title: A changing dialogue within health communication in New Zealand: a case study of the Waikato screening mammography programme

authors: Brunton, Margaret Ann

abstract: As part of changes in the health sector in New Zealand over the past decade, government has provided a number of community-based health interventions. The purpose of such interventions is to provide information and resources that will empower “well” individuals to participate in proactively managing their health, thereby contributing towards both cost and mortality savings.

In 1991, government introduced population-based screening mammography pilot programmes into two communities: one in Otago and Southland, the other in the greater Waikato region. As a community-based health intervention, the breast screening programme communicates with eligible women to encourage them to participate in screening mammograms every two years. The purpose is early detection and treatment of malignant tumours. However, to achieve mortality and cost savings the programme must attain a 70% participation rate of eligible women. The purpose of this research was to examine the ways in which the breast screening programme in the greater Waikato region communicates with women to encourage them both to participate in the programme and also return regularly. In turn, the ways in which a random sample of women responded to that communication were also examined.

To investigate the process, a triangulated approach to data collection and analysis was undertaken. First, a questionnaire survey was sent to a random sample of 1,085 women, stratified by age and ethnicity; 611 (58%) usable responses were returned. Following initial analysis of the questionnaire data, five focus groups were held with 41 women, and 3 individual interviews undertaken to further explore the outcomes from the questionnaire. Nineteen interviews were also held with staff in the breast screening programme to identify the influences on the ways in which they communicate with eligible women who undergo the process of mammography.

The resulting data were analysed and interpreted using a combined quantitative and qualitative approach. Fisher’s exact tests in 2x2 tables and chi-squared tests for independence in contingency tables were used to establish general trends in the data. Qualitative analysis was undertaken using interpretive thematic analysis (Owen, 1984) with a critical turn and reference to Ricoeur (1981).

The findings from this research emphasise the importance of effective communication in the process of screening mammography, to encourage both initial and ongoing participation. There were a number of discrepancies identified between the perception of staff and participants about the communication processes from the breast screening programme. The use of a random sample stratified by ethnicity further identified a number of statistically significant differences among ethnic groups in their responses to communication from the programme. The analysis identifies the divergent communication that women receive from staff in the breast screening programme.

The importance of communication in enhancing both the invitation and physical process for women participating in the population-based breast screening programme is highlighted in this research. Although the programme is provided as a community intervention there appears to be little consultation with participants. Accordingly, the diverse cultural needs of ethnic minority groups are not always recognised in the programme’s practice. A willingness to both recognise and incorporate the varied needs of women undergoing screening mammography would serve to not only enhance the process for participants but also assist the programme to attain the desired 70% participation rate of the eligible population.

text: A changing dialogue within health communication in New Zealand: a case study of the Waikato screening mammography programme As part of changes in the health sector in New Zealand over the past decade, government has provided a number of community-based health interventions. The purpose of such interventions is to provide information and resources that will empower “well” individuals to participate in proactively managing their health, thereby contributing towards both cost and mortality savings.

In 1991, government introduced population-based screening mammography pilot programmes into two communities: one in Otago and Southland, the other in the greater Waikato region. As a community-based health intervention, the breast screening programme communicates with eligible women to encourage them to participate in screening mammograms every two years. The purpose is early detection and treatment of malignant tumours. However, to achieve mortality and cost savings the programme must attain a 70% participation rate of eligible women. The purpose of this research was to examine the ways in which the breast screening programme in the greater Waikato region communicates with women to encourage them both to participate in the programme and also return regularly. In turn, the ways in which a random sample of women responded to that communication were also examined.

To investigate the process, a triangulated approach to data collection and analysis was undertaken. First, a questionnaire survey was sent to a random sample of 1,085 women, stratified by age and ethnicity; 611 (58%) usable responses were returned. Following initial analysis of the questionnaire data, five focus groups were held with 41 women, and 3 individual interviews undertaken to further explore the outcomes from the questionnaire. Nineteen interviews were also held with staff in the breast screening programme to identify the influences on the ways in which they communicate with eligible women who undergo the process of mammography.

The resulting data were analysed and interpreted using a combined quantitative and qualitative approach. Fisher’s exact tests in 2x2 tables and chi-squared tests for independence in contingency tables were used to establish general trends in the data. Qualitative analysis was undertaken using interpretive thematic analysis (Owen, 1984) with a critical turn and reference to Ricoeur (1981).

The findings from this research emphasise the importance of effective communication in the process of screening mammography, to encourage both initial and ongoing participation. There were a number of discrepancies identified between the perception of staff and participants about the communication processes from the breast screening programme. The use of a random sample stratified by ethnicity further identified a number of statistically significant differences among ethnic groups in their responses to communication from the programme. The analysis identifies the divergent communication that women receive from staff in the breast screening programme.

The importance of communication in enhancing both the invitation and physical process for women participating in the population-based breast screening programme is highlighted in this research. Although the programme is provided as a community intervention there appears to be little consultation with participants. Accordingly, the diverse cultural needs of ethnic minority groups are not always recognised in the programme’s practice. A willingness to both recognise and incorporate the varied needs of women undergoing screening mammography would serve to not only enhance the process for participants but also assist the programme to attain the desired 70% participation rate of the eligible population.

year: 2000

title: Finding synaptic couplings from a biophysical model of motor evoked potentials after theta-burst transcranial magnetic stimulation

authors: Wilson, Marcus T.

subjects: Cortical plasticity

abstract: OBJECTIVE: We aimed to use measured input-output (IO) data to identify the best fitting model for motor evoked potentials. METHODS: We analyzed existing IO data before and after intermittent and continuous theta-burst stimulation (iTBS & cTBS) from a small group of subjects (18 for each). We fitted individual synaptic couplings and sensitivity parameters using variations of a biophysical model. A best performing model was selected and analyzed. RESULTS: cTBS gives a broad reduction in MEPs for amplitudes larger than resting motor threshold (RMT). Close to threshold, iTBS gives strong potentiation. The model captures individual IO curves. There is no change to the population average synaptic weights post TBS but the change in excitatory-to-excitatory synaptic coupling is strongly correlated with the experimental post-TBS response relative to baseline. CONCLUSIONS: The model describes population-averaged and individual IO curves, and their post-TBS change. Variation among individuals is accounted for with variation in synaptic couplings, and variation in sensitivity of neural response to stimulation. SIGNIFICANCE: The best fitting model could be applied more broadly and validation studies could elucidate underlying biophysical meaning of parameters.

text: Finding synaptic couplings from a biophysical model of motor evoked potentials after theta-burst transcranial magnetic stimulation OBJECTIVE: We aimed to use measured input-output (IO) data to identify the best fitting model for motor evoked potentials. METHODS: We analyzed existing IO data before and after intermittent and continuous theta-burst stimulation (iTBS & cTBS) from a small group of subjects (18 for each). We fitted individual synaptic couplings and sensitivity parameters using variations of a biophysical model. A best performing model was selected and analyzed. RESULTS: cTBS gives a broad reduction in MEPs for amplitudes larger than resting motor threshold (RMT). Close to threshold, iTBS gives strong potentiation. The model captures individual IO curves. There is no change to the population average synaptic weights post TBS but the change in excitatory-to-excitatory synaptic coupling is strongly correlated with the experimental post-TBS response relative to baseline. CONCLUSIONS: The model describes population-averaged and individual IO curves, and their post-TBS change. Variation among individuals is accounted for with variation in synaptic couplings, and variation in sensitivity of neural response to stimulation. SIGNIFICANCE: The best fitting model could be applied more broadly and validation studies could elucidate underlying biophysical meaning of parameters.

year: 2023-02-15

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