Health Papers

Permanent URI for this collectionhttps://researchcommons.waikato.ac.nz/handle/10289/11371

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Socially responsible and fair AI in healthcare applications in New Zealand
(2025) Yogarajan, Vithya
Issues that need to be considered, include: - Professional liability. - Labour market implications: Skills and expertise required of healthcare providers will change. - Ethical considerations. - Privacy concerns. - Regulatory compliance. - Provider–patient relationship: Empathy skills of healthcare providers have been shown to positively influence patient outcomes. Why is it a good idea? - AI to the rescue. - Productivity. - Workload. - Performance.
Articulations of ableism in sport and physical activity
(SAGE Publications, 2025) Townsend, Robert C; Carroll, Penelope; Madden, Linda; Orakani, Solmaz Nazari; Kelly-Costello, Áine; Movold, Jaden; Witten, Karen
Disabled people continue to experience ableism in sport and physical activity in many forms. Operating as a form of privilege, ableism encompasses a complex and enduring network of beliefs, processes, and practices that place value on nondisabled embodiment and shape our collective understandings of the self, our bodies, and our relationships, and how we perceive, and are perceived by, others. However, the breadth of ableist tendencies, attitudes, and practices prevalent within sport and physical activity are not clearly articulated. This study draws on data generated from eight focus group interviews with 50 participants from across the sport and active recreation sector in Aotearoa New Zealand to paint a fuller picture of how able-bodied privilege operates. Working back-and-forth between theory and data, we expand empirically on the concept of ableism in sport and physical activity, exploring covert and overt articulations of ableism expressed by sports practitioners, while locating them within a broader framework of able-bodied privilege and power. In so doing, we provide a sensitizing framework to identify different forms of ableism present in sport: from neoliberal, institutional, and enlightened attitudes through to benevolent, apologetic, aversive, and abject responses to disability. In illustrating these contemporary manifestations of ableism, we hope to develop a shared language for both understanding and challenging ableism in sport.
Footstrike evaluation in male runners: A comparison of lateral and medial video views against traditional motion capture
(Elsevier, 2025-09) Mo, Shiwei; Yin Chu, Adrian Siu; Shao, Sikun; Chen, Yinjie; Hébert-Losier, Kim; Li, Li; Cheung, Roy T.H.
Footstrike evaluation is essential for understanding running biomechanics and is often performed in research and clinical settings using 2D video analysis. However, whether it is appropriate to analyse both right-left footstrike patterns from a single sagittal plane video is unclear. This study compared medial and lateral video views in assessing footstrike pattern and footstrike angle, using a motion capture system as the gold standard. We analyzed 4,800 footfalls from 20 healthy recreational runners during self-paced treadmill running, recruited through convenient sampling. Footstrike angle agreement was evaluated using Bland-Altman analysis, intraclass correlation coefficients (ICC), and root mean square error (RMSE). The mean difference in footstrike angle between the gold standard and lateral view was 0.40° (95% limits of agreement: 6.05° to −5.25°), while the medial view showed a mean difference of −1.31° (95% limits: 8.37° to −10.99°). ICC values indicated excellent agreement for both lateral (0.979) and medial (0.940) views to the gold standard. RMSE was lower for the lateral (2.91°) than medial (5.11°) view, suggesting greater precision. Footstrike pattern classification was assessed using Cohen's kappa, revealing substantial agreement for the lateral view (κ = 0.785, p < 0.001) and good agreement for the medial view (κ = 0.606, p < 0.001). These results indicate that while both views demonstrate strong agreement, the lateral view aligns more closely with the gold standard in continuous and categorical assessments. Our findings suggest lateral video analysis may be preferable for footstrike evaluation in applied and clinical settings.
Outcomes of cemented and hybrid primary total hip arthroplasty for osteoarthritis: A systematic review with narrative synthesis
(Springer, 2025) Pearce, Amy; Butcher, Anna; Hébert-Losier, Kim
Purpose To compare primary (implant survival and periprosthetic fracture rates, PPF) and secondary (patient reported outcome measures, PROMs) outcomes of cemented and hybrid primary total hip arthroplasty (THA) for osteoarthritis. Methods Four databases (PubMed®, EBSCO, ScienceDirect®, and Scopus®) were searched (1 October 2023 and 15 November 2024) for original studies comparing cemented and hybrid primary THA for osteoarthritis. survival, PPF rates, and PROMs. Included studies were assessed for risk of bias using the Quality in Prognostic Studies or RoB 2.0 tool, critically appraised for strength of evidence using GRADE, and underwent a narrative synthesis. PROSPERO registration number CRD42023462884. Results Eight studies met criteria for review (n = 357,748). Risk of bias was high for two, moderate for three, and low for three studies. Quality of evidence was very low for both primary and secondary outcomes. Five studies met the criteria for the primary outcome (survival) (n = 257,756), two PPF rates (n = 29,581), and three PROMs (n = 382). Three of five studies reported hybrid survival as not significantly different to cemented, and two identified cemented as superior. The three PROMs studies reported no difference between cemented and hybrid THA. A lack of studies and comparative data made it unfeasible to determine PPF outcomes. Conclusion Few high-quality studies and methodological heterogeneity led to moderate to high bias and very low overall evidence certainty. Eligible studies indicated no difference in short to medium term PROMs or 10-year survival between the two fixations. Long-term studies indicated superior cemented survival outcomes. A substantial gap in long-term PROMs and PPF rates is noted.
Maximize or normalize? Examining single-leg drop-land-cut distances in young athletes: A pilot study
(Human Kinetics, 2025) Butcher, Anna J.; Clissold, Tracey; Ward, Sarah; Richards, Jim; Hébert-Losier, Kim
This study investigated differences in leap distance for a single-leg drop-land-cut (CUT) task based on using either a maximal or normalized (150% leg length) method or the influence of condition order and leg dominance on distance achieved. Twenty-six young court and field sport athletes (61.5% female) completed the single-leg drop-land-cut task on the dominant and nondominant leg under maximal and normalized conditions in a randomized order. Multivariate repeated measures analysis of variance tests with post hoc pairwise comparisons were used to determine the effect of condition (maximal and normalized), leg dominance (dominant and nondominant), and interaction effect on leaping distance. Potential order effects were explored as a between-subjects factor within the analysis of variance. Our findings showed significantly larger leap distances under the maximal condition (P < .001, η2p ≥ .417), with the maximal mean being 154.5 (24.7) cm (175.1% [18.6%] leg length) and the normalized mean being 140.7 (19.7) cm (159.0% [5.8%] of leg length). Furthermore, greater distances were achieved during the maximal task when performed following the normalized task (P < .001, 24.5% further). Practically, the normalized task may be better suited for heterogeneous samples; yet, the maximal task may be more suitable for homogeneous samples or pre–post study designs.
How do road runners select their shoes? A systematic review
(Taylor & Francis, 2023) Fife, Andrew; Ramsey, Codi; Esculier, Jean-François; Hébert-Losier, Kim
Running shoes are often considered essential to participate in running. Runners may look for recommendations from friends, specialty running stores, and healthcare professionals when selecting shoes. Despite the existence of shoe prescription guidelines, these recommendations are often not evidence-based or designed with runners’ preferences in mind. This review aims to synthesize original research that identifies how road runners select running shoes. Following PROSPERO registration (CRD42021242523), the PubMed®, Scopus®, Web of Science®, and SPORTDiscus™ electronic databases were systematically searched in March 2021, and monitored until 1 February 2022. Original research that identified factors influencing running shoe selection in road runners published in English were included. Data were qualitatively synthesized. Seven studies representing 1947 road runners were included, and conducted either online, in laboratories, or via interview. Forty influencing factors were identified and thematically sub-grouped into five categories: subjective, shoe-specific characteristics, market features, peer evaluation, and runner characteristics. Comfort, cushioning, fit, and price were cited most frequently as influential factors in road runners’ footwear selection. Most of the studies reviewed were not specifically designed to address the research question of this review. Lack of consistent definitions and varying research methods are found across studies. There is limited research targeting the factors that influence running shoe selection. Comfort and cushioning appear to be the most important factors in shoe selection, although the relationship between both variables may confound their individual importance. Runners also consider fit, price, and several other factors when selecting shoes. Shoe choice remains relatively unexplored, with no running shoe selection study conducted in store.
Validity, reliability, and normative data on calf muscle function in rugby union players from the Calf Raise application
(Taylor & Francis, 2022) Hébert-Losier, Kim; Ngawhika, Te Manawa; Gill, Nicholas D.; Balsalobre-Fernandez, Carlos
We examined the validity and reliability of biomechanical outcomes extracted using the Calf Raise application of three calf muscle tests. We then established normative calf muscle function values for male rugby union players accounting for rugby-related factors (position, level) alone and together with clinical factors (age, leg dominance, BMI, previous injury). In total, 120 athletes performed three single-leg calf muscle tests. Twenty athletes participated in application validation; 18 in test–retest reliability; and all in establishing normative equations. Validity of application outcomes against 3D motion and force plate data was good-to-excellent (CV ≤ 6.6%, ICC ≥0.84). Test–retest reliability was good across outcomes following familiarisation (CV < 10%, ICC ≥0.83). Forwards produced superior power than backs during the bodyweight (59 W, p = 0.007) and weighted (73 W, p < 0.001) power tests. Playing level influenced power outcomes (p < 0.009). Super Rugby players were more powerful than Club (both power tests), Provincial (both power tests), and International (bodyweight power). Backs completed more repetitions (3 repetitions, p = 0.001) and positive displacement (30 cm, p = 0.001) than forwards during endurance testing. When accounting for clinical factors; BMI, age, and previous injury explained some of the differences observed between positions and levels. This study provides initial benchmark values of calf muscle function in rugby union.
Effect of footwear versus barefoot on double-leg jump-landing and jump height measures: A randomized cross-over study
(International Journal of Sports Physical Therapy, 2023) Hébert-Losier, Kim; Boswell-Smith, Caleb; Hanzlíková, Ivana
Background: Assessing individuals in their own athletic footwear in clinics is common, but can affect movement, performance, and clinical measures. Purpose: The aim was to compare overall Landing Error Scoring System (LESS) scores, injury risk categorization, specific LESS errors, and jump heights between habitual athletic footwear and barefoot conditions. Study design: Randomized cross-over laboratory study. Methods: Eighty healthy individuals (55% male) completed the LESS following standard procedures (i.e., land from a 30-cm box to a distance of 50% of body height and then jump upwards maximally). Participants performed the LESS three times in two randomized conditions: footwear and barefoot. LESS data were extracted from 2D videos to compare group-level mean LESS scores, group-level and individual-level injury risk categorization (5-error threshold), specific landing errors, and jump heights between conditions. Results: LESS scores were significantly greater (0.3 errors, p=0.022) and jump heights were significantly lower (0.6 cm, p=0.029) in footwear than barefoot, but differences were trivial (d = 0.18 and -0.07, respectively) and not clinically meaningful. Although the number of high injury-risk participants was not statistically different at a group level (p=1.000); 27 individuals (33.8%) exhibited a clinically meaningful difference between conditions of one error or more in LESS score, categorization was inconsistent for 16.3% of individuals, and four of the 17 landing errors significantly differed between conditions. Conclusion: At a group level, habitual athletic footwear does not meaningfully influence LESS scores, risk categorization, or jump height. At an individual level, footwear can meaningfully affect LESS scores, risk categorization, and alter landing strategies. Use of consistent protocol and footwear is advised for assessing movement patterns and injury risk from the LESS given the unknown predictive value of this test barefoot. Level of Evidence: Level 3.
Effect of an overhead goal on landing error scoring system and jump height measures
(Elsevier, 2023) Hébert-Losier, Kim; Boswell-Smith, Caleb; Hanzlíková, Ivana
Objectives: Compare overall Landing Error Scoring System (LESS) scores, risk categorisation, specific LESS errors, and double-leg jump-landing jump heights between overhead goal and no goal conditions. Design: Randomised cross-over. Setting: Laboratory. Participants: 76 (51% male). Main outcome measures: Participants landed from a 30-cm box to 50% of their body height and immediately jumped vertically for maximum height. Participants completed three trials under two random-ordered conditions: with and without overhead goal. Group-level mean LESS scores, risk categorisation (5-error threshold), specific landing errors, and jump heights were compared between conditions. Results: Mean LESS scores were greater (0.3 errors, p < 0.001) with the overhead goal, but this small difference was not clinically meaningful. Similarly, although the number of high-risk participants was greater with the overhead goal (p = 0.039), the 9.2% difference was trivial. Participants jumped 2.7 cm higher with the overhead goal (p < 0.001) without affecting the occurrence of any specific LESS errors. Discussion: Performing the LESS with an overhead goal enhances sport specificity and elicits greater vertical jump performances with minimal change in landing errors and injury-risk categorisation. Adding an overhead goal to LESS might enhance its suitability for injury risk screening, although the predictive value of LESS with an overhead goal needs confirmation.
Advancements in running shoe technology and their effects on running economy and performance – a current concepts overview
(Informa UK Limited, 2022) Hébert-Losier, Kim; Pamment, Milly
Advancements in running shoe technology over the last 5 years have sparked controversy in athletics as linked with clear running economy and performance enhancements. Early debates mainly surrounded ‘super shoes’ in long-distance running, but more recently, the controversy has filtered through to sprint and middle-distance running with the emergence of ‘super spikes’. This Current Concepts paper provides a brief overview on the controversial topic of super shoes and super spikes. The defining features of technologically advanced shoes are a stiff plate embedded within the midsole, curved plate and midsole geometry, and lightweight, resilient, high-energy returning foam that–in combination–enhance running performance. Since the launch of the first commercially available super shoe, all world records from the 5 km to the marathon have been broken by athletes wearing super shoes or super spikes, with a similar trend observed in middle-distance running. The improvements in super shoes are around 4% for running economy and 2% for performance, and speculatively around 1% to 1.5% for super spikes. These enhancements are believed multifactorial in nature and difficult to parse, although involve longitudinal bending stiffness, the ‘teeter-totter effect’, the high-energy return properties of the midsole material, enhanced stack height and lightweight characteristic of shoes.
Testing the efficacy of a motor analogy designed to promote safe landing by older adults who fall accidentally: a study protocol for a randomised control study
(BMJ, 2022) Oladi, Sana; Uiga, Liis; Hébert-Losier, Kim; Masters, Rich SW
Introduction: Falling is associated with adverse effects on the health of older people. The majority of research into falls among older people has focused on prevention, with less attention to ‘how to fall safely’. Previous research suggests that motor analogies can be used to promote safe landing by young adults; however, the efficacy of this technique for older people remains unknown. This study aims to determine whether a motor analogy is useful for promoting safe falling in the older adult population. Methods and analysis: The study adopts a randomised, controlled, single- blinded study design. People 65 years and older will be randomly allocated to a control condition or a motor analogy condition. They will receive a nudge in a forward, backward or sideways direction (randomised order), which will initiate a fall. The nudge will occur at variable (randomised) time points, so participants will not be aware of when they will fall. Participants in the motor analogy condition will be instructed to ‘land like a feather’, whereas participants in the control condition will be instructed to ‘land safely’. The primary outcome parameters are maximum impact force (normalised by mass) applied to different body segments during impact and fracture risk ratio of wrists and hips. A two- way multivariate analysis of variance will be conducted to examine differences between the motor analogy and control conditions as a function of the different variables.
Biomechanics and subjective measures of recreational male runners in three shoes running outdoors: A randomised crossover study
(Taylor & Francis, 2023) Hébert-Losier, Kim; Knighton, Hannah; Finlayson, Steven J.; Dubois, Blaise; Esculier, Jean-François; Beaven, Christopher Martyn
We compared biomechanical and subjective data from outdoor running in: habitual (OWN), Saucony Endorphin Racer 2 minimal (FLAT) and Nike Vaporfly 4% (VP4) shoes. We also explored relationships between comfort measures and the collected data. Eighteen male recreational runners ran three 1.5-km trials outdoors, once per shoe. The first 1.1 km was run at a self-selected comfortable (slower) speed, and last 400 m at perceived 5-km race pace (faster). A GPS-enabled smartwatch, 15-m Optojump system, high-speed camera and tibial accelerometer collected biomechanical data. Subjective data on comfort, shoe properties and overall running experience were collected using visual analogue scales (VAS) and rankings. Cadence, leg stiffness and vertical stiffness were greater in FLAT than both OWN and VP4 at the slower speed (trivial to small ES). At both speeds, footstrike angles were smaller in FLAT (small to large ES), while propulsion phase was shorter in VP4 (moderate to large ES). FLAT was ranked as the least comfortable at the slower speed and most likely to cause injury, whereas OWN as the most comfortable and least likely to cause injury. Comfort was not significantly different at the faster speed between shoes. Comfort measures were more strongly correlated to subjective than biomechanical data. The two experimental shoes generally had non-significant or small effects on running biomechanics versus OWN. As VP4 are more like traditional than minimal shoes, these were perceived as more comfortable. Running speed appeared to affect subjective measures. Speed should be considered when prescribing and selecting shoes.
Children’s knowledge and experience of compost/ing
(Informa UK Limited, 2025) Tsang, Sophia WR; Sharp, Emma L; Egli, Victoria
The Soilsafe Kids education and research programme conducted focus groups about compost/ing in eight primary school classes in Tāmaki Makaurau Auckland, Aotearoa New Zealand in 2022 to understand what students learning at New Zealand Curriculum Level 2 (generally students aged 5-11 years old) know about compost/ing. Here, we present a qualitative content analysis of focus groups focusing on children’s knowledge about the process of composting and the resulting material. In general, children (n = 117) demonstrated a broad understanding of the typical process of composting and the materials that make up compost. Our findings contrast previous studies which have indicated children’s comprehension of composting was poor. Despite participating in composting activities in schools, respondents more commonly associated compost/ing activities with their home systems where they compost with their families. Although these results demonstrate a considerable baseline knowledge of compost/ing understood by children, they also had many questions about compost/ing, mainly focused on the timing necessary to biodegrade, the underlying processes, and why we compost. These encouraging findings mean educators have a strong base on which to build lessons, but educators should also be mindful of bridging gaps in retention for greatest pedagogical impact, given our findings suggest that students recall off-campus composting experiences more strongly than on-campus ones. This should be further explored to ensure children have equitable access to composting experiences and knowledge.
Navigating protection and presence: Trade-offs around data suppression for small Pacific populations
(Resource Books Ltd., 2025) Turner, Helen; Flynn, Liliiana; Brockway, Catherine; Chong, Rylan; Aporosa, S. 'Apo'; Faiai, Mata'uitafa; Jansen, Chad; Stokes, Alexander
Introduction: Datasets, their analytics and their interpretation are key decision support tools for Pacific Island communities, with the potential to shape public policy, healthcare, and social interventions in the Pacific ‘Blue Continent’. However, in the case of numerically small island populations, privacy concerns have motivated widespread use of data suppression. While suppression safeguards privacy, it also risks erasing the visibility of these populations, leading to ‘statistical invisibility’ that obscures the social, health, and economic challenges. This study critically reviews the practice of data suppression, emphasizing its rationale in privacy protection, but also highlighting the impacts on resource allocation, advocacy, and equitable policy-making for Pacific populations. Methods: We explored the rationale behind data suppression, and its legal and regulatory context. Using case studies including the U.S. Census Bureau, Centers for Disease Control and Behavioral Risk Factor Surveillance System, we assess the impact of suppression thresholds and privacy-preserving methods on Pacific Island communities. We present a novel analysis of data suppression impacts on ICD code suppression across different levels of geographical units in the Pacific to illustrate disproportionate impacts. We review alternative privacy-preserving methods, including data smoothing, statistical masking, and synthetic data generation, that could mitigate the effects of suppression without compromising individual privacy. Finding and Conclusions: We recommend inclusive and transparent data practices needed to prevent data suppression compounding systemic marginalization of small Pacific populations. By critically evaluating current practices and proposing alternative strategies grounded in ‘Critical Data Theory’ and Pacific knowledge epistemology, this paper aims to inform policies that balance protection of individual privacy with the accurate representation of small, geographically dispersed populations.
The rising impact of Asia on New Zealand sport
(Asia New Zealand Foundation, 2022) Thorpe, Holly Aysha; Kavanagh, Thomas Richard
A new report from the Asia New Zealand Foundation Te Whītau Tūhono finds Asia is increasingly shaping global sports trends — but New Zealand needs to do more to help its sporting talent make the most of the region’s opportunities.
The changing nature of Asian participation in play, active recreation and sport: Voices from the community
(Sport New Zealand, 2023) Thorpe, Holly Aysha; Lok, Sheryne; Kavanagh, Thomas Richard
This report draws upon focus groups with Asian New Zealanders living in Auckland to understand the perceptions, barriers and motivations relating to their own sport and physical activity participation in Aotearoa New Zealand.
Building cultural inclusion in sport: Insights from Muslim women in sport and active recreation
(Sport New Zealand, 2020) Ahmad, Nida; Thorpe, Holly Aysha
Commissioned by Sport New Zealand, this report is the first to explore how Muslim women access sport and active recreation in Aotearoa New Zealand, and the challenges in doing so. We recognize the importance of creating spaces for the voices and experiences of Muslim women themselves, as well as those involved in organizing sport and active recreation with Muslim women participants. This report highlights the key themes that emerged from the conversations with Muslim girls and women, and sports administrators, conducted in Auckland, Christchurch, Waikato and Wellington between June - December 2019. It then offers recommendations for building a more culturally inclusive sporting sector.
The PEAR Tool: evaluating portion sizes of food and beverages in food advertising to children using Google Street View
(BMC, 2025) Porter, Jessica; Roy, Rajshri; Van der Werf, Bert; Egli, Victoria
Previous research has established where and what types of advertising are in children’s neighbourhoods. However, no prior research has evaluated the portion sizes in advertisements or how these compare with national dietary recommendations. This study aimed to evaluate portion sizes in advertising on bus shelters surrounding schools in Auckland, New Zealand using images captured on Google Street View. Portion sizes for 265 foods or beverages in 172 advertisements on bus shelters within 500 m of Auckland schools were analysed to determine the discrepancy with nutritional guidelines. School type, decile, distance from school boundary, Walk Score® and Transit Score were analysed. Advertised foods and beverages were exaggerated in all but one advertisement. The main findings demonstrate 1) advertised food and beverage products are enlarged, and 2) advertised portion sizes exceed those deemed appropriate in national nutrition guidelines. Stricter advertising policies with revised definitions are needed to improve the food environments surrounding schools.
Healing through culture: Kava-talanoa as a PTSD therapeutic framework
(Sage, 2025) Aporosa, S. 'Apo'; Vaka, Sione
Introduction: The incidence of post-traumatic stress disorder (PTSD) is increasing, particularly among military personnel, first responders (police, fire, ambulance), and prison officers. PTSD is also a health economic burden, with costs linked to treatment, long-term morbidity, and increased mortality risk. Many cases go undiagnosed due to factors such as trauma-related avoidance behavior, which also negatively impacts PTSD therapy (Watkins et al., 2018, Front. Behav. Neurosci., 12:1-9). There is a significant unmet need for improved and culturally aligned PTSD treatments in the Pacific and beyond. Medical standards of care for acute anxiety/PTSD typically involve psychotropic drugs such as benzodiazepines, tricyclic antidepressants, and antipsychotics. These medications offer short-term relief only, carry addictive risks, are contraindicated for key populations (e.g., the elderly), and have had harmful effects in indigenous communities. Kava (Piper methysticum) is a traditional, culturally significant Pacific Island beverage known for its soporific and relaxant effects, similar to benzodiazepine (Sarris et al., 2012, J. Hum. Psychopharmacol. Clin. Exp., 27:262-9). Unlike benzodiazepines, kava is non-addictive with regular use and extremely safe — regulated as ‘food’ in several countries (Aporosa, 2019, J. Drug Sci. Policy Law, 5:1-13). Kava does not induce marked euphoria or hallucinations (Aporosa et al., 2022, J. Ethnopharm., 291:1-15), and promotes productive discussion known as talanoa—a form of ‘talk therapy’ (Vaka et al., Issues Ment. Health Nurs., 37:537-544). Methods: This ethics approved (21/372) study was guided by the faikava talanoa methodology (Aporosa et al., 2021, Pacific Dynamics, 5:74-92). Self-report experiences of Pacific-based UK and US military veterans and serving combat returnees (n=40) were documented in traditionally influenced kava-use spaces in which attendees engaged in talanoa. While exact kava consumption volumes were not measured, participants typically consumed 3.6 litres (6.33 pints) of kava—approximately 5,000 mg of kavalactones— over six hours. Focused coding was utilised to analyse participant comments. Results: Participants reported that engagement in talanoa within traditionally influenced kava-use spaces increased their relational connectedness, improved meaning making of trauma experiences and promoted better sleep. Conclusions: Aided by kava’s anxiolytic soporific effects, it is suspected that kava use with talanoa reduces the triggering of 'fear structures', minimizes avoidance behavior and aids sleep quality, contributing to symptom reduction. Further, we believe that kava-talanoa offers an innovative, culturally augmented, group-based CBT intervention (Aporosa et al., 2025, Front. Psychol., doi:10.3389/fpsyg.2025.1460731). The findings serve as a foundation for clinical trials (underway) to determine the efficacy of the approach as a much-needed transcultural treatment of trauma that addresses the global PTSD burden.
Healing through culture: Kava-talanoa as a PTSD therapeutic framework
(2025) Aporosa, S. 'Apo'; Vaka, Sione
Introduction: The incidence of post-traumatic stress disorder (PTSD) is increasing, particularly among military personnel, first responders (police, fire, ambulance), and prison officers. PTSD is also a health economic burden, with costs linked to treatment, long-term morbidity, and increased mortality risk. Many cases go undiagnosed due to factors such as trauma-related avoidance behavior, which also negatively impacts PTSD therapy (Watkins et al., 2018, Front. Behav. Neurosci., 12:1-9). There is a significant unmet need for improved and culturally aligned PTSD treatments in the Pacific and beyond. Medical standards of care for acute anxiety/PTSD typically involve psychotropic drugs such as benzodiazepines, tricyclic antidepressants, and antipsychotics. These medications offer short-term relief only, carry addictive risks, are contraindicated for key populations (e.g., the elderly), and have had harmful effects in indigenous communities. Kava (Piper methysticum) is a traditional, culturally significant Pacific Island beverage known for its soporific and relaxant effects, similar to benzodiazepine (Sarris et al., 2012, J. Hum. Psychopharmacol. Clin. Exp., 27:262-9). Unlike benzodiazepines, kava is non-addictive with regular use and extremely safe—regulated as ‘food’ in several countries (Aporosa, 2019, J. Drug Sci. Policy Law, 5:1-13). Kava does not induce marked euphoria or hallucinations (Aporosa et al., 2022, J. Ethnopharm., 291:1-15), and promotes productive discussion known as talanoa—a form of ‘talk therapy’ (Vaka et al., Issues Ment. Health Nurs., 37:537-544). Methods: This ethics approved (21/372) study was guided by the faikava talanoa methodology (Aporosa et al., 2021, Pacific Dynamics, 5:74-92). Self-report experiences of Pacific-based UK and US military veterans and serving combat returnees (n=40) were documented in traditionally influenced kava-use spaces in which attendees engaged in talanoa. While exact kava consumption volumes were not measured, participants typically consumed 3.6 litres (6.33 pints) of kava—approximately 5,000 mg of kavalactones— over six hours. Focused coding was utilised to analyse participant comments. Results: Participants reported that engagement in talanoa within traditionally influenced kava-use spaces increased their relational connectedness, improved meaning making of trauma experiences and promoted better sleep. Conclusions: Aided by kava’s anxiolytic soporific effects, it is suspected that kava use with talanoa reduces the triggering of ‘fear structures’, minimizes avoidance behavior and aids sleep quality, contributing to symptom reduction. Further, we believe that kava-talanoa offers an innovative, culturally augmented, A56 ABSTRACTS group-based CBT intervention (Aporosa et al., 2025, Front. Psychol., doi:10.3389/fpsyg.2025.1460731). The f indings serve as a foundation for clinical trials (underway) to determine the efficacy of the approach as a much-needed transcultural treatment of trauma that addresses the global PTSD burden.

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