Journal Articles
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Item Flourishing together: research protocol for developing methods to better include disabled people's knowledge in health policy development(BioMed Central Ltd, 2022-12) Martin RA; Baker AP; Smiler K; Middleton L; Hay-Smith J; Kayes N; Grace C; Apiata TAM; Nunnerley JL; Brown AEBACKGROUND: To positively impact the social determinants of health, disabled people need to contribute to policy planning and programme development. However, they report barriers to engaging meaningfully in consultation processes. Additionally, their recommendations may not be articulated in ways that policy planners can readily use. This gap contributes to health outcome inequities. Participatory co-production methods have the potential to improve policy responsiveness. This research will use innovative methods to generate tools for co-producing knowledge in health-related policy areas, empowering disabled people to articulate experience, expertise and insights promoting equitable health policy and programme development within Aotearoa New Zealand. To develop these methods, as an exemplar, we will partner with both tāngata whaikaha Māori and disabled people to co-produce policy recommendations around housing and home (kāinga)-developing a nuanced understanding of the contexts in which disabled people can access and maintain kāinga meeting their needs and aspirations. METHODS: Participatory co-production methods with disabled people, embedded within a realist methodological approach, will develop theories on how best to co-produce and effectively articulate knowledge to address equitable health-related policy and programme development-considering what works for whom under what conditions. Theory-building workshops (Phase 1) and qualitative surveys (Phase 2) will explore contexts and resources (i.e., at individual, social and environmental levels) supporting them to access and maintain kāinga that best meets their needs and aspirations. In Phase 3, a realist review with embedded co-production workshops will synthesise evidence and co-produce knowledge from published literature and non-published reports. Finally, in Phase 4, co-produced knowledge from all phases will be synthesised to develop two key research outputs: housing policy recommendations and innovative co-production methods and tools empowering disabled people to create, synthesise and articulate knowledge to planners of health-related policy. DISCUSSION: This research will develop participatory co-production methods and tools to support future creation, synthesis and articulation of the knowledge and experiences of disabled people, contributing to policies that positively impact their social determinants of health.Item Nurses' work in relation to patient health outcomes: an observational study comparing models of primary care.(BioMed Central Ltd, 2024-10-04) Sheridan N; Hoare K; Carryer J; Mills J; Hewitt S; Love T; Kenealy T; Primary Care Models Study GroupBACKGROUND: Māori are over-represented in Aotearoa New Zealand morbidity and mortality statistics. Other populations with high health needs include Pacific peoples and those living with material deprivation. General practice has evolved into seven models of primary care: Traditional, Corporate, Health Care Home, Māori, Pacific, Trusts / Non-governmental organisations (Trust/NGOs) and District Health Board / Primary Care Organisations (DHB/PHO). We describe nurse work in relation to these models of care, populations with high health need and patient health outcomes. METHODS: We conducted a cross-sectional study (at 30 September 2018) of data from national datasets and practices at patient level. Six primary outcome measures were selected because they could be improved by primary care: polypharmacy (≥ 65 years), glucose control testing in adults with diabetes, immunisations (at 6 months), ambulatory sensitive hospitalisations (0-14, 45-64 years) and emergency department attendances. Analysis adjusted for patient and practice characteristics. RESULTS: Nurse clinical time, and combined nurse, nurse practitioner and general practitioner clinical time, were substantially higher in Trust/NGO, Māori, and Pacific practices than in other models. Increased patient clinical complexity was associated with more clinical input and higher scores on all outcome measures. The highest rates of preventative care by nurses (cervical screening, cardiovascular risk assessment, depression screening, glucose control testing) were in Māori, Trust/NGO and Pacific practices. There was an eightfold difference, across models of care, in percentage of depression screening undertaken by nurses and a fivefold difference in cervical screening and glucose control testing. The highest rates of nurse consultations afterhours and with unenrolled patients, improving access, were in PHO/DHB, Pacific, Trust/NGO and Māori practices. Work not attributed to nurses in the practice records meant nurse work was underestimated to an unknown degree. CONCLUSIONS: Transferring work to nurses in Traditional, Health Care Home, and Corporate practices, would release general practitioner clinical time for other work. Worse patient health outcomes were associated with higher patient need and higher clinical input. It is plausible that there is insufficient clinical input to meet the degree of patient need. More practitioner clinical time is required, especially in practices with high volumes of complex patients.Item Introducing 'Ngaruroro', a New Model for Understanding Māori Wellbeing.(MDPI AG, 2024-04-05) Johnson FN; Wehi P; Neha T; Ross M; Thompson V; Tibble S; Tassell-Matamua N; Shedlock K; Fox R; Penman Z; Ritchie T; Winter T; Arahanga-Doyle H; Jose PE; Wright MIndigenous peoples around the world are revitalising their ancestral beliefs, practices, and languages, including traditional understandings of health and wellbeing. In the Aotearoa (New Zealand) context, a number of ground-breaking Māori health- and wellbeing-related models have emerged, each with their own scope and applications. We sought in our qualitative studies to explore and identify several key sources of wellbeing for Māori individuals. Nine interviews were conducted with members of Māori communities to identify key themes of Māori wellbeing. We performed a Reflexive Thematic Analysis on these data and then conducted a further fifteen interviews to revise, refine, and reposition the previously generated themes. The Ngaruroro model describes wellbeing as the embodied and active process of being well in relation with one's (1) here tāngata (social and familial ties), (2) te taiao (the environment), and (3) taonga tuku iho (cultural treasures) while doing what one can to make lifestyle choices that are conducive to the health of one's (4) tinana (body) and (5) wairua (spirit) while cultivating a balanced (6) ngākau (inner-system), fulfilling (7) matea (core needs) and exercising your (8) mana (authority). These themes illustrate that Māori wellbeing is dynamic, interconnected, and holistic.Item Kaumātua Mana Motuhake Pōi: a study protocol for enhancing wellbeing, social connectedness and cultural identity for Māori elders.(BioMed Central, 2020-10-02) Hokowhitu B; Oetzel JG; Simpson ML; Nock S; Reddy R; Meha P; Johnston K; Jackson A-M; Erueti B; Rewi P; Warbrick I; Cameron MP; Zhang Y; Ruru SBACKGROUND: The Aotearoa New Zealand population is ageing accompanied by health and social challenges including significant inequities that exist between Māori and non-Māori around poor ageing and health. Although historically kaumātua (elder Māori) faced a dominant society that failed to realise their full potential as they age, Māori culture has remained steadfast in upholding elders as cultural/community anchors. Yet, many of today's kaumātua have experienced 'cultural dissonance' as the result of a hegemonic dominant culture subjugating an Indigenous culture, leading to generations of Indigenous peoples compelled or forced to dissociate with their culture. The present research project, Kaumātua Mana Motuhake Pōī (KMMP) comprises two interrelated projects that foreground dimensions of wellbeing within a holistic Te Ao Māori (Māori epistemology) view of wellbeing. Project 1 involves a tuakana-teina/peer educator model approach focused on increasing service access and utilisation to support kaumātua with the greatest health and social needs. Project 2 focuses on physical activity and cultural knowledge exchange (including te reo Māori--Māori language) through intergenerational models of learning. METHODS: Both projects have a consistent research design and common set of methods that coalesce around the emphasis on kaupapa kaumatua; research projects led by kaumātua and kaumātua providers that advance better life outcomes for kaumātua and their communities. The research design for each project is a mixed-methods, pre-test and two post-test, staggered design with 2-3 providers receiving the approach first and then 2-3 receiving it on a delayed basis. A pre-test (baseline) of all participants will be completed. The approach will then be implemented with the first providers. There will then be a follow-up data collection for all participants (post-test 1). The second providers will then implement the approach, which will be followed by a final data collection for all participants (post-test 2). DISCUSSION: Two specific outcomes are anticipated from this research; firstly, it is hoped that the research methodology provides a framework for how government agencies, researchers and relevant sector stakeholders can work with Māori communities. Secondly, the two individual projects will each produce a tangible approach that, it is anticipated, will be cost effective in enhancing kaumātua hauora and mana motuhake. TRIAL REGISTRATION: Australia New Zealand Clinical Trial Registry ( ACTRN12620000316909 ). Registered 6 March 2020.Item Exploring the Chemical Properties and Biological Activity of Four New Zealand Monofloral Honeys to Support the Māori Vision and Aspirations(MDPI (Basel, Switzerland), 2022-05) Zucchetta C; Tangohau W; McCallion A; Hardy DJ; Clavijo McCormick AHoney production and export are significant contributors to the Aotearoa New Zealand economy, generating over 400 million dollars in revenue. Its main export is mānuka (Leptospermum scoparium) honey, which has a high commercial value due to its medicinal properties that are linked to its unique chemical composition. The compound methylglyoxal (MGO) has been identified as the main floral marker and is used as a quality indicator, often labelled as unique mānuka factor (UMF). However, the high demand for mānuka honey creates pressure on beekeepers and may have negative ecological consequences by favouring extensive mānuka monocultures to the detriment of other native species. There are other honeys native to New Zealand, such as kāmahi (Weinmannia racemosa), kānuka (Kunzea ericoides), rātā (Metrosideros robusta) and rewarewa (Knightia excelsa), that also have medicinal properties; however, they are less well known in the local and global market. Indigenous Māori communities envision the production and commercialization (locally and internationally) of these honeys as an opportunity to generate income and secure a sustainable future in alignment with their worldview (Te Ao Māori) and values (tikanga Māori). Diversifying the market could lead to a more sustainable income for beekeepers and reduce pressure on Māori and the conservation land, while supporting indigenous communities to realize their vision and aspirations. This manuscript provides an extensive review of the scientific literature, technical literature and traditional knowledge databases describing the plants of interest and their traditional medicinal uses (rongoā) and the chemical properties of each honey, potential floral markers and their biological activity. For each honey type, we also identify knowledge gaps and potential research avenues. This information will assist Māori beekeepers, researchers, consumers and other stakeholders in making informed decisions regarding future research and the production, marketing and consumption of these native monofloral honeys.Item Hā Ora: secondary care barriers and enablers to early diagnosis of lung cancer for Māori communities(BioMed Central Ltd, 2021-02-04) Kidd J; Cassim S; Rolleston A; Chepulis L; Hokowhitu B; Keenan R; Wong J; Firth M; Middleton K; Aitken D; Lawrenson RBackground Lung Cancer is the leading cause of cancer deaths in Aotearoa New Zealand. Māori communities in particular have higher incidence and mortality rates from Lung Cancer. Diagnosis of lung cancer at an early stage can allow for curative treatment. This project aimed to document the barriers to early diagnosis and treatment of lung cancer in secondary care for Māori communities. Methods This project used a kaupapa Māori approach. Nine community hui (focus groups) and nine primary healthcare provider hui were carried out in five rural localities in the Midland region. Community hui included cancer patients, whānau (families), and other community members. Healthcare provider hui comprised staff members at the local primary healthcare centre, including General Practitioners and nurses. Hui data were thematically analysed. Results Barriers and enablers to early diagnosis of lung cancer were categorised into two broad themes: Specialist services and treatment, and whānau journey. The barriers and enablers that participants experienced in specialist services and treatment related to access to care, engagement with specialists, communication with specialist services and cultural values and respect, whereas barriers and enablers relating to the whānau journey focused on agency and the impact on whānau. Conclusions The study highlighted the need to improve communication within and across healthcare services, the importance of understanding the cultural needs of patients and whānau and a health system strategy that meets these needs. Findings also demonstrated the resilience of Māori and the active efforts of whānau as carers to foster health literacy in future generations.Item Inequalities between Māori and non-Māori men with prostate cancer in Aotearoa New Zealand.(Pasifika Medical Association Group (PMAG) previously New Zealand Medical Association (NZMA), 2020-09-04) Egan R; Kidd J; Lawrenson R; Cassim S; Black S; Blundell R; Bateman J; Broughton JMāori experience poorer health statistics in terms of cancer incidence and mortality compared to non-Māori. For prostate cancer, Māori men are less likely than non-Māori men to be diagnosed with prostate cancer, but those that are diagnosed are much more likely to die of the disease than non-Māori men resulting in an excess mortality rate in Māori men compared with non-Māori. A review of the literature included a review of the epidemiology of prostate cancer; of screening; of access to healthcare and of treatment modalities. Our conclusion was that there are a number of reasons for the disparity in outcomes for Māori including differences in staging and characteristics at diagnosis; differences in screening and treatment offered to Māori men; and general barriers to healthcare that exist for Māori men in New Zealand. We conclude that there is a need for more culturally appropriate care to be available to Māori men.Item A Critical Tiriti Analysis of the Pae Ora (Healthy Futures) Bill(New Zealand Medical Association, 2022-03-11) Rae N; Came H; Baker M; McCreanor TAim The Pae Ora (Healthy Futures) Bill is the framework for a reformed health system intended to embed Te Tiriti o Waitangi and centre equity. The Bill is informed by the Wai 2575 Health Kaupapa Waitangi Tribunal Inquiry and the Health and Disability System Review, both of which established an urgent mandate to transform the health sector. This desktop review explores to what extent the proposed Bill is likely to uphold Te Tiriti. Method This paper uses Critical Tiriti Analysis to review the Pae Ora Bill. The analysis involves five phases: (i) orientation; (ii) close reading; (iii) determination; (iv) strengthening practice and (v) Māori final word. As part of that, a determination is made whether the Bill is silent, poor, fair, good or excellent in relation to the Preamble and the four articles (three written, one verbal) of te Tiriti o Waitangi (Māori text). Results The desktop analysis showed fair engagement with most of the Te Tiriti elements; but with good commitment to address equity issues. The Bill was silent in relation to wairuatanga (spirituality) and there is no evidence of Māori values informing it. Conclusion The dominant Crown narrative that interprets kāwanatanga as the right to govern over all peoples pervades this legislation. There are significant power sharing shifts within this Bill and these are welcomed, but whilst the Crown maintains ultimate power and authority only a partial fulfilment of Te Tiriti will be evident within the health system.Item Using vignettes about racism from health practice in Aotearoa to generate anti-racism interventions(John Wiley & Sons Ltd on behalf of Health and Social Care in the Community, 2022-11) Kidd J; Came H; McCreanor TRacism is a key modifiable determinant of health that contributes to health inequities in Aotearoa and elsewhere. Experiences of racism occur within the health sector for workers, patients and their whānau (extended family) every day. This paper uses stories of racism from nurses – reworked into vignettes – to examine the dynamics of racism to generate possible micro, meso and macro anti-racism interventions. A critical qualitative design was utilised, informed by kaupapa Māori approaches. The five vignettes in this paper were sourced from a pair of caucused focus groups with nine senior Māori (Indigenous peoples of Aotearoa) and Tauiwi (non-Māori) nurses held in Auckland Aotearoa in 2019. The vignettes were lightly edited and then critically analysed by both authors to identify sites of racism and generate ideas for anti-racism interventions. The vignettes illustrate five key themes in relation to racism. These include (i) mono-cultural practice, (ii) everyday micro-aggressions; (iii) complexity and the costs of racism, (iv) Pākehā (white settler) privilege and (v) employment discrimination. From analysing these themes, a range of evidence-based micro, meso and macro-level anti-racism interventions were derived. These ranged from engaging in reflective practice, education initiatives, monitoring, through to collective advocacy. Vignettes are a novel way to reveal sites of racism to create teachable moments and spark reflective practice and more active engagement in anti-racism interventions. When systematically analysed vignettes can be utilised to inform and refine anti-racist interventions. Being able to identify racism is essential to being able to effectively counter racism.Item Waka ama: An exemplar of indigenous health promotion in Aotearoa New Zealand(John Wiley and Sons Australia, Ltd on behalf of the Australian Health Promotion Association, 2022-10) Reweti A; Severinsen C; Smith JISSUE ADDRESSED: The use of old-style, top-down health education and awareness programmes in Aotearoa New Zealand, which adopt a single issue-based approach to health promotion, primarily ignores a broad approach to social determinants of health, as well as indigenous Māori understandings of wellbeing. METHODS: This paper draws on the indigenous framework Te Pae Māhutonga as a guide for presenting narratives collated from members of a waka ama rōpū (group) who were interviewed about the social, cultural and health benefits of waka ama. RESULTS: This waka ama case study is an exemplar of community-led health promotion within an indigenous context, where Māori values and practices, such as whanaungatanga (the process of forming and maintaining relationships), manaakitanga (generosity and caring for others) and kaitiakitanga (guardianship), are foundational. The findings highlight the multiple benefits of engagement in waka ama and illustrate effective techniques for enhancing wellbeing within local communities. CONCLUSION: At a time when Aotearoa New Zealand is seeing a decreasing trend in physical activity levels and an increase in mental health challenges, waka ama provides us with an exemplar of ways to increase health and wellbeing within our communities. SO WHAT?: The findings of this research contribute to the evidence base of effective indigenous health promotion, bridging the gap between academia and local community action. To better recognise, comprehend and improve indigenous health and wellbeing, we argue that active participation of people in the community is required to achieve long-term and revolutionary change.