title: What works for midwives supporting māmā through emotional distress?

authors: Roia, Tiaan Mereana Manurangi

abstract: Pregnancy and the postnatal period are particularly vulnerable times for mothers’ mental health, with an increased risk of women experiencing depression and anxiety during this time. Therefore, understanding the level and type of service midwives provide to māmā who experience emotional distress is vital to know what midwives need in order to provide the right care to their clients.
The aim of this study was to find out what tools and resources community-based midwives find most helpful to support the needs of māmā. Seven semi-structured interviews were conducted, including four Māori midwives, who were able to provide insight on their experiences caring for mothers with mental health needs. Overall, the interviews reflected a strong sense of care and empathy from midwives during their time caring for mothers. Midwives appeared to rely on their interpersonal skills and intuition about emotional distress, and emphasised the importance of connecting with people and utilising support from their communities. Whilst midwives were interested and engaged with providing appropriate care to mothers, they were unbeknown to some of the clinical resources that could be available to their clients. The complexity of referrals and access to mental health services was central to the midwives’ frustration around caring for mothers, as well as a lack of education relating to kaupapa Māori, cultural competency, and mental health processes.
Recommendations based on this study are to provide midwives with education and training on topics like kaupapa Māori, on social and mental health resources and processes for referral to increase their ability to support and care for mothers who experience emotional distress. Improvements to the pathways for referrals and access to mental health services is essential. Future research should focus on understanding why midwives aren’t using a range of online apps and tools, and increase awareness of the available modes of support available.

text: What works for midwives supporting māmā through emotional distress? Pregnancy and the postnatal period are particularly vulnerable times for mothers’ mental health, with an increased risk of women experiencing depression and anxiety during this time. Therefore, understanding the level and type of service midwives provide to māmā who experience emotional distress is vital to know what midwives need in order to provide the right care to their clients.
The aim of this study was to find out what tools and resources community-based midwives find most helpful to support the needs of māmā. Seven semi-structured interviews were conducted, including four Māori midwives, who were able to provide insight on their experiences caring for mothers with mental health needs. Overall, the interviews reflected a strong sense of care and empathy from midwives during their time caring for mothers. Midwives appeared to rely on their interpersonal skills and intuition about emotional distress, and emphasised the importance of connecting with people and utilising support from their communities. Whilst midwives were interested and engaged with providing appropriate care to mothers, they were unbeknown to some of the clinical resources that could be available to their clients. The complexity of referrals and access to mental health services was central to the midwives’ frustration around caring for mothers, as well as a lack of education relating to kaupapa Māori, cultural competency, and mental health processes.
Recommendations based on this study are to provide midwives with education and training on topics like kaupapa Māori, on social and mental health resources and processes for referral to increase their ability to support and care for mothers who experience emotional distress. Improvements to the pathways for referrals and access to mental health services is essential. Future research should focus on understanding why midwives aren’t using a range of online apps and tools, and increase awareness of the available modes of support available.

year: 2023

title: Death and homelessness on the streets of Aotearoa New Zealand: Sustaining life

authors: Charvin-Fabre, Sandrine

abstract: In high-income countries, homeless people die 20 to 35 years earlier than domiciled populations. Despite this enduring reality, the issue of death inequality remains underexplored, especially in indigenous homeless contexts, facing the ongoing effects of colonisation. This study centres on the perspectives and aspirations of a Māori street homeless community, known as the “Peeps”. Its objective is twofold: to spotlight to unjust, untimely, and avoidable mortality impacting homeless communities in Aotearoa New Zealand, and to understand how life can be sustained against the adversity of street life. The thesis diverges from conventional public health approaches, which often dichotomise early deaths prevention through improved healthcare access during homelessness, and palliative care provision at the end of life of homeless people. This thesis explores “the temporal space of life prior to death”. Within that temporal realm, the omnipresent “risk of dying” that infiltrates the lives of homeless people, disrupting the linear progression toward death observed in domiciled populations, is recognised. This temporal space is understood as a zone of uncertainty and potentiality, wherein complex life-death dynamics operate, revealing broader political, societal and cultural tensions. This study encountered significant challenges, including the dearth of prior death-related research in Māori homeless contexts, and my non-Māori identity. In response, an indeterminate approach, rooted in relational ethics and complexity and systems thinking — aligned with Māori worldviews — was adopted.  

Part I of the thesis is conceptual and contextual. Part II invites the readers into the fragile “temporal space of life prior to death” and the cyclical research process. Cycle 1 focuses on understanding the local context of death inequality, through relational fieldwork and statistical analysis of coroners’ reports. This analysis uncovers a 30-year life expectancy disparity with domiciled populations, exacerbated by three-quarters of avoidable mortality, mainly due to chronic conditions and suicide. Subsequent cycles sustain relational fieldwork, using collaborative and critical performance ethnography. Cycle 2 reveals the Peeps’ resistance to access healthcare, rooted in experiences of transgenerational trauma and marginalisation of Māori beliefs and values in relation to death and dying within mainstream healthcare institutions. Collaboration with the Peeps leads to the co-creation of a drama, intended to initiate conversations with health professionals from the Peeps’ perspectives and aspirations, to improve the quality of care. This cycle also highlights the impact of disconnection processes with whānau (family, extended family) experienced by the Peeps. Progressing further, cycle 3 illuminates healing processes with whānau using Advance Care Planning, envisioned as a relational space, providing the Peeps with a sense of belonging, and spiritual continuity in the perspective of death and dying. 
 
In addition to shedding light on the profound death inequality that affect Māori homeless people, this thesis argues for homelessness to be recognised as “complex life-threatening conditions associated with serious-related health suffering”. Accordingly, the thesis advocates the shift toward comprehensive care, inclusive of a concurrent prevention and palliation approach over the course of homelessness, to mitigate its impact on the lives of Māori homeless people and enhance holistic wellbeing.

text: Death and homelessness on the streets of Aotearoa New Zealand: Sustaining life In high-income countries, homeless people die 20 to 35 years earlier than domiciled populations. Despite this enduring reality, the issue of death inequality remains underexplored, especially in indigenous homeless contexts, facing the ongoing effects of colonisation. This study centres on the perspectives and aspirations of a Māori street homeless community, known as the “Peeps”. Its objective is twofold: to spotlight to unjust, untimely, and avoidable mortality impacting homeless communities in Aotearoa New Zealand, and to understand how life can be sustained against the adversity of street life. The thesis diverges from conventional public health approaches, which often dichotomise early deaths prevention through improved healthcare access during homelessness, and palliative care provision at the end of life of homeless people. This thesis explores “the temporal space of life prior to death”. Within that temporal realm, the omnipresent “risk of dying” that infiltrates the lives of homeless people, disrupting the linear progression toward death observed in domiciled populations, is recognised. This temporal space is understood as a zone of uncertainty and potentiality, wherein complex life-death dynamics operate, revealing broader political, societal and cultural tensions. This study encountered significant challenges, including the dearth of prior death-related research in Māori homeless contexts, and my non-Māori identity. In response, an indeterminate approach, rooted in relational ethics and complexity and systems thinking — aligned with Māori worldviews — was adopted.  

Part I of the thesis is conceptual and contextual. Part II invites the readers into the fragile “temporal space of life prior to death” and the cyclical research process. Cycle 1 focuses on understanding the local context of death inequality, through relational fieldwork and statistical analysis of coroners’ reports. This analysis uncovers a 30-year life expectancy disparity with domiciled populations, exacerbated by three-quarters of avoidable mortality, mainly due to chronic conditions and suicide. Subsequent cycles sustain relational fieldwork, using collaborative and critical performance ethnography. Cycle 2 reveals the Peeps’ resistance to access healthcare, rooted in experiences of transgenerational trauma and marginalisation of Māori beliefs and values in relation to death and dying within mainstream healthcare institutions. Collaboration with the Peeps leads to the co-creation of a drama, intended to initiate conversations with health professionals from the Peeps’ perspectives and aspirations, to improve the quality of care. This cycle also highlights the impact of disconnection processes with whānau (family, extended family) experienced by the Peeps. Progressing further, cycle 3 illuminates healing processes with whānau using Advance Care Planning, envisioned as a relational space, providing the Peeps with a sense of belonging, and spiritual continuity in the perspective of death and dying. 
 
In addition to shedding light on the profound death inequality that affect Māori homeless people, this thesis argues for homelessness to be recognised as “complex life-threatening conditions associated with serious-related health suffering”. Accordingly, the thesis advocates the shift toward comprehensive care, inclusive of a concurrent prevention and palliation approach over the course of homelessness, to mitigate its impact on the lives of Māori homeless people and enhance holistic wellbeing.

year: 2024

title: A quantitative investigation into the effectiveness of a 2x2, crossover, randomized control trial, for individuals suffering from non-specific chronic lower back pain, using a physical exercise-focused clinical intervention on the transverse abdominus/ multifidus (stability) and rectus abdominals/ erector spinae (dynamic) muscles.

authors: Callaghan, Adam James

subjects: lower back pain

abstract: A plethora of research has been conducted on interventions to reduce non-specific
lower back pain and improve the quality of life of sufferers. However, there is a lack of
distinction on the complementary nature of these interventions. Our primary research goal
was to assess the effectiveness of stability- and dynamic-style clinical interventions, focusing
on exercises to strengthen specific trunk muscles, including the transverse
abdominis/multifidus (stability-AB), and rectus abdominis/ erector spinae (dynamic). We
aimed to determine the effectiveness of these interventions in reducing non-specific chronic
lower back pain. Our research questions focused on whether a two-part clinical intervention
targeting specific core muscle groups (dynamic or stability) improves pain outcomes, whether
exercises targeting specific core muscle groups improve disability index physical impairment
and overall low back pain rating scale scores, and if there is a difference between intervention
groups and the sequential order of intervention for these outcomes. Additionally, we wanted
to investigate the correlation between these outcome measures and trunk endurance strength
scores. Seven participants were randomly assigned to either the stability (N =4) or dynamic
(N = 3) exercise group. Outcome measures included back and leg pain, lower back pain
visual analogue scale scores, disability index, physical impairment, and total Low Back Pain
Rating Scale (LBPRS) scores. Four measures of trunk endurance strength were taken using
Mcgill's Torso Endurance Test Battery (MTETB), which involves trunk extension, trunk
flexor, and trunk lateral tests on both the left and right sides. Assessments were performed
before the first clinical intervention, after the first intervention, and after the completion of
the final intervention. Each intervention phase lasted 4 weeks for each participant before they
switched to the opposing exercise group. The scores of back and leg pain, lower back pain,
disability index, and physical impairment all improved significantly after both interventions.
We found no difference between the groups during these intervention phases, or any potential
crossover/sequential effect, except for the dynamic group showing a significant improvement
in physical impairment scores after the first intervention, which remained consistent between
interventions one and two. In conclusion, both exercise approaches were similar across all
our outcome measures and may serve as complementary interventions for individuals
suffering from non-specific chronic low back pain.

text: A quantitative investigation into the effectiveness of a 2x2, crossover, randomized control trial, for individuals suffering from non-specific chronic lower back pain, using a physical exercise-focused clinical intervention on the transverse abdominus/ multifidus (stability) and rectus abdominals/ erector spinae (dynamic) muscles. A plethora of research has been conducted on interventions to reduce non-specific
lower back pain and improve the quality of life of sufferers. However, there is a lack of
distinction on the complementary nature of these interventions. Our primary research goal
was to assess the effectiveness of stability- and dynamic-style clinical interventions, focusing
on exercises to strengthen specific trunk muscles, including the transverse
abdominis/multifidus (stability-AB), and rectus abdominis/ erector spinae (dynamic). We
aimed to determine the effectiveness of these interventions in reducing non-specific chronic
lower back pain. Our research questions focused on whether a two-part clinical intervention
targeting specific core muscle groups (dynamic or stability) improves pain outcomes, whether
exercises targeting specific core muscle groups improve disability index physical impairment
and overall low back pain rating scale scores, and if there is a difference between intervention
groups and the sequential order of intervention for these outcomes. Additionally, we wanted
to investigate the correlation between these outcome measures and trunk endurance strength
scores. Seven participants were randomly assigned to either the stability (N =4) or dynamic
(N = 3) exercise group. Outcome measures included back and leg pain, lower back pain
visual analogue scale scores, disability index, physical impairment, and total Low Back Pain
Rating Scale (LBPRS) scores. Four measures of trunk endurance strength were taken using
Mcgill's Torso Endurance Test Battery (MTETB), which involves trunk extension, trunk
flexor, and trunk lateral tests on both the left and right sides. Assessments were performed
before the first clinical intervention, after the first intervention, and after the completion of
the final intervention. Each intervention phase lasted 4 weeks for each participant before they
switched to the opposing exercise group. The scores of back and leg pain, lower back pain,
disability index, and physical impairment all improved significantly after both interventions.
We found no difference between the groups during these intervention phases, or any potential
crossover/sequential effect, except for the dynamic group showing a significant improvement
in physical impairment scores after the first intervention, which remained consistent between
interventions one and two. In conclusion, both exercise approaches were similar across all
our outcome measures and may serve as complementary interventions for individuals
suffering from non-specific chronic low back pain.

year: 2024