Does My Stigma Look Big in This? Considering the acceptability and desirability in the inclusive design of technology products

This paper examines the relationship between stigmatic effects of design of technology products for the older and disabled and contextualizes this within wider social themes such as the functional, social, medical and technology models of disability. Inclusive design approaches are identified as unbiased methods for designing for the wider population that may accommodate the needs and desires of people with impairments, therefore reducing ’aesthetic stigma’. Two case studies illustrate stigmatic and nonstigmatic designs

Patient and carer perceived barriers to early presentation and diagnosis of lung cancer: a systematic review

Background Lung cancer is typically diagnosed at a late stage. Early presentation and detection of lung cancer symptoms is critical to improving survival but can be clinically complicated and as yet a robust screening method for diagnosis is not available in routine practice. Accordingly, the barriers to help-seeking behaviour and diagnosis need to be considered. This review aimed to document the barriers to early presentation and diagnosis of lung cancer, based on patient and carer perspectives. Methods A systematic review of databases was performed for original, English language articles discussing qualitative research on patient perceived barriers to early presentation and diagnosis of lung cancer. Three major databases were searched: Scopus, PubMed and EBSCOhost. References cited in the selected studies were searched for further relevant articles. Results Fourteen studies met inclusion criteria for review. Barriers were grouped into three categories: healthcare provider and system factors, patient factors and disease factors. Conclusions Studies showed that the most frequently reported barriers to early presentation and diagnosis of lung cancer reported by patients and carers related to poor relationships between GPs and patients, a lack of access to services and care for patients, and a lack of awareness of lung cancer symptoms and treatment. Addressing these barriers offers opportunities by which rates of early diagnosis of lung cancer may be improved

Barriers to Screening for Gestational Diabetes Mellitus in New Zealand Following the Introduction of Universal Screening Recommendations

Background: In 2014 the New Zealand Ministry of Health implemented a universal program of screening for gestational diabetes mellitus (GDM) in pregnancy; however, data suggest that only half of all women are being screening according to the guidelines. This study aimed to explore women's views and experiences of GDM screening and to determine what the main screening barriers are. Methods: Eighteen women were recruited from the Waikato region of New Zealand, who were either pregnant (>28 weeks of gestation) or had given birth in the last 6 months. These women participated in a semi-structured interview about their experience of GDM screening and the transcripts were thematically analyzed. Of these women, 14 had been screened for gestational diabetes (three were screened late) and four had not been screened at all. Results: Multiple barriers to screening for GDM were identified, with two overarching themes of “confusion, concerns, and access to information for screening,” and “challenges to accessing and completing the screening test.” Specific barriers included the preference of risk-based assessments for GDM by their leading health professional (usually a registered midwife); negative perceptions of “sugar drink test”; needing time off work and childcare; travel costs for rural women; previous negative screening experiences; and reduced health literacy. Conclusion: There appear to be both woman-, midwife-, and system-level barriers to screening for GDM. While screening is ultimately a woman's choice, there does appear to be capacity to increase screening rates by improving awareness of the updated guidelines, and making the test environment more accessible and comfortable.fals

Barriers to Diabetes Self-Management in a Subset of New Zealand Adults with Type 2 Diabetes and Poor Glycaemic Control

Background. Despite the fact that there is an increasingly effective armoury of medications to treat diabetes, many people continue to have substantially elevated blood glucose levels. The purpose of this study was to explore what the barriers to diabetes management are in a cohort of people with diabetes and poor glycaemic control. Methods. Qualitative semistructured interviews were carried out with 10 people with diabetes who had known diabetes and a recent HbA1c of >11.3% (100 mmol/mol) to explore their experiences of barriers to diabetes self-management and glycaemic control. Results. Barriers to diabetes management were based around two key themes: biopsychosocial factors and knowledge about diabetes. Specifically, financial concerns, social stigma, medication side effects, and cognitive impairment due to hyperglycaemia were commonly reported as barriers to medication use. Other barriers included a lack of knowledge about their own condition, poor relationships with healthcare professionals, and a lack of relevant resources to support diet and weight loss. Conclusion. People with diabetes with poor glycaemic control experience many of the same barriers as those reported elsewhere, but also experience issues specifically related to their severe hyperglycaemia. Management of diabetes could be improved via the increased use of patient education and availability of locally relevant resources

Are patients with type 2 diabetes in the Waikato District provided with adequate education and support in primary care to self-manage their condition? A qualitative study.

Introduction In Aotearoa New Zealand (NZ), type 2 diabetes (T2D) is predominantly managed in primary care. Despite established guidelines, patients are often suboptimally managed, with inequitable health outcomes. To date, few NZ studies have evaluated the primary care management of T2D at the time of diagnosis. Aim This study aims to explore patients' the provision of education and delivery of care to patients at the time of diagnosis, which is a crucial time in the disease trajectory. Methods Participants were recruited from a Māori health provider in the Waikato District, and diagnosed with T2D after January 2020. Patients were texted a link to opt into a survey (larger study) and then registered interest by providing contact details for an interview (current study). Semi-structured interviews were conducted and were audio recorded, transcribed, and thematically analysed. Results In total, 11 participants aged 19-65 years completed the interviews (female n  = 9 and male n  = 20); the comprised Māori (n  = 5), NZ European (n  = 5) and Asian (n  = 1) participants. Three overarching themes were identified, including: (1) ineffective provision of resources and education methods; (2) poor communication from healthcare practitioners; and (3) health system barriers. Discussion Evidently, there are difficulties in primary care diabetes mellitus diagnosis and management. Improvements could include locally relevant resources tailored to patients' experiences and cultural identities. Utilising whānau support and a non-clinical workforce, such as health navigators/kaiāwhina, will drastically address current workforce issues and assist patient self-management. This will allow improved diagnosis experiences and better health outcomes for patients and whānau.fals

Inequalities between Māori and non-Māori men with prostate cancer in Aotearoa New Zealand.

Māori experience poorer health statistics in terms of cancer incidence and mortality compared to non-Māori. For prostate cancer, Māori men are less likely than non-Māori men to be diagnosed with prostate cancer, but those that are diagnosed are much more likely to die of the disease than non-Māori men resulting in an excess mortality rate in Māori men compared with non-Māori. A review of the literature included a review of the epidemiology of prostate cancer; of screening; of access to healthcare and of treatment modalities. Our conclusion was that there are a number of reasons for the disparity in outcomes for Māori including differences in staging and characteristics at diagnosis; differences in screening and treatment offered to Māori men; and general barriers to healthcare that exist for Māori men in New Zealand. We conclude that there is a need for more culturally appropriate care to be available to Māori men

The experiences of refugee Muslim women in the Aotearoa New Zealand healthcare system

This study explores the experiences of refugee Muslim women as they accessed and navigated the healthcare system in Aotearoa New Zealand (NZ). A case-oriented approach was used, where semi-structured interviews were carried out with nine Muslim women who arrived in NZ as refugees. Interviews were carried out in 2020, in Hamilton, NZ. Analysis involved a ‘text in context’ approach which employed an iterative and interpretive process, by engaging with participant accounts and field notes to unpack the various meanings behind the experiences of the participants in relation to the literature as well as the broader socio-cultural contexts in which these experiences occurred. The findings of this research identified various structural barriers to accessing healthcare such as cost and issues with interpreters, as well as instances of othering in the healthcare settings experienced by refugee Muslim women. In order to tackle inequity in the health system, structural and institutional barriers need to be addressed first, to prompt other levels of othering and discrimination to reduce over time

‘Look, wait, I’ll translate’: refugee women’s experiences with interpreters in healthcare in Aotearoa New Zealand

This study aimed to explore refugee women's experiences of interpreters in healthcare in Aotearoa, New Zealand (NZ). Semi-structured interviews were conducted with nine women who arrived in NZ as refugees. Analysis involved a ‘text in context’ approach. An iterative and interpretive process was employed by engaging with participant accounts and field notes. The various meanings behind participants' experiences were unpacked in relation to the literature and the broader socio-cultural contexts in which these experiences occurred. Findings highlighted issues with professional and informal interpreters. These issues included cost, discrepancies in dialect, translation outside appointments, and privacy. Findings indicate ethical and practical implications of using interpreters in healthcare for refugee women. A step to achieving equitable healthcare for refugee women in New Zealand entails putting in place accessible and robust communicative infrastructure.fals

Poverty and Well-being in Post-Apartheid South Africa: An Overview of Data, Outcomes and Policy

WP 2006-03 January 2006This is an overview of poverty and well-being in the first decade of post-apartheid South Africa. It is an introduction to a volume that brings together some of the most prominent academic research done on this topic for the 10-year review process in South Africa. This overview highlights three key aspects of the picture that the detailed research paints. First, data quality and comparability has been a constant issue in arriving at a consensus among analysts on the outcomes for households and individuals in postapartheid South Africa. Second, while the outcomes on unemployment, poverty and inequality are indeed bad, the outcomes on social indicators and access to public services are much more encouraging. Third, the prospects for rapid and sustained economic growth, without which poverty and well-being cannot be addressed in the long run, are themselves negatively affected by increasing inequality, poverty and unemployment

Features of home and neighbourhood and the liveability of older South Africans

While older people live in developing countries, little is known about the relative importance of features of their communities in influencing their liveability. We examinecomponents of home and neighbourhood among older South Africans. Linear regression analyses revealed that features of home (basic amenities, household composition, financial status and safety) and neighbourhood (ability to shop for groceries, participate in organizations and feel safe from crime) are significantly associated with life satisfaction. Approaches to liveability that are person-centred and also set within contexts beyond home and neighbourhood are needed to addressboundaries between home and neighbourhood; incorporate personal resources into liveability models and import broader environmental contexts such as health and social policy