Background Some degree of cognitive decline is a normal, non-clinical part of aging. Physical exercise has been suggested as one strategy which may improve cognition in nondemented older adults. The findings of randomised, controlled trials conducted since the 1980s have been promising, but not unequivocal, and much remains to be understood about the relationship between exercise and cognition in older adults. There have also been suggestions that combining exercise and cognitive training may be beneficial. There has, however, been only one reported study comparing the benefits of exercise training, and combined exercise and cognitive training (Fabre, Chamari, Mucci, Masse-Biron, & Prefaut, 2002). While combined training was reported to be even more effective than exercise training alone for improving cognition in older adults, the study had some substantial limitations. Aims The overall aims of this thesis were to further explore the effect of exercise training on cognition in older adults, and to compare exercise training alone with combined exercise and cognitive training. Following a narrative review of the relevant literature, this thesis is presented in two parts. In Part One a randomized, controlled trial comparing the impact of exercise training, and combined exercise and cognitive training, on the cognitive functioning, physical functioning, functional performance, and psychological well-being of communitydwelling older adults is presented. For Part One, there were three specific aims: (1) To assess the efficacy of a 16 week exercise program (relative to control), on measures of cognitive functioning, physical functioning, functional performance, and psychological well-being; (2) To compare the efficacy of the 16 week exercise program with that of a 16 week combined exercise and cognitive training program; and (3) To identify the physical, psychological and training factors associated with changes in cognitive and physical functioning from baseline to post-test. In Part Two a qualitative evaluation of older adults’ experiences and perceptions of exercise training, and combined exercise and cognitive training, is presented. Methods Thirty-nine community dwelling, older adults (aged between 60 and 80 years) were randomly allocated to one of three groups: Exercise, Combination or Control. Participants in the Exercise group attended three aerobic and strength training sessions per week for 16 weeks. Participants in the Combination group attended two aerobic and strength training sessions, and one cognitive training session, per week for 16 weeks. Participants in the Control group were contacted every four weeks. Assessments were conducted at baseline, post-test (16 weeks) and six-month follow-up (40 weeks). Measures of physical function, cognitive function, functional performance, and psychological wellbeing were collected, along with anthropometric and physiological measures. For the qualitative evaluation, participants from the Exercise and Combination groups provided written feedback to questions about their experiences of the two training programs and their perceptions of the outcomes. These qualitative data were collected after post-test. Results Significant within-group improvements in physical and cognitive function, from baseline to post-test, were seen in Exercise and Combination participants. Combination participants also showed significant within-group reductions in symptoms of anxiety and depression. There were, however, only a few significant between-group differences among Exercise and Control participants, and among Exercise and Combination participants. There were no significant within-group improvements in functional performance, from baseline to post-test, among Exercise or Combination participants. Six-month follow-up data were difficult to interpret, due to the paucity of between-group differences at post-test and the small sample size. There were several significant associations between physical, psychological and training factors, and changes in cognitive and physical functioning. The most pertinent finding was that baseline functioning was consistently associated with change, such that participants with low baseline scores were most likely to improve from baseline to posttest. In the qualitative evaluation participants reported positive experiences of the training programs and reported improvements in physical, cognitive, functional and psychological wellbeing. Participants also highlighted components of the programs which require improvement and made recommendations for future programs. Conclusions The results of this thesis provide some cautious support for the notion that exercise, and combined exercise and cognitive training, may result in small improvements in cognition, physical functioning, and psychological well-being in older adults. Some of the findings must be interpreted with caution, however, given the small sample size. More research is required into the functional (or ‘real world’) impact of this type of training, the long-term effects of training, and the factors associated with changes in cognitive and physical function. Based on these findings, recommendations for the development and implementation of future research were made. As the population ages and the public health burden attributable to aging increases, research into the development and efficacy of programs to enhance well-being and independence in older adults is of great importance.

Prescription medicine samples are a product based promotion designed to facilitate brand switching or uptake of a new product. Marketing of pharmaceuticals differs from other products since the primary decision maker (doctor) is not the ultimate consumer (patient). Marketing of medicines also has an overlay of government regulations and political influence. It is argued whether free samples of prescription medicines provided to doctors constitute a “gift” or a trial quantity with which to initiate therapy and test patient tolerance of the drug concerned. Either way, samples are an integral part of the prescription medicine marketing tapestry and they have become woven into the “fabric” of drug promotion. The international literature abounds with papers describing pharmaceutical promotion and myriads of surveys obtaining prescribers’ opinions about pharmaceutical promotion. Few studies have been conducted or reported to ascertain the reasons behind the opinions expressed as disagreement/agreement scales to specific statements. Interventions to alter practice targeting alternative methods of distribution of samples (rather than direct from company to prescriber) are also rare; therefore the aim of this research was to qualitatively explore opinions regarding samples to develop an intervention to ensure samples do not have an adverse effect on prescribing practice and to test the model in a practice environment. In order to assess the place of samples within the totality of pharmaceutical promotion, a model was derived from the literature and tested with a hypothetical, but realistic practice-based scenario. This highlighted the interplay between the various methods involved in pharmaceutical promotion, their target audiences and the potential interplay and synergism that could be achieved through a co-ordinated campaign. Quantification of the expenditure on samples was also required in the Australian context to assess the potential impact of interventions targeting this promotional mode. Samples were found to account for approximately 5% of the total marketing spend in Australia. No clear relationship could be found between sample expenditure and drug sales, utilizing data on the proton pump inhibitor therapeutic class. However, a pattern of decaying spending was found between the amount spent on samples per unit pack dispensed and the time a product had been available on the market. A range of interested parties were then interviewed to gain their opinions about free prescription medicine samples. The interviews were split into two groups: consumers, pharmacists and practicing general practitioners (GPs) provided an operational level focus, while a range of key informants from organisations involved in Quality Use of Medicines in Australia provided a strategic overview. The transcripts of the focus groups and interviews were qualitatively analysed to extract key themes which were quite similar. Examples included ‘pay’ in the operational group compared to ‘cost’ in the strategic group. These concepts express a similar sentiment, yet ‘pay’ is a more personal action whereas ‘cost’ does not imply who must meet the financial outlay. These resultant themes formed the basis of the intervention developed to pilot in a practice environment to assess its practicality for wider study. In addition to the extensive interview process, a mail survey was conducted in three divisions (geographical groupings) of general practice. Each family doctor (General Practitioner (GP)) and community pharmacist within the divisions received a questionnaire to gather their opinions about samples. This was the first time GPs and pharmacists had been surveyed simultaneously to gather comparative results. No differences were found between the metropolitan division and the accumulated results from the two regional divisions. Pharmacists and GPs differed predominantly in their perceptions of promotional influence of samples, appropriateness of self use and meeting legal requirements for labelling dispensed medicines. These factors were incorporated in the pilot study design. An action research methodology was utilised to assess the practicality of community pharmacist dispensing of starter packs for antihypertensives and antidepressants in two regional GP practices in Queensland, Australia. In this pilot study, a total of 32 starter packs were prescribed to 31 patients over the four months of the intervention period, with 29 (91%) dispensed at a study pharmacy and 17 (53%) of subsequent full prescriptions able to be tracked through Medicare Australia data or the study pharmacies. Antidepressants comprised the majority of prescriptions (n=16, 55%) Each of the 29 patients who received a starter pack completed a patient survey which demonstrated high levels of support (n=22, 76%) for the model in the pilot. GPs and pharmacists involved in the pilot were also generally supportive of the pilot model. In conclusion, opinions held about free prescription medicine samples by a wide range of apparently disparate groups show similar themes and community pharmacist involvement in dispensing starter (or sample) packs has general acceptance. The model piloted in this research was applicable in daily practice for general practitioners and community pharmacists in Australia. Consumers accepted the pilot model as an acceptable change to current procedures. The research presented in this thesis provides a solid foundation for development of a more widespread trial for dispensing of all prescription medicine starter packs through community pharmacies to be rigorously evaluated in Australia.

Adolescence is a time of experimentation and exploration. For many young people, a feature of this developmental period is the initiation of substance use. Whilst the majority of young people do not go on to develop substance use problems, any substance use has potential for danger. The current body of literature on the prevention of substance use problems suggests that in order to advance understanding, researchers must adopt a risk-focused approach. There is a wide range of indices that have been cited as risk factors for the development of substance use disorders. Chapter 2 explores some of the aetiological models and literature on risk factors with specific reference to psychological wellbeing, studies highlighting comorbid relationships between adolescent mental health and substance use problems, and the functional value of substances in relation to well-being. Although attention to psychological risk factors has received increased press in the literature, the number of controlled, longitudinal studies is relatively small. A review of recent studies (Chapter 3) indicates that the presence of anxiety, depression, low self-esteem or behavioural problems such as delinquency represent psychological risk factors for the development of later substance use problems, however findings are inconsistent and many studies do not examine differential predictive utility by substance or gender. Thus, Study 1 of this research aimed to add to this body of work by exploring the prediction of alcohol, cannabis and other illicit substance use at age fifteen from key indicators of psychological well-being taken at age thirteen. The data from a normative sample of high school students indicated subtle differences in trajectory for young males and females and effects specific to different drug categories. Delinquency emerged as the most consistent predictor in both males and females. Low self-esteem was also an important indicator for future female marijuana use and marijuana intoxication and both male and female other illicit substance use. The findings highlighted the need for a greater contextual understanding of the relationship between delinquency, self-esteem and substance use. The second study sought to provide a deeper understanding of these issues by examining the perceived functional value of substances in relation to psychological wellbeing, by means of a qualitative study of a group of young people who had experienced problems with their substance use. Chapter 4 explores the limited phenomenological research in this area, with a focus on studies which have used methods of measurement that highlight the perspective of young people. Using a Consensual Qualitative Research approach, Study 2 builds on the drug type and gender contrasts noted in Study 1, and explores the interface between substance use and psychological well-being in depth using a clinical population. A number of key functions are identified by young people, with evidence of both convergence and divergence across drug categories (alcohol, cannabis, other illicit substances). Interviewees reported six functions common to all substances; social connectedness, improve affect, positive self-transformation, better coping with problems, fun and laughter, and feeling intoxicated. Nine additional functions were identified in relation to cannabis and other illicit substances. Several gender differences were also noted, with males tending to report more positive reinforcement from alcohol and cannabis, and young females more frequently describing benefits related to use of other illicit substances. The concluding chapter (Chapter 5) reviews the main findings across both studies and their implications for theory, practice, and future research. Overall, the findings of the research provide support for both problem behaviour and adaptive models of adolescent substance use, and indicate that young people are capable of reflecting on their substance use experiences. Incorporating the wisdom of young people into risk frameworks may enhance prevention, education and intervention efforts.

Adolescence is a time of experimentation and exploration. For many young people, a feature of this developmental period is the initiation of substance use. Whilst the majority of young people do not go on to develop substance use problems, any substance use has potential for danger. The current body of literature on the prevention of substance use problems suggests that in order to advance understanding, researchers must adopt a risk-focused approach. There is a wide range of indices that have been cited as risk factors for the development of substance use disorders. Chapter 2 explores some of the aetiological models and literature on risk factors with specific reference to psychological wellbeing, studies highlighting comorbid relationships between adolescent mental health and substance use problems, and the functional value of substances in relation to well-being. Although attention to psychological risk factors has received increased press in the literature, the number of controlled, longitudinal studies is relatively small. A review of recent studies (Chapter 3) indicates that the presence of anxiety, depression, low self-esteem or behavioural problems such as delinquency represent psychological risk factors for the development of later substance use problems, however findings are inconsistent and many studies do not examine differential predictive utility by substance or gender. Thus, Study 1 of this research aimed to add to this body of work by exploring the prediction of alcohol, cannabis and other illicit substance use at age fifteen from key indicators of psychological well-being taken at age thirteen. The data from a normative sample of high school students indicated subtle differences in trajectory for young males and females and effects specific to different drug categories. Delinquency emerged as the most consistent predictor in both males and females. Low self-esteem was also an important indicator for future female marijuana use and marijuana intoxication and both male and female other illicit substance use. The findings highlighted the need for a greater contextual understanding of the relationship between delinquency, self-esteem and substance use. The second study sought to provide a deeper understanding of these issues by examining the perceived functional value of substances in relation to psychological wellbeing, by means of a qualitative study of a group of young people who had experienced problems with their substance use. Chapter 4 explores the limited phenomenological research in this area, with a focus on studies which have used methods of measurement that highlight the perspective of young people. Using a Consensual Qualitative Research approach, Study 2 builds on the drug type and gender contrasts noted in Study 1, and explores the interface between substance use and psychological well-being in depth using a clinical population. A number of key functions are identified by young people, with evidence of both convergence and divergence across drug categories (alcohol, cannabis, other illicit substances). Interviewees reported six functions common to all substances; social connectedness, improve affect, positive self-transformation, better coping with problems, fun and laughter, and feeling intoxicated. Nine additional functions were identified in relation to cannabis and other illicit substances. Several gender differences were also noted, with males tending to report more positive reinforcement from alcohol and cannabis, and young females more frequently describing benefits related to use of other illicit substances. The concluding chapter (Chapter 5) reviews the main findings across both studies and their implications for theory, practice, and future research. Overall, the findings of the research provide support for both problem behaviour and adaptive models of adolescent substance use, and indicate that young people are capable of reflecting on their substance use experiences. Incorporating the wisdom of young people into risk frameworks may enhance prevention, education and intervention efforts.

Adolescence is a time of experimentation and exploration. For many young people, a feature of this developmental period is the initiation of substance use. Whilst the majority of young people do not go on to develop substance use problems, any substance use has potential for danger. The current body of literature on the prevention of substance use problems suggests that in order to advance understanding, researchers must adopt a risk-focused approach. There is a wide range of indices that have been cited as risk factors for the development of substance use disorders. Chapter 2 explores some of the aetiological models and literature on risk factors with specific reference to psychological wellbeing, studies highlighting comorbid relationships between adolescent mental health and substance use problems, and the functional value of substances in relation to well-being. Although attention to psychological risk factors has received increased press in the literature, the number of controlled, longitudinal studies is relatively small. A review of recent studies (Chapter 3) indicates that the presence of anxiety, depression, low self-esteem or behavioural problems such as delinquency represent psychological risk factors for the development of later substance use problems, however findings are inconsistent and many studies do not examine differential predictive utility by substance or gender. Thus, Study 1 of this research aimed to add to this body of work by exploring the prediction of alcohol, cannabis and other illicit substance use at age fifteen from key indicators of psychological well-being taken at age thirteen. The data from a normative sample of high school students indicated subtle differences in trajectory for young males and females and effects specific to different drug categories. Delinquency emerged as the most consistent predictor in both males and females. Low self-esteem was also an important indicator for future female marijuana use and marijuana intoxication and both male and female other illicit substance use. The findings highlighted the need for a greater contextual understanding of the relationship between delinquency, self-esteem and substance use. The second study sought to provide a deeper understanding of these issues by examining the perceived functional value of substances in relation to psychological wellbeing, by means of a qualitative study of a group of young people who had experienced problems with their substance use. Chapter 4 explores the limited phenomenological research in this area, with a focus on studies which have used methods of measurement that highlight the perspective of young people. Using a Consensual Qualitative Research approach, Study 2 builds on the drug type and gender contrasts noted in Study 1, and explores the interface between substance use and psychological well-being in depth using a clinical population. A number of key functions are identified by young people, with evidence of both convergence and divergence across drug categories (alcohol, cannabis, other illicit substances). Interviewees reported six functions common to all substances; social connectedness, improve affect, positive self-transformation, better coping with problems, fun and laughter, and feeling intoxicated. Nine additional functions were identified in relation to cannabis and other illicit substances. Several gender differences were also noted, with males tending to report more positive reinforcement from alcohol and cannabis, and young females more frequently describing benefits related to use of other illicit substances. The concluding chapter (Chapter 5) reviews the main findings across both studies and their implications for theory, practice, and future research. Overall, the findings of the research provide support for both problem behaviour and adaptive models of adolescent substance use, and indicate that young people are capable of reflecting on their substance use experiences. Incorporating the wisdom of young people into risk frameworks may enhance prevention, education and intervention efforts.

Adolescence is a time of experimentation and exploration. For many young people, a feature of this developmental period is the initiation of substance use. Whilst the majority of young people do not go on to develop substance use problems, any substance use has potential for danger. The current body of literature on the prevention of substance use problems suggests that in order to advance understanding, researchers must adopt a risk-focused approach. There is a wide range of indices that have been cited as risk factors for the development of substance use disorders. Chapter 2 explores some of the aetiological models and literature on risk factors with specific reference to psychological wellbeing, studies highlighting comorbid relationships between adolescent mental health and substance use problems, and the functional value of substances in relation to well-being. Although attention to psychological risk factors has received increased press in the literature, the number of controlled, longitudinal studies is relatively small. A review of recent studies (Chapter 3) indicates that the presence of anxiety, depression, low self-esteem or behavioural problems such as delinquency represent psychological risk factors for the development of later substance use problems, however findings are inconsistent and many studies do not examine differential predictive utility by substance or gender. Thus, Study 1 of this research aimed to add to this body of work by exploring the prediction of alcohol, cannabis and other illicit substance use at age fifteen from key indicators of psychological well-being taken at age thirteen. The data from a normative sample of high school students indicated subtle differences in trajectory for young males and females and effects specific to different drug categories. Delinquency emerged as the most consistent predictor in both males and females. Low self-esteem was also an important indicator for future female marijuana use and marijuana intoxication and both male and female other illicit substance use. The findings highlighted the need for a greater contextual understanding of the relationship between delinquency, self-esteem and substance use. The second study sought to provide a deeper understanding of these issues by examining the perceived functional value of substances in relation to psychological wellbeing, by means of a qualitative study of a group of young people who had experienced problems with their substance use. Chapter 4 explores the limited phenomenological research in this area, with a focus on studies which have used methods of measurement that highlight the perspective of young people. Using a Consensual Qualitative Research approach, Study 2 builds on the drug type and gender contrasts noted in Study 1, and explores the interface between substance use and psychological well-being in depth using a clinical population. A number of key functions are identified by young people, with evidence of both convergence and divergence across drug categories (alcohol, cannabis, other illicit substances). Interviewees reported six functions common to all substances; social connectedness, improve affect, positive self-transformation, better coping with problems, fun and laughter, and feeling intoxicated. Nine additional functions were identified in relation to cannabis and other illicit substances. Several gender differences were also noted, with males tending to report more positive reinforcement from alcohol and cannabis, and young females more frequently describing benefits related to use of other illicit substances. The concluding chapter (Chapter 5) reviews the main findings across both studies and their implications for theory, practice, and future research. Overall, the findings of the research provide support for both problem behaviour and adaptive models of adolescent substance use, and indicate that young people are capable of reflecting on their substance use experiences. Incorporating the wisdom of young people into risk frameworks may enhance prevention, education and intervention efforts.

A clash in perception is taking place. Some perceive predictive genetic testing in young people to be too potentially harmful to allow. Others perceive it to be an opportunity for benefit, even an opportunity for the prevention of harm. In this thesis I consider the issue of potential harm to mature young people who seek predictive genetic tests. / There are two parts to this thesis. In part one (chapters 1-4) I provide a background to the current debate. I describe the prohibitive stance purported within current guidelines, the arguments used to justify this stance and the opposition that has arisen in response. I discuss the psychological and social ways in which young people differ from adults, arguing that it is likely young people will react differently from adults in response to predictive genetic tests. However, I conclude that the lack of empirical evidence means we are unable to determine if these differences will confer a greater potential for harm or benefit when young people are tested. Finally, I present a discussion of two fundamental gaps in our knowledge about testing in young people: a lack of knowledge about current practice and a lack of first-hand evidence about the effects of testing. I argue that empirical research is required. / In part two of this thesis (chapters 5-7) I present the findings of my own empirical research. Firstly, I describe the findings of an international survey of clinical geneticists. Secondly, I describe the outcomes of 18 in-depth interviews performed with young people who have experienced predictive genetic testing for either Familial Adenomatous Polyposis or Huntington Disease. These young people ranged in age from 14 to 25 years. / The international survey uncovered 49 cases where predictive genetic tests had been provided to young people for non-medical reasons. When such tests are provided, the impacts are rarely followed-up as part of a formal research protocol. Clinicians’ reasons for providing and refusing tests are highly varied and are driven more by the nuances of individual cases than by any one ethical principle or set of guidelines. / When young people talk about the predictive genetic tests they have experienced, they refer to the entire experience of being at risk of a genetic condition, not simply the time after receipt of their test result. Young people speak about a far more extensive range of harms and benefits associated with the testing process than have been previously researched. / I argue that some young people growing up at risk of a genetic condition suffer several harms prior to their request for predictive genetic testing, because of their risk status. I argue that when we understand this, it becomes clear that for these mature young people who seek such testing, the provision of a test may not only serve to alleviate some of these harms, but may in fact create benefits for them, irrespective of their test result. In these cases, the provision of a predictive genetic test is appropriate, logical and ethical.

The ability to implement strategies successfully is important to any organisation. Despite the importance of the implementation process within strategic management, this is an area of study often overshadowed by a focus on the strategy formulation process. This thesis concentrates on the strategy implementation process, investigating barriers to strategy implementation. A research framework called the Organisational Minefield was developed to represent the importance of the implementation process to organisations. In contrary to most studies available in strategic management, this research included participants from all levels of the organisation.To identify barriers to strategy implementation, a case study of Air New Zealand was conducted. This involved focussed interviews with 28 participants from the Network and Revenue Management Department of Air New Zealand. Other sources of data such as research articles and secondary company data sources were also used.The findings revealed that: participants from different levels of the organisation have unique perceptions of the implementation process; implementation variables could become roadblocks that undermine the implementation process; these barriers can be overcome if managers are perceptive to the organisation's current situation; and the Organisational Minefield framework presented verified the significance of the role of barriers in the implementation process. The findings add two additional barriers to implementation, namely leadership and power. It was also discovered that the participants acknowledged that these two barriers will impede or enhance the success of Air New Zealand. This was backed by the level of commitment and loyalty shown by the participants, which brought Air New Zealand one step closer to unravelling the mysteries of the implementation process.

A qualitative descriptive approach was undertaken to explore the experience of eight registered nurses and two hospital play specialists who care for children hospitalised with burn injuries. The research participants were recruited from a paediatric ward that offers centralised specialty care to children with burns. Collected through face-to-face interviews, the participants' stories were tape-recorded and transcribed verbatim using a process for analysis informed by van Manen, (1997b).Emerging out of the data was the over-arching theme of 'passionate dedication' that shows the nurses and hospital play specialists genuine compassion and commitment to meet the needs of the children with burns. The findings of the study reveal that the participant's dedication is shaped and determined by a dynamic process that involves having professional integrity and in-depth knowledge of caring for children and burn management. The nurses and the hospital play specialists have a common understanding of what their role entails and the skills required to provide quality care and support to the children and the children's family. On a personal and professional level the participants encounter several challenges in this care context that are physically and emotionally overwhelming. Despite becoming overwhelmed the participants are revealed as being resourceful and resilient in their aptitude to find ways that enable them to cope and get through.This study supports international literature that suggests that caring for children with burns is equally rewarding, as much as it is physically and emotionally demanding. The implication in this study for the organisation is to seriously consider issues regarding productivity and efficiency of the workforce with acknowledgement that nurses and hospital play specialists cannot do this emotional work without effective systems of support in place. With the help of team leaders, managers and educators, the organisation will need to consider ways to monitor the job satisfaction of their staff. Furthermore, reinforce existing comprehensive measures, such as mentorship and clinical supervision programmes to encourage the retention and well-being of all staff, at all stages of their career on the children's burn ward.

This qualitative, descriptive study explored physiotherapists' experience of participating in peer review in public and private health services in New Zealand. Peer review is a professional activity where one health practitioner evaluates the practice of another. Accordingly, much professional effort has been expended on developing peer review systems and implementing review processes, yet the benefits of peer review are uncertain. A changing legislative environment where producing evidence of ongoing professional development is required, has provided impetus for this study given the limited research to support the use of peer review in this context. While the literature identifies competing focuses on professional development and accountability, there is lack of clarity about which model of peer review is being implemented in this country and which might serve the profession better. This study is a first step in clarifying the issues by identifying the personal, professional and organisational factors that influence health professionals' participation in peer review. The methodology consisted of a qualitative descriptive approach situated within a post positivist paradigm. Seven physiotherapists working in the New Zealand health system who had participated in a peer review process within the last 3 years participated in this study. Semi structured interviews were conducted, guided by broad questions relating to central themes identified during an extensive literature review. Interviews were then audio taped and transcribed verbatim to form the data. Transcripts were analysed by assigning content labels to units of text that seemed to encapsulate one complete thought or idea. The labelled groups were analysed into sub themes. Finally, the general themes that arose were described. Findings indicate that while peer review systems have been developed and are carried out as prescribed, therapists lack clarity about the intended outcomes. While recognising the benefits of receiving feedback on practice, many manage the review process to maintain positive working relationships and ensure their practice is favourably reviewed. The strategies they employ and the consequences of managing peer review in these ways are described. Current peer review processes in New Zealand do not provide reliable information about competence to practice. Neither do they fully achieve their potential as a professional development tool. Therefore, the professional emphasis and effort on peer review needs to be revisited. The findings highlight the need for consultation amongst individual physiotherapists, physiotherapy managers, physiotherapy professional organisations, and the registration board, to negotiate whether regulatory or professional development needs will drive peer review processes in New Zealand in the future.