Process, pitfalls and profits: lessons from interviewing New Zealand policy-makers.

Little has been written about interviewing policy-makers in health promotion and public health research. This article explores the process, pitfalls and profits of semi-structured interviews with policy-makers in 10 research projects conducted in New Zealand. Key members of each research team were surveyed about their research and findings verified against research publications. Key aspects of the process of policy-maker interviews include gaining ethical approval, navigating gatekeepers, using personal contacts and multiple research dissemination methods. Pitfalls of interviewing policy-makers include interviewers not having enough knowledge of the topic so efforts were made to use knowledgeable researchers or up-skill others. Interviews provide access to specialist knowledge of the policy process which cannot be obtained by other methods. While this study was conducted in one jurisdiction, it has implications for other countries. Effective policy-maker interviews in health promotion policy research could contribute to improvements in the quality of data collected and uptake of research by policy-makers.

Rural workers' experience of low back pain: exploring why they continue to work.

INTRODUCTION: Many New Zealand rural workers have repeated low back pain (LBP) episodes yet continue to work. We wanted to find out why, given that other manual workers with LBP often end up on long term sick leave or permanently disabled. METHODS: Our primarily qualitative approach used mixed methods to investigate rural workers with non-specific LBP. Participants (n = 33) were surveyed for demographic data, the Brief Illness Perception Questionnaire and the General Self Efficacy Scale followed by one-to-one semi-structured interviews. Analysis ranged from descriptive content to detailed qualitative Interpretative Phenomenological Analysis. RESULTS: Participants had high self efficacy scores, positive perceptions about LBP but strong beliefs that LBP is lifelong. Four distinct themes emerged. "Thinking with my head before my back" and "Knowing the risks" described participants' innovation regarding job modifications. "Just carry on" and "Love of the land" related to stoical resilience and commitment to something more than employment. CONCLUSIONS: This rural workforce adopts a 'can do' attitude to work, managing LBP within the context of having job control and flexible work practices. IMPLICATIONS: Rehabilitation interventions promoting job control and targeting positive attitudes towards getting on with work, whilst accepting LBP as part of everyday life, may have merit for other workers with LBP.

A qualitative case study of policy maker views about the protection of children from smoking in cars.

INTRODUCTION: As little is known about the policy making process around smokefree car laws, we aimed to investigate policy makers' views about such laws in a setting where these have not yet been enacted but where published evidence exists on the hazard of smoking in cars and on relevant public support. METHODS: A New Zealand (NZ) case study (of the NZ health policy community) used documents and qualitative in-depth interviews with 62 national-level and District Health Board (DHB)-level policy makers (during 2008-2009). Forty were government or nongovernmental organization officials, 5 DHB board members, and 17 Members of Parliament. RESULTS: We found very strong themes of policy maker concern for the vulnerability of children and the need for their protection from secondhand smoke. There were mixed reactions to the idea of a smokefree law for cars with children in them. These themes and mixed reactions spanned both the "left" and "right" political parties. The evidence indicates that smokefree car laws are only barely on the NZ national policy making agenda. They are generally not seen as politically attractive, as effective, or easy to implement. DISCUSSION: In this particular policy setting, there appear to have been assumptions by policy makers about the dominance of adult "privacy" over child protection. The lack of awareness in this particular (NZ) policy community of national-level public support for banning smoking in cars with children and of the progress elsewhere on such laws also suggests the importance of information and advocacy if such laws are to be progressed.

Public, private and personal: qualitative research on policymakers' opinions on smokefree interventions to protect children in 'private' spaces.

BACKGROUND: Governments use law to constrain aspects of private activities for purposes of protecting health and social wellbeing. Policymakers have a range of perceptions and beliefs about what is public or private. An understanding of the possible drivers of policymaker decisions about where government can or should intervene for health is important, as one way to better guide appropriate policy formation. Our aim was to identify obstacles to, and opportunities for, government smokefree regulation of private and public spaces to protect children. In particular, to seek policymaker opinions on the regulation of smoking in homes, cars and public parks and playgrounds in a country with incomplete smokefree laws (New Zealand). METHODS: Case study, using structured interviews to ask policymakers (62 politicians and senior officials) about their opinions on new smokefree legislation for public and private places. Supplementary data was obtained from the Factiva media database, on the views of New Zealand local authority councillors about policies for smokefree outdoor public places. RESULTS: Overall, interviewees thought that government regulation of smoking in private places was impractical and unwise. However, there were some differences on what was defined as 'private', particularly for cars. Even in public parks, smoking was seen by some as a 'personal' decision, and unlikely to be amenable to regulation. Most participants believed that educative, supportive and community-based measures were better and more practical means of reducing smoking in private places, compared to regulation. CONCLUSIONS: The constrained view of the role of regulation of smoking in public and private domains may be in keeping with current political discourse in New Zealand and similar Anglo-American countries. Policy and advocacy options to promote additional smokefree measures include providing a better voice for childrens' views, increasing information to policymakers about the harms to children from secondhand smoke and the example of adult smoking, and changing the culture for smoking around children.

A pilot qualitative study of New Zealand policymakers' knowledge of, and attitudes to, the tobacco industry.

BACKGROUND: The actions of policymakers are critical to advancing tobacco control. To evaluate the feasibility of using anonymous in-depth interviews to ascertain policymakers' knowledge about, and attitudes to, the tobacco industry, we undertook a pilot study involving New Zealand policymakers. METHODS: Five politicians (from different political parties) and five senior officials, who were involved in tobacco control policy, were recruited for semi-structured, anonymous, face-to-face interviews. RESULTS: Recruitment of appropriate senior policymakers was found to be possible. Interviewees were willing to answer questions fully and frankly about their knowledge and views of the tobacco industry.The preliminary data from this pilot suggest that some New Zealand politicians appeared to see contact with the industry as similar to contact with other groups, whereas the officials indicated at least a different style of relationship. Only one politician knew if their party accepted funding from tobacco companies. All but one of the interviewees thought that promotion of tobacco to under-16 s still occurs, albeit indirectly. The interviewees' knowledge of the investment in tobacco industries by New Zealand government agencies was low or absent.While most of those interviewed showed scepticism about tobacco company public relations efforts, this was absent in some cases. There was a wide understanding that the tobacco industry will use many tactics in the pursuit of profit, and to counteract government efforts to reduce the harm from smoking. CONCLUSION: In-depth anonymous interviews appear to be feasible and can be productive for exploring sensitive tobacco-related policy issues with policymakers. The preliminary data from this group of New Zealand policymakers suggest important knowledge gaps, but also general distrust of this industry. From a tobacco control perspective, the results may suggest a greater focus by advocates on the funding of political parties by the tobacco industry, and on government agency investment in the tobacco industry.

Coping with multiple sclerosis as a couple: 'peaks and troughs' - an interpretative phenomenological exploration.

PURPOSE: Multiple Sclerosis (MS) is a chronic degenerative condition where illness uncertainty is a key difficulty that people with MS and their significant others have to cope with. Clinicians acknowledge that people with MS need to be seen in the context of their families, however there is little knowledge on what to expect about how people cope as a couple, which this study set out to explore. METHOD: Interpretative Phenomenological Analysis (IPA) exploring, through semi-structured interviews, how seven couples, where one had MS, experienced coping with their situation. RESULTS: Two overarching themes pertaining to coping as a couple emerged from the data: Coping Together: "Peaks and Troughs" and Coping Over the Long Haul, with each overarching theme relating to sub-themes. Two integrative themes emerged also, which were called Faith in Self and Faith in Each Other. CONCLUSIONS: These results will assist clinicians better comprehend how those with MS and their spouses cope in an interconnected way and this in turn affects their experience of rehabilitation. Results from this research indicated that clinicians need to be sensitive to the individual coping strategies of both members of a couple where one has MS, and address the changing needs of their relationship.

Policymakers and the example of smoking to children: A qualitative study.

BACKGROUND: The normality of smoking that children are exposed to is associated with increased risk of smoking uptake. To better understand policymaking that could address this issue, our aim was to identify and document the views of New Zealand policymakers regarding the example of smoking behaviour to children, and the policy responses they preferred. METHOD: We analysed public documents for relevant statements, and conducted semi-structured anonymous interviews with 62 purposively selected policymakers. We identified views of New Zealand policymakers regarding: the example to children of adult smoking behaviour, and the policy responses they preferred. RESULTS: In both public statements and anonymous interviews, policymakers demonstrated that they perceived a clear relationship between the example of smoking and children taking up smoking. However, they showed a general unwillingness to support further smokefree legislation in areas frequented by children. Rather, they preferred to educate adults about their impact as models for youth behaviour. CONCLUSIONS: Health advocates in New Zealand and elsewhere may require more evidence of the effect of relevant legislation and of public support, and wider alliances, to significantly move policies specifically to reduce the example of smoking.

"If I didn't have anybody, what would I have done?": Experiences of older adults and their discharge home after lower limb orthopaedic surgery.

OBJECTIVE: To explore the perceptions of being discharged home following lower limb orthopaedic surgery in older adults. METHODS: Qualitative interviews with 11 patients over the age of 65 years were conducted between 6 and 12 weeks afterdischarge home and analysed using interpretative phenomenological analysis (IPA). RESULTS: Three themes were identified from analysis of the participants' experiences of rehabilitation during the 6­12 weeks following discharge: (i) lack of a shared decision on when to go home; (ii) dependent on family to go home and to feel confident there; and (iii) trial and error rehabilitation.A further theme: a paternalistic medical model was also identified in participants' experiences of contact with health professionals. CONCLUSION: Participants had positive experiences of being discharged home from hospital. However, few participants played an active role in their discharge, all required the support of family to go home, and many were left unsure of how and when to return to usual activities. A paternalistic medical model was apparent. Family support, not without costs,was integral to discharge and rehabilitation at home.