Using interview data the present study applied a leading health care use explanatory model (the Anderson model) to a sample of 502 community-dwelling New Zealand Māori adults. To date the Andersen model has been applied extensively in overseas (principally U.S.) research, yet not specifically to an indigenous population such as the New Zealand Māori. The Andersen model proposes that health service use is a function of three components: predisposing, enabling and need characteristics. Using hierarchical multiple regression analyses three overarching research goals concerning the model were investigated: (1) To test the efficacy of the Andersen model in the prediction of Māori health care utilisation; (2) to extend the model by considering the role of life events as a predictor of Māori health service utilisation; and (3) to extend the model by considering the role of psychological distress as a predictor of Māori health service utilisation. As a further extension on previous work, the present study also sought to: (4) Extend the model by considering the role of traumatic experience in the prediction of Māori health service utilisation. The Andersen model was found to explain between 8.5% and 26% of variability in the sample's use of six types of health care, finding need characteristics to be the major determinants of health care use. Life events was not a significant contributor to explaining use, and psychological distress was effective only in predicting mental health service use. Findings suggest that using aggregate measures of traumatic experience is not a particularly helpful strategy for predicting subsequent health care use by Māori. On reflection of findings and implications the present study concludes with discussion concerning: (1) A need to advance conceptualisations of what constitutes health services for Māori; (2) suggestions for future examination of trauma and Māori health care use; (3) the role of culture in influencing health beliefs and behaviour; and (4) potential barriers to health care access by Māori.

Whole document restricted, see Access Instructions file below for details of how to access the print copy. / This exploratory study investigates Traumatic Brain Injury (TBI) rehabilitation processes and outcomes among culturally diverse outpatients in community-based rehabilitation who have sustained a Mild to Moderate TBI. The major aims of this study are twofold: firstly, to determine whether community-based rehabilitation outcomes following TBI differ across Mäori, Pacific and Pakeha cultures; and secondly, to determine and identify any service delivery needs for Mäori and Pacific people in TBI rehabilitation that may be distinct from Pakeha. A fixed comparative non-experimental design was utilised where participants were selected using direct control based on their self-identified ethnic group resulting in sub-samples of 11 Mäori, l1 Pacific and 11 Pakeha (n=33). A "Close Other" from their care-giving support network was selected by the participant to take part in the study (n=20). Each participant completed the Neurobehavioural Cognitive Status Examination (Cognistat), the Brain Injury Community Rehabilitation Outcome Scales (BICRO Scales), the Client Satisfaction Questionnaire (CSQ-31), the Beck Depression Inventory, 2nd Edition (BDI-II), the Impact of Events Scale Revised (IES-R) and a semi-structured qualitative interview, while a "Close Other" completed a BICRO "Carer" questionnaire. Results indicate that all participants were at a homogenous level of overall cognitive functioning but Pacific peoples scored significantly lower than both Mäori and Pakeha on two Language subtests and significantly lower than Pakeha on the Memory subtest. Statistical analysis suggests that both Years of Formal Education and English as a Second Language are important factors contributing to these differences. Individual handicap increased following TBI and decreased following rehabilitation, with no significant difference across cultures and suggesting efficacy of rehabilitation. Of the total sample, 42% scored in the clinically depressed range (half of whom were Pakeha) and 24% of the sample showed mild signs of post-traumatic stress (of whom almost 90% were Mäori or Pacific). Although 97% of participants were generally satisfied with their overall rehabilitation service, Mäori and Pacific people were significantly less satisfied with their Physical Surroundings and the Quantity of Services they received. In conclusion, there appears to be universalities in TBI experience and global rehabilitation outcomes that transcends individual cultures. However, there are micro-level cultural variations that have valuable implications when planning culturally appropriate rehabilitation services for the future. For Mäori and Pacific People, acculturation levels will determine the extent to which these implications apply.

Daily use of inhaled preventer medication is recommended for most people with asthma. However, research suggests many do not adhere to this regime. The current thesis comprises two research studies utilising the common-sense model of self-regulation as the theoretical basis to explore how people make decisions about inhaled preventer use in asthma. The purpose of Study One was to compare a self-report and an objective measure of adherence to preventer medication for asthma and to examine the illness representations and treatment beliefs associated with these measures. Accordingly, 1,936 U.K. General Practice patients who were using preventer medication for asthma completed a questionnaire assessing illness and medication perceptions and gave consent for information to be obtained from their medical records. Adherence to preventer medication was calculated from the Medication Adherence Report Scale (MARS) and an objective measure, the proportion of prescribed medication that the participant collected over the previous year. Results show that nearly nine out of ten participants (88.4%) reported some non-adherence to their preventer medication. The most common form of non-adherence was using preventer inhaler only when feeling breathless. The relationships between participants’ representations of their asthma and their beliefs about their preventer medication and adherence measures were tested using structural equation modelling. Seeing asthma as a condition that was not present when asymptomatic was associated with more non-adherence (β=.22 p<.001) and also with collecting a smaller proportion of prescribed preventer medication over the past year (β=-.15, p<.001). Seeing asthma as an acute condition, as a condition without serious consequences, and as a condition that could not be controlled by treatment were also representations associated with non-adherence. Those who did not see the need for preventer medication at all, or did not see the need for preventer medication when asymptomatic were more likely to be non-adherent. The relationship between illness representations and self-report adherence was mediated by the belief that medication was necessary. Having identified a number of key beliefs that were associated with use of preventer medication in asthma, Study Two explored the way in which these beliefs may be developed through the process of appraisal of the influence of medication use on symptom experience. Using quantitative methods, 77 patients from a New Zealand General Practice completed a questionnaire measuring the reasons for experimenting and stopping medication, illness representations and treatment beliefs. Thirty percent of the sample reported actively experimenting with their medication. These participants were more likely to hold the belief that medication did not help in the absence of symptoms (Mann-Whitney U=343.5, p<.05) and to report trying to avoid thinking about asthma (Mann-Whitney U=330.5, p<.05). Fifty-one of the participants were subsequently interviewed about their experiences with using medication and transcripts of these interviews were subjected to a qualitative analysis. Participants’ responses suggested that the process of appraising whether medication is necessary was influenced by the match between what the participant expects to happen when using the medication and what actually does happen. The process of deciding when medication is necessary is influenced by the threshold at which medication is deemed to be necessary and the speed at which symptoms return if medication is stopped. These findings have implications for the development of interventions to improve adherence to preventer medication for asthma. They suggest that a key component of self-management education is educating patients about the nature of asthma as a chronic condition that is present even in the absence of symptoms. Additionally, they provide evidence that many patients are involved in an active process of appraising the success of their medication. Health professionals should be aware of that this process is likely to be influenced by patients’ expectations of medication, the level of symptoms at which they believe action is required to control asthma and the speed at which symptoms return if medication is discontinued. Future research could take the form of a randomised controlled intervention to assess whether discussion of these factors with patients could improve quality of life for people with asthma. / Whole document restricted, but available by request, use the feedback form to request access.

In this thesis, Stroop task performance was investigated (using behavioural, electrophysiological and functional magnetic resonance imaging (fMRI) techniques) in late and proficient adult bilinguals currently living in the second language (L2) environment. Monolingual participants, matched for age and handedness, were recruited as controls. The Stroop colour-word task was considered an appropriate tool to test the general hypothesis that bilingualism might influence executive or cognitive control processes. In Study One, a dual-task paradigm was used for assessing the lateralisation of language functions (given the linguistic nature of the Stroop paradigm used here) in the bilinguals (Macedonian-English/M-E). Bilinguals showed a more bilateral hemispheric involvement, for both languages, compared to monolinguals. These findings also provided supporting evidence for the hypothesis of greater right-hemispheric involvement for language in bilinguals. In Study Two, two behavioural Stroop task paradigms (manual and verbal) were used in order to assess the magnitude of the Stroop effect between the groups. Bilinguals (M-E, German-English/G-E) showed a trend of smaller interference scores across both languages compared to monolinguals. In Study Three, manual Stroop task performance with concurrent electroencephalograph (EEG) recording revealed that bilinguals had temporal shifts in the N400 component (of about 30-40 ms) for the interference comparison for both languages compared to monolinguals. Also, relative to monolinguals, M-E bilinguals (for both L1 and L2) and G-E bilinguals (for L2) had fewer electrodes over frontal and central sites with a significant amplitude difference in the interference comparison (i.e., a reduced interference effect). In Study Four, the neural substrates engaged during Stroop task performance were investigated using fMRI. In general, monolinguals showed greater activation in regions such as the prefrontal cortex and anterior cingulate (regions associated with good executive control). This suggested that relative to bilinguals, monolinguals require more neural resources to accomplish conflict resolution. Taken together, Stroop task performance in late and proficient bilinguals currently living in the L2 environment differed from that of monolinguals across all methods of investigation. It appears that cognitive processing changes at the executive level can be observed as a result of bilingualism. The results also provide some evidence for changes in L1 processing following late L2 acquisition, as similar results across both languages and tasks were observed for the M-E bilinguals. It is also possible that slight modifications to cerebral laterality as a result of the late learning of (and continuous exposure to) a second language could contribute to these differences in executive functioning. The language environment might therefore be a major factor in the lateralisation of language processing and executive functioning in bilinguals. These conclusions, though tentative and require further investigation, have important implications for language and executive processing in general and for theories regarding cognitive flexibility in bilinguals. / Auckland University Doctoral Scholarship

Medical textbooks have previously represented women’s bodies and menopause life transitions by using notions of ‘machine productivity’ and ‘machine breakdown’ (Martin, 1987). This study aimed to explore whether these representations have changed, especially given recent HRT clinical trial results. Eight relevant compulsory medical textbooks for first and second year medical students at two New Zealand Universities were identified. A Foucauldian discourse analysis (Parker, 1990) was undertaken on relevant content to identify representations of menopause, HRT, women’s bodies, and ageing. Five major discourses were employed in the textbooks in descriptions of menopause and HRT: failure, estrogen deficiency as disease; HRT as saviour; obscurity and the new discovery discourse. Menopause continues to be represented as resulting from a ‘failure’ of a machine-like body. Although the recent HRT clinical trials were reported as a serious risk factor in half of the textbooks, HRT was also represented as a saviour particularly against postmenopausal osteoporosis. The discovery of ‘new’ drugs to ‘treat’ HRT and the ‘postmenopausal’ patient were heralded with much excitement. Medical textbooks continue to use failure discourses to describe women’s bodies at menopause. New risk-based HRT assessments for ‘patients’ with menopause ‘symptoms’ are promoted. These portrayals reinforce linear and reductionist ways of thinking about menopause and women at midlife and provide few spaces for resistance or alternative constructions to more accurately reflect women’s embodied worlds.

This current project begins with a brief history of Maori education since colonisation, and creates a picture of TWOA and its students and the struggle they undertook to develop into a first class education institution. Then, using Laclau and Mouffe’s discourse theory, I offer some deconstructive possibilities which provide alternative interpretations of the media discourse that ignited the public’s vilification of the institute. I describe what transpired over the time of 2005-2006 and critically examine and analyse the language used to express the two-party attack on TWOA and its Tumuaki, Rongo Wetere. I find that the language used by politicians and media commentators positioned TWOA as an inefficient and corrupt Maori institution in need of Pakeha (NZ European) governance and management. Through an investigation of the selection and promulgation of particular tropes, the interests of the political elite are shown as serving to marginalise the institution, limit its growth and channel its students into Pakeha educational institutions. The Wananga brought tertiary education to those New Zealanders who had hitherto been excluded or who had failed in mainstream education. Its astonishing success caused its decline.

Treatment for perpetrators of Intimate partner violence (IPV) is most often provided by community based IPV perpetrator programmes. These programmes have become an integral part of the response to IPV despite the fact that they are plagued by high rates of attrition and researchers suggest their effectiveness may be limited. It has been suggested that the retention rates and effectiveness of the programmes may be improved by tailoring treatment to specific subgroups of IPV perpetrators. This study was an evaluation of a community based IPV perpetrator programme. Participants were twenty two male IPV perpetrators who were court and not court ordered to treatment for violence towards a female intimate partner. Only seven participants completed the programme. Their self reported incidents of violence, alcohol consumption, change readiness and levels of working alliance were measured up to four times during the 18 week programme. Results indicated that participants who completed the programme or the majority of it significantly reduced their violence towards intimate partners and their levels of alcohol consumption. Higher levels of violence were associated with alcohol abuse and non court ordered status. As expected, court ordered participants reported lower levels of readiness to change and working alliance, and higher levels of alcohol abuse. However they were more likely to complete the programme compared with non court ordered participants. Implications of these findings are discussed.

The non-associative framework on fear argues that evolutionary-relevant fears, such as heights and water, are largely innate and do not require associative conditioning experiences to develop (Menzies & Clarke, 1993a, b; Poulton & Menzies, 2002a). However, this framework has been criticized for its reliance on retrospective recall for empirical support (Mineka & Öhman, 2002), which has been found to be highly unreliable (Taylor, Deane, & Podd, 1999). Thirty height-fearful undergraduate students completed the Origins Questionnaire-II (OQ-II; Menzies & Parker, 2001) and were classified into one of the several associative and non-associative pathways of fear onset based on their responses. A control group of 43 non-fearful students completed a modified version of the OQ-II to report any past experiences with heights. To examine the stability of these responses over time, the same questionnaires for both groups were completed again three months (Time 2) and 12 months (Time 3) after the initial administration of the test, along with measures of fear severity. Results showed that neither associative nor non-associative accounts took precedence over the other in explaining the onset of height fear. Instabilities in pathway ascriptions were observed in 18.18% of cases over three months (between Time 1 and Time 2), and 27.27% of cases over nine months (between Time 2 and Time 3). The theoretical and practical implications of the results are discussed with consideration of some of the study’s procedural and instrumental limitations. In light of these limitations, this study identified a substantial role of non-associative pathways on the development of height fear, and provided further support for the limitations of retrospective recall for ascertaining the pathway to fear onset.

Western health professions have historically struggled with the notion that spirituality could be studied empirically. This trend has changed in recent decades with there being a marked increase in the health literature pertaining to spirituality. For indigenous people spirituality is a fundamental attribute of their worldviews. Mäori, as the Indigenous people of Aotearoa, have always acknowledged the importance of wairua, (spirituality as defined by Mäori worldviews) to their health and well-being. This thesis aims to explore wairua as an important aspect of Mäori well-being from a psychological perspective. Two research goals underpin this thesis. The first goal involved developing an understanding of what Mäori mean when they talk about wairua. This was achieved through a qualitative study. While there are implicit shared understandings among Mäori regarding the nature of wairua, this study was one of the first attempts to make some of those shared understandings more explicit. The second goal involved investigating the relationship between an orientation to wairua and Mäori well-being using a newly developed measure. This was a quantitative study. Conceptualisations of wairua fell into four themes; direct descriptions, personal experiences, personal beliefs and Mäori worldviews. According to the qualitative information, wairua was described as a fundamental attribute that enables Mäori to engage with their reality; an intuitive consciousness. Through wairua Mäori identity is expressed, relationships are forged, balance is maintained, restrictions and safety are adhered to, healing is transmitted, and the connection between te ao wairua and te ao Mäori are maintained. These aspects of Mäori reality are inclusive and interconnected. The qualitative study information led to the formation of a 30 item self report measure named the Kia Ngawari ki te Awatea Orientation to Wairua measure. This measure was used to investigate the relationship between an orientation to wairua and Mäori health and well-being. The results showed that orientations to wairua had relatively modest associations with wellbeing when conceptualised and measured in a variety of ways. Due to the variability in the results, support for the overarching hypothesis of a relationship between wairua and well-being was mixed. A number of limitations were acknowledged with recommendations for future research offered. The findings of these studies have a number of implications for clinical psychological practice with Mäori clients.

Whole document restricted, see Access Instructions file below for details of how to access the print copy. / This exploratory study investigates Traumatic Brain Injury (TBI) rehabilitation processes and outcomes among culturally diverse outpatients in community-based rehabilitation who have sustained a Mild to Moderate TBI. The major aims of this study are twofold: firstly, to determine whether community-based rehabilitation outcomes following TBI differ across Mäori, Pacific and Pakeha cultures; and secondly, to determine and identify any service delivery needs for Mäori and Pacific people in TBI rehabilitation that may be distinct from Pakeha. A fixed comparative non-experimental design was utilised where participants were selected using direct control based on their self-identified ethnic group resulting in sub-samples of 11 Mäori, l1 Pacific and 11 Pakeha (n=33). A "Close Other" from their care-giving support network was selected by the participant to take part in the study (n=20). Each participant completed the Neurobehavioural Cognitive Status Examination (Cognistat), the Brain Injury Community Rehabilitation Outcome Scales (BICRO Scales), the Client Satisfaction Questionnaire (CSQ-31), the Beck Depression Inventory, 2nd Edition (BDI-II), the Impact of Events Scale Revised (IES-R) and a semi-structured qualitative interview, while a "Close Other" completed a BICRO "Carer" questionnaire. Results indicate that all participants were at a homogenous level of overall cognitive functioning but Pacific peoples scored significantly lower than both Mäori and Pakeha on two Language subtests and significantly lower than Pakeha on the Memory subtest. Statistical analysis suggests that both Years of Formal Education and English as a Second Language are important factors contributing to these differences. Individual handicap increased following TBI and decreased following rehabilitation, with no significant difference across cultures and suggesting efficacy of rehabilitation. Of the total sample, 42% scored in the clinically depressed range (half of whom were Pakeha) and 24% of the sample showed mild signs of post-traumatic stress (of whom almost 90% were Mäori or Pacific). Although 97% of participants were generally satisfied with their overall rehabilitation service, Mäori and Pacific people were significantly less satisfied with their Physical Surroundings and the Quantity of Services they received. In conclusion, there appears to be universalities in TBI experience and global rehabilitation outcomes that transcends individual cultures. However, there are micro-level cultural variations that have valuable implications when planning culturally appropriate rehabilitation services for the future. For Mäori and Pacific People, acculturation levels will determine the extent to which these implications apply.