Journal Articles
Permanent URI for this collectionhttps://mro.massey.ac.nz/handle/10179/7915
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Item Is equity meaningfully incorporated into pandemic preparedness and response? A scoping review and critical analysis of Ebola andCOVID-19 outbreak responses in Uganda 2019-2023(Taylor and Francis Group, 2025-12-31) Redondo G; Murray L; Bromhead C; Makumbi ISocietal inequities produce vulnerabilities that infectious disease can exploit. Current approaches to pandemic prevention, detection and response are led by the International Health Regulations IHR and the Global Health Security Agenda. However, to contain the spread of infectious diseases, localised action to address systemic inequities must be considered. The purpose of this scoping review and equity analysis is to 1) Synthesise the available information on Uganda’s Ebola Virus Disease (EVD) and COVID-19 preparedness and outbreak responses between 2019 and 2023, and 2) Critique if and how Uganda’s Ministry of Health incorporated concepts of health equity in its EVD and COVID-19 interventions, while building national capacity to identify and prevent public health emergencies. This scoping review and critical analysis was conducted following the five-stage process defined by Levac et al. After identification and screening, the scoping review was based on six preparedness and response plans, three after-action reviews, and 20 grey literature and peer-reviewed articles. The findings revealed that the EVD and COVID-19 preparedness and response plans in Uganda show the country’s commitment and readiness for early detection and response to infectious disease outbreaks. However, further examination of the plans reveals missed opportunities to address systemic inequities. The ongoing mpox outbreak, declared a PHEIC by WHO on July 23, 2022, with significant impacts in African countries including Uganda, further underscores the need for a paradigm shift in managing infectious disease outbreaks. Such a shift may be similar to that experienced by the field of disaster risk reduction, which underwent a significant transformation at the Sendai Conference in 2015 towards a more holistic and proactive approach that addresses underlying systemic issues and focuses on building resilience. The exclusive focus on biomedical strategies to manage infectious diseases fails to address the social aspects of transmission, the local perceptions of illness, and community vulnerabilities often associated with social and historical perspectives. The social determinants of health disparities should be incorporated into pandemic planning and response. This will contribute to fostering equitable health outcomes and resilience in the face of the multifaceted challenges posed by future pandemics and environmental changes.Item Why public health practitioners and researchers must stop using the term ‘culturally and linguistically diverse (CALD)’(CSIRO Publishing, 2025-08-21) Pourmarzi D; Murray L; Zulfiqar T; Kaur G; Olsen AThe term ‘culturally and linguistically diverse’ (CALD) is used in Australia to describe some groups of migrants. Implicitly, the term defines ‘others’ who are ‘different’ to the dominant normative Australian. The use of the term as standard language in health literature and public discourse has increased dramatically over the past decade. Australians who are labelled as CALD have argued that the term affects their sense of belonging to the Australian community. As public health researchers and practitioners, we must minimise potential risks of harm, maximise health benefits and ensure the rigour of our data collection, analysis and reporting methods. We argue that we must refrain from continuing to use this concept and that there is no need for a new label to categorise some members of our diverse Australian population as ‘others’.Item ‘Let us enjoy the fruits of our own labour, we have our own solutions’ Creative co-design methods and narratives of Māori whānau with chronic pain(Taylor and Francis Group on behalf of the Royal Society of New Zealand, 2025-07-07) Davies C; Devan H; Kokiri Whānau; Te Morenga LChronic or persistent pain disproportionately affects Māori and their whānau (family and significant others). Our previous engagement with Māori living with persistent pain has identified significant barriers for Māori to accessing primary, secondary, and tertiary services. This paper describes the insights obtained from Māori living with persistent pain by using a creative art-based data collection method as part of a co-design process to understand how they would like to be supported in their pain management journey. We used brainstorming discussion sessions and a creative art session to encourage divergent thinking and to stimulate innovative ideas for better pain management support for Māori. The creations showed a deep connection to taiao (nature) and the support of whānau as sources of strength. Connecting with other whānau living with pain in a safe space (i.e. community setting or a marae (community meeting place)) was an aspiration. Existing mainstream services were viewed as deficit-focused with an overwhelming support for Māori-led solutions delivered kanohi-ki-te-kanohi (face-to-face). Creative activities can be used as a culturally appropriate research method for both generating rich insights into the lived experiences of Māori living with persistent pain and how to deliver culturally responsive pain services.Item Re-framing Pacific education, teacher knowledge and practice: innovations from within Aotearoa New Zealand(Taylor and Francis Group, 2024-10-14) Hunter J; Samu T; Rimoni FIn many countries including Aotearoa New Zealand, rapidly changing population demographics have led to increasing cultural diversity in classrooms. Developing equitable outcomes for diverse learners including those from indigenous and migrant heritage requires educators to both respect cultural diversity and enact intercultural understanding and capability. This has implications for both pre-service and in-service teacher education and more broadly educational policy. In this article, we draw on examples from New Zealand of shifts in Pacific education policy and practice related to teacher education. We track policy development over the past three decades that originated from concerns about inequity for Pacific students in schooling to more recent policy initiatives that engage deeply with Pacific learners, families, and communities. We illustrate the shifts in educational policy and teacher education by using three cases of the Pacific led initiatives to exemplify the reframing of Pacific education, teacher knowledge, and practice, by listening to and privileging the voices of Pacific people. We argue that to address equitable education for diverse student communities, teacher education needs explicitly to recognise and acknowledge structural inequities and racism inherent in education systems while providing opportunities for reflection and deep learning about differing knowledge systems and ways of being.Item Priority Health Needs and Challenges in New Zealand Pacific Communities-A Qualitative Analysis of Healthcare Delivery during the COVID-19 Pandemic.(MDPI (Basel, Switzerland), 2023-08-09) Reddy R; Sluyter J; Kiadarbandsari A; Ofanoa M; Heather M; Fa'alau F; Nosa V; Younis MZBACKGROUND: The Pacific community in New Zealand experienced an increased risk of COVID-19 transmission due to delayed contact tracing, along with a disproportionate prevalence of health challenges. The community is representative of a diverse population who proudly identify with the vibrant Pacific Island nations of Samoa, Tonga, Cook Islands, Niue, Fiji, etc. Pacific communities in New Zealand face a higher burden of health challenges compared to other groups. These challenges include obesity, high blood pressure, diabetes, mental health disorders, respiratory issues, smoking, excessive alcohol consumption, disabilities, and chronic conditions. Concerns were raised regarding the oversight of Pacific community views in the initial pandemic response planning. Pacific healthcare professionals expressed concerns about inadequate state support and the need for active involvement in decision making. METHODS: This article reports thematic analyses of text data gained from open-ended questions from a purposive anonymous online survey completed by Pacific healthcare professionals in New Zealand. RESULTS: The participants shared their experiences and opinions, which generated four major themes highlighting priority health needs and challenges. These themes included the necessity for a culturally appropriate healthcare plan, adequate resourcing, addressing discrimination, and emphasising a united and collaborative effort for consistency. The research's limitation is the narrow scope of open-ended questions in the questionnaire survey. However, conducting semi-structured face-to-face interviews can provide more in-depth data and offer further insights beyond the four broad themes identified in the analysis. CONCLUSIONS: The findings can inform the development of future research to provide more in-depth data and offer further insights beyond the four broad themes identified in the analysis. This will help develop future tailored healthcare delivery plans that address specific Pacific community needs.Item Enabling Rural Telehealth for Older Adults in Underserved Rural Communities: Focus Group Study(JMIR Publications, 2022-11-04) Hunter I; Lockhart C; Rao V; Tootell B; Wong SBackground: Telehealth is often suggested to improve access to health care and has had significant publicity worldwide during the COVID-19 pandemic. However, limited studies have examined the telehealth needs of underserved populations such as rural communities. Objective: This study aims to investigate enablers for telehealth use in underserved rural populations to improve access to health care for rural older adults. Methods: In total, 7 focus group discussions and 13 individual interviews were held across 4 diverse underserved rural communities. A total of 98 adults aged ≥55 years participated. The participants were asked whether they had used telehealth, how they saw their community’s health service needs evolving, how telehealth might help provide these services, and how they perceived barriers to and enablers of telehealth for older adults in rural communities. Focus group transcripts were thematically analyzed. Results: The term telehealth was not initially understood by many participants and required an explanation. Those who had used telehealth reported positive experiences (time and cost savings) and were likely to use telehealth again. A total of 2 main themes were identified through an equity lens. The first theme was trust, with 3 subthemes—trust in the telehealth technology, trust in the user (consumer and health provider), and trust in the health system. Having access to reliable and affordable internet connectivity and digital devices was a key enabler for telehealth use. Most rural areas had intermittent and unreliable internet connectivity. Another key enabler is easy access to user support. Trust in the health system focused on waiting times, lack of and/or delayed communication and coordination, and cost. The second theme was choice, with 3 subthemes—health service access, consultation type, and telehealth deployment. Access to health services through telehealth needs to be culturally appropriate and enable access to currently limited or absent services such as mental health and specialist services. Accessing specialist care through telehealth was extremely popular, although some participants preferred to be seen in person. A major enabler for telehealth was telehealth deployment by a fixed community hub or on a mobile bus, with support available, particularly when combined with non–health-related services such as internet banking. Conclusions: Overall, participants were keen on the idea of telehealth. Several barriers and enablers were identified, particularly trust and choice. The term telehealth is not well understood. The unreliable and expensive connectivity options available to rural communities have limited telehealth experience to phone or patient portal use for those with connectivity. Having the opportunity to try telehealth, particularly by using video, would increase the understanding and acceptance of telehealth. This study highlights that local rural communities need to be involved in designing telehealth services within their communities.Item Audiological Service Delivery and Uptake in New Zealand Regional Areas.(MDPI (Basel, Switzerland), 2023-11-28) Boseley H; Welch D; Reddy R; Silberberg MBackground: In New Zealand, as in many places, a significant proportion of the population lives outside the main urban centres. People living in regional areas have similar needs for audiological services as those living in urban centres; however, economic and geographical barriers can be a barrier to accessible services. The objective of this research was to explore factors that influence equitable audiological service provision and user uptake of services in regional areas of New Zealand. Methods: Fifteen participants who represented either audiological service users living in rural or non-urban areas (regional) or audiological service providers in these areas were recruited. Semi-structured interviews were conducted virtually and on average took forty minutes to complete. The interviews were transcribed and analysed using thematic analysis to identify themes and subthemes related to audiological service delivery and uptake. Results: Seven themes were identified. These are related to service provision, geographical barriers, and cultural appropriateness. Conclusions: This study provides a basis for understanding the challenges of delivering and accessing audiological services in non-urban areas in New Zealand, and in principle elsewhere. There is scope for future research to further understand policy directions needed to achieve equitable audiological service provision in regional areas.Item Examining the mathematics education values of diverse groups of students(Taylor and Francis Group, 2023-03-19) Hill JL; Hunter JIn recent years, there has been increasing interest in examining values in relation to mathematics education research. Our exploratory study examines the mathematics education values of culturally diverse middle school students in New Zealand. We investigated how student values differed across demographic variables including school, ethnicity, gender and grades. Students completed an online survey to indicate the importance of 14 different mathematics education values. The overall mean ratings for each of the 14 values determined the relative value importance across the sample. One-way ANOVA assessed demographic group differences. Findings showed that respect was rated as the most important value across all student groups. Students from Pacific nations placed significantly greater importance on accuracy, communication, family and recall compared to the other ethnicities. Female students emphasized family, practice, respect, risk-taking and utility more than males. We argue that to provide equitable mathematics classrooms that support wellbeing, we need to recognize what diverse student groups value and then transform pedagogy to align with and build from students’ values. This article provides a contribution by offering a way of understanding and highlighting similarities and differences in student values which impact on students’ learning experiences and wellbeing.Item Stitching a new garment: Considering the future of the speech–language therapy profession globally(AOSIS, 2022-11-21) Staley B; Fernandes M; Hickey E; Barrett H; Wylie K; Marshall J; Pillay M; Kathard H; Sowden R; Rochus D; Westby CE; Roman TR; Hartley SDProviding equitable support for people experiencing communication disability (CD) globally is a historical and contemporary challenge for the speech–language therapy profession. A group of speech–language therapists (SLTs) with ongoing and sustained experiences in Majority and Minority World contexts participated in five virtual meetings in 2021. The aim of these meetings was to develop provocative statements that might spur a global discussion among individuals and organisations that support people experiencing CD. The following questions were discussed: What is our vision for the future of the profession globally? What are the global challenges around access to speech–language therapy services? Four main themes emerged: (1) the need to centre people experiencing CD as the focal point of services, (2) participation, (3) equity and (4) community. The themes relate to the need for a process of de-imperialism in the profession. Suggestions were made to develop more suitable terminology and to establish a global framework that promotes more equitable access to communication services. We seek the adoption of approaches that focus on reciprocal global engagement for capacity strengthening. Alternative models of culturally sustaining and equitable service delivery are needed to create impact for people experiencing CD, and their families worldwide. Contribution: Provocative statements were developed to prompt global conversations among speech–language therapy professionals and associations. We encourage readers to consider the questions posed, share their viewpoints and initiate positive change towards a global strategy.Item Human Papillomavirus (HPV) Self-Sampling among Never-and Under-Screened Indigenous Māori, Pacific and Asian Women in Aotearoa New Zealand: A Feasibility Study(MDPI (Basel, Switzerland), 2021-10) Bromhead C; Wihongi H; Sherman SM; Crengle S; Grant J; Martin G; Maxwell A; McPherson G; Puloka A; Reid S; Scott N; Bartholomew KIn Aotearoa, New Zealand, the majority of cervical cancer cases occur in women who have never been screened or are under-screened. Wāhine Māori, Pacific and Asian women have the lowest rate of cervical screening. Self-sampling for human papillomavirus (HPV-SS) has been shown to increase participation in cervical cancer screening. A whole-of-system approach, driven by evidence in the most effective delivery of HPV-SS, is required to mitigate further widening of the avoidable gap in cervical screening access and outcomes between groups of women in Aotearoa. This single-arm feasibility and acceptability study of HPV self-sampling invited never- and under-screened (≥5 years overdue) 30-69-year-old women from general practices in Auckland, Aotearoa. Eligible women were identified by data matching between the National Cervical Programme (NCSP) Register and practice data. Focus groups were additionally held with eligible wāhine Māori, Asian and Pacific women to co-design new patient information materials. Questionnaires on HPV knowledge and post-test experience were offered to women. Our follow-up protocols included shared decision-making principles, and we committed to follow-up ≥90% of women who tested positive for HPV. Data matching identified 366 eligible never- and under-screened wāhine Māori, Pacific and Asian women in participating practices. We were only able to contact 114 women, and 17, during the discussion, were found to be ineligible. Identifying and contacting women overdue for a cervical screen was resource-intensive, with a high rate of un-contactability despite multiple attempts. We found the best uptake of self-sampling was at focus groups. Of the total 84 HPV-SS tests, there were five positive results (6%), including one participant with HPV18 who was found to have a cervical Adenocarcinoma at colposcopy. In our feasibility study, self-sampling was acceptable and effective at detecting HPV and preventing cervical cancer in under-screened urban wāhine Māori, Pacific and Asian women in Aotearoa. This is the first report of cervical Adenocarcinoma (Grade 1B) as a result of an HPV-18 positive self-sample in Aotearoa. We co-designed new patient information materials taking a health literacy and ethnicity-specific approach. This work provides policy-relevant information to the NCSP on the resources required to implement an effective HPV self-sampling programme to improve equity in national cervical cancer screening.