Factors predicting forgone healthcare among Asian adolescents in New Zealand: unmasking variations in aggregate data.

AIM: To examine the relationship between social support, safety, healthcare experience and forgone healthcare for Asian secondary school students in New Zealand by unmasking variations in aggregate Asian data. METHODS: The study population included 1,911 Asians (1,272 East Asians and 604 South Asians) from the Youth19 survey. The reference group included 3,053 Pakeha. RESULTS: We found disparities in family socioeconomic status (SES), social support, safety in school and neighbourhood, healthcare experience and forgone healthcare between East Asians and South Asians compared to Pakeha. One in five Asians (20%) reported forgone healthcare. Compared to their Pakeha peers (18%), Asian students (AOR=1.18, CI=1.04-1.33) and East Asian students (AOR=1.24, CI=1.06-1.45) were more likely to experience forgone healthcare, but South Asian students were not (AOR=1.05, CI=0.86-1.28). Important unique predictors of forgone healthcare for both East and South Asian students were: being discriminated against by health professionals due to ethnicity, not having a family member to talk about their worries with, and unfair treatment by teachers. Other unique predictors varied: lower community and family SES, not getting enough quality time with family, and being bullied at school were significant predictors for East Asian students; low perceived neighbourhood safety was a predictor for South Asian students. CONCLUSIONS: A complicated picture underlies the seemingly positive findings for the overall Asian group. We highlight the importance of disaggregating Asian youth data into East Asian and South Asian, to identify disparities in risk/protective factors and better inform targeted interventions.

Factors influencing the negotiation of ethnic identity among 1.5 and second-generation Asian migrants: A mixed methods systematic review.

INTRODUCTION: Whilst positive ethnic identity is associated with higher self-esteem, prosocial tendencies and peer acceptance, it is inversely associated with depressive symptoms and drug use among ethnic minority individuals. Negotiating ethnic identity is particularly challenging for 1.5-and second-generation migrant populations, finding themselves positioned between host culture and culture of origin. To inform positive youth development policies and practices, this systematic literature review aimed to identify factors influencing the negotiation of ethnic identity for 1.5-and second-generation Asian migrants living in high-income countries. METHODS: A mixed-methods systematic review was conducted of peer-reviewed literature in four databases: MEDLINE, EMBASE, PsychInfo and Scopus. Articles were screened by title, abstract and full text to ascertain whether they met the inclusion criteria. Quality of studies were assessed using MMAT Version 2011. Mixed-method thematic analysis was used to synthesis the data according to Bronfenbrenner's Ecological Model. RESULTS: Forty-seven studies met the inclusion criteria. The review findings confirm a wide range of factors influencing the negotiation of ethnic identity from three systems in Bronfenbrenner's Ecological Model, most commonly from the macrosystem (e.g stereotyping), followed by microsystem (e.g family) and individual factors (e.g heritage language use). CONCLUSIONS: Results indicate negotiating ethnic identity can be challenging and difficult, where the culture/norms of country of origin and host country play a significant role. Positive youth development policies and practices need to reflect these wide range of factors. More research is needed in countries where data is not available to facilitate greater response to needs of this increasing population group.

Co-creating a large-scale adolescent health survey integrated with access to digital health interventions.

AIM: This paper describes how we engaged with adolescents and health providers to integrate access to digital health interventions as part of a large-scale secondary school health and wellbeing survey in New Zealand. METHODS: We conducted nine participatory, iterative co-design sessions involving 29 adolescents, and two workshops with young people (n = 11), digital and health service providers (n = 11) and researchers (n = 9) to gain insights into end-user perspectives on the concept and how best to integrate digital interventions in to the survey. RESULTS: Students' perceived integrating access to digital health interventions into a large-scale youth health survey as acceptable and highly beneficial. They did not want personalized/normative feedback, but thought that every student should be offered all the help options. Participants identified key principles: assurance of confidentiality, usability, participant choice and control, and language. They highlighted wording as important for ease and comfort, and emphasised the importance of user control. Participants expressed that it would be useful and acceptable for survey respondents to receive information about digital help options addressing a range of health and wellbeing topics. CONCLUSION: The methodology of adolescent-practitioner-researcher collaboration and partnership was central to this research and provided useful insights for the development and delivery of adolescent health surveys integrated with digital help options. The results from the ongoing study will provide useful data on the impact of digital health interventions integrated in large-scale surveys, as a novel methodology. Future research on engaging with adolescents once interventions are delivered will be useful to explore benefits over time.

What Is Meaningful Participation for Older People? An Analysis of Aging Policies.

BACKGROUND AND OBJECTIVES: The language used to construct policy problems influences the solutions created. Recent aging policies emphasize participation as essential to aging well, encouraging independence and active involvement in all aspects of life. However, it is less clear whether participation in the creation of policies or in policy goals and aspirations is meaningful. This article addresses the question: "How is meaningful participation reflected and enabled in policy?" RESEARCH DESIGN AND METHODS: Eleven global, national, and local policies were purposively selected and analyzed using thematic and discourse analysis. RESULTS: Policies framed population aging as a challenge and active aging as a value as or part of the policy-making process, participation is enabled (or not) through the types of participation encouraged by policy makers and the kinds of participation used to engage with older people. DISCUSSION AND IMPLICATIONS: Our analysis identifies a strong pattern of discourses regarding individual responsibility to age well; underlying tensions between productive and passive participation; and tensions inherent to the concept of consultation. Implications include the need for those in the consultative phase of policy making to engage with diverse older people and to use participatory methods to explore what meaningful participation means for older people themselves.