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Mustafa S, Norman K, Kenealy T, Paul R, Murphy R, Lawrenson R, Chepulis L. Management of type 2 diabetes in New Zealand: a scoping review of interventions with measurable clinical outcomes. Public Health 2024; 234:1-15. [PMID: 38908052 DOI: 10.1016/j.puhe.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/28/2024] [Accepted: 05/15/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE This review aimed to assess the effectiveness of interventions for type 2 diabetes (T2D) management in New Zealand on clinical outcomes, and explore the factors impacting their feasibility and acceptability. STUDY DESIGN Scoping review. METHODS Three databases (PubMed, Web of Science and Scopus) were searched between January 2000 and July 2023. Reference lists of included studies were hand searched to identify additional articles. RESULTS The search yielded 550 publications, of which 11 were included in the final review. Most interventions (n = 10) focussed on education and seven were delivered by health professionals. Supporting factors for interventions included clinical/peer support (n = 8) and whānau (family) involvement (n = 6). Hindering factors included non-adherence (n = 4) and high drop-out (n = 4). Most studies reported modest improvement in HbA1c and weight at six months, but minimal change in HbA1c, weight, lipids, renal profile, and blood pressure by two years. CONCLUSION Future interventions should involve culturally appropriate approaches to improve engagement and acceptability while addressing lifestyle and medication adherence for T2D management. T2D interventions not widely disseminated via academic channels need to be further identified.
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Affiliation(s)
- S Mustafa
- Medical Research Centre, Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand.
| | - K Norman
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - T Kenealy
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - R Paul
- Medical Research Centre, Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand; Te Whatu Ora Health New Zealand, Hamilton, New Zealand
| | - R Murphy
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - R Lawrenson
- Medical Research Centre, Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand; Te Whatu Ora Health New Zealand, Hamilton, New Zealand
| | - L Chepulis
- Medical Research Centre, Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand
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Matheson A, Wehipeihana N, Gray R, Walton M, Uia T, Lindberg K, Shanthakumar M, Lopez MI, Reidy J, Firestone R, Ellison-Loschmann L. Building a systems-thinking community workforce to scale action on determinants of health in New Zealand. Health Place 2024; 87:103255. [PMID: 38710122 DOI: 10.1016/j.healthplace.2024.103255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/08/2024]
Abstract
This article describes findings from the evaluation of Healthy Families NZ (HFNZ), an equity-driven, place-based community health initiative. Implemented in nine diverse communities across New Zealand, HFNZ aims to strengthen the systems that can improve health and well-being. Findings highlight local needs and priorities including the social mechanisms important for reorienting health and policy systems towards place-based communities. Lessons encompass the importance of local lived experience in putting evidence into practice; the strength of acting with systems in mind; the need for relational, learning, intentional, and well-resourced community organisation; examples of how to foster place-based 'community-up' leadership; and how to enable responsiveness between communities and local and national policy systems. A reconceptualisation of scaling in the context of complexity and systems change is offered, which recognises that relationships and agency are key to making progress on the determinants of health.
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Affiliation(s)
- Anna Matheson
- School of Health, Te Herenga Waka - Victoria University of Wellington, Kelburn 6012, Wellington, New Zealand.
| | - Nan Wehipeihana
- Weaving Insights, PO Box 147, Levin 5540, Horowhenua, New Zealand
| | - Rebecca Gray
- School of Health, Te Herenga Waka - Victoria University of Wellington, Kelburn 6012, Wellington, New Zealand
| | - Mat Walton
- Institute of Environmental Science and Research Limited (ESR), Kenepuru Science Centre: 34 Kenepuru Drive, Kenepuru, Porirua 5022, PO Box 50348, Porirua 5240, New Zealand
| | - Tali Uia
- School of Health, Te Herenga Waka - Victoria University of Wellington, Kelburn 6012, Wellington, New Zealand
| | - Kirstin Lindberg
- Environmental Health Intelligence New Zealand, Massey University, Wallace Street, Mount Cook, Wellington 6021, New Zealand
| | - Mathu Shanthakumar
- Environmental Health Intelligence New Zealand, Massey University, Wallace Street, Mount Cook, Wellington 6021, New Zealand
| | - Maite Irurzun Lopez
- Health Services Research Centre, Te Herenga Waka, Victoria University of Wellington, Kelburn 6012, Wellington, New Zealand
| | - Johanna Reidy
- School of Health, Te Herenga Waka - Victoria University of Wellington, Kelburn 6012, Wellington, New Zealand
| | - Riz Firestone
- Centre for Hauora and Health, Massey University, Wallace Street, Mount Cook, Wellington 6021, New Zealand
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Hine R, Gladstone B, Reupert A, O’Dea L, Cuff R, Yates S, Silvén Hagström A, McGaw V, Foster K. StigmaBeat: Collaborating With Rural Young People to Co-Design Films Aimed at Reducing Mental Health Stigma. QUALITATIVE HEALTH RESEARCH 2024; 34:491-506. [PMID: 38029299 PMCID: PMC11080393 DOI: 10.1177/10497323231211454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Little is known about the experience and impact of intersectional stigma experienced by rural young people (15-25 years) who have a parent with mental health challenges. The StigmaBeat project employed a co-design approach to create short films to identify and challenge mental health stigma from the perspective of young people who have experienced this phenomenon. The aim of this paper is to describe the co-design methodological approach used in StigmaBeat, as an example of a novel participatory project. We describe one way that co-design can be employed by researchers in collaboration with marginalised young people to produce films aimed at reducing mental health stigma in the community. Through describing the processes undertaken in this project, the opportunities, challenges, and tensions of combining community development methods with research methods will be explored. Co-design with young people is a dynamic and engaging method of collaborative research practice capable of harnessing lived experience expertise to intervene in social issues and redesign or redevelop health services and policies. The participatory approach involved trusting and implementing the suggestions of young people in designing and developing the films and involved creating the physical and social environment to enable this, including embedding creativity, a critical element to the project's methodological success. Intensive time and resource investment are needed to engage a population that is often marginalised in relation to stigma discourse.
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Affiliation(s)
- Rochelle Hine
- Monash Rural Health, Monash University, Warragul, VIC, Australia
| | - Brenda Gladstone
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Andrea Reupert
- School of Educational Psychology and Counselling, Monash University, Warragul, VIC, Australia
| | - Lotti O’Dea
- Independent Consultant, Naarm/Collingwood, VIC, Australia
| | - Rose Cuff
- Satellite Foundation, Naarm/Collingwood, VIC, Australia
| | - Scott Yates
- School of Applied Social Sciences, De Montfort University, Leicester, UK
| | | | | | - Kim Foster
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, VIC, Australia
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Gustafson P, Lambert M, Bartholomew K, Ratima M, Aziz YA, Kremer L, Fusheini A, Carswell P, Brown R, Priest P, Crengle S. Adapting an equity-focused implementation process framework with a focus on ethnic health inequities in the Aotearoa New Zealand context. Int J Equity Health 2024; 23:15. [PMID: 38280997 PMCID: PMC10822165 DOI: 10.1186/s12939-023-02087-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/20/2023] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND Health intervention implementation in Aotearoa New Zealand (NZ), as in many countries globally, usually varies by ethnicity. Māori (the Indigenous peoples of Aotearoa) and Pacific peoples are less likely to receive interventions than other ethnic groups, despite experiencing persistent health inequities. This study aimed to develop an equity-focused implementation framework, appropriate for the Aotearoa NZ context, to support the planning and delivery of equitable implementation pathways for health interventions, with the intention of achieving equitable outcomes for Māori, as well as people originating from the Pacific Islands. METHODS A scoping review of the literature to identify existing equity-focused implementation theories, models and frameworks was undertaken. One of these, the Equity-based framework for Implementation Research (EquIR), was selected for adaptation. The adaptation process was undertaken in collaboration with the project's Māori and consumer advisory groups and informed by the expertise of local health equity researchers and stakeholders, as well as the international implementation science literature. RESULTS The adapted framework's foundation is the principles of Te Tiriti o Waitangi (the written agreement between Māori rangatira (chiefs) and the British Crown), and its focus is whānau (extended family)-centred implementation that meets the health and wellbeing aspirations, priorities and needs of whānau. The implementation pathway comprises four main steps: implementation planning, pathway design, monitoring, and outcomes and evaluation, all with an equity focus. The pathway is underpinned by the core constructs of equitable implementation in Aotearoa NZ: collaborative design, anti-racism, Māori and priority population expertise, cultural safety and values-based. Additionally, the contextual factors impacting implementation, i.e. the social, economic, commercial and political determinants of health, are included. CONCLUSIONS The framework presented in this study is the first equity-focused process-type implementation framework to be adapted for the Aotearoa NZ context. This framework is intended to support and facilitate equity-focused implementation research and health intervention implementation by mainstream health services.
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Affiliation(s)
- Papillon Gustafson
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, PO Box 56, Dunedin, Aotearoa, New Zealand, 9054
| | - Michelle Lambert
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, PO Box 56, Dunedin, Aotearoa, New Zealand, 9054
| | - Karen Bartholomew
- Te Whatu Ora Waitematā and Te Toka Tumai Auckland, Auckland, Aotearoa, New Zealand
| | - Mihi Ratima
- Taumata Associates, Hāwera, Aotearoa, New Zealand
| | - Yasmin Abdul Aziz
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, PO Box 56, Dunedin, Aotearoa, New Zealand, 9054
| | - Lisa Kremer
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, PO Box 56, Dunedin, Aotearoa, New Zealand, 9054
| | - Adam Fusheini
- Preventive and Social Medicine, University of Otago, Dunedin Campus, Dunedin, Aotearoa, New Zealand
| | | | - Rachel Brown
- National Hauora Coalition, Auckland, Aotearoa, New Zealand
| | - Patricia Priest
- Preventive and Social Medicine, University of Otago, Dunedin Campus, Dunedin, Aotearoa, New Zealand
| | - Sue Crengle
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, PO Box 56, Dunedin, Aotearoa, New Zealand, 9054.
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Urquhart L, Roberts (Dunghutti) K, Gibbs (Muruwari) C, Fisher K, Brown LJ, Duncanson K. Experiences of co-designing research about a rural Aboriginal well-being program: Informing practice and policy. Aust J Rural Health 2022; 30:747-759. [PMID: 36250967 PMCID: PMC10092418 DOI: 10.1111/ajr.12924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/10/2022] [Accepted: 09/11/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The objective of this study was to explore data and Aboriginal and non-Aboriginal researchers' experiences and reflexivity in co-designing research about a rural Aboriginal well-being program to inform practice and policy. SETTING Gumbaynggirr, Birpai, Kamilaroi and Awabakal countries located in regional and rural New South Wales, Australia. PARTICIPANTS Rural and regionally located research team who co-designed processes to challenge the status quo about a critically framed, rural-based Aboriginal well-being research project. DESIGN Researchers drew on data from a research project in an interpretive cycle of collaborative Yarning. Data included 90 published articles, 12 Yarning transcripts and 26 reflective journal text sets, as well as researcher experiences and reflexivity. RESULTS The Duguula Gayirray (Yarning together), Yandaarray (walking together) and Duguula Nguraljili (sharing together) co-design practice model was developed to represent key actions in the context of an Aboriginal well-being program in a rural context. Actions were supported by seven interpersonal ways of being and were underpinned by respectful relationships between community and researchers. DISCUSSION Duguula Gayirray, Yandaarray and Duguula Nguraljili are critical to co-design practice and are grounded in respectful relationships. Our experiences led us to critique our perceptions of power sharing, equitable partnerships and collaborative knowledges towards opportunity for collective research co-design. CONCLUSION Duguula Gayirray, Yandaarray and Duguula Nguraljili transformed our understanding of achieving liberation from dominant western research in the context of a rurally located Australian Aboriginal well-being program. This study contributes to progression of Aboriginal health research practice and policy recommendations, enabling real cultural change in health care with rurally located Aboriginal communities.
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Affiliation(s)
- Lisa Urquhart
- Department of Rural Health, College of Health, Medicine and WellbeingThe University of NewcastleCoffs HarbourNew South WalesAustralia
| | | | | | - Karin Fisher
- Department of Rural Health, College of Health, Medicine and WellbeingThe University of NewcastleTamworthNew South WalesAustralia
| | - Leanne J. Brown
- Department of Rural Health, College of Health, Medicine and WellbeingThe University of NewcastleTamworthNew South WalesAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
| | - Kerith Duncanson
- Centre of Research Excellence in Digestive HealthUniversity of NewcastleCallaghanNew South WalesAustralia
- College of Health, Medicine and WellbeingThe University of NewcastleCallaghanNew South WalesAustralia
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Rolleston AK, Korohina E, McDonald M. Navigating the space between co-design and mahitahi: Building bridges between knowledge systems on behalf of communities. Aust J Rural Health 2022; 30:830-835. [PMID: 36098452 PMCID: PMC10087323 DOI: 10.1111/ajr.12916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/25/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022] Open
Abstract
AIMS To provide knowledge and recommendations for researchers, health professionals and policymakers on navigating between science and mātauranga (knowledge) Māori when using co-design methodologies. CONTEXT It is well known that the health system in Aotearoa/New Zealand does not provide culturally responsive services, programmes or approaches. Indigenous, remote and vulnerable populations that are not well served by medical and scientific models would be better served by the underlying premise of co-design methodology. However, co-design is a Western methodology. Mahitahi is presented here as a culturally responsive method of co-design that builds approaches by utilising the worldview of the people that the health system most needs to have impact upon. Co-design and mahitahi have synergies, and working at the interface between Western and Māori knowledge systems can provide innovative solutions that draw on the strengths of both approaches. APPROACH Authors will outline the benefit co-design processes have for improving health outcomes for remote and vulnerable populations. Mahitahi will be described and the synergies with co-design emphasised with important distinctions also highlighted. The use of Indigenous knowledge systems, using Māori as the case example, will be outlined. CONCLUSION Recommendations will be provided to guide researchers, health professionals and policy makers when planning a co-design approach with remote and vulnerable communities.
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Affiliation(s)
| | - Erina Korohina
- Manawa Ora - The Centre for Health, Tauranga, New Zealand
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McKelvie-Sebileau P, Rees D, Swinburn B, Gerritsen S, D'Souza E, Tipene-Leach D. Combining Cognitive Mapping and indigenous knowledge to improve food environments in regional New Zealand. Health Promot J Austr 2021; 33:631-641. [PMID: 34674331 PMCID: PMC9542597 DOI: 10.1002/hpja.549] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/27/2021] [Accepted: 10/13/2021] [Indexed: 11/10/2022] Open
Abstract
Issue addressed Hawke's Bay has one of the highest rates of childhood obesity in New Zealand. While several initiatives exist aiming to decrease obesity through physical activity, there are few nutritional interventions. This study adopted a systems science and mātauranga Māori approach to identify and target underlying drivers of rising childhood obesity and engage the community to improve the food environment. Methods Cognitive mapping interviews (CM) with local stakeholders (school principals, Iwi and district health board representatives, education managers and local councillors) were conducted. The aim was to map participants’ mental models of the causes of rising childhood obesity and to identify key principles for engaging with the local community in a meaningful, impactful and culturally appropriate way for future action. Results Eleven interviews were conducted face‐to‐face and cognitive maps were constructed. Follow‐up interviews were carried out online, due to COVID restrictions, to present the maps and for interviewees to make any adjustments. Four composite themes emerged through centrality and cluster analysis of the resulting cognitive maps: the importance of building in mātauranga Māori (Māori knowledge and ways of being), the “hauora” of children, working with the community and integrating existing initiatives. Two contextual factors are also considered: the growing need for food security in our communities and the opportunity to start interventions in the school setting. Conclusion Cognitive mapping can produce useful insights in the early stages of community engagement. The six “pou” (pillars) underscore the importance of incorporating indigenous knowledge when embarking on public health interventions, particularly around obesity and in regional communities. So what? When designing a public health initiative with a community with a high indigenous population, indigenous knowledge should be promoted to focus on holistic health, working with the community and creating opportunities for cohesion. These founding principles will be used to structure future community actions to improve children's food environments in regional New Zealand.
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Affiliation(s)
- Pippa McKelvie-Sebileau
- Research and Innovation Centre, Eastern Institute of Technology, Napier, New Zealand.,School of Population Health, University of Auckland, Auckland, New Zealand
| | | | - Boyd Swinburn
- Research and Innovation Centre, Eastern Institute of Technology, Napier, New Zealand
| | - Sarah Gerritsen
- Research and Innovation Centre, Eastern Institute of Technology, Napier, New Zealand
| | - Erica D'Souza
- Research and Innovation Centre, Eastern Institute of Technology, Napier, New Zealand.,School of Population Health, University of Auckland, Auckland, New Zealand
| | - David Tipene-Leach
- School of Population Health, University of Auckland, Auckland, New Zealand
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Harding T, Oetzel J. Implementation effectiveness of health interventions with Māori communities: a cross-sectional survey of health professional perspectives. Aust N Z J Public Health 2021; 45:203-209. [PMID: 33818865 DOI: 10.1111/1753-6405.13093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 01/01/2021] [Accepted: 02/01/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To identify factors that New Zealand health professionals rate as important for implementation effectiveness for health interventions with Māori communities. METHODS Health professionals (N=200) participated in an online cross-sectional survey. The survey was organised in three sections: a) participants' general perceptions of key features for implementation effectiveness; b) participants' direct experience of implementing health interventions with Māori communities, and c) general demographic information. RESULTS Paired sample t-tests revealed four levels of importance for implementation effectiveness with teamwork and community autonomy as being most important. Only 24% of participants had experience with a previous health intervention in Māori communities. A multiple regression model identified two key overall factors that were associated with participants' rating of implementation effectiveness in these previous interventions: process (B=0.29 p<0.01), and community (B=0.14, p<0.05). CONCLUSIONS Key areas of implementation effectiveness were community engagement and participatory process; this contributes to the body of literature that challenges traditional top-down approaches of implementation. Implications for public health: This study provides the perspectives of health professionals on implementation effectiveness when working with Māori/Indigenous communities. These professionals often lead the implementation of health interventions to address health equity. The study supports the inclusion of community voice in implementing community health interventions.
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Affiliation(s)
- Truely Harding
- Waikato Management School, University of Waikato, New Zealand
| | - John Oetzel
- Waikato Management School, University of Waikato, New Zealand
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Ufua DE, Osabuohien E, Ogbari ME, Falola HO, Okoh EE, Lakhani A. Re-Strategising Government Palliative Support Systems in Tackling the Challenges of COVID-19 Lockdown in Lagos State, Nigeria. GLOBAL JOURNAL OF FLEXIBLE SYSTEMS MANAGEMENT 2021. [PMCID: PMC7970778 DOI: 10.1007/s40171-021-00263-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This research covered the palliative material distribution project in Lagos State, Nigeria, during the lockdown and restriction on movement because of COVID-19 pandemic. The study engaged reports from extant literature and tertiary data sources such as the newspapers, the Internet, and website source. Relevant data gathered from these sources were conceptually analysed and discussed along with extant literature. The research also adopted the use of rich pictures for further presentation of the research. A key finding from the research is the need to redesign the distribution process and consider proper structuring of the project. And further engagement with the affected stakeholders to address crucial issues such as marginalisation that can defeat the purpose, which is to emancipate the affected indigents of the State from the harrowing effects of COVID-19 lockdown and other emergencies-related critical incidences such as starvation and criminalities. The study proposed a model for a resilience approach to effectively address the current palliative distribution process challenges in Lagos State, the epicentre of COVID-19 in Nigeria.
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