lockdown with disability advocates and practitioners working with BLV persons identified that. For example, the government website on COVID19 was initially inaccessible for BLV persons and there were assumptions of digital accessibility and literacy within the domestic space of the home. Taken together, these exacerbated existing inequities for BLV persons, some of whom experience multiple domains of exclusion (for example, Indigenous BLV persons with reduced access to services and for whom English is their second language). Drawing on Lefebvre’s (1991) work on the dialectics of space and Lewin’s (1936/2013) construction of the life-space, we consider the interplay of space and experience with regards to the digital and physical space(s) available and inhabited during the shared social experience of lockdown. We discuss possibilities for co-creating socially inclusive (digital) spaces of belonging that reflect and refract life-space relational connections across social groups. Our reflections on the lockdown experience include opportunities post-pandemic for policy makers and practitioners to address digital accessibility inequities.

text: COVID-19 and blind spaces: Responding to digital (in)accessibility and social isolation during lockdown for blind, deafblind, low vision, and vision impaired persons in Aotearoa New Zealand In this chapter we, as Indigenous (Māori) and non-Indigenous (Pākehā) academics, practitioners, and disability advocates critically examine the experiences of people who are blind, deafblind, low vision and vision impaired (BLV) during the COVID-19 lockdown of Aotearoa New Zealand. We pay particular attention to the ways in which access (or lack thereof) to digital spaces facilitated experiences of social inclusion (and exclusion). Digital connectivity was heavily relied upon during lockdown in Aotearoa New Zealand to disseminate health information and to connect people socially. The use of digital technologies during lockdown extended the interpersonal space of the home beyond the physicality of the urban home people were confined to, drawing people together across the country and creating a sense of shared experience. However, these experiences were not shared equally across the citizenry. Conversations during lockdown with disability advocates and practitioners working with BLV persons identified that. For example, the government website on COVID19 was initially inaccessible for BLV persons and there were assumptions of digital accessibility and literacy within the domestic space of the home. Taken together, these exacerbated existing inequities for BLV persons, some of whom experience multiple domains of exclusion (for example, Indigenous BLV persons with reduced access to services and for whom English is their second language). Drawing on Lefebvre’s (1991) work on the dialectics of space and Lewin’s (1936/2013) construction of the life-space, we consider the interplay of space and experience with regards to the digital and physical space(s) available and inhabited during the shared social experience of lockdown. We discuss possibilities for co-creating socially inclusive (digital) spaces of belonging that reflect and refract life-space relational connections across social groups. Our reflections on the lockdown experience include opportunities post-pandemic for policy makers and practitioners to address digital accessibility inequities.

year: 2021

title: Insecure here, precarious there?  Workfare-style welfare provision in the age of precarious employment in Aotearoa New Zealand

authors: East, Dayna Erin

abstract: Aotearoa New Zealand’s adoption of workfare, beginning in the late 1980s, was designed to reduce welfare dependency and reinforce employment as the pathway to greater wellbeing. Concurrent with these policy developments in welfare provision were changes in the labour market, which led to an increase in employment arrangements that can be considered precarious. Feminist literature highlights that women are more negatively impacted by these kinds of changes to the welfare system and the labour market. In light of recent policy shifts, it is timely to draw attention to the ways in which the intersection between these two phenomena has led to increases in insecurity across different realms of life, and decreases to wellbeing overall. My research seeks to define and discuss precarious employment and workfare as significant and intersecting structural phenomena that shape lives in New Zealand, particularly of those in receipt of a benefit. This research takes a feminist approach to research in order to explore the connection between these two phenomena, and draws on both existing literature and statistical data to establish the impact of these phenomena, how many people move between workfare and precarious employment, and who these people are. Six interviews were also undertaken with insiders from New Zealand’s welfare system, including two wāhine welfare recipients, in order to see how women in receipt of welfare experience this connection. Based on this research, I argue that the prevalence of precarious employment undermines the policy imperative of employment as a pathway to increased wellbeing. I also challenge the notion of employment and the pursuit of it as an ideal source of wellbeing, as workfare and the punitive measures associated with it are a problem in and of itself. The everyday experiences of the interview participants highlight the loss of wellbeing that occurs from interactions with the workfare system and precarious employment. The interviews also illustrate the distinct problems that emerge from a lack of coordination between central and regional offices of the workfare system that undermine the capacity of the system to challenge a reliance on unsustainable employment options and a less punitive approach to welfare provision. Ultimately, I argue that the intersecting sources of marginalisation that emerge from participation in the workfare system and precarious employment need to be better understood if the problems within the welfare system are to be addressed. This is particularly vital given the ways in which both structures perpetuate intersectional inequalities that compound in the lives of women in Aotearoa New Zealand.

text: Insecure here, precarious there?  Workfare-style welfare provision in the age of precarious employment in Aotearoa New Zealand Aotearoa New Zealand’s adoption of workfare, beginning in the late 1980s, was designed to reduce welfare dependency and reinforce employment as the pathway to greater wellbeing. Concurrent with these policy developments in welfare provision were changes in the labour market, which led to an increase in employment arrangements that can be considered precarious. Feminist literature highlights that women are more negatively impacted by these kinds of changes to the welfare system and the labour market. In light of recent policy shifts, it is timely to draw attention to the ways in which the intersection between these two phenomena has led to increases in insecurity across different realms of life, and decreases to wellbeing overall. My research seeks to define and discuss precarious employment and workfare as significant and intersecting structural phenomena that shape lives in New Zealand, particularly of those in receipt of a benefit. This research takes a feminist approach to research in order to explore the connection between these two phenomena, and draws on both existing literature and statistical data to establish the impact of these phenomena, how many people move between workfare and precarious employment, and who these people are. Six interviews were also undertaken with insiders from New Zealand’s welfare system, including two wāhine welfare recipients, in order to see how women in receipt of welfare experience this connection. Based on this research, I argue that the prevalence of precarious employment undermines the policy imperative of employment as a pathway to increased wellbeing. I also challenge the notion of employment and the pursuit of it as an ideal source of wellbeing, as workfare and the punitive measures associated with it are a problem in and of itself. The everyday experiences of the interview participants highlight the loss of wellbeing that occurs from interactions with the workfare system and precarious employment. The interviews also illustrate the distinct problems that emerge from a lack of coordination between central and regional offices of the workfare system that undermine the capacity of the system to challenge a reliance on unsustainable employment options and a less punitive approach to welfare provision. Ultimately, I argue that the intersecting sources of marginalisation that emerge from participation in the workfare system and precarious employment need to be better understood if the problems within the welfare system are to be addressed. This is particularly vital given the ways in which both structures perpetuate intersectional inequalities that compound in the lives of women in Aotearoa New Zealand.

year: 2020