Conversion practices in Aotearoa New Zealand: Developing a holistic response to spiritual abuse.

Research arising from conversion practices, also known as conversion therapy and sexual orientation and gender identity change efforts, has generally been underpinned by an emancipatory discourse that has evolved to counter harmful practices by evidencing associated harms and estimating prevalence. Little attention, however, has focused on what is required to support survivors, inclusive of those currently or those having previously experienced conversion efforts. Within a context of Aotearoa New Zealand having recently criminalised conversion practices, this study adopted an in-depth qualitative research design, informed by a dual adherence to life history and an empowerment methodology. Twenty-three religious conversion practice survivors, who had experienced religious conversion practices across a range of Christian identified faith settings, were interviewed. Participants had a median age of 34 and the majority identified as New Zealand European, cisgender, and gay. Participant narratives were discursively analysed. Three primary discourses were identified that inform the needed development of interventions and supports: 1) pervasive framing of conversion practices as harm, rather than spiritual abuse, has minimised the impacts of conversion practices. Rather, conceptualising conversion as spiritual abuse positions conversion practices as requiring urgent intervention and ongoing support, inclusive of the development of policy and operational responses; 2) the coercive nature of spiritual abuse needs to be appreciated in terms of spiritual, social, and structural entrapment; 3) the metaphor of a pipeline was enlisted to encapsulate the need for a multidimensional array of interventions to ensure those entrapped within spiritual abuse have a "pipeline to safety". Holistic survivor-centric conversion-related responses to spiritual abuse are required. These need to be informed by an understanding of entrapment and the associated need for holistic responses, inclusive of extraction pathways and support for those entrenched within abusive religious settings, support immediately after leaving abusive environments, and support throughout the survivors' healing journeys.

Disabled people's experiences accessing healthcare services during the COVID-19 pandemic: a scoping review.

BACKGROUND: Disruptions to healthcare services during the COVID-19 pandemic are well-recognised problems. However, a dearth of research exists on disabled people's experiences with accessing these services. A scoping review was undertaken to identify and explore research on the experience of disabled people in accessing healthcare services between 2020 and 6 February 2023. METHODS: PubMed, Web of Science, CINAHL, and OVID were employed to search for research that included the voice of disabled people, or their parents or caregivers. Over two distinct phases, a total of 2,201 articles were reviewed according to article titles, keywords, and abstracts. Eighty-one studies were identified that met the inclusion criteria; these were reviewed in full. RESULTS: Eighteen studies specifically described the experiences of accessing healthcare or disability services, and sixty-three raised healthcare challenges as a secondary consideration. Many disabled people struggled to access healthcare services and felt they were invisible; as a result, individuals' mental health was negatively affected. Disabled people with compounding vulnerabilities were at the most risk of experiencing a lack of healthcare access. CONCLUSIONS: There is an urgent need for research and policy that is responsive to disabled people's access to healthcare during the pandemic; currently many health policies are 'disability-blind' and exclude these members of the global community. Furthermore, to assist in creating disability-responsive research, funding needs to prioritise researchers within the disabled community.

Ableism, Human Rights, and the COVID-19 Pandemic: Healthcare-Related Barriers Experienced by Deaf People in Aotearoa New Zealand.

The COVID-19 pandemic significantly affected global healthcare access and exacerbated pre-pandemic structural barriers. Literature on disabled people's experiences accessing healthcare is limited, with even less framing healthcare access as a human rights issue. This study documents and critically analyses Deaf people's healthcare access experiences in Aotearoa New Zealand during the COVID-19 pandemic. Eleven self-identified Deaf individuals participated in semi-structured videoconferencing interviews. Discourse analysis was applied to participant narratives with discourses juxtaposed against a human rights analysis. Barriers influencing healthcare access included: (1) the inability of healthcare providers to communicate appropriately, including a rigid adherence to face mask use; (2) cultural insensitivity and limited awareness of Deaf people's unique needs; and (3) the impact of ableist assumptions and healthcare delaying care. Barriers to healthcare access represent consecutive breaches of rights guaranteed under the United Nations Convention on the Rights of Persons with Disabilities (CRPD). Such breaches delay appropriate healthcare access and risk creating future compounding effects. Action is required to address identified breaches: (1) The CRPD should also underpin all health policy and practice development, inclusive of pandemic and disaster management responsiveness. (2) Health professionals and support staff should be trained, and demonstrate competency, in Deaf cultural awareness and sensitivity.

Re-orientating health and nursing care: a qualitative study on indigenous conceptualisations of wellbeing.

BACKGROUND: Health systems often fail to address the wellbeing needs of older Indigenous populations; this is attributed to a lack of knowledge of Indigenous health systems arising from a privileging of dominant western biomedical epistemologies. In Aotearoa/New Zealand, there is a dearth of nursing knowledge relating to Maori, which negatively impacts on the provision of holistic nursing care. This research explores insights and perspectives of older Maori adult's (pakeke) perceptions of wellbeing so nurses can provide culturally responsive care and support the wellbeing of Indigenous New Zealanders. METHODS: An Indigenous kaupapa Maori methodology underpinned and directed this research project. Audio-recorded interviews were conducted face to face in participants' homes, marae (meeting house) and workplaces. Pakeke over the age of 55 participated in in-depth interviews. A total of 10 pakeke were interviewed and narratives were thematically analysed in accordance with meanings derived from Maori worldviews. RESULTS: Wellbeing was attributed to the holistic interconnection and balancing of whanau (wider family), whanaungatanga (social connectedness), hinengaro (mental and emotional wellbeing), taha tinana (physical wellbeing) and wairua (spirituality). CONCLUSION: The findings offer unique insights into how wellbeing is constructed for pakeke; the results are unique but consistent with international accounts of older Indigenous peoples. Pakeke wellbeing can be supported by acknowledging existing cultural and spiritual beliefs and peer-support initiatives. Nursing models of care should prioritise Indigenous ways of knowing; this research offers nursing-focused recommendations to improve care.

Access to Health and Disability Services for New Zealanders With Impaired Vision During the COVID-19 Pandemic 2020-2022.

Introduction: The COVID-19 pandemic has affected access to health and social services globally, leading to delays in accessing appropriate care. However, while there is a growing base of research into service access for the general population, there remains scarce information on the implications of the pandemic on disabled people. This article describes issues with health and disability support access for people with impaired vision in Aotearoa New Zealand (Aotearoa). Methods: Applying an Interpretive Description methodology, 62 interviews were conducted with disabled people; 10 of these individuals identified as having impaired vision. Findings were analyzed thematically for the entire group of 62, representing varied impairment groups, and then for the 10 who had impaired vision. Results: Five key themes arose from the interviews, including transportation difficulties, mental distress, loss of community, loss of physical contact and signals, and general loss of support. Participants identified that this loss of support occurred at multiple levels, meaning that the disability and healthcare system as a whole was ill-equipped to manage their needs. Participants reported a lag-time in accessing care, meaning that the effects of the pandemic are still felt due to a lack of available support and resources. Discussion: This article remains one of a few studies to look at the implications of the pandemic on access to health and disability services for those with impaired vision. It highlights that despite Aotearoa's good track record in managing the pandemic, groups were forgotten and marginalized by the collective response to managing COVID-19. Implications for Practitioners: Blindness professionals must be aware of the possible disadvantages and impacts of pandemics and other disasters on people with impaired vision and their access to health and disability services. Policymakers must include disabled people at the decision-making table so that the diverse needs of these populations are managed.

Evaluation of a Healthy Relationship Smartphone App With Indigenous Young People: Protocol for a Co-designed Stepped Wedge Randomized Trial.

BACKGROUND: We co-designed a smartphone app, Harmonised, with taitamariki (young people aged 13-17 years) to promote healthy intimate partner relationships. The app also provides a pathway for friends and family, or whanau (indigenous Maori extended family networks), to learn how to offer better support to taitamariki. OBJECTIVE: The aim of our taitamariki- and Maori-centered study is to evaluate the implementation of the app in secondary schools. The study tests the effectiveness of the app in promoting taitamariki partner relationship self-efficacy (primary outcome). METHODS: We co-designed a pragmatic, randomized, stepped wedge trial (retrospectively registered on September 12, 2019) for 8 Aotearoa, New Zealand, secondary schools (years 9 through 13). The schools were randomly assigned to implement the app in 1 of the 2 school terms. A well-established evaluation framework (RE-AIM [Reach, Effectiveness, Adoption, Implementation, Maintenance]) guided the selection of mixed data collection methods. Our target sample size is 600 taitamariki enrolled across the 8 schools. Taitamariki will participate by completing 5 web-based surveys over a 15-month trial period. Taitamariki partner relationship self-efficacy (primary outcome) and well-being, general health, cybersafety management, and connectedness (secondary outcomes) will be assessed with each survey. The general effectiveness hypotheses will be tested by using a linear mixed model with nested participant, year-group, and school random effects. The primary analysis will also include testing effectiveness in the Maori subgroup. RESULTS: The study was funded by the New Zealand Ministry of Business, Innovation, and Employment in October 2015 and approved by the Auckland University of Technology Ethics Committee on May 3, 2017 (application number: 17/71). CONCLUSIONS: This study will generate robust evidence evaluating the impact of introducing a healthy relationship app in secondary schools on taitamariki partner relationship self-efficacy, well-being, general health, cybersafety management, and connectedness. This taitamariki- and indigenous Maori-centered research fills an important gap in developing and testing strengths-based mobile health interventions in secondary schools. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12619001262190; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377584. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/24792.

Insights into the oral health crisis amongst pre-schoolers in Aotearoa/New Zealand: a discourse analysis of parent/caregiver experiences.

BACKGROUND: The oral health of pre-schoolers is garnering international as a crisis as good oral health is a key precursor to positive health outcomes. Internationally, and within Aotearoa/New Zealand, responses been restricted to those based in a medical model and the commercialisation of oral health. Absent from existing commentary are the lived realities of parents/caregivers beliefs, attitudes and responsiveness, or lack of, to the oral health of pre-schoolers. METHODS: The researcher undertook a discursive analysis of parents/caregivers narratives to understand the barriers to engaging in effective protective behaviours. The 15 focus groups were conducted in urban and rural locations across Aotearoa/New Zealand. RESULTS: A discursive analysis revealed several pervasive discourses, including 'second chance' and 'enjoyment' discourses, and systems-related deficits that act as barriers to engaging in good oral healthcare practices. CONCLUSIONS: The analysis demonstrates the benefit of placing the lived experiences of parents/caregivers as central to the development of oral health interventions. There is a need to link oral health data with primary care data and to distribute accurate oral health information to support parents'/caregivers' decision making. This research reveals several pervasive discourses and systems-related deficits that provide a fertile ground for future public health responsiveness.

Thinking differently: Re-framing family violence responsiveness in the mental health and addictions health care context.

Aotearoa New Zealand's high rates of intimate partner violence (IPV) and child abuse and neglect point to a clear need to develop and resource equitable mental health and addiction practices that are responsive both to people experiencing and using violence, and to their families. Current responses to IPV in mental health and addiction settings in Aotearoa New Zealand require a critical re-framing, from an individualistic autonomy and empowerment framework that constrains practitioners' practice, to an understanding IPV as a form of social entrapment. Using a composite story constructed from 28 in-depth New Zealand family violence death reviews, we highlight current problematic practice and discuss alternative responses that could create safer lives for people and families. Re-framing IPV as a form of social entrapment acknowledges it as a complex social problem that requires collective steps to secure people's safety and well-being. Importantly, a social entrapment framework encompasses interpersonal and structural forms of violence, such as the historical and intergenerational trauma of colonization and links to ongoing structural inequities for Maori (the indigenous people of Aotearoa) in Aotearoa New Zealand.