Abstract The original intention for the Partnership Community Worker (PCW) project in 2006 was for it to be an extension of the Pegasus Health General Practice and furthermore to be a bridge between the community and primary healthcare. It was believed that a close working relationship between the Practice Nurse and the PCW would help the target population of Māori, Pacifica and low income people to address and overcome their perceived barriers to healthcare which included: finance, transport, anxiety, cultural issues, communication, or lack of knowledge. Seven years later although the PCW project has been deemed a success in the Canterbury District Health Board annual reports (2013-14) and community and government agencies, including the Christchurch Resettlement Service (2012), many of the Pegasus Health General Practices have not utilised the project to its full extent, hence the need for this research. I was interested in finding out in the first instance if the model had changed and, if so why, and in the second instance if the promotional material currently distributed by Pegasus Health Primary Health Organisation reflected the daily practice of the PCW. A combination of methods were used including: surveys to the Pegasus Health General Practices, interviews with PCWs, interviews with managers of both the PCW host organisations and referring agencies to the PCW project. All the questions asked of all the participants in this research were focussed on their own perception of the role of the PCW. Results showed that the model has changed and although the publications were not reflecting the original intention of the project they did reflect the daily practice of the PCWs who are now struggling to meet much wider community expectations and needs. Key Results: Partnership Community Worker (PCW) interviews: Seventeen PCWs of the 19 employed were interviewed face to face. A number expressed interest in more culturally specific training and some are pursuing qualifications in social work; for many pay parity is an issue. In addition, many felt overwhelmed by the expectations around clients with mental health issues and housing issues now, post-earthquakes. Medical Practice surveys: Surveys were sent to eighty-two Pegasus Health medical practices and of these twenty five were completed. Results showed the full capacity of the PCW role was not clearly understood by all with many believing it was mostly a transport service. Those who did understand the full complexity of the role were very satisfied with the outcomes. PCW Host Community Manager Interviews: Of the ten out of twelve managers interviewed, some wished for more communication with Pegasus Health management because they felt aspects of both the PCW role and their own role as managers had become blurred over time. Referring organisations: Fifteen of the fifty referring community or government organisations participated. The overall satisfaction of the service was high and some acknowledged the continuing need for PCWs to be placed in communities where they were well known and trusted. Moreover results also showed that both the Canterbury earthquakes 2010-2011 and the amalgamation of Partnership Health PHO and Pegasus Health Charitable Limited in 2013 have contributed to the change of the model. Further future research may also be needed to examine the long term effects on the people of Canterbury involved in community work during the 2011-2014 years.
Research on responses to trauma has historically focused on the negative repercussions of a struggle with adversity. However, more recently, researchers have begun to examine posttraumatic growth: the positive psychological change that emerges from the struggle with a potentially traumatic event. Associations have been found between posttraumatic growth and greater peritraumatic distress, greater objective severity of trauma exposure, greater perceived stressfulness of events, social support, female gender, cognitive and behavioural responses to trauma, and personality measures. Posttraumatic growth has been measured typically in individuals with varying levels of posttraumatic stress disorder symptoms and other psychological difficulties, such as depression and anxiety. Although some theory and research posits that higher resilience would prohibit posttraumatic growth, no studies have examined posttraumatic growth in a resilient sample. The Canterbury earthquake sequence of 2010 and 2011 involved potentially traumatic events that saw the community struggle with a variety of challenges. However, in the midst of earthquake destruction, some positive initiatives emerged, driven by locals. The Gap Filler project (using city spaces left empty from fallen buildings for art and interactive community projects) and the Student Volunteer Army (groups of volunteers coordinated to help others in need) are examples of this. In this context, it seemed likely that posttraumatic growth was occurring and might be seen in individuals who were coping well with challenges. Culture is theorised to influence the posttraumatic growth process (Calhoun, Cann, & Tedeschi, 2010), and the nature of the trauma undergone is also likely to influence the process of growth. The current thesis measures posttraumatic growth quantitatively and qualitatively in a New Zealand sample. It measures and describes posttraumatic growth in a resilient population after the earthquake sequence of 2010 and 2011 in Canterbury, New Zealand. Findings are used to test current models of posttraumatic growth for individuals coping well after trauma and to elaborate on mechanisms proposed by models such as the comprehensive model of posttraumatic growth (Calhoun et al., 2010) and the organismic valuing theory of growth through adversity (Joseph & Linley, 2005). Correlates of posttraumatic growth are examined and likely supporting factors of posttraumatic growth are identified for this population. Study 1 used quantitative analysis to explore correlates of posttraumatic growth and found that greater posttraumatic growth related to greater peritraumatic distress, greater perceived stressfulness of earthquake events, greater objective stressfulness of earthquake events, greater difficulty with stressful life events, less satisfaction with social support, and female gender. Findings from Study 1 give important detail about the nature of distress included in the comprehensive model of posttraumatic growth (Calhoun et al., 2010) for this population. Levels of posttraumatic growth were lower than those in North American studies but similar to those in a Chinese study. The current sample, however, showed lower endorsement of Relating to Others than the Chinese study, perhaps because of cultural differences. Study 2 used qualitative analysis to examine the experience of posttraumatic growth in the sample. The theme of ‘a greater sense of community’ was found and adds to the comprehensive model of posttraumatic growth, in that an expression of posttraumatic growth (a greater connection with others) can inform ongoing social processing in the posttraumatic growth process. Having a formal or informal role in earthquake recovery appeared to influence self-concept and reflection; this elaborates on the influence of role on reflection in Calhoun et al.’s model. Findings illustrate possible mechanisms of the organismic valuing process theorised by Joseph and Linley (2005). Implications include the importance of providing opportunities for individuals to take on a role after a crisis, encouraging them to act to respond to difficulties, and encouraging them to meet personal needs for relatedness, competence, and autonomy. Finding positive aspects to a difficult situation, as well as acknowledging adversity, can be supported in future to help individuals process their traumas. As a society, we can help individuals cope with adversity by providing ways they can meet their needs for relatedness, competence, and autonomy. Community groups likely provide opportunities for members to act in ways that meet such needs. This will allow them to effectively act to meet their needs in times of crisis.
