title: Health Literacy: A Hermeneutic Study of New Zealand Baby Boomers

authors: Davey, Janet

subjects: Health literacy

abstract: Health literacy has traditionally been conceptualised as individual skills in a health context. Although there is growing consensus that health literacy is a multidimensional construct, interacting with socio-cultural contextual influences, such aspects are under-researched. In particular, there is limited research regarding the interrelationships between individuals’ and primary healthcare professionals’ (PHCPs) health literacy beliefs and experiences. Despite the predicted impact of the ageing population on healthcare costs and services, little empirical research has been conducted in New Zealand (NZ) on the health-related behaviour of the influential baby boomer cohort. The purpose of this thesis is to explore the phenomenon of health literacy among NZ baby boomers and PHCPs.  

Using hermeneutics as both the theoretical lens and the research method, this research draws on in-depth interviews to understand the participants’ constructions of health literacy and how their constructions influence healthcare goals and service encounters. The research takes a broad perspective of health literacy to answer the overarching research question, How are the roles and practices of health literacy perceived/constructed and performed in primary healthcare?

This thesis makes an original contribution to knowledge as the first empirical investigation of health literacy of NZ baby boomers (46 participants) and NZ primary healthcare professionals (11 participants). Specifically, this research contributes to health literacy knowledge in a geographic area (NZ) and among individuals within a generational cohort not defined by health condition or health risk. 

NZ baby boomers construct health literacy as a highly contextualised social practice linked to [a]symmetries in health-related information, power, autonomy, and patient-practitioner roles. These participants stress the importance of an individual’s personal health context, capabilities, relational processes, and networks in health literacy. Interpreting these baby boomers’ health literacy behaviours leads to five categories of description - seeker, decider, networker, sensemaker, and manager, which are appropriately framed within two horizons of self and interactivity, providing conceptual space within which individuals move and adapt their health literacy roles, responsibilities, and behaviours. 

In the PHCPs’ experiences regarding baby boomers’ health literacy there are underlying power and information imbalances, conflicting authority concerns, and [de-]professionalisation issues. Using categories of description, the PHCPs’ health literacy behaviours are described as – knowledge broker, ethical agent, and enabler. Iteratively drawing on pre-understandings, these meanings are theorised in a collective notion of managed empowerment that implies a negotiated balance between PHCP expert control and professional expertise, and patient-consumer autonomy and expertise. 

This study extends the understanding of health literacy by presenting an empirically-based conceptual framework, depicting health literacy operating across multiple levels, relationships, and networks, variably influenced by contextual factors of the postmodern health context; the communication and information revolution; and neo-liberalism and consumerism. The thesis contributes to health literacy knowledge by illustrating the fundamental role of relational processes in co-producing individuals’ health literacy and in subsequently reaching individuals’ health goals. Primary healthcare service providers, policy makers, and health promotion advocates can benefit from this study as it reveals particular health literacy roles and behaviours likely to be influential in encouraging individuals’ authentic involvement in their healthcare.

text: Health Literacy: A Hermeneutic Study of New Zealand Baby Boomers Health literacy has traditionally been conceptualised as individual skills in a health context. Although there is growing consensus that health literacy is a multidimensional construct, interacting with socio-cultural contextual influences, such aspects are under-researched. In particular, there is limited research regarding the interrelationships between individuals’ and primary healthcare professionals’ (PHCPs) health literacy beliefs and experiences. Despite the predicted impact of the ageing population on healthcare costs and services, little empirical research has been conducted in New Zealand (NZ) on the health-related behaviour of the influential baby boomer cohort. The purpose of this thesis is to explore the phenomenon of health literacy among NZ baby boomers and PHCPs.  

Using hermeneutics as both the theoretical lens and the research method, this research draws on in-depth interviews to understand the participants’ constructions of health literacy and how their constructions influence healthcare goals and service encounters. The research takes a broad perspective of health literacy to answer the overarching research question, How are the roles and practices of health literacy perceived/constructed and performed in primary healthcare?

This thesis makes an original contribution to knowledge as the first empirical investigation of health literacy of NZ baby boomers (46 participants) and NZ primary healthcare professionals (11 participants). Specifically, this research contributes to health literacy knowledge in a geographic area (NZ) and among individuals within a generational cohort not defined by health condition or health risk. 

NZ baby boomers construct health literacy as a highly contextualised social practice linked to [a]symmetries in health-related information, power, autonomy, and patient-practitioner roles. These participants stress the importance of an individual’s personal health context, capabilities, relational processes, and networks in health literacy. Interpreting these baby boomers’ health literacy behaviours leads to five categories of description - seeker, decider, networker, sensemaker, and manager, which are appropriately framed within two horizons of self and interactivity, providing conceptual space within which individuals move and adapt their health literacy roles, responsibilities, and behaviours. 

In the PHCPs’ experiences regarding baby boomers’ health literacy there are underlying power and information imbalances, conflicting authority concerns, and [de-]professionalisation issues. Using categories of description, the PHCPs’ health literacy behaviours are described as – knowledge broker, ethical agent, and enabler. Iteratively drawing on pre-understandings, these meanings are theorised in a collective notion of managed empowerment that implies a negotiated balance between PHCP expert control and professional expertise, and patient-consumer autonomy and expertise. 

This study extends the understanding of health literacy by presenting an empirically-based conceptual framework, depicting health literacy operating across multiple levels, relationships, and networks, variably influenced by contextual factors of the postmodern health context; the communication and information revolution; and neo-liberalism and consumerism. The thesis contributes to health literacy knowledge by illustrating the fundamental role of relational processes in co-producing individuals’ health literacy and in subsequently reaching individuals’ health goals. Primary healthcare service providers, policy makers, and health promotion advocates can benefit from this study as it reveals particular health literacy roles and behaviours likely to be influential in encouraging individuals’ authentic involvement in their healthcare.

year: 2015

title: A randomised crossover trial on the effects of foot starting position on calf raise test outcomes: Position does matter

authors: Hébert-Losier, Kim

subjects: Ankle

abstract: Background: This randomised crossover study with repeated measures examined the influence of the three most common foot starting positions used in conducting the calf raise test (CRT) on test outcomes. This study also accounted for the potential influence of gender, age, body mass index (BMI), and level of physical activity on test outcomes. Methods: Forty-nine healthy individuals (59 % female, 21 ± 4 years) performed single-leg calf raise repetitions in a human movement laboratory in three randomised foot starting positions: flat, 10° incline, and step. The validated Calf Raise application was used to track the vertical displacement of a marker placed on the foot using computer vision. The application extracted the following CRT outcomes from the vertical displacement curve: number of repetitions, peak vertical height, total vertical displacement, and total positive work. Data were analysed using mixed-effects models and stepwise regression. Results: There was a significant main effect (P < 0.001) of foot starting position on all outcomes, with all paired comparisons being statistically significant (P ≤ 0.023). Repetitions, total vertical displacement, and total positive work were greatest in flat and lowest in step, whereas peak vertical height was greatest in incline and lowest in step. Gender (P = 0.021; males>females) and BMI (P = 0.002; lower BMI>higher BMI) significantly influenced the number of repetitions. Gender (P < 0.001; males>females) also influenced total positive work. Age and physical activity levels did not significantly influence CRT outcomes. Conclusions: CRT foot starting position mattered and significantly affected all CRT outcomes. CRT foot starting position needs consideration when contrasting data in research and practice.

text: A randomised crossover trial on the effects of foot starting position on calf raise test outcomes: Position does matter Background: This randomised crossover study with repeated measures examined the influence of the three most common foot starting positions used in conducting the calf raise test (CRT) on test outcomes. This study also accounted for the potential influence of gender, age, body mass index (BMI), and level of physical activity on test outcomes. Methods: Forty-nine healthy individuals (59 % female, 21 ± 4 years) performed single-leg calf raise repetitions in a human movement laboratory in three randomised foot starting positions: flat, 10° incline, and step. The validated Calf Raise application was used to track the vertical displacement of a marker placed on the foot using computer vision. The application extracted the following CRT outcomes from the vertical displacement curve: number of repetitions, peak vertical height, total vertical displacement, and total positive work. Data were analysed using mixed-effects models and stepwise regression. Results: There was a significant main effect (P < 0.001) of foot starting position on all outcomes, with all paired comparisons being statistically significant (P ≤ 0.023). Repetitions, total vertical displacement, and total positive work were greatest in flat and lowest in step, whereas peak vertical height was greatest in incline and lowest in step. Gender (P = 0.021; males>females) and BMI (P = 0.002; lower BMI>higher BMI) significantly influenced the number of repetitions. Gender (P < 0.001; males>females) also influenced total positive work. Age and physical activity levels did not significantly influence CRT outcomes. Conclusions: CRT foot starting position mattered and significantly affected all CRT outcomes. CRT foot starting position needs consideration when contrasting data in research and practice.

year: 2024-09-01

title: Boat electrofishing survey of fish abundance in the Ohau Channel, Rotorua, in 2017

authors: Hicks, Brendan J.

abstract: The aim of the survey was to provide on-going monitoring of the fish communities and abundance by boat electrofishing in the Ohau Channel, especially fish species that are taonga to Maori (tuna, or eels, morihana, or goldfish, and kōura, or freshwater crayfish). In the current study, we present the findings from the eleventh year of sampling (2017) and a summary of previous surveys.
We used the University of Waikato’s 4.5 m-long, aluminium-hulled electrofishing boat to catch a total of 1,110 fish and 3 kōura (18.2 kg in total) from 11 sites on 5 December 2017. The sites comprised 2,909 lineal m and 11,636 m2 in area. Kōura (freshwater crayfish) and 6 fish species were present, with common bully the most abundant species (up to 29.6 fish 100 m⁻² at the site 8, edge habitat). Goldfish (up to 14.2 100 m⁻²) was the next most abundant species, with most goldfish at sites 8 and 11 in and around the side channel. Common smelt were next the most abundant species (up to 11.4 fish 100 m⁻²). Mean density of bullies (7.8 fish 100 m⁻²) was much higher than for smelt (1.69 fish 100 m⁻²). Kōura had a patchy distribution with only 3 individuals were caught at two sites.
Comparing catches over the 11 years of sampling, the mean abundance of common bullies in 2017 was consistent with densities in most post-wall years (after 2007), but lower than in 2007 before wall closure (Newman-Keuls multiple range test, P = 0.034). The cause of fluctuating bully abundance is not known, and was not accounted for by changes in water clarity expressed as black disc distance (BDD), water temperature, or water conductivity. Poor water clarity can reduce the efficiency of electrofishing, but low BDD did not correspond with low common bully densities. In 2017, smelt abundance had recovered somewhat from the low catches from 2014 to 2016.
Goldfish biomass increased initially (2009-2010) because of targeted fishing in the side channel (site 11), which has dense macrophytes and offers good habitat for goldfish with no flow. However, the continued rise in goldfish density from 2012 on suggests a real increase in goldfish numbers. In contrast to most previous years, no eels were caught in 2017.
Analysis of fish densities before and after wall closure is hampered by the single data point before closure. However, we now have 10 years of post-wall data, and comparisons of means and standard deviations suggest that the number of bullies have been lower since 2008 with the exception of 2015, when bully densities were the same as 2007, i.e., before wall closure. The large number of small juvenile bullies (<30 mm) suggests that recruitment is taking place in the channel, so fluctuating bully abundance is likely to be controlled by factors other than wall closure.

text: Boat electrofishing survey of fish abundance in the Ohau Channel, Rotorua, in 2017 The aim of the survey was to provide on-going monitoring of the fish communities and abundance by boat electrofishing in the Ohau Channel, especially fish species that are taonga to Maori (tuna, or eels, morihana, or goldfish, and kōura, or freshwater crayfish). In the current study, we present the findings from the eleventh year of sampling (2017) and a summary of previous surveys.
We used the University of Waikato’s 4.5 m-long, aluminium-hulled electrofishing boat to catch a total of 1,110 fish and 3 kōura (18.2 kg in total) from 11 sites on 5 December 2017. The sites comprised 2,909 lineal m and 11,636 m2 in area. Kōura (freshwater crayfish) and 6 fish species were present, with common bully the most abundant species (up to 29.6 fish 100 m⁻² at the site 8, edge habitat). Goldfish (up to 14.2 100 m⁻²) was the next most abundant species, with most goldfish at sites 8 and 11 in and around the side channel. Common smelt were next the most abundant species (up to 11.4 fish 100 m⁻²). Mean density of bullies (7.8 fish 100 m⁻²) was much higher than for smelt (1.69 fish 100 m⁻²). Kōura had a patchy distribution with only 3 individuals were caught at two sites.
Comparing catches over the 11 years of sampling, the mean abundance of common bullies in 2017 was consistent with densities in most post-wall years (after 2007), but lower than in 2007 before wall closure (Newman-Keuls multiple range test, P = 0.034). The cause of fluctuating bully abundance is not known, and was not accounted for by changes in water clarity expressed as black disc distance (BDD), water temperature, or water conductivity. Poor water clarity can reduce the efficiency of electrofishing, but low BDD did not correspond with low common bully densities. In 2017, smelt abundance had recovered somewhat from the low catches from 2014 to 2016.
Goldfish biomass increased initially (2009-2010) because of targeted fishing in the side channel (site 11), which has dense macrophytes and offers good habitat for goldfish with no flow. However, the continued rise in goldfish density from 2012 on suggests a real increase in goldfish numbers. In contrast to most previous years, no eels were caught in 2017.
Analysis of fish densities before and after wall closure is hampered by the single data point before closure. However, we now have 10 years of post-wall data, and comparisons of means and standard deviations suggest that the number of bullies have been lower since 2008 with the exception of 2015, when bully densities were the same as 2007, i.e., before wall closure. The large number of small juvenile bullies (<30 mm) suggests that recruitment is taking place in the channel, so fluctuating bully abundance is likely to be controlled by factors other than wall closure.

year: 2018