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A Feeling of Belonging: Barriers to Participation for Disabled People

This study was based on qualitative research and was conducted in response to a request by CCS. The aim of the study was to interview disabled people aged 15-65 living in the Dunedin area to evaluate the feeling of belonging in the community and identify the barriers they face in their day to day life. 

CCS provided a list of potential study participants and we selected thirty and interviewed them in pairs. Participants had varying levels of disabilities and had varying communicating abilities. The participants were asked questions on education, employment, business opportunity, political participation, physical environment, communication, life style, medical care, accommodation, supports and their feeling of belonging in the community.

Based on the results that were obtained we made some recommendations that may help minimise barriers to participation for disabled people. 

Authors of Report

Joyce Chai, Angus Colquhoun, Chamila De Alwis, Kent Johnston, Sharmini Muttaiyah, Steve Tripp

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Barriers to Good Diabetes Care in Otago

Aim

The aims of this patient survey were to determine patient awareness of diabetes services and barriers to their access in Otago region. 

Method

A mail survey of 400 randomly selected (240 from urban area and 160 from rural area) type II diabetic patients was undertaken.  Participants were selected from the Otago Diabetes Register.  The questionnaire was designed to elicit information on awareness of services, usage, barriers, and how our respondents access information.  

Results

There were 200 valid respondents and 17 deceased from our sample.  There was no significant difference between rural and urban demographic make up.  There were similar levels of awareness and usage of service between rural and urban populations.  The most commonly identified barrier was transport.  General practitioners (GPs) were the most frequently accessed source of information.  Over 50% of respondents preferred a list of services available and their contact details. 

Conclusions

This study has confirmed some of the hypotheses from the anecdotal reports by the Otago Local Diabetes Team and current literature regarding the barriers to accessing diabetic services. The results showed varying levels of awareness and usage between diabetic services.  The retinal screening program had an excellent utilisation rate, whereas the free annual GP check-up had a lower level of usage.  There was no significant difference between rural and urban populations in terms of awareness or utilisation of services, except in awareness of the dietician service.  The main barrier was transport.  Most respondents regarded GP as their main source of diabetes information.  This has significant implications in how resources and information should be distributed.  In general, respondents were satisfied with their diabetic care.

Authors of Report

Farah bt Alwi, Azira bt Azmi, Emily Liu, Lesley Nicol, Penina Pereira, Vincent Yiu, Caroline Zhou

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Current Primary Care Management of Intermittent Claudication: A Survey of General Practitioners in the Otago Region

Aims

  1. To review the current evidence about the diagnosis and management of intermittent claudication
  2. To investigate the current management of intermittent claudication by general practitioners in Otago.To make recommendations about how management of intermittent claudication at the primary care level could be improved.

Method

Names and addresses of 207 GPs in the Otago region were obtained from the RCGP CME database.  GPs were classified geographically into two groups: Dunedin and Non-Dunedin, using Telecom New Zealand area codes.  Each GP was assigned a 3-digit identification code.  61 GPs from each group were randomly selected using random numbers, giving a total of 122 GPs in the sample.  A questionnaire which consisted of questions based on the GP's management of patients with intermittent claudication were sent out.  Non-respondents were followed-up by phone a week later.  Replies received after the deadline were not included in the analysis.

The results were analysed using SPSS statistical programme.  We compared the two groups to evaluate any differences between the two populations.

Results

Of the 122 GPs sampled, 33 were not eligible. Of those eligible, 15 GPs (17%) declined, 29 GPs (33%) did not respond. 45 GPs (51%) participated and 84% (38 GP's) of these had seen and managed a case of IC. The prevalence of patients with IC in primary care practices in the Otago region calculated using the estimates provided by the GP's was 67 per 10 000 population. No statistical comparisons were made because our study had a small sample size (38 GP's), thus reducing its power. However, we considered a percentage difference of greater than 20% as noteworthy. The salient features included:

  1. 67% of the Dunedin GPs and 91% of the Non-Dunedin GPs said there was no exercise programme in their area.
  2. 2/3 (66%) of all GPs thought that an exercise programme was an effective management strategy.
  3. The majority of GPs would usually refer patients to a tertiary centre, regardless of number of years practised as a GP (64% of those who had practised more than 20 years, 54% 11 - 20 years, and 60% 0 - 10 years).
  4. The majority of GPs also thought that exercise was an effective management strategy for IC (64% 20+years, 73% 11-20 years, and 80% 0 - 10 years).
  5. More of the GPs with fewer years of practice thought that exercise had a direct effect on IC, compared to those with more experience (70% 0-10 years, 62% 11-20 years, and 21% 20+ years).
  6. There were no significant differences in the results between those exposed to CME and those not exposed. However, 61% of those exposed to CME thought exercise was an effective management strategy compared to 81% of those not exposed. Also, 39% of those exposed to CME thought that exercise had a direct effect on IC, compared to 56% of those not exposed.

Conclusions

Exercise programme interventions including: walking only, "physical training" or dynamic leg exercise and treadmill training.  The type, frequency, duration and intensity of exercise varied between studies.  The intensity included: moderate pain, to the point of pain, beyond pain and unknown.  (From the Introduction ->): Patients are usually advised to walk for at least 30 to 40 minutes three hours a week.  They should walk until the pain is too uncomfortable and resume again when the pain goes away.  Patients are also advised to increase the duration of exercise as tolerated to daily exercise sessions.

Authors of Report

Ali Al-Dameh, Rekha Gangaraju, Cheryl Buhay, Timothy Hii, Sean Galvin, Dilushini Silva

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Equitable Resource Allocation: A Review of Arthritis Educator Services for Arthritis New Zealand

Aim

To investigate the range of factors that can be used to determine criteria for the equitable distribution of Arthritis Educator resources for Arthritis New Zealand.

Methods

Initially the descriptive epidemiology of arthritis was assessed, followed by an outline of Arthritis Educator services and the theory of equity and resource allocation. The pros and cons of the current formula were assessed and variables considered for a new formula. The general structure of the formula was established, and each of the variables was tested for relevance and sensitivity, before a final recommendation was made.

Information regarding the nature of Arthritis NZ and the breakdown of Division and Arthritis Educator services was gathered from the organisation’s website (www.arthritis.org.nz), their National Office, and the Otago Division Educator based in Dunedin.  Prevalence data of disabling arthritis came from the 2001 Household Disability Survey; and New Zealand population statistics came from the 2001 Census data available through the Statistics New Zealand website (www.stats.govt.nz/).

Results and Conclusion

Equity was defined as equal access for equal need.  Allocation of hours was used as the most appropriate way of distributing the Arthritis Educator resource throughout the 18 Divisions of Arthritis NZ. The disability weighted population was chosen as a burden of disease marker, and the variables age, gender, ethnicity, rurality, and socio-economic status were considered and tested for sensitivity if deemed relevant.

The final formula consists of the variables disability-weighted population and age.  The reasons for discarding other variables are discussed along with recommendations for future reviews. The new allocation of hours dramatically alters the distribution nationwide, with a large increase seen in Auckland balanced against decreases in other regions such as Gisborne, Wairarapa and South Canterbury.  We have suggested that our formula is not ideal, and have provided recommendations for the more accurate collection of data in order to enable the inclusion of other variables in the future.

Authors of Report

Debbie Barham, Charlie Cheng, Steve Harris, Luke Kain, Jess Mouat, Jann Pickard

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Gut Feelings: Community Awareness of Zoonoitc Enteric Disease in Otago

Introduction

New Zealand has one of highest rates of enteric infections in the industrialised world. These infections are a major cause of morbidity in the Otago population. This study aimed to determine the public's attitudes, beliefs, and behaviours related to zoonotic enteric infections in Dunedin and Otago.

Method

A questionnaire was designed using the “health beliefs model”. A cross-sectional study was undertaken where 300 people were randomly selected from the Dunedin South and Otago electoral rolls. The subjects were contacted by mail and provided with a copy of the questionnaire. Non-respondents were sent a reminder letter.

Results

The response rate was 60%. Few people reported having had enteric infections, and most thought that the commonest mode of transmission of enteric disease was via food. The main barrier to reducing the chance of food and animal borne illnesses was limited access to washing water. Female respondents took more precautions to reduce the risk of foodborne and animal borne infections. There was no relation between type of water supply and the average number of precautions taken. Education level made no difference to the number of precautions taken.

Discussion

The respondents had good knowledge about the modes of transmission and methods to prevent enteric infection and most acted on this knowledge. Further studies need to be done to establish causal relationships for aetiological risk factors implicated in zoonotic enteric infections.

Authors of Report

William Kenyon, Damon Lane, Homayoun Zargar Shoshtari, Ritva Vyas, King Yee Yong

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Nutrition of 2-5 Year Old Children Attending Childcare Centres in Dunedin

Background

The nutrition that children receive while in day care may form a significant proportion of their daily intake.  It follows that this influence has been increasing as the number of children attending childcare has grown.  This is an important area of interest as nutrition is important at this early age yet we know very little about nutrition in child care centres.

Aim

We aimed to evaluate the nutritional content of meals provided for 2-5 year olds in childcare centres in Dunedin, New Zealand and to identify barriers and areas for improvement.

Methods

Our study focussed on 2-5 year olds attending full time day care centres where food was supplied by the child care centre.  The study consisted of three parts:  a semi-structured interview with the childcare centre manager, a questionnaire for parents and an analysis of the menus at the centre.

Results

12 out of 13 centres identified participated in the study.  We found a general interest in the nutrition of children at the centres by staff and parents.  There was no perception of any problem.  A variety of methods were used to form the menus for the centres ranging from making what looked like a balanced diet to the involvement of a dietician in one case.  However there is no standard process or guidelines set for creating menus or reviewing them.  In analysis of the menus we found that only 5/12 centres met our criteria for providing all four food groups over the course of a week.  5/12 met the guidelines for 3 food groups and 2/12 centres only met 2 groups.  Despite this parents opinion of the food their children received was very positive.

Conclusion

Parents and childcare centres show interest in the nutrition of children and express no complaints about the current state of nutrition supplied.  Our analysis of the menus showed some noticeable deficits in the menus as supplied by the childcare centres.  However some of this may be related to the non-standardised way that the menus are presented.  Even with generous interpretation of the menus many centres fell short of meeting the recommended guidelines on nutrition.  Guidelines on menu planning and menu reporting should be produced to clarify this area.  This would enable more accurate assessment of the nutrition provided to children and ensure that it is more adequate.

Authors of Report

Sainimere Boladuadua, Emeline Fonua, David Highton, Aleksandra Popadich, Caroline Robins, Janine Stevens

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Risk Evaluation and Communication in General Practice

Aims

  1. To identify the best format for presentation of risk information to patients (from literature review).
  2. To determine what information general practitioners currently use, and what they want, in assisting their patients to make decisions about lifestyle changes that might prevent disease.
  3. Using examples of cardiovascular diseases, to identify helpful NZ data on mortality and morbidity, and information on risk factors and disease prevention. To use this to compile a resource list of data, references, and sources of information (including web sites) for general practitioners.
  4. To make recommendations concerning the use of existing materials or development of new ones.

Method

A sample of 90 GPs were selected from a list of 127 GPs in the Otago region. A letter explaining the study was sent to these 90 GPs before they were contacted by phone to get their consent to participate in the study. 23 GPs were selected to participate in the study. These GPs were interviewed by phone and face-to-face. The questionnaire used in the interview was design to collect information on communication and assessment of cardiovascular risk as an example.

Result

There were 23 total respondents who participated in our study. The most common methods of risk communication were; 1) showing risk charts to patients, 2) using verbal quantifiers, 3) using absolute risks and 4) using risk assessment software. All GPs used the correct independent/causal cardiovascular risk factors. The most commonly used tool for risk assessment was the NZ Heart Foundation guidelines. With the tools and guidelines available most GPs are confident most of the time in calculating and conveying cardiovascular risks in their patients.

Conclusion

From our study we found that all GPs use a variety of methods to communicate risk, not just one method. Younger GPs prefer to use percentages while older GPs prefer verbal quantifiers in presenting risk to patients. Those GPs who use absolute risk to convey risks believe that the method is easier (for the GPs) and faster, while those who use verbal quantifiers believe that it is easier for patients to understand.

Authors of Report

Sarah Bowker, Catherine Latu, Irene Lau, Vinita Mathew, Mohd. Iskandar Mohd Ghazalli, Sevvandi Premachandra, Fairulliza Suha

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