School of Community and Public Health
Permanent link for this collectionhttps://hdl.handle.net/10292/10764
The School of Community and Public Health includes the following groups:
• Public Health
• Hauora Māori
• Disaster Risk Management and Development
• Pacific Health
• Violence and Trauma
• Health Law and Ethics
• Psychotherapy
• Counselling
• Mental Health & Addictions
• Lived Experience
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Item Positive Mental Health and Its Promotion: A Bicultural Perspective and Narrative Synthesis from Aotearoa New Zealand(LIDSEN Publishing Inc, 2026-05-18) Tudor, Keith; Haenga-Collins, MariaPositive mental health frameworks in Aotearoa New Zealand have largely been shaped by Western individualist assumptions and have given limited attention to Indigenous and bicultural understandings of wellbeing. This article examines positive mental health and its promotion in Aotearoa New Zealand, through a bicultural lens grounded in <em>Te Tiriti o Waitangi.</em> It reports on two cross-cultural mental health searches and discusses several models of health from te Ao Māori (the Māori world). Based on the view that positive mental health (and, indeed, health as a whole) is both constructed and contextual, our understanding of it in Aotearoa New Zealand must reflect the nation’s bicultural foundation and obligations. Māori models of wellbeing are advanced as offering holistic, culturally grounded, relational, and equity-oriented frameworks for understanding positive mental health, challenging Western atomism and individualism while aligning with international calls for inclusive, contextual, and culturally responsive approaches to wellbeing. Drawing on <em>Te Tiriti o Waitangi</em>, the article proposes a meta‑theoretical framework for positive mental health that is both locally grounded and globally relevant, suggesting that Tiriti-informed approaches may offer valuable insights for culturally responsive mental health thinking in other national and Indigenous contexts.Item Experiential Classes Plus Digital Logging in Antenatal Care for Pregnant Women in China: Mixed Methods Study(JMIR Publications Inc., 2026-04-21) Sun, Zhenfeng; Yang, Fuwen; Wang, Xi; Sun, Yin; Zhang, Suhan; Ma, LiangkunBACKGROUND: Maternal health during the perinatal period is a global public health priority. While antenatal education is widely implemented, conventional lecture-based models often fail to achieve sustained behavior change. Innovative approaches that integrate experiential learning with digital support may enhance maternal knowledge, self-management, and pregnancy outcomes. OBJECTIVE: The aim of this study is to evaluate the feasibility and preliminary effectiveness of a combined experiential class and online logging intervention for pregnant women in China and to explore the mechanisms underpinning its impact on health practices and service experiences. METHODS: A mixed methods design was used in a district-level maternal and child health hospital in Beijing. In the quantitative arm, 40 women (intervention group, n=20; control group, n=20) were enrolled in a quasi-experimental comparison. Outcomes included knowledge-attitude-practice indicators, service satisfaction, and clinical birth outcomes. Given the limited sample size, a qualitative arm was conducted to complement statistical findings: semistructured interviews with 20 women (10 per group) were analyzed thematically. Quantitative and qualitative results were integrated during interpretation to provide a comprehensive evaluation. RESULTS: Compared with the experiential class alone, the combined intervention was associated with higher knowledge scores (mean difference 1.6 points, 95% CI 0.8-2.4), stronger adherence to recommended health practices (composite adherence score difference 1.0, 95% CI 0.4-1.6), and higher overall service satisfaction (mean difference 0.6, 95% CI 0.2-1.0). Across multiple domains, a higher proportion of participants in the intervention group met dietary, exercise, and supplementation recommendations. Clinical outcome differences were exploratory, as the study was not powered for these end points. Qualitative analysis revealed 3 mechanisms, such as empowerment and self-efficacy, practice and persistence, and systemic/environmental support, through which the intervention influenced experiences and practices. CONCLUSIONS: The experiential class plus online logging model is feasible and acceptable in a real-world antenatal setting. Although limited by a small sample size, findings suggest that the intervention improves maternal knowledge, health practices, and service experiences and may inform future adequately powered trials to evaluate pregnancy outcomes. Qualitative insights highlight mechanisms of health practice change and provide contextual depth, underscoring the value of mixed methods designs in maternal health research.Item Assessing the Institutional Provision of Maternal Nutrition Services in Antenatal Clinics in Beijing(Informa UK Limited, 2026-02-22) Li, Yini; Wang, Xi; Wang, Dongjun; Zhang, Suhan; Li, Ye; Hu, Mingyue; Sun, Yin; Ma, LiangkunOBJECTIVE: To evaluate the availability, quality, and delivery of maternal nutrition services in antenatal clinics across Beijing, focusing on service types, provider qualifications, resource adequacy, and barriers to effective service delivery. The study also aims to identify factors influencing service availability and institutional variation and propose a framework for improving maternal nutrition care in urban China. METHODS: A cross-sectional study was conducted across 110 antenatal clinics in Beijing, using structured surveys targeting institutional characteristics, service coverage, personnel qualifications, and service delivery methods, supplemented by qualitative insights from open-ended responses. RESULTS: Among 104 valid responses, 56% of institutions offered prenatal nutrition education classes. Provision varied descriptively by facility type (e.g. 12.5% in private hospitals vs ∼55-57% in other facility types), but the facility-type comparison was not statistically significant (chi-square = 5.72, df = 3, p = 0.13). While 76% of institutions reported having personnel with formal nutrition qualifications, gaps in training and reliance on non-specialized staff were common. Resource constraints (e.g. space, equipment, and limited digital support) were frequently reported as barriers. Institutional respondents reported high perceived patient satisfaction and the presence of feedback systems, but no patient-level outcomes were measured. CONCLUSION: This city-wide institutional survey suggests that maternal nutrition services in Beijing antenatal clinics are broadly available but heterogeneous in delivery, staffing, and resources. Observed contrasts across facility types should be interpreted as descriptive patters rather than confirmed group differences. Future work should evaluate whether standardization, workforce development, infrastructure strengthening, and digital support improve service quality and equity, using patient-level and implementation indicators.Item Clinical Consensus Statements on Intervention Content for Gambling Treatment: A Contextualised Delphi Study With Clinical Researchers(Springer Science and Business Media LLC, 2026-01-30) Keshani, Imran; Merkouris, Stephanie; Rodda, Simone; Abbott, Max; Aubin, Henri-Jean; Bellringer, Maria; Berman, Anne; Billieux, Joel; Bowden-Jones, Henrietta; Browning, Colette ; Carlbring, Per; Castrén, Sari; Chamberlain, Samuel; Christensen, Darren; Demetrovics, Zsolt; Derevensky, Jeffrey; Fernandez-Aranda, Fernando; Gainsbury, Sally; Ginley, Meredith K; Griffiths, Mark D; Håkansson, Anders; Hodgins, David C; Jackson, Alun; Jimenez-Murcia, Susana; King, Daniel L; Landon, Jason; Luquiens, Amandine; Molander, Olof; Nilsson, Anders; Odlaug, Brian L; Potenza, Marc N; Thomas, Shane A; Whelan, James; Dowling, Nicki AThere is little consensus on the optimal components of gambling psychological treatments. This study aimed to identify clinical consensus statements regarding the perceived effectiveness of gambling intervention content (change techniques, participant/recruitment characteristics, delivery characteristics, and evaluation characteristics) from a panel of researchers with psychological gambling treatment expertise across 11 countries. A two-round modified Delphi study was conducted. Thirty-five panellists rated the perceived effectiveness of 96 gambling intervention components for achieving clinically helpful change, which was defined as “reduction in gambling severity, expenditure, and frequency”. Consensus criteria on effectiveness and ineffectiveness were defined a priori. Consensus statements were identified for four of 19 change techniques (motivational enhancement, relapse prevention, cognitive restructuring, and plan social support), five of 23 participant/recruitment characteristics (e.g. eligibility screening took place), 17 of 47 delivery characteristics (e.g. the therapy goal was to reduce time and/or money spent gambling), and three of seven evaluation characteristics (e.g. specific process or mediators are targeted by the intervention). These statements, when interpreted with consideration of contextual factors, can inform the selection of likely effective components to employ in gambling treatment programs and indicate where future research efforts may be most beneficial.Item Newborn Enrolment, Engagement, and Immunisation in Primary Care: A Qualitative Study on Healthcare Providers’ Perspectives(CSIRO Publishing, 2026-04-23) Young, A; McIntosh, C; Ware, F; Best, E; Turner, N; Charania, Nadia; Campbell, A; Davis, TA; Marsh, SINTRODUCTION: Childhood immunisation coverage in Aotearoa New Zealand (NZ) is not meeting recommended targets. Enrolment and engagement with primary care are associated with timely immunisation uptake, yet enrolment and immunisation are inequitable, with Māori and Pacific children less likely to be enrolled and receive their 6-week vaccinations on time. AIM: This study aimed to understand healthcare providers' perceptions of barriers and enablers to primary healthcare enrolment from birth and provide recommendations to support enrolment, engagement, and immunisation, particularly for Māori whānau (families). METHODS: This qualitative study, guided by a Kaupapa Māori-aligned methodology, involved interviews and focus groups to explore barriers and enablers to enrolment from the perspective of people working within the NZ healthcare sector (n = 27). Analysis was undertaken using qualitative content analysis. RESULTS: Many participants expressed that the current system was contributing to inequitable enrolment and immunisation of pēpi (infants). Four categories were constructed: health services may not be accessible or practical for whānau; perceived complexity and skill shortages; the need to prioritise communication and engagement; and services must be built on cultural safety and trust. DISCUSSION: Reasons for inadequate enrolment include poorly designed systems, limited resourcing, and inconsistent approaches. Enrolment needs to be simplified, with integrated and automated systems to reduce administrative burden for staff. Flexible whānau-centred practices can help support enrolment, engagement, and immunisation of pēpi.Item Associations Between Body Mass Index and Body Composition Among Pacific Adolescents in Aotearoa New Zealand(Nature Portfolio, 2026-05-21) Dai, Yajun; Howe, Anna S; Iusitini, Leon; Tautolo, El-Shadan; Whitcombe-Dobbs, Sarah; Mohammed, Jalal; Schlüter, Philip JBMI and BMI z-scores are widely used to classify adolescent overweight and obesity (OWOB), but they do not distinguish fat from fat-free mass and may misclassify adiposity. This study aimed to examine how BMI and BMI z-scores relate to body composition among Pacific adolescents in Aotearoa New Zealand (A-NZ). Cross-sectional data from an A-NZ Pacific birth cohort were analysed, assessing body size, body composition, and demographics in 871 adolescents (median age 14.2 years). Body composition was estimated using conventional and vector bioelectrical impedance analysis. Sex-stratified analytical comparisons included fractional polynomial regression of BMI z-scores with fat mass index (FMI) and fat-free mass index (FFMI), Hattori plots, and vector analysis parameters. From BMI z-scores, OWOB was defined in 337 (80.3%) females and 342 (75.8%) males. BMI z-scores fitted FFMI well, but important nonlinear patterns emerged between BMI z-scores and FMI. At any given BMI, Pacific adolescents displayed wide variation in FMI and FFMI combinations, with greater variability among males than females. Mean vector length shortened progressively with increasing body size. Phase angle increased from normal weight to overweight but plateaued from overweight to obesity. BMI-defined OWOB inadequately captured adiposity in this population.Item Knowledge and Decisions About Maternal Immunisation by Pregnant Women in Aotearoa New Zealand(Springer Science and Business Media LLC, 2022-06-14) Young, A; Charania, NA; Gauld, N; Norris, P; Turner, N; Willing, EBackground: Maternal vaccinations for influenza and pertussis are recommended in New Zealand to protect mothers and their infant from infection. However, maternal immunisation coverage in New Zealand is suboptimal. Furthermore, there is unacceptable inequitable maternal immunisation rates across the country with Māori and Pacific women having significantly lower maternal immunisation rates than those of other New Zealanders. Methods: This research set out to explore what pregnant/recently pregnant Māori and Pacific women knew about immunisation during pregnancy and what factors influenced their decision to be vaccinated. A semi-structured interview guide was developed with questions focusing on knowledge of pertussis and influenza vaccination during pregnancy and decision-making. Māori and Pacific women aged over 16 years were purposively sampled and interviewed in Dunedin and Gisborne, New Zealand between May and August 2021. Interviews were analysed following a directed qualitative content approach. Data were arranged into coding nodes based on the study aims (deductive analysis) informed by previous literature and within these participant experiences were inductively coded into themes and subthemes. Results: Not all women were aware of maternal vaccine recommendations or they diseases they protected against. Many underestimated how dangerous influenza and pertussis could be and some were more concerned about potential harms of the vaccine. Furthermore, understanding potential harms of infection and protection provided by vaccination did not necessarily mean women would choose to be vaccinated. Those who decided to vaccinate felt well-informed, had vaccination recommended by their healthcare provider, and did so to protect their and their infant’s health. Those who decided against vaccination were concerned about safety of the vaccines, lacked the information they needed, were not offered the vaccine, or did not consider vaccination a priority. Conclusions: There is a lack of understanding about vaccine benefits and risks of vaccine-preventable diseases which can result in the reinforcement of negative influences such as the fear of side effects. Furthermore, if vaccine benefits are not understood, inaccessibility of vaccines and the precedence of other life priorities may prevent uptake. Being well-informed and supported to make positive decisions to vaccinate in pregnancy is likely to improve vaccine coverage in Māori and Pacific Island New Zealanders.Item An Exploration of Sexual and Reproductive Health of Australian Women Living With Inflammatory Bowel Disease: A Mixed Methods Study(Taylor and Francis Group, 2026-02-11) O’Reilly, Kate; Holroyd, Eleanor; You, Wenpeng; Peters, KathInflammatory bowel disease (IBD) is an unpredictable condition that is more prevalent in females (57%) and commonly presents during reproductive years. This study explored the sexual and reproductive health of women who live with IBD in Australia using an online survey and interviews (March–November 2024). Survey responses from 64 women and qualitative data from 14 interviews highlighted menstrual changes, misinformation received regarding fertility, and the impact of IBD on women’s sexuality. Findings from this study highlight the need to ensure discussions about sexuality are more actively incorporated into clinical care for women with IBD.Item Sexual and Reproductive Service Interventions for Menstrual Regulation, Safe Abortion, and Post-Abortion Care and Their Effectiveness During Disaster Response: A Global Systematic Review(Springer Science and Business Media LLC, 2024-06-12) Ray-Bennett, NS; Ekezie, W; Biswas, I; Choudhary, NI; Cowie, D; Dissanayake, L; Macleod, L; Nnaji, A; Sahoo, MSexual and reproductive health (SRH) services are crucial for women especially during disasters, to reduce maternal mortality and morbidity from miscarriages, unsafe abortions, and post-abortion complications. This study explored the SRH interventions provided during disaster response. A systematic review was conducted to identify what menstrual regulation (MR), safe abortion (SA), and post-abortion care (PAC) approaches/interventions exist to promote resilience in the health system in disaster settings; what intervention components were most effective; and challenges and opportunities to meeting SRH rights. Five electronic databases were searched, resulting in 4194 records. Following the screening process, seven publications were included. The intervention-related information in each publication was assessed based on availability, accessibility, acceptability, and quality. Two SRH approaches/interventions were found. The effectiveness of intervention components could not be conducted due to the limited number of relevant studies. Challenges were found at facility and community levels, and opportunities included overcoming them, making MR, SA, and PAC integral to the mitigation phase, and policy change to overcome barriers related to unaffordability and inaccessibility. Recommendations are provided to encourage research and policy towards improving neglected SRH in disaster settings to realize Sustainable Development Goal 3 and the Global Strategy and Sendai Framework’s priority to promote disaster-resilient health systems.Item Improving Fitness Professional Education in Working With Older Adults — A Case Study From a Therapeutic Relationship Perspective(Emerald, 2026-04-29) Ting, Chien Ju; Bercades, LuigiPurpose As populations around the world, including Aotearoa New Zealand (NZ), continue to age, supporting the well-being of older adults has become increasingly important. Regular physical activity (PA) is a key contributor to healthy ageing and enhancing well-being. Fitness instructors play a crucial role in engaging older adults in ongoing PA; however, many trainers lack adequate training and support to work effectively with this population to sustain their long-term engagement. This study aims to explore the role of the therapeutic relationship (TR) in facilitating long-term and sustained engagement in PA among older adults. Specifically, it examines how fitness professionals (FPs) construct trust, negotiate power and foster adherence in ways that go beyond physical training alone. Design/methodology/approach In this case study, we focus on “expert voice” and interviewed two veteran trainers from the never2old exercise programme. We explore the aspects that contribute to the establishment of a TR, which is characterised by collaboration and trust. A Foucauldian discourse analysis approach is used to explain how power and trust can be co-constructed and shared. Findings The findings show how FPs construct trust, negotiate power and engage with older adults. The paper identifies concrete facilitators (self-disclosure, joint decision-making, communication strategies, innovation and autonomy), and makes practical recommendations to the current curricula for trainer education beyond creating a workout plan. Research limitations/implications This study highlights the need to reframe frailty discourse within FP education, moving beyond age-based deficit models towards strengths-based, self-determination approaches. It also shows that as NZ becomes more diverse in population, training needs to foster cultural awareness. While the research only contains expert interviews from two participants, their experience provided rich data to explore the case study. Further studies could draw on the older clients’ perspectives and co-design what is needed for the future curriculum. Practical implications Training should integrate motivational interviewing, intercultural competence and age-appropriate communication strategies to better support Aotearoa New Zealand’s super-diverse and ageing population. Institutional cultures that privilege narrow notions of “Kiwiness” require critical reflection to avoid exclusion. Promoting workplace autonomy and innovation may enhance practitioner engagement and client trust. The principle of the TR should be part of the curriculum. Social implications Socially, this study suggests that FP education can either reinforce or disrupt ageism and cultural exclusion. Reframing frailty as resilience challenges deficit-based views of older adults and supports dignity and participation. Strengthening intercultural competence is critical in Aotearoa New Zealand’s super-diverse context to ensure equitable access. Promoting autonomy and shared decision-making further enhances older adults’ agency, voice and social inclusion in later life. Originality/value This study presents a unique methodological approach, combining the theoretical lens of the TR with a Foucauldian approach, to offer evidence-informed implications for fitness trainers’ education.Item Academics’ Perceptions and Experiences of Demographic Influences on Peer Review: A Qualitative Study(Informa UK Limited, 2026-03-27) Hammond, Kay; McChesney, Katrina; Trafford, JulieThe peer review process for scholarly work originated in Eurocentric and hierarchical structures that can perpetuate oppression and harm. Experiences of peer review can vary among different demographic groups, raising equity concerns. Previous studies have also reported academics’ emotional distress in relation to peer review. This paper uses data from a qualitative study involving 25 published academics from an Aotearoa / New Zealand university. These academics shared how aspects of their identities influenced their perceptions and experiences of peer review. Most participants felt that demographic factors–particularly gender and culture–influenced either the outcomes of, or their responses to, peer review. However, some were hesitant or uncertain about the impact of demographic factors or felt demographic factors had no impact on peer review or their responses to it. The findings raise questions related to privilege, disadvantage, and intersectionality. Overall, this study highlights the need for greater awareness of current risks and harms, as well as good practices, in order to ensure peer review is equitable, safe, and inclusive while preserving the vital role of research quality assurance.Item Kia Tīmata Pai Video Project: Impact of an Oral Language Intervention (ENRICH) on Linguistic Aspects of Educator-Toddler Interactions(Elsevier BV, 2026-05-14) Zhang, Yuxin; Bakir-Demir, Tuğçe; Taumoepeau, Mele; Salmon, Karen; Reese, ElaineThis study investigated the impact of an educator-implemented oral language intervention, Enhancing Rich Interactions (ENRICH), on linguistic aspects of educator-toddler interactions. Twenty-four early childhood classrooms were assigned to either ENRICH or an Active Control condition; ENRICH educators received professional development in serve-and-return interactions. For book-reading, results revealed effects of ENRICH for educators' shorter conversational turn length and children's increased utterances over time. An exploratory analysis further showed a more balanced child-to-educator conversational turn ratio during book-reading in ENRICH centers. However, there were no significant effects of ENRICH for linguistic aspects of educator-toddler interactions in mealtime, play, group, and diapering/toileting contexts. Professional development programs aimed at improving educator-toddler interactions should consider focusing on specific contexts where the intervention shows promise, alongside strengthening components targeting speech quality across daily routines.Item Social Frailty in the Context of Healthy Ageing in Aotearoa New Zealand(Wiley, 2026-04-17) Teh, Ruth; Rolleston, Anna; Tautolo, El-Shadan; Leaumoana, Tulua; Miskelly, Philippa; Korohina, Erina; Campbell, Karen; Harwood, Matire; Wong Soon, Hoy Neng; Henning, Marcus AFor many older adults, maintaining optimal physical and cognitive function is more important than longevity. To optimise functional ability for older adults, developing a comprehensive understanding of the intersection of different determinants of healthy ageing from the perspectives of a group of diverse older persons is essential. The current research aimed to explore the essence of social frailty within the context of healthy ageing. We conducted seven focus groups consisting of 43 older Māori, Pacific people aged 55+ and non‐Māori/non‐Pacific people aged 65+, who are part of the culturally diverse landscape of Aotearoa New Zealand, to explore what social frailty meant to this cohort. The interviews were audio‐recorded, and the data analysed using an inductive thematic analysis approach. Four themes emerged from the data with cultural backgrounds embedded within the intricate nexus of these: (1) physical and cognitive health, (2) mindset, (3) resources and (4) connections. Declining physical or cognitive health can impact an individual’s confidence and motivation to maintain social connections, potentially leading to loneliness and isolation. Mindset, influenced by belief systems and cultural backgrounds, plays a pivotal role in activating (e.g., competency) and accessing (e.g., healthcare services) resources for physical and mental health and fostering social connections. The theme ‘Connections’ extends beyond family, friends and community to include aspects of whakapapa (genealogy) and spirituality. These findings informed the development of a social frailty framework that best characterises Aotearoa New Zealand. This research, conducted through interviews with older adults residing in the community, has enriched our understanding of social frailty. The cultural context lens is important because it reveals differences, both obvious and nuanced, in how people from diverse cultural backgrounds view social frailty. These insights extend a Euro‐centric perspective of social frailty by acknowledging the role culture plays within the context of healthy ageing.Item A Gambling Just-in-time Adaptive Intervention (GamblingLess: In-The-Moment): Protocol for a Microrandomized Trial(JMIR Publications, 2022-08-23) Dowling, Nicki A; Merkouris, Stephanie S; Youssef, George J; Lubman, Dan I; Bagot, Kathleen L; Hawker, Chloe O; Portogallo, Hannah J; Thomas, Anna C; Rodda, SimoneBACKGROUND: The presence of discrete but fluctuating precipitants, in combination with the dynamic nature of gambling episodes, calls for the development of tailored interventions delivered in real time, such as just-in-time adaptive interventions (JITAIs). JITAIs leverage mobile and wireless technologies to address dynamically changing individual needs by providing the type and amount of support required at the right time and only when needed. They have the added benefit of reaching underserved populations by providing accessible, convenient, and low-burden support. Despite these benefits, few JITAIs targeting gambling behavior are available. OBJECTIVE: This study aims to redress this gap in service provision by developing and evaluating a theoretically informed and evidence-based JITAI for people who want to reduce their gambling. Delivered via a smartphone app, GamblingLess: In-The-Moment provides tailored cognitive-behavioral and third-wave interventions targeting cognitive processes explicated by the relapse prevention model (cravings, self-efficacy, and positive outcome expectancies). It aims to reduce gambling symptom severity (distal outcome) through short-term reductions in the likelihood of gambling episodes (primary proximal outcome) by improving craving intensity, self-efficacy, or expectancies (secondary proximal outcomes). The primary aim is to explore the degree to which the delivery of a tailored intervention at a time of cognitive vulnerability reduces the probability of a subsequent gambling episode. METHODS: GamblingLess: In-The-Moment interventions are delivered to gamblers who are in a state of receptivity (available for treatment) and report a state of cognitive vulnerability via ecological momentary assessments 3 times a day. The JITAI will tailor the type, timing, and amount of support for individual needs. Using a microrandomized trial, a form of sequential factorial design, each eligible participant will be randomized to a tailored intervention condition or no intervention control condition at each ecological momentary assessment across a 28-day period. The microrandomized trial will be supplemented by a 6-month within-group follow-up evaluation to explore long-term effects on primary (gambling symptom severity) and secondary (gambling behavior, craving severity, self-efficacy, and expectancies) outcomes and an acceptability evaluation via postintervention surveys, app use and engagement indices, and semistructured interviews. In all, 200 participants will be recruited from Australia and New Zealand. RESULTS: The project was funded in June 2019, with approval from the Deakin University Human Research Ethics Committee (2020-304). Stakeholder user testing revealed high acceptability scores. The trial began on March 29, 2022, and 84 participants have been recruited (as of June 24, 2022). Results are expected to be published mid-2024. CONCLUSIONS: GamblingLess: In-The-Moment forms part of a suite of theoretically informed and evidence-based web-based and mobile gambling interventions. This trial will provide important empirical data that can be used to facilitate the JITAI's optimization to make it a more effective, efficient, and scalable tailored intervention. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12622000490774; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380757&isClinicalTrial=False. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/38958.Item Culture, Church, and Collective: A Qualitative Study About Gambling Harm Prevention and Reduction in Aotearoa/New Zealand - A Tongan Male Perspective(BMC, 2022-12-03) Fehoko, Edmond; Bellringer, Maria; Fairbairn-Dunlop, PeggyBackground: In New Zealand, Pacific people continue to be more at risk of gambling harm than the general population, despite increasing public health efforts and treatment service provisions introduced to address this social and health issue. In looking at why this is so, our first concern was to ask why the delivery of the prevailing gambling-focussed programmes was not influencing Pacific gambling behaviours. In seeking to answer this question, it was important to explore ethnic-Pacific-specific factors of gambling harm prevention and reduction. Methods: The research design was interpretivist/constructivist and phenomenological, applied through the lens of a Tongan worldview. Participants comprised Tongan male elders and youth. Recruitment of participants was through snowball sampling from churches and kava-drinking circles. A total of 28 elders and 18 youth participated through focus group talanoa and individual talanoa. This study employed descriptive thematic analysis. Results: Participants were not aware of any policy document or problem-gambling preventative programmes. Four key themes were raised, which include raising the awareness of existing gambling harm treatment providers, the church influence in addressing gambling harm, community-based strategies, and cultural-based approaches. Conclusions: This study proposes several recommendations such as more awareness of gambling harm providers in community, increasing cultural spaces and church engagements, and calls for further research in addressing the prevention and reduction of gambling harm amongst the Tongan community in New Zealand.Item Predicting the Side Effects of Influenza Vaccination(Oxford University Press (OUP), 2025-03-26) Silvester, C; Gasteiger, C; Gamble, GD; Wilson, MS; Faasse, K; Petrie, KJ; MacKrill, KBACKGROUND: Side effects following vaccination intensify vaccine hesitancy, which remains a significant challenge to public health. Research suggests that a proportion of side effects are not caused by the vaccine but are instead associated with psychological factors that influence nocebo responding. PURPOSE: This study investigates the psychological and demographic factors associated with symptom reporting postvaccination, the attribution of these symptoms as side effects, and their influence on future intentions to vaccinate. METHODS: A prospective, longitudinal design was employed with 225 influenza vaccination recipients. Demographic and psychological measures (including anxiety, vaccination attitudes, and side effect expectations) were completed at baseline. Side effects were measured immediately and 1-week following the vaccination. Future intentions to vaccinate were measured 1-week postvaccination. RESULTS: Anxiety (P < .001) and perceived sensitivity to vaccines (P = .044) predicted the number of symptoms reported immediately following vaccination. Anxiety (P < .001) and perceived sensitivity (P = .035) along with baseline symptoms (P < .001) predicted symptoms 1 week following the vaccination. Female gender (P = .003), younger age (P = .018), anxiety (P < .001), and baseline symptoms (P = .009) predicted whether participants attributed symptoms as vaccination side effects. Anti-vaccination attitudes were associated with less intention to vaccinate in the future (P = .033). CONCLUSIONS: Nocebo-associated psychological factors contributed to symptoms experienced after an influenza vaccination. Findings demonstrate that the way symptoms are noticed, and then interpreted as side effects, appear to be separate mechanisms promoted by different factors. This study improves identification of side effect reporters prior to vaccination.Item Anti-fracture Efficacy of 5- or 10- Yearly Zoledronate in Women Aged 50-60y: Secondary Analyses of a Randomized Trial(Oxford University Press, 2025-10-18) Bolland, Mark J; Nisa, Zaynah; Mellar, Anna; Gasteiger, Chiara; Pinel, Veronica; Mihov, Borislav; Bastin, Sonja; Grey, Andrew; Reid, Ian R; Gamble, Greg; Horne, AnneCONTEXT: We recently reported that zoledronate given once at baseline or twice (every 5y) reduced fracture risk over 10y. OBJECTIVE: We assessed whether the effects of zoledronate differ over time or across important baseline variables, and how they relate to changes in bone mineral density (BMD) over time. DESIGN: 10y, prospective, randomized, double-blind, placebo-controlled trial, from 2012 to 2023. SETTING: Clinical research centre. PARTICIPANTS: 1054 post-menopausal women, aged 50-60y, with BMD T-score at the lumbar spine, femoral neck or total hip between 0 and -2.5. INTERVENTION: Either 5-yearly 5mg zoledronate (zol-zol), 5mg zoledronate infusion at baseline and placebo at 5y (zol-placebo), or 5-yearly placebo (placebo-placebo). MAIN OUTCOME MEASURES: Morphometric vertebral fractures, major osteoporotic and any fractures. RESULTS: Morphometric vertebral fractures were not reduced in years 0-5 following zoledronate but were reduced in years 5-10 by 58% (95% CI 21-77%) (zol-zol) and 57% (21%-77%) (zol-placebo). For any fracture and major osteoporotic fracture, similar temporal patterns were observed. There were no interactions between treatment effect and baseline variables (including age, body mass index, BMD, falls or fracture history, and estimated fracture risk) or between treatment effect and changes in BMD with zoledronate. CONCLUSIONS: Fracture reductions with single dose or 5-yearly zoledronate appear greater in years 5-10 than years 0-5. The risk reductions are broadly consistent across this cohort and independent of baseline or change in BMD. This suggests that routine BMD monitoring may not be necessary for low-risk women considering the option of less frequent zoledronate for long-term fracture risk reduction.Item Life Course Trajectories for Young Pasifika in Aotearoa: Protocol for the 25-year Follow-up of the Pacific Islands Families Study Cohort(JMIR Publications, 2025-11-10) Tautolo, El-Shadan; Bakir-Demir, Tugce; Jalili-Moghaddam, Shabnam; Savila, Faasisila; Kokaua, Jesse; Schluter, Philip J; Ofe-Grant, Maulupeivao Betty; Rush, Elaine; Mohammed, Jalal; Vaka, Sione; Tiatia-Siau, Jemaima; Cammock, Radilaite; Te Ao, Braden; Fa'alili-Fidow, Jacinta; Fifita, 'Ilaisaane ME; Manuela, Sam; Iusitini, LeonBACKGROUND: From birth, many young Pacific people in Aotearoa New Zealand experience a disproportionately high burden of psychological distress, metabolic disease, and socioeconomic disparities within education and employment which contribute to significant health inequalities. Further research is needed to understand the drivers influencing these outcomes. OBJECTIVE: This paper provides a comprehensive overview of the quantitative component of the Pacific Island Families Study: Ala mo Tupulaga Pasifika Aotearoa (PIF:ATP; Life Course Trajectories for Young Pasifika in Aotearoa), the latest follow-up of the longitudinal PIF birth cohort study, which uses a mixed-methods approach. METHODS: The PIF Study is a multidisciplinary longitudinal study that tracks the health and development of 1398 Pacific children born in 2000 at Middlemore Hospital, South Auckland, Aotearoa, New Zealand. Data collection has occurred at 10 time points from infancy through young adulthood, with this PIF:ATP assessment phase occurring at ages 25-26 years, which aims to reach at least 750 cohort members. The assessments will take place at participants' homes or at Auckland University of Technology for those residing in Auckland. Data collection will be conducted across multiple sites, including Auckland, Wellington, Hamilton, and Whangārei in Aotearoa New Zealand, as well as Brisbane, Sydney, and Melbourne in Australia. Physical measurements such as weight, height, waist and hip circumferences, grip strength, body fat mass and muscle mass, blood pressure and pulse, glucose and lipid screening, and skin carotenoid concentration will be undertaken. In addition, self-reported data will be collected on psychological well-being (eg, depression, anxiety, and family functioning), nutritional and metabolic well-being (eg, food intake and physical activity), and economic well-being (eg, educational attainment, employment status, and job occupation and industry). RESULTS: Data collection is scheduled to commence in June 2025 and conclude by December 2026. The first set of results and analysis is expected to be published from December 2027 onward. Reporting of all results will comply with the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines. CONCLUSIONS: This paper presents the protocol for the 25-year follow-up of the first Pacific longitudinal cohort study, which will comprehensively examine psychological, nutritional, metabolic, and economic well-being of Pacific young adults. With 25 years of longitudinal data and extensive expertise in life course research, this protocol outlines the design, methodology, and scope of the quantitative component of the PIF:ATP research program. This phase is uniquely positioned to address key issues identified by Pacific communities and generate evidence to inform meaningful interventions and guide policy development while providing robust, contemporary, high-quality empirical evidence.Item What Counts as Care? Structural Critique of Digital Health Models(SAGE Publishing, 2026-01-19) Wang, Xi; Yang, Fuwen; Trafford, Julie; Qiu, Wuqi; Conn, CathIn a world increasingly saturated with digital health technologies, the promise of empowerment through information has become almost axiomatic. Yet what if access does not equate to understanding, and what if the sleek interfaces and personalized nudges of today's tools merely simulate agency while displacing it? This presentation interrogates the epistemological and ethical limits of four dominant models underpinning digital health design: the information deficit model, the knowledge–attitude–practice (KAP) framework, health literacy strategies, and behavioral nudging. Despite their differences, each presumes a rational, autonomous user who simply needs the right data or design to act wisely. Drawing on critical public health literature and sociotechnical theory, we argue that these frameworks obscure the structural and social determinants of health (SDoH), such as time poverty, financial stress, and cultural tensions, that fundamentally constrain genuine agency. Rather than merely optimizing individual behavior, this commentary compels the field to confront fundamental questions of power: Who gets to define health? Who designs the algorithm? And who is excluded in the process? By centering these inquiries, the real frontier is not smarter apps, but fairer governance. The paper concludes that addressing the digital divide requires structural interventions, such as participatory oversight and redistributive design, ensuring that digital health systems are grounded in human understanding rather than just administrative efficiency.Item Reflections on Community Academic Partnership in Health Research With the Niue Community Using the Matalili‑Aga Gahua (Matalili Wellbeing Framework)(Springer Science and Business Media LLC, 2026-04-29) Lau, K; Vorster, A; Togiamua, E; Eruthayam, C; Wepa, D; Hock, B; Patutaue-Tongatule, H; Garrett, NCommunity-academic partnerships are essential for addressing health inequities and ensuring public health research reflects the values and priorities of communities. This study presents reflections from community and academic researchers in a collaborative research project conducted during the COVID-19 pandemic to explore the wellbeing of the Niue community in Aotearoa New Zealand. The research was guided by the Matalili Wellbeing Framework, a model developed from Niue cultural values and traditional knowledge, with the principles of Vahā Loto-Agaaga Ofania (Spirit of Care), Fakafetuiaga (Inclusive Relationship), and Fakamalolo (Empowerment). Using a collaborative autoethnographic approach, both community and academic researchers contributed written reflections spanning all stages of the research process. The reflections in this study described how community members were involved in the broader health research project, contributing to its initial conceptualisation and design and participating in data collection, interpretation, and dissemination. The reflections also highlighted the importance of trust-building, flexibility, and integrating traditional knowledge and lived experience. Informal and inclusive settings, supported by technology and collaborative practices, facilitated active participation and mutual learning. The partnership successfully navigated tensions between institutional procedures and community practices, demonstrating how culturally inclusive, community-led research can yield outcomes that are academically rigorous and socially meaningful. The study offers contextually grounded implications for practice that may inform effective community-academic partnerships in future community health research and public health policy development involving the Niue community, as part of the wider Pacific communities. The findings reinforce the importance of co-design and relational accountability in public health research.