How do people with multiple long-term health conditions experience the self-management approach to health care? : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy, Massey University, Palmerston North, New Zealand

The health system in New Zealand has devised approaches intended to meet the needs of people with long-term conditions (LTCs) based on the international theories of the Chronic Care Model (CCM) and a self-management framework (Bodenheimer, Wagner, & Grumbach, 2002b; Lorig, 1993; Wagner, 1998). LTCs and multimorbidity are socially patterned so often people with several LTCs are also contending with chaotic lives as well as the implications of their Illnesses. The self-management framework is based on the assumption that everyone has the agency or freewill to make the daily decisions that would benefit their health and ignores the powerful effect of social context. Because the behaviours recommended to optimise health are so entwined with a person’s social context, LTCs are particularly sensitive to the social determinants of health. This multiple case study follows the complex lives of sixteen people with several significant long-term health conditions using the theories of both Cockerham (2005, 2010, 2013b) and Link and Phelan (1995, 2010) to explore their experiences. Ongoing contact with the patient-participants comprised two interviews, four-weekly contacts and interviews with their primary health care clinicians. The patient-participants’ stories reveal complex, entangled lives marked by loss, poverty and daily challenges. They are significantly constrained by the overwhelming social contexts of their lives and reduced to survival mode by their cumulative losses across the four domains of the Whare Tapa Wha model. Personal agency is neither a choice nor readily achieved. They are left too exhausted to work their way through a health system that does not recognise their needs, empower them or compensate for their lack of energy. The weary patient-participants in this study bear little resemblance to the idealised expert patient of the self-management framework. Clinicians are left manoeuvring to compassionately and pragmatically support the patient-participants as best they can within an unhelpful system. The findings however do surface examples of care that are valued by both patient- and clinician-participants that sit outside the self-management approach. These valued aspects are explored alongside the harm reduction, recovery and palliative models of care. These all offer contributions towards an approach that would optimise the quality of life for people with significant, multiple LTCs. An exploration of this re-awakened approach to care is described. Care that is constricted self-management approach could wrap around the patient and support them to use their residual agency in a direction of their choosing. Clinicians would be released from their current programmed response be able to more fully utilise their clinical expertise. Clinicians and patients would have the freedom to be more pragmatic around quality of life and the issues that matter to the individual with LTCs

Representations of the Kauffman bracket skein algebra I: invariants and miraculous cancellations

We study finite-dimensional representations of the Kauffman skein algebra of a surface S. In particular, we construct invariants of such irreducible representations when the underlying parameter q is a root of unity. The main one of these invariants is a point in the character variety consisting of group homomorphisms from the fundamental group of S to SL_2(C), or in a twisted version of this character variety. The proof relies on certain miraculous cancellations that occur for the quantum trace homomorphism constructed by the authors. These miraculous cancellations also play a fundamental role in subsequent work of the authors, where novel examples of representations of the skein algebra are constructed.Comment: Version 3: Improvements in the exposition following referee reports. This version also fixes a small gap in the proof of the miraculous cancellations of Theorems 4 and 21, originally caused by an incorrect interpretation of the reference [Bu] used to create a shortcut in the computations; the results are unchanged, and the modifications to the proof very minima

“Membership Retention in the Fitness Industry: A Qualitative Study and the Development of a Predictive Model"

The concern over poor membership retention rates in the fitness industry is increasing, yet it has attracted little empirical research. So far, membership retention has mostly been indirectly and narrowly addressed, whereby research has either measured member satisfaction or member usage of a fitness club from mainly a service quality perspective. This paper introduces a mixed-method (QUAL→quan) research project and presents the findings of the qualitative study. 30 semi-structured telephone interviews were conducted with a stratified random sample of current and past members of a fitness club. The responses were thematically analysed and used in the development of a predictive model of fitness club membership retention. The model seeks to predict club usage and actual retention, and includes components such as attitudinal, normative, control beliefs, motivation orientation as well as perceived quality, brand identity and commitment

"Can the Research-Practice Gap Ever Really be Bridged? Applying the ‘Applied’ in Evidence-Based Organisational Practice"

Applied Occupational Psychology research provides a valuable evidence base which can potentially be used to inform and improve organisational practice. In reality, however, its actual usage in organisational practice is not a given. After a brief overview of the characteristics of applied research and the challenges faced when conducting it, the valuable role that applied research can have in interpreting organisational behaviour and developing interventions is emphasised. However, this is just the first hurdle for applied researchers, seeking to bridge their research-practice gap. Whilst researchers might succeed in applying their findings to the development of an intervention or practical recommendations, numerous challenges may be encountered during the actual application of these interventions/ recommendations into organisational practice. Subsequently, the gap between research and practice is at risk of remaining unbridged. Using my own PhD research as an exemplar ("Membership retention in the health and fitness industry: A predictive model"), these issues will be illustrated and discussed, including ways in which the gap between research and practice can be successfully bridged

Membership Retention in the Fitness Industry: The Development and Validation of a Predictive Model.

Fitness club managers are becomingly increasingly concerned with membership retention rates yet there appears to be no empirical research into the factors underlying member attrition i.e. what makes people decide to cancel the membership? Whilst there is a wealth of research into member attendance (exercise adherence) as well as member satisfaction there is little, if any, empirical research which bridges the gap between member attendance and retention. The aim of this paper is three-fold. Firstly, to introduce the design of this research project aimed at developing a predictive model of membership retention in fitness clubs. Secondly, to report the findings to date and thirdly, to suggest the managerial implications of this findings. This PhD research project is mixed-method in design (QUAL-Quan); which began with a qualitative phase. This phase consisted of a literature review followed by telephone interviews conducted with a stratified random sample of gym members (n=25). The findings of the interviews were combined with the results of the literature review to identify potential components of a conceptual model of fitness club attendance and retention. Thus, the quantitative phase began. The identified components suggested as underpinning attendance and retention included attitudinal, normative and control beliefs towards attending their fitness club, levels of self-determination towards attending fitness clubs, habitual attendance, social anxiety, social identity, perceived service quality, brand identification and commitment. The Membership Retention Questionnaire (MRQ) was developed to measure the components in this model and firstly ‘snowballed’ to a purposive sample of gym members and secondly distributed to members of one club. This model is subject to further factor analysis and structural equation modelling of the quantitative findings. This research methodology is unique in its application to researching fitness club retention, due to its sampling of fitness club members; not just fitness club users, and an upcoming longitudinal analysis (12 months) of the model’s value in predicting actual membership retention; not just membership intentions. The managerial implications of these findings include the importance of distributing the MRQ to members at various time points throughout their club membership. This allows the measurement of relevant behavioural and psychological factors which can be used to assess ‘risk’ in members and implement effective interventions in order to increase attendance and retention rates