The alcohol industry-A commercial determinant of poor health for Rainbow communities.

BACKGROUND: Alcohol use is an area of challenge for health promotion internationally. The alcohol industry operates as a key commercial determinant of health in that its actions contribute to alcohol misuse, resulting in a range of health and social harms to individuals, families and communities. Rainbow people (including those who identify as lesbian, gay, bisexual, transgender or gender diverse) are one group experiencing considerable harm from alcohol use. METHODS: Data from 24 focus groups involving 131 people held in six cities in New Zealand during 2018, were used to explore local understandings of the ways in which the alcohol industry operates as a commercial determinant of health for Rainbow communities. The focus group discussions were analysed thematically. RESULTS: Three key themes were identified. First, the alcohol industry was identified as present in the 'everyday', through targeted alcohol promotion to Rainbow people, and due to the centrality of bars to their social and cultural landscapes. Second, participants recognised the benefits of alcohol industry support for Rainbow communities. Last, an opposing view was articulated, with the alcohol industry and its commercial activities viewed negatively. CONCLUSIONS: These findings highlight that alcohol as a commodity and the alcohol industry are successfully and firmly embedded within Rainbow communities. Overall, given alcohol is widely regarded in a positive way, this is likely to create difficulties for health promotion efforts to reduce alcohol related harm in these communities.

Holding on and letting go: Views about filial piety among adult children living in New Zealand.

AIMS AND OBJECTIVES: The study aimed to explore the perspectives of adult children about late-life living and care arrangements for their ageing immigrant parents living in New Zealand. BACKGROUND: Older immigrants' well-being is closely associated with filial relations and is often reliant on families as a main source of social, financial and emotional support. Research among migrant Asian adults has reported mixed findings regarding intergenerational perspectives of filial practices. DESIGN: Qualitative design using focused ethnographic lens. METHODS: Semi-structured individual interviews were undertaken with 45 adult children of older immigrants living in New Zealand to explore their views about filial piety. The CoREQ checklist was used in reporting methods and findings. RESULTS: Two major themes were identified in this study of adult children's view of filial piety and late-life care for their ageing parents. The first theme, 'holding on-reconfiguring values', referred to a process described by the participants as upholding the core values and cultural familial expectations, looking after their ageing parents, yet modifying the ways in which they provide care. The second major theme 'letting go-reconfigured expectations', described participants' views of aged care for themselves, which meant they no longer held traditional values that needed to be enacted by their children. CONCLUSIONS: Adult children from immigrant families were positioned as intermediaries of these shifting values of their own and within younger generations. The adult children's shift of thinking and acceptance of reconfigured expression of filial duties impact care and living arrangements of older people from immigrant and culturally diverse backgrounds, which also influences health and well-being in later life. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals including nurses working in the ageing and aged care sector need to accommodate the changing generational perspectives about filial piety to cater to the unique late-life care requirements and health needs of older people and their families.

Exploring talk about sexuality and living gay social lives among Chinese and South Asian gay and bisexual men in Auckland, New Zealand.

Objective: To identify ways Chinese and South Asian gay and bisexual men living in Auckland talk about issues related to sexuality and experiences of living 'gay social lives.' Results will be available to inform health policy and practice.Design: A qualitative design with individual interviews and thematic analysis was used. Semi-structured digitally recorded interviews were undertaken with 27 Chinese and 17 South Asian gay and bisexual men living in Auckland.Results: Four themes in the data related to talk about sexuality and living gay social lives are reported: (a) 'Happy in my skin': Being gay is Ok! (b) 'To come out or not': Managing sexual identity, (c) 'Places to go, people to see': Connecting with others, and (d) 'What's wrong with being Asian': Tolerating discrimination.Conclusion: There are many similarities in the ways these men talked about their identity and sexuality that can be usefully considered by health policy makers and service planners. The concept of gay (and bisexual) sexuality had some salience for the men interviewed, despite the adoption and acknowledgement of same-sex identity being a relatively new phenomenon in some Asian countries. This supports the use of these terms in local health interventions. However, as these men closely managed their gay identity and typically had not disclosed their sexuality to others, including healthcare professionals, interventions to address the skills and comfort of healthcare providers in addressing sexuality in clinical settings appear warranted to facilitate optimal healthcare. These men are not well connected with others and this has implications for HIV health promotion that is based on creating cultural norms among networks to encourage safe sex. Discrimination results in many Chinese and South Asian gay and bisexual men disengaging from connecting with others and should be addressed.

Late-life living and care arrangements of older Filipino New Zealanders.

AIMS AND OBJECTIVES: To explore the living and care arrangement plans of older Filipino immigrants in New Zealand. BACKGROUND: New Zealand is rapidly becoming the host to an increasing number of ageing Filipino immigrants. Despite this sizeable population growth of ageing Filipinos in New Zealand, still very little is known about this ethnic group's care needs and living arrangement preferences in later life within the New Zealand context. DESIGN: Qualitative descriptive approach. METHODS: Data were collected from 15 older Filipinos who participated in face-to-face interviews. Data were analysed using a thematic analytical framework. RESULTS: Two major themes were identified from the data analysis. The first theme "preferred living and care arrangements" is about older Filipinos' preferred plans for future residence and in receiving care when no longer able to function independently in their own homes. The second theme "negotiating readiness and acceptance" is about hypothetical situations that older Filipinos described and anticipated that will greatly facilitate their readiness and acceptance to living in aged care facilities. CONCLUSION: The study results have implications for service delivery within the New Zealand residential aged care sector. Due to an increasing number of older Filipino immigrants requiring care, residential aged care facilities must ensure their care models meet the needs of this growing group of older people. RELEVANCE TO CLINICAL PRACTICE: Nursing staff skill sets in the aged care sector require sensitivity to older immigrants' health needs without compromising cultural beliefs and practices while living in residential aged care facilities.

An integrative review of the factors related to building age-friendly rural communities.

AIM AND OBJECTIVES: To identify the theories and concepts related to building age-friendly rural communities. BACKGROUND: Global population is rapidly ageing. Creating environments that support active ageing was a catalyst for the World Health Organization to develop Global Age-Friendly Cities guidelines. Although the age-friendly movement has captured the attention of some countries, little is known about the participation of older people in rural settings. METHOD: An integrative review approach was employed to summarise the research literature on this topic. Using a systematic search strategy, databases including Discover (EBSCO's electronic database system), Web of Science, Scopus, PubMed, CINAHL, PsycINFO, Medline and Google Scholar were searched. Primary, peer-reviewed studies were included if published during 2007-2014 in the English language. RESULTS: Nine studies were eligible for inclusion. The studies were set predominantly in Canada, with the exception of one from Ireland. The findings were summarised and clustered into main topics which included: theoretical perspectives; geographic and demographic characteristics; collaboration and partnerships; sustainability and capacity; and finally, future research agendas. CONCLUSIONS: Rural communities are changing rapidly and are becoming increasingly diverse environments. Community characteristics can help or hinder age-friendliness. Importantly, the fundamental starting point for age-friendly initiatives is establishing older peoples' perceptions of their own communities. RELEVANCE TO CLINICAL PRACTICE: It is important for nurses, working in primary health care settings, to understand the needs of older people in the communities in which they practice. This includes the community characteristics that can be enablers and barriers to older people being able to remain and age within their own communities.

The condom imperative in anal sex - one size may not fit all: a qualitative descriptive study of men who have sex with men.

AIMS AND OBJECTIVES: To explore men who have sex with men's views about condom use when having anal intercourse. BACKGROUND: Internationally, health promotion campaigns use behavioural change strategies to support men who have sex with men to always use condoms when having anal sex with other men. The health promotion message given to this group is consistent and explicitly stated that 'use a condom every time for anal sex regardless of relationship status'. DESIGN: Qualitative analysis of data from a cohort of New Zealand men who have sex with men. METHODS: A total of 960 useable questionnaires were completed: 571 online and 389 in hard copy. Qualitative data were analysed using a thematic data analytic process. RESULTS: Three themes relating to condom use in men who have sex with men were identified. These are as follows: 'Safer sex is good sex', 'Condom use is good but …' and 'I use condoms sometimes'. CONCLUSIONS: The range of responses towards condom use for anal sex in men who have sex with men in our sample reveal this as a complex public health issue, with not all men who have sex with men willing to consistently use condoms. RELEVANCE TO CLINICAL PRACTICE: It is important that nurses do not assume that all men who have sex with men are willing to use condoms for anal sex, and should create opportunities for men who have sex with men to raise any concerns about the use of condoms. In this way, nurses can assist in providing information that may help men who have sex with men to make decisions that will minimise risk of contracting infections associated with sexual activity.

Evaluation of a diabetes nurse specialist prescribing project.

AIMS AND OBJECTIVES: To evaluate the diabetes nurse specialist prescribing project with the aim of determining whether diabetes nurse specialist prescribing is safe and effective and to inform the implementation and extension of registered nurse prescribing. BACKGROUND: Registered nurses in many countries are able to prescribe medicines, but in New Zealand, prior to the diabetes nurse specialist project, nurse practitioners were the only nurses who could prescribe medicines. New regulations allowed the nurses to prescribe a limited number of prescription medicines. DESIGN: The study was a process and outcome clinical programme evaluation. METHODS: The project took place between April-September 2011 and involved 12 diabetes nurse specialist in four localities. Quantitative data were collected from clinical records maintained by the diabetes nurse specialist for the project (1274 patients and 3402 prescribing events), from surveys with stakeholders (general practitioners, n = 30; team members, n = 19; and patients, n = 89) and audits from patient notes (n = 117) and prescriptions (n = 227), and qualitative data from interviews with project participants (n = 18) and patients (n = 19). All data were analysed descriptively. RESULTS: Diabetes nurse specialist prescribing was determined to be safe, of high quality and appropriate. It brought important benefits to the effectiveness of specialist diabetes services, was acceptable to patients and was supported by the wider healthcare team. CONCLUSIONS: These findings are consistent with the findings reported in the international literature about nurse prescribing in a range of different practice areas. Clarification of the education and competence requirements and resourcing for the ongoing supervision of nurses is recommended if the prescribing model is to be extended. RELEVANCE TO CLINICAL PRACTICE: Diabetes nurse specialist prescribing improved access to medicines by providing a more timely service. Nurses felt more satisfied with their work because they could independently provide a complete episode of care. As novice prescribers, nurses need to be well prepared educationally and have access to supportive clinical supervision.

Social marketing campaigns that promote condom use among MSM: a literature review.

The turn of the century has seen an increase in reported cases of sexually transmitted infections including the human immunodeficiency virus, particularly in groups of men who have sex with men. Both internationally and in New Zealand the implementation of social marketing human immunodeficiency virus prevention programmes are identified as appropriate mechanisms to promote condom use in men who have sex with men. This paper presents a review of the literature on research-based social marketing initiatives designed to decrease sexually transmitted infections, including the human immunodeficiency virus, through an increase in condom use by men who have sex with men. Eleven quality assured articles met the inclusion criteria and were consequently included in the review. The review presented here strongly supports the utilisation of behaviourally based social marketing campaigns to increase condom use in men who have sex with men. Nurses are frequently first point of contact for consumers of health services. As such they need to have a sound understanding of not only Get it On!, a New Zealand social marketing campaign designed to promote condom use, but also about existing international campaigns. Nurses should also know about social marketing principles if they are to effect positive changes in condom use and address the complex challenges inherent in tackling increased rates of sexually transmitted infections, including the human immunodeficiency virus.

Perceptions of ageing as an older gay man: a qualitative study.

AIMS AND OBJECTIVES: To explore the ageing experiences of gay men in New Zealand over the age of 65 years. BACKGROUND: An increased acceptance by many people in Western societies towards men who are same-sex attracted is likely to result in a corresponding increase in the number of visible older gay men being the recipients of nursing care. Previous research has shown that nursing has some way to go towards providing a service that is culturally safe and appropriate. DESIGN: A critical gerontological approach was employed to explore the ageing experiences of gay men in New Zealand over the age of 65 years. This methodology ensured the voices of older gay men were foregrounded in the research. METHODS: Semi-structured digitally recorded individual interviews with 12 gay men aged between 65-81 years who lived in the community were undertaken. Data were analysed using thematic analysis to identify the repeated patterns across the men's talk. RESULTS: Three main themes relating to the ageing experiences of these men were identified: 'homophobia', 'being with someone' and 'future care'. CONCLUSIONS: Resilience was a significant factor in how well older gay men aged even in an environment where homophobia and heterosexism were common. Having a strong social support network was an important factor that contributed to supporting the ageing process. These gay men were wary about having to go into residential care, preferring to age in their own homes. RELEVANCE TO CLINICAL PRACTICE: Nurses and other healthcare professionals need to ensure healthcare services meet the needs of older gay men. Any interaction with older gay men should occur in a way that is open and respectful. The usage of best practice guidelines will assist organisations to deliver culturally safe and appropriate care to this group.

Gay men's explanations of health and how to improve it.

Little is known about the health views of gay men. In this article we report on how gay men explained health and the ways they discussed how health for gay men can be improved. We conducted a thematic analysis of data collected from 45 gay men in 11 focus groups and identified that health was mainly explained in individual terms, as were the ways to improve health (personal health care services and health promotion). The second way health was explained drew on social and community factors, with the societal acceptance of gay men being reported as essential for health improvements. These individual and social/community approaches were in tension; overall, the individualized approaches dominated. In line with other theorizing in health, we argue that appropriate policy and service provision to meet the health needs of gay men require greater acknowledgment of the social and community explanations of health and ways of improving health.

Justifications for heavy alcohol use among gender and sexually diverse people.

A range of research reports that many gender and sexually diverse people drink alcohol at heavy levels. This study used 24 focus groups to explore shared understandings of alcohol use among gender and sexually diverse people living in New Zealand. An inductive, data-driven thematic analysis was employed to identify explanations for heavy drinking among gender and sexually diverse people. Three key explanations were articulated: alcohol is needed for socialising; drinking helps coping with stress; alcohol and drug treatment services are inadequate. These results demonstrate justifications for heavy drinking in certain contexts. This behaviour runs counter to public health approaches and messages that highlight low-risk levels of drinking or not drinking as desirable. Public health interventions should continue to address alcohol use at a whole population level but should be supplemented by policy and interventions that take into account the sociocultural contexts and structural conditions that encourage drinking among gender and sexually diverse people.

Beginning on an age-friendly journey: Barriers to implementing age-friendly initiatives.

OBJECTIVE: To explore the barriers to communities in New Zealand developing age-friendly initiatives. METHODS: A qualitative participatory approach underpinned this study. Semi-structured digitally recorded individual interviews were undertaken with 24 government officials, local government steering group members and community representatives from an urban city, provincial city and a rural district. A general inductive data analytic process was undertaken. The consolidated criteria for reporting qualitative research (COREQ) guidelines were followed to ensure rigour in this study. RESULTS: (a) Being at the beginning, (b) Minimal diversity and (c) Problems getting started were three key issues identified. CONCLUSIONS: New Zealand is in the early stages of becoming age-friendly. Findings from this study provide a place-based New Zealand perspective and have influenced central government social policy and practice development, culminating in resources supporting local government and communities to successfully implement age-friendly initiatives.

Accessing rural health services: Results from a qualitative narrative gerontological study.

OBJECTIVE: Explore how older adults' talk about accessing rural community health services. METHODS: A qualitative narrative gerontological approach explored issues related to accessing health services in their community. Semi-structured digitally recorded individual interviews were undertaken with 32 community-dwelling older people aged between 75 and 93 years. A narrative data analytic process was undertaken. The COnsolidated criteria for REporting Qualitative research guidelines were followed to ensure rigour in this study. RESULTS: Three collective narratives resulted from the data analytic process: (a) "accessing local health services"; (b) "accessing specialist services"; and (c) "accessing emergency services." CONCLUSIONS: Narrators identified a number of issues related to accessing rural health services. These included long waiting times, lack of continuity in care provision by doctors and difficulties accessing specialist and emergency services. Nurses were frequently cited as a reliable point of contact for these older people. Expansion of nursing roles would enhance the provision of rural health-care services.

Older Filipino immigrants' reconfiguration of traditional filial expectations: a focus ethnographic study.

BACKGROUND: One of the many socio-cultural issues impacting older immigrants in host countries is the cultural expectations of filial piety from their adult children. OBJECTIVE: To understand older Filipino immigrants' beliefs and values towards filial expectations. DESIGN: Focused ethnography. RESULTS: Two major themes were identified. The first theme 'moving away from filial expectations' drew out older Filipino's changing views of cultural expectations from their adult children. The second theme 'maintaining cultural values through good family relationships' highlighted the importance of acknowledging the cultural values considered to be most important by older Filipinos, which was having harmonious relationships and avoiding family conflict. CONCLUSION: The reconfigured expectation was salient with participants' who identified 'not being a burden' to their adult children and the ardent desire to maintain positive family relationships. Impact Statement: Nurses need to be aware of changes to our current understanding of filial piety when providing care to older Filipinos.

Men who have sex with men account for nonuse of condoms.

Despite several decades of health promotion activity targeted at men who have sex with men (MSM), rates for nonuse of condoms for anal sex among MSM worldwide and in New Zealand have been increasing in recent times. In this article we report on the first local qualitative investigation undertaken in Auckland, New Zealand, of how members of a particular group of MSM account for nonuse of condoms for anal sex with other men. We collected qualitative data from 22 MSM (17 face-to-face interviews, and three online interviews involving 5 men). Thematic analysis led to the identification of five patterns that account for the nonuse of condoms: (a) substance use, (b) psychological aspects, (c) difficulties using condoms, (d) condoms in relationships, and (e) managing risk. We conclude that although this information generally confirms the findings in the wider research literature, it is also important in the local context as the first research that can be used with confidence in developing and refining health promotion initiatives to address this issue.

Condom use in men who have sex with men: a literature review.

The aim of this paper is to present a review of the literature on the key issues impacting on the decisions, by men who have sex with men, to use, or not use, condoms for anal intercourse. 250 publications were accessed, reviewed, read and sorted; 200 of these were research based and 50 were opinion pieces of work. In addition, 240 of the 250 had undergone a peer review process. The review presented here shows that men who have sex with men communities are a heterogeneous group and their reasons for engaging in unprotected anal intercourse are inter-related and diverse. Six main themes related to sexual risk behaviour and condom use were identified: the availability of HIV treatments, physical issues, psychosocial issues, intentional practices, internet and substance use. Nurses need to understand these factors if they are to effect positive changes in condom use and address the complex challenges inherent in tackling increased rates of HIV infection.

"Engaging in my rural community": perceptions of people aged 85 years and over.

PURPOSE:  Globally, numbers of people aged 85 years and over are increasing. Many older people, including those 85 years and over, are ageing in rural areas. For successful ageing in place, physical and social environments must be appropriate. The aim of this study is to understand the influence the physical and social environments have on enabling those aged 85 years and over to remain engaged in a rural community. Method: Utilizing an environmental gerontological approach, semi-structured interviews were undertaken with 15 people who lived independently in a rural community. Following transcription data were analyzed and themes identified. Results: Two themes were identified; "Negotiating the physical environment: 'Getting there and back'" and "Maintaining social networks: 'Places to go, people to see'". The findings provide insight into the importance of driving, parking close to amenities and negotiating the local environment to this group of older people and their ability to engage with their community. All participants agreed social engagement with friends, family or neighbors was important to them. Conclusion: These findings highlight the interconnection between physical and social environments. An enabling physical environment is essential to support social participation of people aged 85 years and over.