Journal Articles

Objective: Opioid tapering is a complex process for both clinicians and patients with chronic pain. This qualitative study explored the experiences of Aotearoa New Zealand clinicians in managing opioids for patients with chronic non-cancer pain. Methods: Purposive and snowball sampling were used to interview nineteen health professionals including general practitioners (n=5), pain medicine specialists (n=5), addiction medicine specialists (n=4), pain fellows (n=3), addiction medicine registrar (n=1) and a pain nurse practitioner (n=1). Data were collected using a face-to-face focus group and fourteen individual interviews conducted via Zoom. The data were analysed using a Reflexive Thematic Analysis approach. Independent parallel coding was done by members of our research team, and the final themes were iteratively developed by mutual consensus. Results: This qualitative study suggests that meaningful opioid tapering requires a patient-centred approach that considers the individual’s unique sociopsychobiomedical context. Clinicians emphasised the importance of building trust, addressing fears, and tailoring tapering regimens to patients’ needs and motivations. While opioid tapering is a complex process for all patients, participants acknowledged unique considerations for supporting people living in rural areas – Māori and Pasifika and their whānau (families and significant others) addressing social determinants of health. There were overwhelming accounts of clinician distress from all participants especially for rural general practitioners due to the lack of support, conflicting practices, limited resourcing, and time constraints. Conclusion: These findings call for a co-ordinated, multidisciplinary approach to opioid tapering that addresses systemic inequities and prioritises patient and clinician well-being.

We examined content posted on TikTok on the topic of kai Māori (traditional food and associated customs of the indigenous people of Aotearoa New Zealand) to inform strengths-based approaches to health promotion in Māori communities. We conducted a content analysis of 100 unique TikTok videos labelled with the hashtags #kai and #Maori and coded content characteristics and viewer engagement for each video. Twenty foods were determined to be key Māori identity foods from this analysis. We also undertook a reflexive thematic analysis of the content of all videos and user engagement from a sample of 40 videos. Three themes relating to the value of kai Māori were identified: Mauri ora (kai as an expression of pride in Māori identity), Ahikā kai (a means of keeping traditions alive) and Tūhononga (a means of connecting with Te Ao Māori). Māori used TikTok to celebrate Māori identity by sharing and discussing content about kai Māori that was informative and often humorous or self-deprecating. Health promotion in Māori communities should draw on the values of kai as more than food. Kai has an important role in strengthening wellbeing through facilitating cultural connections and linking healthy lifestyles with traditional practices like collecting seafood. Glossary of Māori words: Ahikā kai: keeping Māori traditions alive; Ahuriri: Napier, Aotearoa New Zealand; Aotearoa NZ: Aotearoa New Zealand; aroha: love; atua: deity, ancestor; ehe: e hē: an expression of no in Ngāi Tūhoe Iwi [tribe] dialect; hāngī: food cooked in an earth steam oven or gas steamer; he kai reka tenei: this food is yum or sweet; he tīno reka: very yummy; he reka: yum, sweet; huhu: huhu grub, Prionoplus reticularis; kai: food; kai Māori: traditional food and associated customs; kaimoana: food from the sea including fish and shellfish; kaitiaki: custodians, guardians; kānga wai/ kānga pirau: fermented ‘rotten’ corn; kamokamo: squash, vegetable marrow; kao: no; karakia: blessing, giving thanks; kare: an endearment; karengo /parengo: seaweed; kaupapa Māori: a Māori approach, Māori philosophy and principles guide practice; kia ora: hello, greetings, thank you; kina: sea urchin; koro:grandfather; kumara: sweet potato; kupu: word; kūtai: mussels; inanga: whitebait; mahinga kai: traditional food gathering place; mana whenua: Māori people who have customary authority and rights over identified land; manaakitanga: the act of showing support, caring for others; Māoritanga: Māori culture, way of life; mātua: parents; marae: a place of cultural significance to gather and meet; mauri: spirit, life essence; mauri ora: strong pride in having a unique Māori identity; meke: too much, good; mirimiri: to rub; moana: ocean; Ngāpuhi: northern iwi [tribe] of Aotearoa; noa: ordinary, unrestricted; ora: to be alive, healthy and well; Pākehā: New Zealanders of European descent; paraoa: fry bread; patu: traditional club used in warfare; paua: abalone; pikopiko: young fern shoots; pipi: shellfish, clam; puha: a sow thistle green; Rakiura: Stewart Island; rangatahi: Māori youth; rawe: excellent; reka: sweet; rēwana: fermented bread made with potato; Tā: Sir, Knight; tamariki Māori: Māori children; Tangaroa: the Māori atua (god) for the oceans; tapu: restricted, to be sacred, under atua protection; tautoko: show support; Te Ao Māori: the Māori world and its traditions; te taiao: the natural world; Te Whare Tapa Whā: a model of Māori health developed by Tā Professor Mason Durie; tēnā koe: greetings (speaking to an individual); tikanga: traditional customs or practices; tinana: body, physical self; tino reka: an expression of deliciousness; tino reka te kai: the kai is yum; tītī: mutton bird Puffinus griseus; toa: brave, accomplished, competent; toheroa: large clam;f toroi / whakamara: a fermented dish of cooked mussels and puha; tuatua: shellfish, clam; tūhononga: connecting with Te Ao Māori; tuna: eel; tūpuna / tīpuna: ancestors, grandparents; wahine: woman; Whaea: Mother, Aunty; whakaiti: look down on; whakapapa: lineage, genealogy, ancestry; a central concept in Māori culture of identity, relation and connection to people, place, and culture; whānau: family group, including extended family; whanaunga: relative, kin; whanaungatanga: relationship building; whenua: land, ground.

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