The three-term Hawke’s Bay DHB member and Hastings Health Centre primary care liaison and long-term conditions nurse specialist received her PhD from Massey University’s School of Nursing. Her studies included following 16 people with significant long-term conditions over about 18 months, alongside their primary care clinicians.

She was driven to embark on the study after identifying gaps in the self-management approach to healthcare, which was geared to meet the needs of people with only one serious illness, the money or the connections to fully take advantage of that care.

“The families I talked to had all sorts of awful things going on in their lives – poverty and other disadvantages – and their health never really gets to the top of their pile of priorities, and the care we offer does not meet their needs as well as it could.

“One woman in my study was really, really sick, but she was also a caregiver for her brother, who was far more ill than she was. She couldn’t look after her health because her priority was looking after her brother.”

She said another woman had had heart attacks, asthma, diabetes, arthritis, and more. Her daughter had serious mental health issues, so she also took on six grandchildren aged from 4 to 16.

“As health professionals we say to you go for a walk or stop smoking – you may or may not do that, there’s not much stopping you.

“But for other people who may be looking after their grandchildren, have no money, are unemployed, or who are really sick and caring for other people it’s really hard for these people to pay attention to their own health.”

She said the doctors and nurses she spoke to found this frustrating because often they would be caring for other members of the patient’s families.

They had a good idea of what would work, but working within a system where forms had to be filled in and boxes ticked they felt they were not meeting their needs as well as they could be.

“We need to look at other ways of doing things,” Dr Francis said.

Having now completed her studies, she was also preparing to step down after 10 years at Hastings Health Centre, where she was working as a contractor until Christmas.

She said the plan was to create some space to see if she could do something with the findings of her study.

“It’s a bit difficult in Hawke’s Bay being quite far away from the main centres but I will look at what opportunities there are and how I can use my studies to help people regionally and nationally.

“I really hope my research might go some way to making people think differently about how we approach this sector of the community.”