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Burkhardt N, Gomez Fernandez C, Dunn D. The Impact of COVID-19 on Māori Patients Attending Diabetes Annual Review. Cureus 2024; 16:e63571. [PMID: 39087145 PMCID: PMC11290040 DOI: 10.7759/cureus.63571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2024] [Indexed: 08/02/2024] Open
Abstract
Māori, the indigenous population of New Zealand, represent 17.1% of the country's population (Statistics New Zealand 2021) and are over-represented in all negative indices. In particular, Māori are underprivileged in terms of socioeconomics and health due to the residual effects of colonization. The global COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, has been one of the most significant public health crises in modern history. Vulnerable populations, such as the elderly and those with underlying health conditions, were and remain at higher risk of severe outcomes. In the New Zealand context and given the health statistics, Māori were identified as a group that was at high risk from COVID-19. Using a mixed method approach, we attempt to identify the reasons why a cohort of New Zealand Māori with type II diabetes mellitus (DM II) and a history of regular attendance failed their Diabetes Annual Review (DAR) post-COVID-19. Twelve Māori participants were recruited (> 18 years) from a Māori Diabetes database of an urban General Practitioners (GP) Clinic in Northland. A 9-point questionnaire and an unstructured telephone conversation utilizing a Kaupapa Māori (Māori philosophy) approach were utilized, and data were collated. Findings suggest the New Zealand government's COVID-19 vaccine mandates served to exacerbate Māori distrust of health professionals. Trust is the foundation of every successful relationship whether it be business, professional, health, or personal. Health delivery and uptake are based on this foundation. Whatever the reason for the loss of trust in the medical profession, historical colonial trauma, swayed by conspiracy theory, or otherwise, considering this factor should influence the structure and approach of public health initiatives directed toward Indigenous people internationally.
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Affiliation(s)
- Natalie Burkhardt
- Family and Community Medicine, Oceania University of Medicine, Whangarei, NZL
| | | | - Donna Dunn
- General Practice, Devonport Naval Base Medical Center, Auckland, NZL
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Brewer KM, Taueetia-Su'a T, Hanchard S, Vaka S, Ameratunga S, Tane T, Newport R, Selak V, Grey C, Harwood M. Māori and Pacific families' experiences and perspectives of cardiovascular care; A qualitative study. Aust N Z J Public Health 2024; 48:100149. [PMID: 38733861 DOI: 10.1016/j.anzjph.2024.100149] [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: 09/19/2023] [Revised: 02/18/2024] [Accepted: 04/02/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVE This study aimed to understand the reasons behind evidence-practice gaps and inequities in cardiovascular care for Māori and Pacific people, as evidenced by the experiences and perspectives of patients and their families. METHODS The research was guided by Māori and Pacific worldviews, incorporating Kaupapa Māori Theory and Pacific conceptual frameworks and research methodologies. Template analysis was used to analyse interview data from 61 Māori and Pacific people who had experienced a cardiovascular disease (CVD) risk assessment, acute coronary syndrome, and/or heart failure. RESULTS The range of experiences relating to participants' heart health journeys are presented in five main themes: Context, Mana (maintaining control and dignity), Condition, People and Journey. CONCLUSIONS Māori and Pacific people want to take charge of their heart health but face challenges. Participants described important obligations to family, community and tikanga (the culturally correct way of doing things). Participants described times when health care undermined existing responsibilities, their dignity and/or their mana, and they felt excluded from treatment as a result. IMPLICATIONS FOR PUBLIC HEALTH Good reciprocal communication, stemming from a high-quality relationship is essential for successful outcomes. A workforce that is representative of the population it serves and is culturally safe lays the foundation for excellence in care.
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Affiliation(s)
- Karen Marie Brewer
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
| | - Tua Taueetia-Su'a
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Sandra Hanchard
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Sione Vaka
- The University of Waikato Te Huataki Waiora School of Health Dean's Office, Hamilton, New Zealand
| | - Shanthi Ameratunga
- Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand; Te Whatu Ora | Health New Zealand - Counties Manukau, Auckland, New Zealand
| | - Taria Tane
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Rochelle Newport
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Vanessa Selak
- Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Corina Grey
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Matire Harwood
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Penney S, Dicker B, Harwood M. Cultural safety in paramedic practice: experiences of Māori and their whānau who have received acute pre-hospital care for cardiac symptoms from paramedics. J Prim Health Care 2024; 16:180-189. [PMID: 38941254 DOI: 10.1071/hc24010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/08/2024] [Indexed: 06/30/2024] Open
Abstract
Background Cardiovascular disease is a major health issue for Māori that requires timely and effective first-response care. Māori report culturally unsafe experiences in health care, resulting in poor health outcomes. Research in the pre-hospital context is lacking. This study aimed to explore experiences of cultural (un)safety for Māori and their whānau who received acute pre-hospital cardiovascular care from paramedics. Methods Utilising a qualitative descriptive methodology and Kaupapa Māori Research (KMR), in-depth semi-structured interviews were undertaken with 10 Māori patients and/or whānau, and a general inductive approach was used for analysis. Results Three key themes were identified: (1) interpersonal workforce skills, (2) access and service factors and (3) active protection of Māori. Participants described paramedics' clinical knowledge and interpersonal skills, including appropriate communication and ability to connect. Barriers to accessing ambulance services included limited personal and community resources and workforce issues. The impact of heart health on communities and desire for better preventative care highlighted the role of ambulance services in heart health. Conclusion Māori experience culturally unsafe pre-hospital care. Systemic and structural barriers were found to be harmful despite there being fewer reports of interpersonal discrimination than in previous research. Efforts to address workforce representation, resource disparities and cultural safety education (focussing on communication, partnership and connection) are warranted to improve experiences and outcomes for Māori.
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Affiliation(s)
- Sarah Penney
- Department of Paramedicine, Faculty of Health and Environmental Science, Auckland University of Technology, AUT South Campus, Private Bag 92006, Auckland, 1142, New Zealand
| | - Bridget Dicker
- Department of Paramedicine, Faculty of Health and Environmental Science, Auckland University of Technology, AUT South Campus, Private Bag 92006, Auckland, 1142, New Zealand; and Clinical Audit and Research, Hato Hone St John, 600 Great South Road, Ellerslie, Auckland, 1051, New Zealand
| | - Matire Harwood
- Department of General Practice and Primary Care, Faculty of Medical and Health Sciences, University of Auckland, Building 507, 28 Park Avenue, Grafton, Auckland, 1023, New Zealand
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Goff M, Jacobs S, Hammond J, Hindi A, Checkland K. Investigating the impact of primary care networks on continuity of care in English general practice: Analysis of interviews with patients and clinicians from a mixed methods study. Health Expect 2024; 27:e14032. [PMID: 38556844 PMCID: PMC10982586 DOI: 10.1111/hex.14032] [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: 12/02/2023] [Revised: 02/28/2024] [Accepted: 03/14/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION In England, primary care networks (PCNs) offer opportunities to improve access to and sustainability of general practice through collaboration between groups of practices to provide care with a broader range of practitioner roles. However, there are concerns that these changes may undermine continuity of care. Our study investigates what the organisational shift to PCNs means for continuity of care. METHODS The paper uses thematic analysis of qualitative data from interviews with general practitioners and other healthcare professionals (HCPs, n = 33) in 19 practices in five PCNs, and their patients (n = 35). Three patient cohorts within each participating practice were recruited, based on anticipated higher or lower needs for continuity of care: patients over 65 years with polypharmacy, patients with anxiety or depression and 'working age' adults aged between 18 and 45 years. FINDINGS Patients and clinicians perceived changes to continuity in PCNs in our study. Larger-scale care provision in PCNs required better care coordination and information-sharing processes, aimed at improving care for 'vulnerable' patients in target groups. However, new working arrangements and ways of delivering care in PCNs undermine HCPs' ability to maintain continuity through ongoing relationships with patients. Patients experience this in terms of reduced availability of their preferred clinician, inefficiencies in care and unfamiliarity of new staff, roles and processes. CONCLUSIONS New practitioners need to be effectively integrated to support effective team-based care. However, for patients, especially those not deemed 'vulnerable', this may not be sufficient to counter the loss of relationship with their practice. Therefore, caution is required in relation to designating patients as in need of, or not in need of continuity. Rather, continuity for all patients could be maintained through a dynamic understanding of the need for it as fluctuating and situational and by supporting clinicians to provide follow-up care. PATIENT AND PUBLIC INVOLVEMENT (PPI) A PPI group was recruited and consulted during the study for feedback on the study design, recruitment materials and interpretation of findings.
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Affiliation(s)
- Mhorag Goff
- Centre for Primary CareThe University of ManchesterManchesterUK
| | - Sally Jacobs
- Centre for Primary CareThe University of ManchesterManchesterUK
| | | | - Ali Hindi
- Centre for Primary CareThe University of ManchesterManchesterUK
| | - Kath Checkland
- Centre for Primary CareThe University of ManchesterManchesterUK
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Owen HE, Wyeth EH, Maclennan B, Barson D, McBride P, Gabbe BJ, Civil I, Derrett S. Cohort profile: The Trauma Outcomes Project, a prospective study of New Zealanders experiencing major trauma. BMJ Open 2023; 13:e075480. [PMID: 38011969 PMCID: PMC10685924 DOI: 10.1136/bmjopen-2023-075480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE Patient-reported outcome measures (PROMs) are useful for trauma registries interested in monitoring patient outcomes and trauma care quality. PROMs had not previously been collected by the New Zealand Trauma Registry (NZTR). More than 2500 New Zealanders are admitted to hospital for major trauma annually. The Trauma Outcomes Project (TOP) collected PROMs postinjury from three of New Zealand's (NZ's) major trauma regions. This cohort profile paper aims to provide a thorough description of preinjury and 6 month postinjury characteristics of the TOP cohort, including specifically for Māori (Indigenous population in Aotearoa me Te Waipounamu/NZ). PARTICIPANTS Between July 2019 and June 2020, 2533 NZ trauma patients were admitted to one of 22 hospitals nationwide for major trauma and included on the NZTR. TOP invited trauma patients (aged ≥16 years) to be interviewed from three regions; one region (Midlands) declined to participate. Interviews included questions about health-related quality of life, disability, injury recovery, healthcare access and household income adequacy. FINDINGS TO DATE TOP recruited 870 participants, including 119 Māori. At 6 months postinjury, most (85%) reported that the injury still affected them, 88% reported problems with≥1 of five EQ-5D-5L dimensions (eg, 75% reported problems with pain or discomfort, 71% reported problems with usual activities and 52% reported problems with mobility). Considerable disability (World Health Organization Disability Assessment Schedule, WHODAS II, score ≥10) was reported by 45% of participants. The prevalence of disability among Māori participants was 53%; for non-Māori it was 44%. Over a quarter of participants (28%) reported trouble accessing healthcare services for their injury. Participation in paid work decreased from 63% preinjury to 45% 6 months postinjury. FUTURE PLANS The 12 and 24 month postinjury data collection has recently been completed; analyses of 12 month outcomes are underway. There is potential for longer-term follow-up interviews with the existing cohort in future. TOP findings are intended to inform the National Trauma Network's quality improvement processes. TOP will identify key aspects that aid in improving postinjury outcomes for people experiencing serious injury, including importantly for Māori.
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Affiliation(s)
- Helen E Owen
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Emma H Wyeth
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Brett Maclennan
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - David Barson
- Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Paul McBride
- New Zealand Health Quality and Safety Commission, Wellington, New Zealand
| | - Belinda J Gabbe
- Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ian Civil
- New Zealand National Trauma Network, Wellington, New Zealand
| | - Sarah Derrett
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
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Bourke JA, Owen HE, Derrett S, Wyeth EH. Disrupted mana and systemic abdication: Māori qualitative experiences accessing healthcare in the 12 years post-injury. BMC Health Serv Res 2023; 23:130. [PMID: 36755278 PMCID: PMC9906590 DOI: 10.1186/s12913-023-09124-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 01/27/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Māori have been found to experience marked health inequities compared to non-Māori, including for injury. Accessing healthcare services post-injury can improve outcomes; however, longer-term experiences of healthcare access for injured Māori are unknown. This paper reports on data from the longitudinal Prospective Outcomes of Injury Study - 10 year follow up (POIS-10) Māori study in Aotearoa/New Zealand (NZ), to qualitatively understand Māori experiences of accessing injury-related healthcare services long-term. METHODS Follow-up telephone interviews were conducted with 305 POIS-10 Māori participants, who were injured and recruited 12-years earlier, experiencing a range of injury types and severities. Free text responses about trouble accessing injury-related health services were thematically analysed. RESULTS Sixty-one participants (20%) reported trouble accessing injury-related health services and provided free text responses. Three related themes describing participants' experiences were connected by the overarching concept that participants were engaging with a system that was not operating in a way it was intended to work: 1) Competing responsibilities and commitments encapsulates practical barriers to accessing services, such as a lack of time and having to prioritise other responsibilities such as work or whānau (family); 2) Disrupted mana refers to the feelings of personal disempowerment through, for example, receiving limited support, care or information tailored to participants' circumstances and is a consequence of patients contending with the practical barriers to accessing services; and 3) Systemic abdication highlights systemic barriers including conflicting information regarding diagnoses and treatment plans, and healthcare provider distrust of participants. CONCLUSIONS Twelve years post-injury, a considerable proportion of Māori reported experiencing barriers to accessing healthcare services. To restore a sense of manaakitanga and improve Māori access to healthcare, Māori-specific supports are required and systemic barriers must be addressed and removed.
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Affiliation(s)
- John A. Bourke
- grid.29980.3a0000 0004 1936 7830Ngāi Tahu Māori Health Research Unit, University of Otago, PO Box 56, Dunedin, 9054 New Zealand ,grid.413145.60000 0004 0508 2586Burwood Academy Trust, Burwood Hospital, 300 Burwood Road, Burwood, Christchurch, 8083 New Zealand
| | - Helen E. Owen
- grid.29980.3a0000 0004 1936 7830Ngāi Tahu Māori Health Research Unit, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | - Sarah Derrett
- grid.29980.3a0000 0004 1936 7830Ngāi Tahu Māori Health Research Unit, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | - Emma H. Wyeth
- grid.29980.3a0000 0004 1936 7830Ngāi Tahu Māori Health Research Unit, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
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Nelson V, Lambert M, Richard L, Derrett S, Wyeth E. Examining the barriers and facilitators for Māori accessing injury and rehabilitation services: a scoping review protocol. BMJ Open 2022; 12:e048252. [PMID: 35105564 PMCID: PMC8808416 DOI: 10.1136/bmjopen-2020-048252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Injury accounts for 10% of the global burden of disease. While the literature is scarce, research investigating injury among Indigenous populations has found incidence and prevalence rates are higher, compared with non-Indigenous populations. New Zealand is no exception; Māori have higher rates of injury and disability compared with non-Māori. Given the burden of injury for Māori, this scoping review aims to identify, understand and map available literature related to the barriers and facilitators to accessing injury-related healthcare for Māori in New Zealand. METHODS AND ANALYSIS A scoping review will be conducted to identify the relevant literature and provide an opportunity to highlight key concepts and research gaps in the literature. This work will be guided by the scoping review framework developed by Arksey and O'Malley and will be underpinned by Kaupapa Māori research principles. The overall project is also be guided by a Māori advisory group. Database searches, for example, MEDLINE (Ovid), Scopus and Embase, will be used to identify empirical literature, and Google, New Zealand government websites and relevant non-government organisations will be used to identify relevant grey literature. ETHICS AND DISSEMINATION To the best of our knowledge, this scoping review is the first to systematically examine the currently available literature relating to the barriers and facilitators of accessing injury-related healthcare for Māori in New Zealand. Ethical approval was not required for this scoping review. Dissemination will include publication of the scoping review findings in a peer-reviewed journal, as well as presentations at conferences, to the project's advisory group, and staff working in the field of Māori disability and rehabilitation.
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Affiliation(s)
- Vicky Nelson
- Ngāi Tahu Māori Health Research Unit, Preventive and Social Medicine, University of Otago, Dunedin Campus, Dunedin, New Zealand
| | - Michelle Lambert
- Ngāi Tahu Māori Health Research Unit, Preventive and Social Medicine, University of Otago, Dunedin Campus, Dunedin, New Zealand
| | - Lauralie Richard
- General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sarah Derrett
- Ngāi Tahu Māori Health Research Unit, Preventive and Social Medicine, University of Otago, Dunedin Campus, Dunedin, New Zealand
| | - Emma Wyeth
- Ngāi Tahu Māori Health Research Unit, Preventive and Social Medicine, University of Otago, Dunedin Campus, Dunedin, New Zealand
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Blackmore T, Norman K, Kidd J, Cassim S, Chepulis L, Keenan R, Firth M, Jackson C, Stokes T, Weller D, Emery J, Lawrenson R. Barriers and facilitators to colorectal cancer diagnosis in New Zealand: a qualitative study. BMC FAMILY PRACTICE 2020; 21:206. [PMID: 33003999 PMCID: PMC7530960 DOI: 10.1186/s12875-020-01276-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/23/2020] [Indexed: 01/07/2023]
Abstract
Background New Zealand (NZ) has high rates of colorectal cancer but low rates of early diagnosis. Due to a lack of understanding of the pre-diagnostic experience from the patient’s perspective, it is necessary to investigate potential patient and health system factors that contribute to longer diagnostic intervals. Previous qualitative studies have discussed delays using The Model of Pathways to Treatment, but this has not been explored in the NZ context. This study aimed to understand the patient experience and perception of their general practitioner (GP) through the diagnostic process in the Waikato region of NZ. In particular, we sought to investigate potential barriers and facilitators that contribute to longer diagnostic intervals. Methods Ethical approval for this study was granted by the New Zealand Health and Disability Ethics Committee. Twenty-eight participants, diagnosed with colorectal cancer, were interviewed about their experience. Semi-structured interviews were audio recorded, transcribed verbatim and analysed thematically using The Model of Pathways to Treatment framework (intervals: appraisal, help-seeking, diagnostic). Results Participant appraisal of symptoms was a barrier to prompt diagnosis, particularly if symptoms were normalised, intermittent, or isolated in occurrence. Successful self-management techniques also resulted in delayed help-seeking. However if symptoms worsened, disruption to work and daily routines were important facilitators to seeking a GP consultation. Participants positively appraised GPs if they showed good technical competence and were proactive in investigating symptoms. Negative GP appraisals were associated with a lack of physical examinations and misdiagnosis, and left participants feeling dehumanised during the diagnostic process. However high levels of GP interpersonal competence could override poor technical competence, resulting in an overall positive experience, even if the cancer was diagnosed at an advanced stage. Māori participants often appraised symptoms inclusive of their sociocultural environment and considered the impact of their symptoms in relation to family. Conclusions The findings of this study highlight the importance of tailored colorectal cancer symptom communication in health campaigns, and indicate the significance of the interpersonal competence aspect of GP-patient interactions. These findings suggest that interpersonal competence be overtly displayed in all GP interactions to ensure a higher likelihood of a positive experience for the patient.
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Affiliation(s)
- Tania Blackmore
- Medical Research Centre, University of Waikato, Hamilton, New Zealand.
| | - Kimberley Norman
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Jacquie Kidd
- Auckland University of Technology, Auckland, New Zealand
| | - Shemana Cassim
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Lynne Chepulis
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Rawiri Keenan
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Melissa Firth
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | | | - Tim Stokes
- Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - David Weller
- Centre for Population Health Studies, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Jon Emery
- Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Ross Lawrenson
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
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Experiences of Perceived Gender-based Discrimination Among Women Veterans: Data From the ECUUN Study. Med Care 2020; 58:483-490. [PMID: 32000171 DOI: 10.1097/mlr.0000000000001304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Experiences of discrimination are associated with poor health behaviors and outcomes. Understanding discrimination in health care informs interventions to improve health care experiences. OBJECTIVE Describe the prevalence of, and variables associated with, perceived gender-based discrimination in the Veterans Affairs (VA) Healthcare System among women Veterans. DESIGN A cross-sectional, telephone-based survey of a random national sample of young female Veterans. PARTICIPANTS Female VA primary care patients aged 18-45 years. MAIN MEASURES The primary outcome was perceived gender-based discrimination in VA health care. Logistic and linear regression models were used to determine associations between any perceived discrimination and cumulative perceived discrimination with patient and health service characteristics. KEY RESULTS Among 2294 women Veterans, 33.7% perceived gender-based discrimination in VA. Perceiving gender-based discrimination was associated with medical illness [adjusted odds ratio (aOR)=1.67, 95% confidence interval (CI)=1.34, 2.08], mental illness (aOR=2.06, 95% CI=1.57, 2.69), and military sexual trauma (aOR=2.65, 95% CI=2.11, 3.32). Receiving most health care from the same VA provider (aOR=0.73, 95% CI=0.57, 0.94) and receiving care at a VA site with a women's health clinic (aOR=0.76, 95% CI=0.61, 0.95) were associated with reduced odds of any perceived gender-based discrimination. Among those who perceived gender-based discrimination (n=733), perceived discrimination scores were higher among women with increased age, medical illness, or history of military sexual trauma and lower among those who saw the same VA provider for most medical care. CONCLUSIONS One third of women Veterans perceived gender-based discrimination in VA. Obtaining most medical care from the same VA provider and having a women's health clinic at one's VA were associated with less perceived discrimination.
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Shrivastava R, Couturier Y, Simard-Lebel S, Girard F, Aguirre NVB, Torrie J, Emami E. Relational continuity of oral health care in Indigenous communities: a qualitative study. BMC Oral Health 2019; 19:287. [PMID: 31865901 PMCID: PMC6927186 DOI: 10.1186/s12903-019-0986-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 12/11/2019] [Indexed: 11/23/2022] Open
Abstract
Background The relational continuity of care is an essential function of primary health care. This study reports on the perspectives of Cree communities and their primary health care providers regarding the barriers and enablers of relational continuity of oral health care integrated at a primary health care organization. Methods A multiple case study design within a qualitative approach and developmental evaluation methodology were used to conduct this research study in Cree communities of Northern Québec. Maximum variation sampling and snowball techniques were used to recruit the participants. Data collection consisted of individual interviews and focus group discussions. Thematic analysis was conducted which included transcription, debriefing, codification, data display, and interpretation. The consolidated criteria for reporting qualitative studies (COREQ) were used to guide the reporting of study findings. Results A total of six focus group discussions and 36 individual interviews were conducted. Five major themes emerged from the thematic analyses for barriers (two) and enablers (three). Themes for barriers included impermanence and lack of effective communication, whereas themes for enablers included culturally competent professionals, working across professional boundaries, and proactive organizational engagement. Conclusions Based on these findings, relational continuity can be empowered by effective strategies for overcoming barriers and encouraging enablers, such as recruitment of permanent professionals, organizing cultural competency training, development of a Cree language dental glossary, encouraging inter-professional collaboration, and promoting the organization’s efforts.
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Affiliation(s)
- Richa Shrivastava
- Faculty of Dentistry, Université de Montréal, Montréal, Québec, H3C 3J7, Canada
| | - Yves Couturier
- School of Social Work, Université de Sherbrooke, Sherbrooke, J1H 4C4, Québec, Canada
| | | | - Felix Girard
- Faculty of Dentistry, Université de Montréal, Montréal, Québec, H3C 3J7, Canada
| | | | - Jill Torrie
- Director of Specialised Services, Cree Board of Health and Social Services of James Bay, Mistissini, Québec, G0W 1C0, Canada
| | - Elham Emami
- Faculty of Dentistry, McGill University, Montréal, Québec, H3A 1G1, Canada.
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Htun H, Elwood J, Ioannides S, Fishman T, Lawrenson R. Investigations and referral for suspected cancer in primary care in New Zealand-A survey linked to the International Cancer Benchmarking Partnership. Eur J Cancer Care (Engl) 2017; 26. [DOI: 10.1111/ecc.12634] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2016] [Indexed: 11/29/2022]
Affiliation(s)
- H.W. Htun
- Department of Epidemiology and Biostatistics; School of Population Health; University of Auckland; Auckland New Zealand
| | - J.M. Elwood
- Department of Epidemiology and Biostatistics; School of Population Health; University of Auckland; Auckland New Zealand
| | - S.J. Ioannides
- Department of Epidemiology and Biostatistics; School of Population Health; University of Auckland; Auckland New Zealand
| | - T. Fishman
- Department of General Practice and Primary Health Care; School of Population Health; University of Auckland; Auckland New Zealand
| | - R. Lawrenson
- Waikato Clinical Campus; University of Auckland; Hamilton New Zealand
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Lawrenson R, Seneviratne S, Scott N, Peni T, Brown C, Campbell I. Breast cancer inequities between Māori and non-Māori women in Aotearoa/New Zealand. Eur J Cancer Care (Engl) 2016; 25:225-30. [DOI: 10.1111/ecc.12473] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2016] [Indexed: 11/30/2022]
Affiliation(s)
- R. Lawrenson
- Waikato Clinical Campus; The University of Auckland; Hamilton New Zealand
| | - S. Seneviratne
- Department of Surgery; Faculty of Medicine; National Hospital of Sri Lanka; University of Colombo; Colombo Sri Lanka
| | - N. Scott
- Te Puna Oranga; Waikato District Health Board; Hamilton New Zealand
| | - T. Peni
- Waikato Clinical Campus; The University of Auckland; Hamilton New Zealand
| | - C. Brown
- Waikato Clinical Campus; The University of Auckland; Hamilton New Zealand
| | - I. Campbell
- Waikato Clinical Campus; The University of Auckland; Hamilton New Zealand
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