A Maori perspective of health

PregNut survey: knowledge, attitude, and practices of midwives regarding plant-based diets during pregnancy

BACKGROUND

Plant-based diets (PBD) are gaining global popularity, yet there is limited research on the experiences of pregnant women adhering to these diets. This study employed the knowledge, attitudes, and practices (KAP) framework to assess midwives' readiness in managing the growing plant-based trend in Aotearoa New Zealand (NZ).

METHODS

A cross-sectional, online-administered survey was developed in collaboration with midwifery academics, and was presented in three sections: knowledge, attitudes, and practices towards nutrition in general, towards PBD during pregnancy, and practice information. Questions included Likert-style, free text responses, and check boxes. Currently practising lead maternity carer midwives in NZ were invited to participate, primarily via an email newsletter disseminated by the New Zealand College of Midwives. Descriptive statistics, chi-square tests, and content analysis were used to interpret data.

RESULTS

The study received 133 valid responses from a total of 1246 registered midwives in NZ, reflecting a demographic profile similar to the current midwifery workforce. Although respondents demonstrated foundational knowledge of plant-based nutrition, midwives reported feeling significantly less prepared to advise clients following PBD, compared with omnivorous diets (96% vs. 72%, Χ2 (1, n = 133) = 29.03, p <.001)). While attitudes towards PBD appeared positive, midwives reported higher expectations of knowledge from plant-based clients, compared with omnivore-based clients. Midwives' practices towards their PBD clients varied considerably, with some inconsistencies attributable to reported barriers including lack of time or feeling unqualified. Respondents' personal dietary patterns were correlated with preparedness, knowledge of emerging concepts, and the belief that PBD are better for mothers and infant development.

CONCLUSION

This study, conducted within NZ innovative midwifery care system, reveals discrepancies between midwives reported levels of preparedness to manage clients following PBD compared with omnivorous diets, despite a strong foundation of general and plant-based nutrition knowledge. The reported desire to expand midwives understanding of PBD nutrition and improve practices reiterates the importance of access to current research, evidence-based practice protocols, and support avenues to enhance midwives' preparedness in advising the growing number of individuals following PBD.

Experiences of accessing injury prevention, treatment and rehabilitation services for older Māori

OBJECTIVE

Unintentional injuries cause significant morbidity and mortality for older adults. Māori, the Indigenous people of Aotearoa New Zealand (NZ), experience inequitable access to injury treatment and care services; however, the extent to which this impacts older Māori is unknown. Our objective was to explore older Māori, family and stakeholders' perceptions and experiences of injury-related care and access for older Māori.

METHODS

Convenience sampling was used to recruit three participant groups: older Māori (aged ≥55, and living in two regional areas of NZ); family/support network members (whānau) of older Māori; stakeholders (roles in injury prevention/care, health professionals, injury policy, health navigators or Indigenous health service development). Data were collected through demographic questionnaires and in-person interviews or focus groups. A general inductive approach to thematic analysis was utilised, guided by Māori research theory to situate the findings in the relevant social, political and cultural context for Māori.

RESULTS

Forty-four people participated between September and November 2021 (n = 23 older Māori; n = 21 stakeholders). The findings generated four themes. First, quality of care impacts holistic well-being. Second, informed advocates and advocacy to access and connect injury-related care. Third, culturally safe and Māori-led care. Fourth, the role of family and self in injury-related care.

CONCLUSIONS

Unintentional injury-related care in older Māori is difficult to access and navigate, often not meeting the multidimensional well-being needs of older Māori. Solutions that support advocacy and navigation through the health system are required to respond to mental health and social, as well as physical needs.

Māori and Pasifika Whānau expertise and experiences in the ear and hearing health system in the Counties Manukau Region, Auckland

Unaddressed hearing loss and middle ear problems have lifelong implications for speech and language development, social skills, education, and future employment opportunities. In Aotearoa New Zealand, Māori and Pasifika peoples are overrepresented in ear and hearing health statistics and experience many unmet needs. Despite the promise of equal outcomes under Te Tiriti o Waitangi, there is a well-established body of literature reporting poor health-related outcomes for Māori and Pasifika peoples. Tamariki (children) and their whānau (families) face a range of multi-factorial barriers when accessing ear and hearing health services. This study aims to explore the experiences of Māori and Pasifika whānau accessing these services in the Counties Manukau region, Auckland. The research was guided by Kaupapa Māori and Pan-Pacific research principles, which aim to address power relationships in research, critique deficit discourses, and maintain high quality standards for Māori and Pacific health research. Six whānau interviews were conducted and thematic analysis of data resulted in three themes - Whānau are experts, Power and control, and What makes a good ear and hearing health service. In addition, Māori and Pasifika whānau made suggestions for improvements in ear and hearing healthcare, which will inform larger scale ear and hearing health projects in NZ. Glossary of Māori words: hapū: kinship group, clan, tribe, subtribe - section of a large kinship group; iwi: tribe, nation, people, nationality, race; karakia: prayer, grace, blessing; lotu: prayer, blessing; Māori: normal, ordinary, indigenous people of Aotearoa New Zealand; mokopuna: grandchild, great-nephew or great-niece; Pākehā: (Te Reo Māori) European; Papa'a: (Cook Island Māori) European; raranga: weaving; tamariki: children; taonga: treasure; Tauiwi: (Te Reo Māori) non-Māori people of Aotearoa New Zealand; Te Taiao: world; Earth; natural world; environment; tikanga: correct procedure, custom, method, manner, rule, way, code, practice; wāhine: woman, female; whakapapa: genealogy; lineage; descent; whānau: extended family network, family group.

The perspectives of Māori on community treatment orders: A thematic analysis

AIM

To understand the themes for Māori subjected to compulsory community treatment orders.

BACKGROUND

The Mental Health (Compulsory Assessment and Treatment) Act 1992 has been utilised in Aotearoa New Zealand for more than three decades. Despite Māori having higher rates of being subject to community treatment orders, there is little research examining their perspectives of its benefits and harms.

METHODS

Thematic analysis of a purposive sample of Māori in Hawke's Bay, New Zealand.

RESULTS

Five themes were developed. Māori described community treatment orders as restrictive and stigmatising. Some Māori described being poorly informed of the structures surrounding the use of community treatment orders and saw it as a mechanism to circumvent information-giving regarding treatment. Counterbalancing these, Māori described community treatment orders as mandating support and saw them as a mechanism to access care. Finally, some described their compulsory treatment status as unimportant and irrelevant.

CONCLUSIONS

Thematic analysis identified five clear themes from interview participants. Conceptualisation of community treatment orders was largely negative, although Māori acknowledged that being subject to community treatment orders demanded more support from services. Themes of stigma and restriction are common in the literature, however, conception of the use of community treatment orders to bypass consent is novel. The literature describes community treatment orders as providing support, however, in this study, the interpretation suggests a need to lose personal autonomy to receive care, a potentially 'slippery slope' towards a two-tier type service. These findings remind services of the importance of attending to cultural elements of care, being clear around the process of consent. In terms of policy, weaving in cultural understanding appears to be important from an Indigenous perspective.

From Hinengaro to Hineora: Tracing the origins of Intergenerational Trauma to attain Intergenerational Healing

In Aotearoa New Zealand, colonisation continues to impact Indigenous Māori lived realities. However, Māori have been steadily progressing towards reclamation of all that was suppressed during colonisation, including tūpuna (ancestor) understandings of trauma and healing, of which wairua (referring to spirit) is at the centre. My research aimed to understand the role of wairua in the intergenerational transmission of trauma and healing through exploring my own lived experiences of trauma and healing. My methodology was developed based on tūpuna knowledge, resulting in the implementation of a Rongo-ā-Wairua Framework, a Whakapapa Methodological Approach, Whakapapa Wānanga and Te Pūtake: An Origin Analysis. Through this application of tūpuna knowledge and the centring of wairua within the research process, I uncovered the origins of the soul wounds I had inherited, enabling me to transform from Hinengaro, The Obscured Daughter into who I am now - Hineora, The Daughter of Healing.

Narratives of holistic mental health recovery in New Zealand Defence Force personnel

Research on military mental health recovery has tended to focus on therapy outcomes while backgrounding the role of diverse healing influences. The New Zealand Defence Force (NZDF) is a bicultural military integrated with Māori customs and cultural perspectives on holistic health and wellbeing. This study used narrative analysis to examine the semi-structured interviews of 21 active duty NZDF personnel who had accessed mental healthcare to understand what factors contributed to their return to wellness. Narratives described an orientation toward recovery as a process, where many interrelated wellbeing and social factors together supported the return to health. Culturally available Māori wellbeing metaphors were adopted as heuristics by service members in their storying of growth and healing. Findings are considered in terms of how wellbeing and recovery are conceptualized and promoted within militaries with diverse cultures. Discussion focuses on how narratives within military institutions can promote resilience and support service member recovery from mental distress.

Situating Health Experiences: A Culture-Centered Interrogation

Culture-centered studies of health communication de-center the theorization of health as an individual behavior and reveal the structural conditions that shape inequalities in health outcomes. The present study examines the ways in which space and housing shape experiences of health in a low-income site in Auckland undergoing radical redevelopment. We draw from a culture-centered project undertaken in 2018-2021 predominantly among Māori and Pasifika peoples involving 60 initial in-depth interviews, seven focus groups, a series of filmed interviews, and 32 additional in-depth interviews conducted during the COVID-19 pandemic. The residents' narratives foregrounded the detrimental health impact of inadequate housing, financial constraints, transience, and displacement that severs ties to place and community. These findings reveal the relationship between housing challenges, economic marginalization, and neoliberal capitalism, highlighting the need for policy interventions to address housing as a fundamental determinant of health disparities among marginalized communities.

Tū Kaha: he mōhio ki ngā Māori o te kōmaoa waewae (Stand Strong: A qualitative study of Māori with venous leg ulcers in Aotearoa New Zealand)

Venous leg ulcers have impact on people's lives far beyond that of a skin lesion but these impacts have not been explored from an Indigenous perspective. We used a Māori-centered narrative approach to interview 13 Māori in Aotearoa New Zealand with venous leg ulcers. Data analysis was informed by a reflexive thematic approach and four themes were identified: Ko waewae ahau (I wear the leg); Ngā mea hōhā (annoying things); Ka tangi te ngākau (heartfelt grief); and Mamae (pain, sore, hurt). Recognizing patients' expertise in their condition, the inclusion of whānau (family) in care planning and provision, while providing consistent advice and resource access, would all enhance the experience of venous ulcer management. Training in venous leg ulcer care needs to move beyond a focus on the leg and toward a more holistic approach that encompasses a broader understanding of patient experiences and cultural contexts when managing venous ulcers.

A novel framework for Indigenous eye health care in New Zealand: Ngā Mata o te Ariki

CLINICAL RELEVANCE

Development of an Indigenous eye health framework could offer the opportunity for eye health professionals to enhance engagement with Indigenous populations.

BACKGROUND

Indigenous populations globally experience disproportionately poorer eye health outcomes than non-Indigenous peoples. Incorporating Māori perspectives of eye care and pre-existing Indigenous models of health offers potential to enhance Māori experience and engagement with eye health services. This study seeks to develop and refine a practical framework for eye health care that incorporates nine established Indigenous health principles.

METHODS

Qualitative methodology, guided by Indigenous Māori research principles, was used to evaluate interviews with five leading senior Māori academics surrounding the ongoing development and refinement of a Kaupapa Māori (Māori worldview centric) framework for eye care in Aotearoa New Zealand, created following Māori health consumer consultation. Interviews were semi-structured and analysed using reflexive thematic analysis.

RESULTS

Seven key themes arose in relation to the development of a Kaupapa Māori framework for eye care in Aotearoa New Zealand: 1) vision is critical to Māori well-being, 2) cultural safety is important, 3) Māori health beliefs must be upheld, 4) achieving pae ora (healthy futures) is important, 5) key concepts and focus of the framework must be clear, 6) pūrākau (traditional Indigenous stories) are valuable resources in developing health frameworks and 7) embedding Matariki (fundamental Māori) principles is valuable.

CONCLUSIONS

Using Kaupapa Māori principles allowed development and refinement of a framework that encourages clinicians to consider Indigenous health principles when engaging with Māori patients who seek eye care. Application of this framework may contribute to enhancing cultural safety and responsiveness of eye care for Māori.

Experiences and Acceptability of a Weight Loss Intervention for Diabetes (Diabetes Remission Clinical Trial-DiRECT) in Aotearoa New Zealand: A Qualitative Study within a Pilot Randomised Controlled Trial

The Diabetes Remission Clinical Trial (DiRECT) demonstrated that substantial weight loss and remission from type 2 diabetes can be achieved with low-energy total diet replacement and behavioural support. However, the acceptability of the DiRECT intervention in diverse populations with strong cultural emphases on food and shared eating remains unclear. We conducted a qualitative study nested within a pilot randomised controlled trial of DiRECT in one Māori (the Indigenous people of New Zealand) primary care provider in Aotearoa New Zealand. Participants with type 2 diabetes or prediabetes, obesity, and a desire to lose weight were randomised to either dietitian-supported usual care or the dietitian-supported DiRECT intervention for twelve months. The DiRECT intervention included three months of total diet replacement, then food reintroduction and supported weight loss maintenance. At three and twelve months, semi-structured interviews explored the acceptability of DiRECT and participants' experiences of each intervention. Interview transcripts from 25 participants (aged 48 ± 10 years, 76% female, 78% Māori or Pacific) at three months and 15 participants at twelve months were analysed. Participants viewed their pre-enrolment selves as unhealthy people with poor eating habits and desired professional weight loss support. For DiRECT participants, the total diet replacement phase was challenging but well-received, due to rapid improvements in weight and health. Food reintroduction and weight loss maintenance each presented unique challenges requiring effective strategies and adaptability. All participants considered individualised and empathetic dietetic support crucial to success. Sociocultural factors influencing success were experienced in both interventions: family and social networks provided support and motivation; however, eating-related norms were identified as challenges. The DiRECT intervention was considered an acceptable approach to weight loss in participants with type 2 diabetes or prediabetes with strong cultural emphases on food and shared eating. Our findings highlight the importance of individualised and culturally relevant behavioural support for effective weight loss and weight loss maintenance.

Perspectives and experiences of Māori and Pasifika peoples living with cardiac inherited disease: a qualitative study

OBJECTIVE

Cardiac inherited diseases can have considerable psychosocial effects, including lifestyle limitations, anxiety and depression. Most research to date on patient experiences of CID has been conducted with people from Western cultures, yet culture can shape patient views and experiences of health. The aim of this research was to explore the experiences and perspectives of Māori and Pasifika living with a cardiac inherited disease (CID).

METHODS AND MEASURES

Semi-structured interviews were conducted with 14 Māori and 14 Pasifika patients living with a cardiac inherited disease and seven of their family members, using Talanoa and Kaupapa Māori methodologies. Themes from the interviews were identified using interpretative phenomenological analysis.

RESULTS

Three common themes were identified as important in shaping participants' perceptions and experiences of CID: (1) difficulty in understanding the disease as separate from symptoms, (2) considering ancestors and future generations and (3) the role of spirituality and religion.

CONCLUSION

This study highlights a gap between indigenous patients' understanding of CID and the western biomedical approach. Patients' understanding and treatment behaviours depend on symptoms, familial ties and spirituality. The findings support the need for transparency and culturally appropriate practices in healthcare. Considering these aspects may help to reduce health inequities for these populations.

Before and after: COVID-19 impacts on dental students' well-being, clinical competency and employment opportunities

INTRODUCTION

The onset of COVID-19 challenged dental schools worldwide, impacting clinical training. In Australasia, New Zealand adopted a COVID-19 'elimination strategy', involving nationwide lockdowns that halted face-to-face education. The 'elimination strategy' adopted at the pandemic onset, which permitted return to 'normal life' in 2021, allowed the pandemic impacts and those related workforce transition to be teased out. This study aimed to evaluate perceived impacts of the COVID-19 pandemic on health and well-being, clinical competency and employment opportunities of dental students.

MATERIALS AND METHODS

Two surveys were distributed to final year dental students (n = 94; age range 20-35): one during their final semester and the second six months following graduation. Surveys included open and closed ended questions on participants' self-perceived impacts of COVID-19 on health and well-being, clinical competency and employment opportunities. Average percentages were calculated and descriptive statistics performed.

RESULTS

Pre-graduation, participants reported COVID-19 negatively impacted their mental and social health. Slightly lower scores on all dimensions of health post-graduation were likely due to transitioning to the workforce. Pre-graduation, less than half of participants felt prepared to provide the full scope of dental treatment; post-graduation most felt confident to do so. Most participants expected COVID-19 would negatively impact employment opportunities for their cohort, despite all participants being employed when the second survey was conducted.

CONCLUSION

Participants self-rated health and clinical competency scores were lower post-graduation when NZ returned to 'normal life', meaning lower scores were related to workforce transition. Dental schools need to be prepared to provide alternative forms of dental education and help mitigate mental health impacts of future major course disruptions.

He Taonga Te Wareware: Connecting Older Māori Experiences of Wairuatanga with Mate Wareware (Dementia)

Mate wareware (dementia) is a complex disease of the brain that progressively inhibits memory and cognitive ability, affecting many Māori (the Indigenous people of Aotearoa New Zealand) kaumātua (elderly persons) in Aotearoa (New Zealand). Mate wareware care aims to protect and sustain wellbeing, yet Māori perspectives of wellbeing that consider wairuatanga (Māori spirituality) are often neglected within current treatment planning. This study investigates the presence of wairuatanga within kaumātua lives, drawing upon 61 interviews with kaumātua to glean a Māori understanding of mate wareware and to develop a diagnostic screening tool for mate wareware. Recorded responses were thematically analysed using reflexive qualitative analysis, informing four key themes that influence wairuatanga: he hononga tangata (social connection), tūrangawaewae (places of connection), tuakiritanga (identity) and mahi mauritau (mindful practices). These themes consider the value of creating rich and gratifying lifestyles for kaumātua that cultivate their spiritual wellbeing. This study validates diverse understandings and experiences of wairuatanga as essential to Māori wellbeing, affirming the relevance of wairuatanga to improve outcomes for Māori living with mate wareware.

A quality improvement approach to improving recognition of Māori tamariki (children) and assessing barriers to culturally responsive care in a paediatric ward setting

BACKGROUND

Health inequity persists in Aotearoa (New Zealand) and internationally amongst most indigenous peoples. To address these health inequities, countries need to contend with the ramifications of entrenched historical, cultural and systemic failures. Within Aotearoa part of the solution to rectifying persistent health inequities lies in shifting everyday healthcare practices towards a more culturally responsive, patient-centred approach that utilises Māori knowledge and principles. Although the need for culturally responsive services in healthcare settings is clearly evident, most practitioners struggle with the challenge of creating a culturally safe environment. Further to these challenges, there are issues related to accurate recognition of ethnicity within the time constraints of an overwrought hospital environment. Within this environment, the correct identification of ethnicity is a fundamental step in the process of moving towards culturally responsive and more inclusive care.

METHOD

The research was concerned with indigenous Māori patients being consistently and correctly identified so that they might receive culturally appropriate interaction and treatment. The research specifically focused on the impact of introducing a customised sticker prompt on the front cover of clinical notes of Māori tamariki (children) to assist with correct ethnicity identification. Surveys were conducted on the paediatric ward over a 3-week period, prior to and during the intervention to evaluate the effect of the customised stickers. This study sought to (1) assess the efficacy of a sticker to improve recognition of Māori tamariki (children), (2) examine key barriers to identifying ethnicity and (3) identify wider impacts of a sticker prompt on clinical practice.

RESULTS

Results showed wide ranging positive impacts on clinical practice and culturally responsive care. Sixty-four per cent of participants indicated that the stickers were a useful tool to improve identification of Māori tamariki. Respondents reported increased accuracy of identifying patients by ethnicity, as well as improved awareness of existing ethnicity documentation, and increased engagement regarding cultural needs and ethnicity.

CONCLUSIONS

This study identified that sticker prompts are a useful tool for healthcare workers to improve recognition and awareness of ethnicity and to increase dialogue around cultural needs. The stickers led to increased consideration of the wider elements of holistic wellbeing and therefore improved culturally responsive care for Māori tamariki.

Epistemic inclusion in the Qanuilirpitaa? Nunavik Inuit health survey: developing an Inuit model and determinants of health and well-being

OBJECTIVE

At the request of Nunavik Inuit health authorities and organizations, the Qanuilirpitaa? 2017 Nunavik regional health survey included an innovative "community component" alongside youth and adult epidemiological cohort studies. The community component objective was to identify and describe community and culturally relevant concepts and processes that lead to health and well-being.

METHODS

A qualitative, community-based research process involving workshops and semi-structured interviews was used to generate a corpus of data on health concepts and processes specific to Inuit communities in Nunavik. Thematic analysis and repeated community validation allowed for the identification of three key dimensions of health salient to Inuit experience and eight community-level health determinants.

RESULTS

The health model consists of three linked concepts: ilusirsusiarniq, qanuinngisiarniq, and inuuqatigiitsianiq, which reflect distinct dimensions of Inuit health phenomenology. The determinants community, family, identity, food, land, knowledge, economy, and services were generated through analysis and reflect community-level sources of health and well-being.

CONCLUSION

The development of the culturally grounded health models and determinants is an exercise of epistemic inclusivity through which researchers and Indigenous communities may form new and equitable paths of knowledge creation.

Mental health promotion practice in Aotearoa New Zealand: findings from a qualitative study

Mental health promotion (MHP) is integral to improving the overall health and well being of individuals, communities, and populations. However, knowledge and reporting about MHP which occurs throughout Aotearoa New Zealand (NZ) is limited. This article reports findings from a qualitative study that sought to understand NZ health promotion practitioners' (HPPs) MHP practice. Semi-structured interviews were undertaken with 15 HPPs employed at various health promotion organizations. Thematic analysis of interview transcripts identified three key themes. Two themes (planning and evaluation) related to practice directly and included various subthemes: needs assessment; principles/approaches/frameworks; operationalizing equity and te Tiriti o Waitangi; collaborative approaches; planning for evaluation; process evaluation domination; and evaluation challenges. The third theme related to the context of practice and encompassed various system influences restricting HPPs from practising as they wished. These were represented in four subthemes: contractual agreements; field fragmentation; in the shadows of mental ill-health and workforce capacity. Study findings highlight several opportunities to improve MHP practice in NZ. Most pertinently, the need for system-level action to address the factors restricting HPPs' practice.

Psychosocial well-being in Long-Term Care in the Wake of COVID-19: Findings from a Qualitative Study in New Zealand

Drawing on Mason Durie's (1985) New Zealand Whare Tapa Whā model of health (spiritual, emotional, physical, and family domains), the goal was to link a model of well-being with the lived reality for long-term care residents and bereaved family members during COVID-19. Interviews were conducted with five residents and six family members of previous residents of one long-term care in one urban centre between July and September 2020. The increased demands imposed by the pandemic highlighted the gaps in well-being for residents and families. In particular, the inability to connect with family during COVID-19 restrictions reduced perceptions of well-being for residents. Study findings indicate that the provision of well-being for older adults and families in long-term care extends beyond the narrow bounds of the biomedical model. The Whare Tapa Whā model provides a valuable framework describing the holistic balance needed between the four health domains.

Identifying strategic research priorities of stakeholders for fetal alcohol spectrum disorder in Aotearoa

Fetal alcohol spectrum disorder (FASD) is under-researched in Aotearoa New Zealand (NZ). There is a pressing need to establish a research agenda that is aligned with Te Tiriti o Waitangi and relevant to both stakeholders and end-users, to improve the outcomes and support for people affected by FASD. We conducted hui and interviews to identify consensus on research priorities among key stakeholders for FASD in NZ, including whānau and caregivers, health care workers, educators, academics and clinicians. The hui focused on three main topics: prevention; assessment and diagnosis; and intervention. Hui transcripts were analysed to identify priorities. Once the research questions or priorities were identified we sent a follow-up survey to participants asking them to rate each research question on their importance and relevance. Four hui and ten interviews (n = 52) were conducted across the North Island between April and July 2021. We identified 20 research priorities from the hui and interviews. Based on participant feedback (n = 18), the most important and relevant priority was: 'What can we do to encourage success for people with FASD throughout their lives?'. The priorities identified through the workshops and hui will be valuable in guiding future research and policies relating to FASD.

Because its power remains naturalized: introducing the settler colonial determinants of health

Indigenous people suffer earlier death and more frequent and severe disease than their settler counterparts, a remarkably persistent reality over time, across settler colonized geographies, and despite their ongoing resistance to elimination. Although these health inequities are well-known, they have been impervious to comprehensive and convincing explication, let alone remediation. Settler colonial studies, a fast-growing multidisciplinary and interdisciplinary field, is a promising candidate to rectify this impasse. Settler colonialism's relationship to health inequity is at once obvious and incompletely described, a paradox arising from epistemic coloniality and perceived analytic challenges that we address here in three parts. First, in considering settler colonialism an enduring structure rather than a past event, and by wedding this fundamental insight to the ascendant structural paradigm for understanding health inequities, a picture emerges in which this system of power serves as a foundational and ongoing configuration determining social and political mechanisms that impose on human health. Second, because modern racialization has served to solidify and maintain the hierarchies of colonial relations, settler colonialism adds explanatory power to racism's health impacts and potential amelioration by historicizing this process for differentially racialized groups. Finally, advances in structural racism methodologies and the work of a few visionary scholars have already begun to elucidate the possibilities for a body of literature linking settler colonialism and health, illuminating future research opportunities and pathways toward the decolonization required for health equity.

Estimating quality of life: A spatial microsimulation model of well-being in Aotearoa New Zealand

Quality of life is a complex concept characterised by several dualities, it has many definitions depending on the field of research and an abundance of diverse objective and subjective measures. The latter often represents the extent of perceived (dis)satisfaction with various domains of life experienced by individuals or groups, and research is increasingly focusing on subjective measures of well-being to better understand personal drivers related to quality of life. A better understanding of these factors at a local level has potential to shed light on an often-overlooked aspect of the mental health landscape in Aotearoa New Zealand. Individual-level data on adults (15+ years) is sourced from the New Zealand Attitudes and Values Study 2018 (N = 47,949) and aggregate-level data from the Census 2018 (N = 3,775,854). Matching constraint variables include sex, age, ethnicity, highest qualification, and labour force status. Outcome variables include personal and national well-being scores from 0 to 10 (extremely dissatisfied-extremely satisfied). Spatial microsimulation is used to create a synthetic population based on the above data. Results show lower mean national well-being scores than personal well-being scores, with spatial variations that broadly reflect patterns of socioeconomic deprivation. Low mean values for both personal and national well-being scores are seen in rural areas of high socioeconomic deprivation, particularly those with large Māori populations. High mean values are associated with areas of low deprivation. Additionally, high national well-being scores are associated with areas of agricultural activity, particularly in the South Island. Consideration should be given to factors that influence responses in such topics however, including demographic profiles as well as economic and social conditions of individuals and their surrounding communities. This study demonstrates that spatial microsimulation can be used as a powerful tool to understand population well-being. It can help support future planning and resource allocation, aiding in achieving health equity.

Evaluating an emotion coaching programme for parents of young adolescents attending Child Adolescent Mental Health Services (CAMHS) in New Zealand: protocol for a multi-site feasibility trial including co-design with service users

BACKGROUND

Early adolescence is a time of increased vulnerability for the development of common mental health conditions such as anxiety and depression (internalising outcomes). Current treatments such as cognitive-behavioural therapy and antidepressant medication are focused on the individual and have small effect sizes, particularly in real-world clinical settings such as the public Child Adolescent Mental Health Services (CAMHS). Parents are an important and under-utilised resource in treating these conditions in young adolescents. Teaching parents how to respond to their young person's emotions can improve emotion regulation and reduce internalising outcomes. One emotion-focused programme for parents of this age group is Tuning in to Teens (TINT). This is a structured, manualised skills group for parents only focused on teaching skills to coach young people through their emotional experiences. This study aims to investigate the impact of TINT in the clinical setting of publicly funded CAMHS in New Zealand.

METHODS

The trial will evaluate the feasibility of a two-arm multi-site randomised control trial (RCT). Participants will be 10-14-year-olds referred to CAMHS in Wellington, New Zealand, with anxiety or depression, and their parents or guardians. Arm 1 will be parents attending and implementing TINT (in addition to the usual care received at CAMHS). Arm 2 will be usual care only. TINT groups will be facilitated by CAMHS clinicians who have been trained in the programme and will be delivered over 8 weekly sessions. Prior to the RCT, a co-design methodology will be used with service users to inform outcome measures used in the trial. A group of service users meeting the RCT criteria will be recruited to take part in workshops to help determine their priority outcomes. Measures based on the results of workshops will be included in the outcome measures. The primary feasibility outcomes will be the recruitment and retention of participants, acceptability of the intervention for service users and clinicians and acceptability of outcome measures.

DISCUSSION

There is a need to improve outcomes for the treatment of adolescent anxiety and depression. TINT is a programme with the potential to enhance outcomes for those accessing mental health services by providing targeted support to parents of adolescents. This trial will inform whether a full RCT is feasible to evaluate TINT. Including service users in the design will increase its relevance of an evaluation in this setting.

TRIAL REGISTRATION

The Australian New Zealand Clinical Trials Registry (ACTRN): ACTRN12622000483752. Registered on 28 March 2022.

Health-related quality of life measures used with Indigenous children/youth in the Pacific Rim: a scoping review

OBJECTIVE

To identify and describe (1) which health-related quality of life (HRQoL) measures have been used with Indigenous children/youth (aged 8-17 years) within the Pacific Rim; and (2) studies that refer to Indigenous health concepts in the use of child/youth HRQoL measures.

DESIGN

A scoping review.

DATA SOURCES

Ovid (Medline), PubMed, Scopus, Web of Science and CINAHL were searched up until 25 June 2020.

ELIGIBILITY CRITERIA

Eligible papers were identified by two independent reviewers. Eligible papers were written in English, published between January 1990 and June 2020 and included an HRQoL measure used in research with Indigenous child/youth populations (aged between 8 and 17 years) in the Pacific Rim region.

DATA EXTRACTION AND SYNTHESIS

Data extracted included study characteristics (year, country, Indigenous population, Indigenous sample size, age group), HRQoL measure characteristics (generic or condition-specific measure, child or adult measure, who completed the measure(s), dimensions, items and response scale of measure) and consideration of Indigenous concepts (created for Indigenous population, modified for Indigenous population, validated for Indigenous population, reliability in Indigenous populations, Indigenous involvement, reference to Indigenous theories/models/frameworks).

RESULTS

After removing duplicates, 1393 paper titles and abstracts were screened, and 543 had full-text review for eligibility. Of these, 40 full-text papers were eligible, reporting on 32 unique studies. Twenty-nine HRQoL measures were used across eight countries. Thirty-three papers did not acknowledge Indigenous concepts of health, and only two measures were specifically created for use with Indigenous populations.

CONCLUSIONS

There is a paucity of research investigating HRQoL measures used with Indigenous children/youth and a lack of involvement of Indigenous peoples in the development and use of HRQoL measures. We strongly recommend explicit consideration of Indigenous concepts when developing, validating, assessing and using HRQoL measures with Indigenous populations.

Describing the health-related quality of life of Māori adults in Aotearoa me Te Waipounamu (New Zealand)

PURPOSE

In Aotearoa me Te Waipounamu (New Zealand; NZ) there are considerable inequities in health status and outcomes for Māori, the Indigenous peoples of NZ. It is therefore important that the health status and preferences of Māori are specifically considered in healthcare policy and decision making. This paper describes the health-related quality of life of 390 Māori adults who took part in the NZ EQ-5D-5L valuation study.

METHODS

Responses on the five dimensions of the EQ-5D-5L were dichotomised into "no problems" and "any problems", summarised and disaggregated by age group. Mean preference weights were reported by age group and overall. Mean utility values (calculated by applying each participant's preference weights to their EQ-5D-5L profile) were summed and respective means and standard deviations reported by age, chronic disease status and disability.

RESULTS

The EQ-5D-5L dimensions with the highest proportion of participants reporting any problems were pain/discomfort (61.5%) and anxiety/depression (50%). The most commonly-reported chronic disease was mental illness/distress (24.6%). Anxiety/depression ranked as the most important dimension, with usual activities, the least important. The mean utility value was 0.83 with the lowest value (0.79) found in the 18-24 and 45-54 age groups. For participants with at least one chronic disease the mean utility value was 0.76 compared to 0.91 for those with none.

CONCLUSION

To reduce inequities experienced by Māori it is crucial that the health status of Māori and the values Māori place on health-related quality of life are properly understood. This can only be achieved using Māori-specific data.

Understanding health literacy from a traditional Chinese medicine perspective

Health literacy is critical to improving individual and public health. However, indigenous perceptions of health are largely absent from Western-derived measurements, contributing to disparities in health outcomes between indigenous and non-indigenous populations. China is the country with the world's largest population and only officially introduced the term "health literacy" in 2008. Current measures of health literacy in China are primarily based on Western-derived constructs, which have been shown to have poor comparability to the unique dual medical system in China. Given its significant importance to health management globally, understanding health perceptions from a traditional Chinese medicine perspective is essential. This review explores the concept and core elements of indigenous health literacy, evaluates the existing definitions and measurement tools as applied to the concept, and proposes a new model of traditional Chinese medicine health literacy.

Counting what counts: a systematic scoping review of instruments used in primary healthcare services to measure the wellbeing of Indigenous children and youth

BACKGROUND

Primary healthcare services have principal responsibility for providing child and youth wellbeing and mental health services, but have lacked appropriate measurement instruments to assess the wellbeing of Indigenous children and youth or to evaluate the effectiveness of programs and services designed to meet their needs. This review assesses the availability and characteristics of measurement instruments that have been applied in primary healthcare services in Canada, Australia, New Zealand and the United States (CANZUS countries) to assess the wellbeing of Indigenous children and youth.

METHODS

Fifteen databases and 12 websites were searched in December 2017 and again in October 2021. Pre-defined search terms pertained to Indigenous children and youth, CANZUS country names, and wellbeing or mental health measures. PRISMA guidelines were followed, with eligibility criteria guiding screening of titles and abstracts, and selected full-text papers. Results are presented based on the characteristics of documented measurement instruments assessed according to five desirability criteria: development for Indigenous youth populations, adherence to relational strength-based constructs, administration by child and or youth self-report, reliability and validity, and usefulness for identifying wellbeing or risk levels.

RESULTS

Twenty-one publications were found that described the development and or use by primary healthcare services of 14 measurement instruments, employed across 30 applications. Four of the 14 measurement instruments were developed specifically for Indigenous youth populations, four focused solely on strength-based wellbeing concepts but none included all Indigenous wellbeing domains.

CONCLUSION

There is a diversity of measurement instruments available, but few fit our desirability criteria. Although it is possible that we missed relevant papers and reports, this review clearly supports the need for further research to develop, refine or adapt instruments cross-culturally to measure the wellbeing of Indigenous children and youth.

General well-being of intensive care nurses: A prototype analysis

BACKGROUND

Prototype analyses of well-being have identified central characteristics and prototypicality for New Zealand teachers, lawyers, adolescents, and work well-being of nurses. What has not yet been explored is the broad construct of well-being in intensive care nurses.

AIMS

To identify intensive care nurses' conceptions of general well-being and investigate whether their general well-being is prototypically organized.

DESIGN

Prototype analysis.

METHODS

Three linked studies conceptualize well-being in this prototype analysis. In study 1, nurses reported features of well-being. Study 2 investigated the organization of these features. Study 3 sought confirmation of prototypical organization.

RESULTS

Sixty-five New Zealand nurses participated. For study 1 (n = 23), the most frequently reported elements of well-being included physical health (n = 26), work-life balance (n = 20), and personal relationships (n = 18). For study 2 (n = 25), the highest rated elements included mental and emotional health, [general] health, work-life balance, and love. Work-life balance, physical health, and personal relationships were in the top five most frequently reported and were rated in the top 12 most central. Overall, ratings of centrality and the number of times reported were positively correlated (r = 0.33, P < .005). For study 3 (n = 17), confirmatory analyses did not reach statistical significance (P = .15).

CONCLUSIONS

Physical health, work-life balance, and personal relationships are key characteristics of well-being for intensive care nurses. Mental, emotional, and general health and work-life balance were considered most important for well-being.

RELEVANCE TO CLINICAL PRACTICE

Physical health, work-life balance, and personal relationships are key characteristics of well-being for intensive care nurses. These characteristics of the broad construct of well-being are helpful in both defining and identifying conceptual models of well-being that may be used to inform the development and measurement of well-being programmes.

What factors predict outcome from an inpatient multidisciplinary chronic pain service? A prospective cohort study

Objective To identify baseline factors associated with outcomes from an inpatient multidisciplinary pain management program (PMP) located in a bicultural area of Aotearoa New Zealand. Methods A prospective cohort study was undertaken involving 164 people with chronic pain who attended the PMP. Demographic, clinical, and psychosocial measures were obtained at baseline, whereas clinical and psychosocial outcome measures were also obtained at program discharge and 3-month follow up (N  = 100). Multivariate analyses were used to determine baseline demographic variables that were associated with outcomes at discharge and follow up. Results Being male and working full-time were associated with poorer outcomes in select measures at discharge. At the 3-month follow up, Māori ethnicity, working full-time, being retired or unemployed, or having chronic widespread pain were associated with poorer outcomes for some measures, whereas those with rheumatoid arthritis had greater self-efficacy. Conclusions Sex, ethnicity, employment status, and patient condition impact clinical outcomes from the program and in the time from discharge to follow up. Program content and/or delivery should be altered to promote more equitable outcomes for all patients in the long term.

Learnings on Doing Health Research with Muslim Communities in Aotearoa New Zealand from a Study on Health and Ramadan

The Muslim community is a vibrant part of New Zealand society. As this community grows, researchers will need to strengthen engagement and collaboration to tailor the delivery of services. Given the paucity of the literature, this conceptual paper drawing on a study on health and Ramadan presents an exemplar for doing research with Muslim communities. This paper proposes several key elements (i) the importance of relationships, (ii) engagement with imams (mosque leaders), (iii) cultural and religious safety, (iv) a gendered approach and (v) utilizing religious festivals. These findings will be of interest to policy makers, practitioners and scholars wishing to engage with this community.

Cultural Differences in Psychological Distress and Illness Perceptions Amongst People Living With Cardiac Inherited Diseases

Cardiac Inherited diseases (CID) and minority ethnic status are both associated with anxiety and depression. This study aimed to investigate differences in patient experiences of CID between ethnic groups in New Zealand (NZ) in order to inform psychosocial interventions and promote health equity. A cross-sectional survey was administered to a NZ CID database. One-hundred and fifty-two (152) NZ Europeans, 19 Māori, and two Pasifika participated. Māori and Pasifika peoples reported significantly greater symptom perceptions, shorter timeline perceptions, higher perceived risk of severe symptoms, and were less likely to attribute the cause of their CID to hereditary factors than NZ Europeans. Māori and Pasifika also reported more anxiety and distress, although both groups reported beneficial medication perceptions and high medication adherence. Differences could not be attributed to clinical or other demographic variables. The use of screening tools and development of culturally appropriate interventions may help reduce both distress and health inequities.

Identifying threshold concepts in postgraduate general practice training: a focus group, qualitative study

OBJECTIVE

To identify threshold concepts (TCs) for physicians undergoing postgraduate medical education (PGME) in general practice.

DESIGN

An explorative, qualitative study with 65 min focus group interviews and thematic analysis was used. Participants were asked to describe their most transformative learning experiences. Heuristical TCs were identified from the thematic analysis.

SETTING

Aotearoa/New Zealand (A/NZ).

PARTICIPANTS

Fifty participants, mostly comprising current trainees and educators from urban centres, and of NZ/European ethnicity.

RESULTS

Twenty TCs covering many aspects of postgraduate general practice experience were derived from themes identified in the data. Presented in medical proverbial form for ease of recollection, these included: Money makes the practice go round; Be a legal eagle; Manage time or it will manage you; Guidelines, GPs' little helpers; Right tool, right word, right place; The whole of the practice is greater than the sum of the parts; The personal enhances the professional; Beat biases by reflection; Chew the Complexity, Unpredictability, Diversity; Embrace the uncertainty; Not knowing is knowing; Seek and you shall find; Waiting and seeing, waiting and being; Look, listen, think between the lines; Treat the patient beyond the disease; No patient is an island; Words work wonders; Hearing is healing; Being you and being there; and; The relationship is worth a thousand consults. These TCs mapped onto core competencies in A/NZ's PGME in general practice curriculum.

CONCLUSIONS

Participants readily identified transformative and troublesome moments in their PGME in general practice. These findings confirmed evidence for a wide range of TCs with many newly identified in this study. All TCs were fundamentally based on the doctor-patient relationship, although often involving the context and culture of general practice. Actively incorporating and teaching these identified TCs in PGME in general practice may enable trainees to grasp these important learning thresholds earlier and more easily and aid in identity and role formation.

Participation in paid and unpaid work one year after injury and the impact of subsequent injuries for Māori: Results from a longitudinal cohort study in New Zealand

INTRODUCTION

Indigenous populations experience greater injury burdens than non-indigenous groups. This paper investigated, for injured Māori (New Zealand's indigenous population): 1) participation in paid and unpaid work 12 months after injury, 2) whether subsequent injuries are predictive of reduced participation, and 3) if particular characteristics of subsequent injuries predict reduced participation.

METHODS

The Subsequent Injury Study utilised data from the earlier Prospective Outcomes of Injury Study, a study of 2856 injured New Zealanders (including 566 Māori; 20%) who had an Accident Compensation Corporation (ACC; New Zealand's no-fault injury insurer) entitlement claim (sentinel injury). Data about subsequent injuries reported to ACC and hospital discharge data for injuries resulting in hospitalisation were also utilised. Multivariable models were used to examine if certain aspects of subsequent injury predicted either of two outcomes - reduced participation in paid, and unpaid work 12 months after a sentinel injury.

RESULTS

Eligible participants were identified from the 405 Māori participants interviewed at 12 months. Thirty-two percent sustained at least one ACC subsequent injury, and 16% reported reduced participation in unpaid work. Of the eligible participants working for pay at the time of their sentinel injury, 35% reported reduced participation in paid work. Although the relationship between sustaining a subsequent injury (or not) and reduced participation in paid work was unclear (aRR 1.4, 95%CI 0.9,2.3), particular subsequent injury characteristics were identified as being independently predictive: subsequent injury resulting from an assault (aRR 2.4, 95%CI 1.2,4.9), a subsequent injury involving an entitlement claim (aRR 2.0, 95%CI 1.1,3.4), sustaining more than one subsequent injury (aRR 2.0, 95%CI 1.1,3.6), and only non-work-related subsequent injuries (aRR 1.6, 95%CI 1.0,2.7).

CONCLUSIONS

Reduced participation in paid work is prevalent for Māori after an ACC entitlement claim injury. Particular characteristics of subsequent injuries after such an event impacts on participation in paid work 12 months after the sentinel injury, but the picture is less clear for unpaid work. Understanding the changes in paid and unpaid work, and the predictive characteristics of subsequent injuries for injured Māori, is important for future injury prevention strategies and supporting return to work rehabilitation programmes, specifically for Māori.

Malnutrition Risk: Four Year Outcomes from the Health, Work and Retirement Study 2014 to 2018

This study aimed to determine four-year outcomes of community-living older adults identified at ‘nutrition risk’ in the 2014 Health, Work and Retirement Study. Nutrition risk was assessed using the validated Seniors in the Community: Risk Evaluation for Eating and Nutrition, (SCREENII-AB) by postal survey. Other measures included demographic, social and health characteristics. Physical and mental functioning and overall health-related quality of life were assessed using the 12-item Short Form Health Survey (SF-12v2). Depression was assessed using the verified shortened 10 item Center for Epidemiologic Studies Depression Scale (CES-D-10). Social provisions were determined with the 24-item Social Provisions Scale. Alcohol intake was determined by using the Alcohol Use Disorders Identification Test (AUDIT-C). Among 471 adults aged 49–87 years, 33.9% were at nutrition risk (SCREEN II-AB score ≤ 38). The direct effects of nutrition risk showed that significant differences between at-risk and not-at-risk groups at baseline remained at follow up. Over time, physical health and alcohol use scores reduced. Mental health improved over time for not-at-risk and remained static for those at-risk. Time had non-significant interactions and small effects on all other indicators. Findings highlight the importance of nutrition screening in primary care as nutrition risk factors persist over time.

Sleep health in later life: interviews exploring experiences, attitudes and behaviours of older people

Sleep is vital for health and wellbeing across the lifecourse. Ethnic differences have been observed with regards to the prevalence and predictors of self-reported sleep problems. An understanding of sleep experiences with ageing and across ethnicities is required to better support older people. Open-ended interviews were conducted with 23 people living in Aotearoa/New Zealand aged 61–92 years (12 Māori and 11 non-Māori) concerning current sleep status, changes over their lifecourse and personal strategies for supporting good sleep. Participants typically expressed satisfaction with current sleep (usually pertaining to duration) or feelings that sleep was compromised (usually pertaining to waking function). Comparisons to a socially perceived ‘ideal’ sleep were common, with sleep transitions presented as a gradual and accepted part of ageing. Participants resisted medicalising sleep disruptions in older age. While participants were aware of ways to enhance their sleep, many acknowledged engaging in practices that undermined it. Unique insights from some Māori participants indicated that sleep disruptions were not so readily pathologised compared to Western views and that sleeplessness could provide opportunity for cultural or spiritual connection. Common narratives underpinning the themes were: ‘You don't need as much sleep when you're older’, ‘Sleep just fits in’ and ‘Having the time of my life’. Findings provide personal experiences and cultural interpretations relating to sleep and ageing. This provides the foundation for future participatory research to co-design sleep health messages which are meaningful for ageing well across ethnicities.

A Secondary-Primary Mental Health Integrated Care Model for Communities with Diverse Population and Complex Health Needs - a Case Study with Health Care Utilization Evaluation

Integrated care is expected to improve patient experience, patient outcomes and assist with the increasing demand on health services from those with long term conditions including mental disorder. Few studies have evaluated health care utilization as a consequence of increased integration of mental health care. This study considers the factors known to influence secondary health service utilization and investigated the impact of a locality based mental health integrated model of care (ILoC) providing specialist consultation and liaison advice to primary care, to support early diagnosis and treatment. Using existing hospital databases, the study-cohort was identified (service users supported by ILoC, and then referred within 6 months to specialist mental health services (MHS) care between 2017- 2018) and compared on health services utilization with a matched-cohort (without ILoC support before referral to specialist services). The length-of-care in the non-acute MHS was 71% shorter for the ILoC study-cohort, and differences increased in the subgroup taking antidepressants. The ILoC study-cohort was less likely to be admitted to acute MHS on first referral post ILoC intervention and had a 25% lower relative risk of acute MHS admissions at any time in follow-up. There was no difference in the average MHS inpatient length-of-stay. The risk of general hospital acute inpatient admission was marginally higher in the ILoC study-cohort.

Conclusions

ILoC appears to shorten non-acute length-of-specialist-care and reduce acute mental health admission. The study provides a first step in understanding the clinical characteristics and specialist services health-care utilization of patients supported by an integrated mental care approach.

Land loss and the intergenerational transmission of wellbeing: The experience of iwi in Aotearoa New Zealand

We analyse the impact of land loss, through colonisation, on contemporary cultural wellbeing and health outcomes of Māori, the Indigenous population of Aotearoa New Zealand. In 1840, Māori legally owned all land in the country; by 2017, Māori owned just 5% of land. Ties to the land (whenua) have been identified as being critical to spirituality (wairua) and health (hauora). All tribes (iwi) experienced major land loss, but the timing, extent and nature of land loss differed across iwi. In some cases, land was confiscated following the New Zealand wars of the nineteenth century. We draw on recently derived data for historical landholdings of 70 (North Island) iwi to link the extent of historical landholdings, and whether land was confiscated, to contemporary outcomes for five cultural wellbeing and health outcomes for each iwi: te reo Māori (Māori language) proficiency, importance of involvement in Māori culture, visiting an ancestral marae (meeting place), difficulty in finding support for Māori cultural practices, and rates of regular smoking. We find that higher land retention within an iwi's rohe at the end of the nineteenth century is supportive of contemporary cultural wellbeing outcomes, while confiscation is linked to higher contemporary rates of smoking. The evidence is consistent with historical trauma having significant effects on the cultural wellbeing and health outcomes of Aotearoa New Zealand's Indigenous population over a century later.

Nutrition risk prevalence and associated health and social risk factors in Māori and non-Māori: Results from the New Zealand Health, Work and Retirement Study

OBJECTIVE

To determine the nutrition risk prevalence and associated health and social risk factors amongst community-living Māori and non-Māori older adults in New Zealand.

METHODS

As part of the 2014 Health, Work and Retirement postal survey, 2914 community-living older adults (749 Māori) aged 49-87 years completed the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN II-AB) to determine nutrition risk status and sociodemographic and health measures.

RESULTS

Half (50.2%) of Māori and 32.7% of non-Māori were at nutrition risk. Independent risk factors were as follows: for Māori, being unpartnered and rating general health as fair, and for non-Māori, being unpartnered and rating general health as fair or poor, lower life satisfaction, higher number of health conditions and emotional loneliness.

CONCLUSIONS

Findings highlight the need for culturally appropriate intervention strategies, which provide opportunity for older adults to eat with others, especially for those who are unpartnered and lonely.

iSelf-Help: a co-designed, culturally appropriate, online pain management programme in Aotearoa

INTRODUCTION

Current best practice recommends group-based pain management programmes for long-term improvements in persistent pain-related disability. However, there are barriers for people to access in-person delivered pain management programmes in Aotearoa.

AIMS

To develop a co-designed, culturally responsive, online group-based pain management programme (iSelf-help) for people with persistent pain.

METHODS

A modified participatory action research (PAR) framework was used to co-design contents and cultural-appropriateness of iSelf-help. The PAR team included: (1) seven end-users living with persistent pain, who had previously attended an in-person delivered group pain management programme, (2) two pain management clinicians, (3) two health researchers, (4) two digital health experts, and (5) a health literacy expert. Five meetings were held with the PAR group and a Nominal Group Technique was used to rank order the preferred features of content delivery. In parallel, to ensure cultural appropriateness of iSelf-help, three focus groups (n = 15) were held with Māori (the Indigenous population of Aotearoa) living with persistent pain in collaboration with a Māori community health trust. All contents were reviewed by a Māori Health literacy expert and core contents were translated into Te Reo (Māori language). All contents were finalised by iterative discussion among the PAR team and consultation with Māori stakeholders. The preliminary version of iSelf-help was pilot tested with the PAR group participants and Māori community members living with persistent pain and their feedback was included. The iterative co-design process occurred over a period of nine months.

RESULTS

The finalised version of iSelf-help included a total of 130 resources organised in to 12 content relevant online modules plus a dedicated welcoming page and an online community forum. Each module included: short videos, animations explaining main concepts, patient stories, written content to accompany visual content, podcasts of relaxation techniques, illustrated texts, and evidence-summaries. A dedicated module of videos demonstrating cardiovascular and strengthening exercises of varying intensity was also included.

CONCLUSIONS

This is the first co-created, culturally appropriate, on-line group pain management programme for people with persistent pain, developed in Aotearoa. The next step is to evaluate the clinical and cost-effectiveness of iSelf-help compared to in-person delivered pain management programme.

Māori elders’ perspectives of end-of-life family care: whānau carers as knowledge holders, weavers, and navigators

Background:

There is growing interest in palliative care within Indigenous communities, and within Aotearoa New Zealand, of the significant role that Māori (Indigenous people) families play in caring for older relatives. This study explored the centrality of culture in how Māori extended families (whānau) in Aotearoa New Zealand interpret and enact family-based care roles within the Māori world (Te Ao Māori).

Methods:

Applying Māori-centered and community-based participatory research principles, we examined 17 interviews with older Māori who shared experiences of palliative care for a partner or family member. The thematic analysis used a cultural-discursive framework incorporating Māori principles of wellbeing and values expressed within the care relationship.

Results:

The findings centered on three whānau roles in palliative care: whānau as (1) Holders and protectors of Māori knowledge; (2) Weavers of spiritual connection; and (3) Navigators in different worlds.

Conclusion:

The study problematizes the notion of a single ‘primary caregiver’, privileges whānau as an inter-woven relational, dynamic care network, and encourages health professionals to recognize the cultural embeddedness of dominant approaches to palliative care.

Adapting Traditional Healing Values and Beliefs into Therapeutic Cultural Environments for Health and Well-Being

Although research has long established that interaction with the natural environment is associated with better overall health and well-being outcomes, the Western model mainly focuses on treating symptoms. In Aotearoa/New Zealand, the Indigenous Māori have long demonstrated significantly more negative health outcomes than non-Māori. Little research has examined the causes compared to Western populations or the role of the natural environment in health outcomes for Māori. An exploration of rongoā Māori (traditional healing system) was conducted to ascertain the importance of landscape in the process of healing. Eight rongoā healers or practitioners took part in semi-structured narrative interviews from June to November 2020. Transcribed interviews were analysed using an interpretative phenomenological analysis and Kaupapa Māori techniques. The findings show how rongoā is underpinned by a complex set of cultural values and beliefs, drawing from the connection to wairua (spirit), tinana (body), tikanga and whakaora (customs and healing), rākau (plants), whenua (landscape) and whānau (family). Incorporating such constructs into the landscape can foster our understanding of health and well-being and its implications for conceptualising therapeutic environments and a culturally appropriate model of care for Māori and non-Māori communities.

Ka mura ka muri: understandings of organ donation and transplantation in Aotearoa New Zealand

In this article, we refer to the separation of solid organs from the body as bio-objects. We suggest that the transfer of these bio-objects is connected to emotions and affects that carry a range of different social and cultural meanings specific to the context of Aotearoa New Zealand. The discussion draws on research findings from a series of qualitative indepth interview studies conducted from 2008 to 2013 with Māori (the Indigenous people of Aotearoa New Zealand) and Pākehā (European settler New Zealanders) concerning their views on organ donation and transplantation. Our findings show both differences and similarities between Māori and Pākehā understandings of transplantation. Nevertheless, while many Māori draw on traditional principles, values and beliefs to reflect on their experiences in relation to embodiment, gift-giving, identity and well-being, Pākehā tend to subscribe to more Western understandings of identity in terms of health and well-being, in line with international literature on the topic. Rather than reflecting individualistic notions of the body and transplantation as the endpoint of healthcare as do Pākehā, Māori views are linked to wider conceptions of family, ancestry and belonging, demonstrating how different rationalities and ontologies affect practices and understandings surrounding organ transfer technology. In the article, we focus predominantly on Māori perspectives of organ transfer, contextualising the accounts and experiences of our research participants against the backdrop of a long history of settler colonialism and health inequalities in Aotearoa New Zealand.

Explorations of Health in Aotearoa New Zealand's Low-income Suburbia

Underpinned by the notion that community voices should be central to the development of localized communication infrastructures for health and well-being, this study applied Dutta's culture-centered approach to examine the meanings of health and the navigation of being healthy among 118 people residing in low-income suburban areas in Aotearoa New Zealand. The culture-centered approach is based on dialog between researchers and community members, and it centralizes local contexts by building theories from within the culture and co-creating dialogic spaces of listening, formed at the intersection of structure, culture, and agency. In this study, participants constructed health in relation to food, housing, and health care, underpinned by financial inaccessibility and a deep-rooted cultural conflict between the collectivist norms practiced by the community and the neoliberal individualized structure. The study illuminates how the pathologization of culture by structure constitutes poor health outcomes and how agentic expressions of culture negotiate local structures to regain health and well-being through acts of resistance.

Conceptualizing Indigenous Human-Animal Relationships in Aotearoa New Zealand: An Ethical Perspective

This article considers the complexity and diversity of ethical concepts and beliefs held by Māori, the indigenous people of Aotearoa New Zealand (hereafter New Zealand), relating to animals. A combination of interviews and focus group discussions were conducted with individuals who identify as Māori and were working with wildlife, primarily in an eco-tourism and conservation context. Two main themes emerged from the data: ethical concepts relating to the environment, and concepts relating to the spiritual relationships between people, animals and the environment. These findings highlight that the connections between humans and animals through a Māori lens are nuanced in ways not typically accounted for in Western philosophy. This is of particular importance because of the extent to which standard Western thought is embodied in law and policy related to human treatment of animals and the environment. In New Zealand, relationships and partnerships are informed by Te Tiriti ō Waitangi, one of New Zealand's founding documents. Where these partnerships include activities and environments involving human-animal interaction, policy and legislation should account for Māori knowledge, and diverse of thought among different hapū (tribal groups). We conclude by exploring ways of including Māori ethical concepts around animals in general, and wild animals in particular, in law and policy, providing a case study relevant to other bicultural or multicultural societies.

Conceptualising Therapeutic Environments through Culture, Indigenous Knowledge and Landscape for Health and Well-Being

Academic research has long established that interaction with the natural environment is associated with better overall health outcomes. Notably, the area of therapeutic environments has been borne out of the recognition of this critical relationship, but much of this research comes from a specific Western perspective. In Aotearoa-New Zealand, Māori (the Indigenous people of the land) have long demonstrated significantly worse health outcomes than non-Māori. Little research has examined the causes compared to Western populations and the role of the natural environment in health outcomes for Māori. The present study aimed to explore the relationship between Māori culture, landscape and the connection to health and well-being. Eighteen Māori pāhake (older adults) and kaumātua (elders) took part in semi-structured interviews carried out as focus groups, from June to November 2020. Transcribed interviews were analysed using interpretative phenomenological analysis and kaupapa Māori techniques. We found five overarching and interrelated key themes related to Indigenous knowledge (Mātauranga Māori) that sit within the realm of therapeutic environments, culture and landscape. A conceptual framework for Therapeutic Cultural Environments (TCE) is proposed in terms of the contribution to our understanding of health and well-being and its implications for conceptualising therapeutic environments and a culturally appropriate model of care for Māori communities.

"I couldn't even do normal chores": a qualitative study of the impacts of injury for Māori

AIMS

To investigate the rehabilitation experiences of Māori who were still reporting disability 24 months after an injury resulting in hospitalisation.

METHODS

Participants had been hospitalised for an Accident Compensation Corporation (New Zealand's no-fault injury compensation insurer) entitlement claim injury between 2007 and 2009, and were experiencing disability 24 months post-injury. In-depth kanohi ki te kanohi (face-to-face) qualitative interviews with 12 participants aged between 37 and 71 years at the time of interviews were conducted. Interpretive analyses of interview transcripts, focused on the impacts of injury was conducted with the aid of NVivo software.

RESULTS

The overarching theme identified during the analysis was "Impact" with four sub-themes of: Impact on daily life; Impact on relationships, Impact on employment; and, long-term or ongoing impacts.

CONCLUSIONS

For Māori living with disability 24 months after hospitalisation for injury, adjusting to life after the injury and the rehabilitation process was challenging. Participants discussed frustration with feeling dependent on others, being bored and feeling unfulfilled after their injury, and that many aspects of their lives were impacted on and not always in the expected directions. Many reported longer lasting impacts even after rehabilitation was completed. Implications for rehabilitation programmes e.g., strengthening programmes by taking into account issues discussed by participants, recognising the long-term impacts on both those injured and their whānau (family), and further investigations required are also discussed.IMPLICATIONS FOR REHABILITATIONDisability after injury can have long term impacts for injured Māori and their relationships.Social impacts can be perceived as more debilitating than the physical impacts after injury.Experiences of employment changes and future prospects are often difficult to navigate for Māori returning to work after an injury.

Psychosocial Aspects of Delivering Cancer Care to Indigenous People: An Overview

Globally, a growing body of evidence has reported significant disparities in cancer outcomes between indigenous and nonindigenous people. Although some effort is being made to address these disparities, relatively little attention has been directed toward identifying and focusing on the psychosocial aspects of cancer care for indigenous patients, which are critical components in improving cancer care and outcomes. The purpose of this article is to describe the results of a scoping review of the psychosocial aspects of cancer care for indigenous people. We highlight considerations in undertaking research in this field with indigenous people and the implications for clinical practice.

Inequities in people with gout: a focus on Māori (Indigenous People) of Aotearoa New Zealand

Health equity can be defined as the absence of systematic disparities in health between more and less advantaged social groups. Gout is one of the most common forms of arthritis and disproportionally affects Indigenous peoples, including Māori in Aotearoa New Zealand. Inequities in gout management are well documented and clearly evidenced in Indigenous populations. For example, while gout occurs at a younger age and is more severe in Māori, there is less regular dispensing of urate-lowering therapies. Indigenous peoples are also under-represented in clinical trials. Herein, we will review inequities in gout using Aoteoaroa New Zealand as an example. We will explore reasons for health inequities and challenges that need to be faced to achieve health equity.

Cultural efficacy predicts body satisfaction for Māori

This paper examines the relationship between body mass index (BMI), self-esteem and self-reported confidence and capability in expressing oneself culturally as Māori (cultural efficacy) for 5,470 Māori who participated in Te Rangahau o Te Tuakiri Māori me Ngā Waiaro ā-Pūtea | The Māori Identity and Financial Attitudes Study (MIFAS) in 2017. Adjusting for demographics, self-reported health, education and socio-economic status, we found that a higher BMI was associated with lower body satisfaction and self-esteem. However, higher scores on cultural efficacy were associated with higher levels of body satisfaction and self-esteem for respondents. Furthermore, the negative association between BMI and both body satisfaction and self-esteem was weaker for those with higher cultural efficacy. This held for BMI scores of 25, 30, and 35+. While our data suggest higher cultural efficacy may directly or interactively shield Māori from developing lowered self-esteem typically associated with higher BMI in Western populations, further research, using more comprehensive measures of body satisfaction should explore the extent to which Māori may find the Western "thin ideal" personally desirable for their own bodies.

Indigenous ethnic identity, in-group warmth, and psychological wellbeing: A longitudinal study of Māori

Longitudinal studies into the relationship between affect (positive or negative feelings) towards one’s own ethnic group and wellbeing are rare, particularly for Indigenous peoples. In this paper, we test the longitudinal effects of in-group warmth (a measure of ethnic identity affect) and ethnic identity centrality on three wellbeing measures for New Zealand Māori: life satisfaction (LS), self-esteem (SE), and personal wellbeing (PW). Longitudinal panel data collected from Māori (N = 3803) aged 18 or over throughout seven annual assessments (2009–2015) in the New Zealand Attitudes and Values Study were analyzed using latent trajectory models with structured residuals to examine cross-lagged within-person effects. Higher in-group warmth towards Māori predicted increases in all three wellbeing measures, even more strongly than ethnic identity centrality. Bi-directionally, PW and SE predicted increased in-group warmth, and SE predicted ethnic identification. Further, in sample-level (between-person) trends, LS and PW rose, but ethnic identity centrality interestingly declined over time. This is the first large-scale longitudinal study showing a strong relationship between positive affect towards one’s Indigenous ethnic group and wellbeing. Efforts at cultural recovery and restoration have been a deliberate protective response to colonization, but among Māori, enculturation and access to traditional cultural knowledge varies widely. The data reported here underline the role of ethnic identity affect as an important dimension of wellbeing and call for continued research into the role of this dimension of ethnic identity for Indigenous peoples.

Indigenous Environmental Justice within Marine Ecosystems: A Systematic Review of the Literature on Indigenous Peoples’ Involvement in Marine Governance and Management

We develop and apply a systematic review methodology to identify and understand how the peer-reviewed literature characterises Indigenous peoples’ involvement in marine governance and management approaches in terms of equity and justice worldwide. We reviewed the peer-reviewed English-language research articles between January 2015 and September 2020 for examples of Indigenous peoples’ involvement in marine governance and management using the analytical lens of environmental justice. The majority of research studies highlighted that Indigenous peoples experienced some form of environmental injustice linked to existing marine governance and management, most notably in the context of inequitable decision-making procedures surrounding the establishment and operation of marine protected areas. However, there are significant gaps in the current literature, including a notable absence of studies exploring Indigenous women and other gender minorities’ involvement in marine planning and management and the limited number of studies about Indigenous peoples living throughout Asia, the Arctic, Russia, and Africa. More studies are needed to explore collaborative and intersectional approaches, including co-governance and co-management and ecosystem-based management, and critically evaluate what constitutes inclusive, equitable, and just marine governance and management processes, practices, and outcomes for different Indigenous peoples occupying diverse social–ecological systems.