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Harris R, Li C, Stanley J, King PT, Priest N, Curtis E, Ameratunga S, Sorensen D, Tibble F, Tewhaiti-Smith J, Thatcher P, Araroa R, Pihema S, Lee-Kirk S, King SJR, Urlich T, Livingstone NZ, Kamau Brady S, Matehe C, Paine SJ. Racism and Health Among Aotearoa New Zealand Young People Aged 15-24 years: Analysis of Multiple National Surveys. J Adolesc Health 2024:S1054-139X(24)00230-1. [PMID: 38970605 DOI: 10.1016/j.jadohealth.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 07/08/2024]
Abstract
PURPOSE This Aotearoa New Zealand-based study addresses a gap in literature focusing on individual experiences of racism among adolescents and young adults and its links to health. METHODS This cross-sectional study uses data from multiple instances of the New Zealand Health Survey (2002/03, 2006/07, 2011/12, 2016/17) and General Social Survey (2008-2016) restricted to participants aged 15-24 years. Prevalence of reported experiences of racism are estimated. Meta-analytic techniques to pool data and multiple regression analyses are used to examine associations between experiences of racism and outcomes measures (mental and physical health, general health and well-being, life satisfaction, inability to access health care, and identity). The study used an ethical co-design process between university researchers and a rangatahi Māori (Māori young people) partnership group. RESULTS Racism was higher among Māori, Pacific, and Asian young people compared to European young people. Racism was associated with all negative health and well-being measures examined for young people, including negative mental and physical health measures (12-Item Short Form Survey, Kessler Psychological Distress Scale), lower self-rated health, negative life satisfaction, higher unmet need for primary care, and identity measures (feelings of not belonging in New Zealand, less able to express their identity). DISCUSSION The results of this study are concerning. Non-European young people disproportionately bear the burden of racism in Aotearoa New Zealand with a potentially substantial impact on their health and well-being. This is a breach of Indigenous (for Māori) and other international human rights and should be motivation to act to eliminate racism in all its forms.
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Affiliation(s)
- Ricci Harris
- Te Rōpū Rangahau Hauora a Eru Pōmare, University of Otago, Wellington, New Zealand.
| | - Chao Li
- Te Kupenga Hauora Māori, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Paula Toko King
- Te Rōpū Rangahau Hauora a Eru Pōmare, University of Otago, Wellington, New Zealand
| | - Naomi Priest
- The Centre for Social Policy Research, Canberra, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Elana Curtis
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Shanthi Ameratunga
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dakota Sorensen
- Rangatahi Partnership Group, University of Auckland, Auckland, New Zealand
| | - Fushia Tibble
- Rangatahi Partnership Group, University of Auckland, Gisborne, New Zealand
| | - Jordan Tewhaiti-Smith
- Rangatahi Partnership Group, Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Paeone Thatcher
- Rangatahi Partnership Group, University of Otago, Dunedin, New Zealand
| | | | - Sarah Pihema
- Rangatahi Partnership Group, Napier, New Zealand
| | | | | | - Tupua Urlich
- Rangatahi Partnership Group, Ngāti Kahungunu Ki Heretaunga, Auckland, New Zealand
| | | | - Soraya Kamau Brady
- Rangatahi Partnership Group, Te Paepae Ārahi Trust, 2 Face Drama, Mahia, Hawkes Bay, New Zealand
| | | | - Sarah-Jane Paine
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Teng A, Stanley J, Jackson C, Koea J, Lao C, Lawrenson R, Meredith I, Sika-Paotonu D, Gurney J. The growing cancer burden: Age-period-cohort projections in Aotearoa New Zealand 2020-2044. Cancer Epidemiol 2024; 89:102535. [PMID: 38280359 DOI: 10.1016/j.canep.2024.102535] [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: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Cancer is a major cause of premature death and inequity, and global case numbers are rapidly expanding. This study projects future cancer numbers and incidence rates in Aotearoa New Zealand. METHODS Age-period-cohort modelling was applied to 25-years of national data to project cancer cases and incidence trends from 2020 to 2044. Nationally mandated cancer registry data and official historical and projected population estimates were used, with sub-groups by age, sex, and ethnicity. RESULTS Cancer diagnoses were projected to increase from 25,700 per year in 2015-2019 to 45,100 a year by 2040-44, a 76% increase (2.3% per annum). Across the same period, age-standardised cancer incidence increased by 9% (0.3% per annum) from 348 to 378 cancers per 100,000 person years, with greater increases for males (11%) than females (6%). Projected incidence trends varied substantially by cancer type, with several projected to change faster or in the opposite direction compared to projections from other countries. CONCLUSIONS Increasing cancer numbers reinforces the critical need for both cancer prevention and treatment service planning activities. Investment in developing new ways of working and increasing the workforce are required for the health system to be able to afford and manage the future burden of cancer.
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Affiliation(s)
- Andrea Teng
- Department of Public Health, University of Otago, PO Box 7343, Wellington, New Zealand.
| | - James Stanley
- Department of Public Health, University of Otago, PO Box 7343, Wellington, New Zealand
| | - Christopher Jackson
- Department of Medicine (Dunedin), University of Otago, PO Box 56, Dunedin, New Zealand
| | - Jonathan Koea
- General Surgery, Waitakere Hospital, Private Bag 92019, Auckland, New Zealand; Medical Surgery, The University of Auckland, Auckland, New Zealand
| | - Chunhuan Lao
- Medical Research Centre, The University of Waikato, Private Bag 3105, Hamilton, New Zealand
| | - Ross Lawrenson
- Medical Research Centre, The University of Waikato, Private Bag 3105, Hamilton, New Zealand; Commissioning, Te Whatu Ora, Hamilton, Waikato, New Zealand
| | - Ineke Meredith
- General Surgery, Wakefield Hospital, 30 Florence Street, Wellington, New Zealand
| | - Dianne Sika-Paotonu
- Dean's Department UOW & Division of Health Sciences, University of Otago, PO Box 7343, Wellington, New Zealand
| | - Jason Gurney
- Department of Public Health, University of Otago, PO Box 7343, Wellington, New Zealand
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Kremer LJ, Smith A, Tahitahi KA, Mapusua T, Anwar M, Rutherford G, Cho H, Guy W. Ko au tēnei: This is me - Exploring the lived experience of underrepresented groups with pharmacy services to inform the development of pharmacy case-based learning. CURRENTS IN PHARMACY TEACHING & LEARNING 2024; 16:167-173. [PMID: 38331625 DOI: 10.1016/j.cptl.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/23/2023] [Accepted: 12/18/2023] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Demographic and social characteristics of underrepresented groups are often poorly described in pharmacy case-based learning, leading to poor representation of these groups in the pharmacy curriculum. This research project aimed to understand the lived experience of underrepresented groups with pharmacy services and to use this to inform the development of pharmacy case-based student learning materials. METHODS This was a single centre, grounded theory, qualitative study. Focus groups were undertaken with six underrepresented groups: Māori, Pacific, Asian, LGBTQIA+ (lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual), disability, and refugee. These focus groups were conducted in Dunedin, Aotearoa New Zealand from July to August 2022. Focus group sessions were recorded and analysed to identify beliefs, ideas, and themes shared between participants and groups. FINDINGS Participants in all focus groups had a strong desire to be seen and represented in pharmacy cases, however this was conditional on the learning being delivered in a way that upholds their beliefs, values, and voices. From these lived experiences, cultural, environmental, personal, and social factors were identified as being critical for inclusion in pharmacy case-based learning materials. CONCLUSIONS The lived experience of underrepresented populations provides critical insights that will enhance pharmacy case-based learning. The key factors that could be included in case-based learning are: ethnicity, personal beliefs, language, disability, gender identity, sexual identity, and family. To achieve health equity and improve cultural awareness and intelligence of our future pharmacy workforce, these experiences need to become more present in curricula.
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Affiliation(s)
- Lisa J Kremer
- University of Otago School of Pharmacy, 18 Frederick Street, Dunedin 9054, New Zealand.
| | - Alesha Smith
- University of Otago School of Pharmacy, 18 Frederick Street, Dunedin 9054, New Zealand.
| | - Kelly-Ann Tahitahi
- University of Otago Office of Māori Development, 87 Saint David Street, North Dunedin 9016, New Zealand.
| | - Talai Mapusua
- University of Otago Centre for Pacific Health (Va'a o Tautai), 71 Frederick Street, North Dunedin 9016, New Zealand.
| | - Mudassir Anwar
- University of Otago School of Pharmacy, 18 Frederick Street, Dunedin 9054, New Zealand.
| | - Gill Rutherford
- University of Otago College of Education, 145 Union Street East, Central Dunedin 9016, New Zealand.
| | - Hyunah Cho
- University of Otago College of Education, 145 Union Street East, Central Dunedin 9016, New Zealand.
| | - William Guy
- University of Otago School of Pharmacy, 18 Frederick Street, Dunedin 9054, New Zealand.
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Yew SQ, Trivedi D, Adanan NIH, Chew BH. Facilitators and barriers of digital health technologies implementation in hospital settings in lower-income and middle-income countries since the COVID-19 pandemic: a scoping review protocol. BMJ Open 2024; 14:e078508. [PMID: 38296272 PMCID: PMC10831434 DOI: 10.1136/bmjopen-2023-078508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/17/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION The implementation of digital health technologies (DHTs) in hospitals worldwide has been uneven since the COVID-19 pandemic. Ambiguity in defining the landscape of DHTs adds to the complexity of this process. To address these challenges, this scoping review aims to identify the facilitators and barriers of implementing DHTs in hospitals in lower-income and middle-income countries (LMIC) since COVID-19, describe the DHTs that have been adopted in hospital settings in LMIC during this period, and develop a comprehensive classification framework to define the landscape of DHTs implemented in LMIC. METHODS AND ANALYSIS We will conduct a systematic search in PubMed, Scopus, Web of Science and grey literature. Descriptive statistics will be used to report the characteristics of included studies. The facilitators and barriers to DHTs implementation, gathered from both quantitative and qualitative data, will be synthesised using a parallel-results convergent synthesis design. A thematic analysis, employing an inductive approach, will be conducted to categorise these facilitators and barriers into coherent themes. Additionally, we will identify and categorise all available DHTs based on their equipment types and methods of operation to develop an innovative classification framework. ETHICS AND DISSEMINATION Formal ethical approval is not required, as primary data collection is not involved in this study. The findings will be disseminated through peer-reviewed publications, conference presentations and meetings with key stakeholders and partners in the field of digital health.
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Affiliation(s)
- Sheng Qian Yew
- Department of Public Health Medicine, Universiti Kebangsaan Malaysia Fakulti Perubatan, Cheras, Federal Territory of Kual, Malaysia
| | - Daksha Trivedi
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hertfordshire, UK
| | | | - Boon How Chew
- Department of Family Medicine, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Langridge FC, Paynter J, Ghebreab L, Heather M, Matenga-Ikihele A, Percival T, Nosa V. A study of Samoan, Tongan, Cook Island Māori, and Niuean infant care practices in the Growing Up in New Zealand study. BMC Public Health 2024; 24:166. [PMID: 38216915 PMCID: PMC10785414 DOI: 10.1186/s12889-024-17680-1] [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: 05/02/2023] [Accepted: 01/05/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Despite a low rate of infant mortality, Aotearoa New Zealand has a high rate of Sudden Unexpected Death in Infants (SUDI), with disproportionate impact for Pacific infants. This study explored the infant care practices, factors and relationships associated with increased risk of SUDI amongst Tongan, Samoan, Cook Islands Māori, and Niuean mothers in New Zealand, to inform evidence-based interventions for reducing the incidence of SUDI for Pacific families and their children. METHODS Analysis comprised of data collected in 2009-2010 from 1089 Samoan, Tongan, Cook Islands Māori and Niuean mothers enrolled in the Growing Up in New Zealand longitudinal cohort study. The sleeping environment (bed-sharing and sleep position) of the infants was assessed at 6 weeks. Multivariable logistic regression analysis were conducted, controlling for sociodemographic factors to explore the association between selected maternal and pregnancy support and environment factors and the sleeping environment for infants. RESULTS Mothers who converse in languages other than English at home, and mothers who consulted alternative practitioners were less likely to follow guidelines for infant sleeping position. Similarly language, smoking, alcohol, household dwelling, crowding and access to a family doctor or GP were associated with mothers following guidelines for bed-sharing. CONCLUSION The impact of SUDI on Pacific infants may be lessened or prevented if communication about risk factors is more inclusive of diverse ethnic, cultural worldviews, and languages. Societal structural issues such as access to affordable housing is also important. This research suggests a need for more targeted or tailored interventions which promote safe sleeping and reduce rates of SUDI in a culturally respectful and meaningful way for Pasifika communities in Aotearoa, New Zealand.
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Affiliation(s)
- Fiona C Langridge
- Department of Paediatrics: Child and Youth Health, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
| | - Janine Paynter
- Department of General Practice and Primary Healthcare, School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Luam Ghebreab
- Department of General Practice and Primary Healthcare, School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Maryann Heather
- Pacific Health Section, School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | | | - Teuila Percival
- Department of Paediatrics: Child and Youth Health, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Vili Nosa
- Pacific Health Section, School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Harris R, Cormack D, Waa A, Edwards R, Stanley J. The impact of racism on subsequent healthcare use and experiences for adult New Zealanders: a prospective cohort study. BMC Public Health 2024; 24:136. [PMID: 38195436 PMCID: PMC10777617 DOI: 10.1186/s12889-023-17603-6] [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: 09/04/2023] [Accepted: 12/27/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Racism is an important determinant of health and driver of racial/ethnic health inequities. Experience of racism has been linked to negative healthcare use and experiences although most studies have been cross-sectional. This study examines the relationship between reported experience of racism and subsequent use and experience of health services. METHODS This is a prospective cohort study design. The 2016/2017 adult New Zealand Health Survey (NZHS) provided the sampling frame and baseline data on exposures, health status and confounders. This stand-alone study invited all exposed individuals to participate when sampled based on their reported experience of racism (ever), stratified by broad ethnic groupings (Māori, Pacific, Asian, European/Other). Equal numbers of unexposed participants were selected for invitation using propensity score matching (propensity to experience racism, based on key available predictive factors). Follow-up was one to two years after NZHS interview. Outcome variables (last 12 months) were: unmet healthcare need (overall, for mental health, for a general practitioner); satisfaction with usual medical centre; and experiences with general practitioners (explaining care, involvement in decision-making, treated with respect/dignity, confidence and trust). Logistic regression models examining the association between experience of racism (at baseline) and health service use and experience (at follow-up) used doubly-robust estimation to weight for propensity scores used in the sampling with additional adjustment for confounders. RESULTS The study had 2010 participants. Experience of racism (ever) at baseline was associated with higher overall unmet need at follow-up (adjusted OR (aOR) = 1.71, 95% CI 1.31, 2.23), with similar patterns for other unmet need measures. Experience of racism was associated with higher dissatisfaction with a usual medical centre (aOR = 1.41, 95% CI 1.10, 1.81) and with higher reporting of negative patient experiences. CONCLUSION In line with how racism structures oppression, exposure to racism is largely felt by non-European groups in Aotearoa New Zealand. Experiences of racism potentially lead to poorer healthcare and healthcare inequities through higher unmet need, lower satisfaction and more negative experiences of healthcare. The health system has a critical role to play in addressing racism within healthcare and supporting societal efforts to eliminate racism and ethnic inequities.
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Affiliation(s)
- Ricci Harris
- Eru Pōmare Māori Health Research Centre, University of Otago, Wellington 23a Mein Street, Newtown, Wellington, New Zealand.
| | - Donna Cormack
- Eru Pōmare Māori Health Research Centre, University of Otago, Wellington 23a Mein Street, Newtown, Wellington, New Zealand
| | - Andrew Waa
- Eru Pōmare Māori Health Research Centre, University of Otago, Wellington 23a Mein Street, Newtown, Wellington, New Zealand
| | - Richard Edwards
- Department of Public Health, University of Otago, Wellington 23a Mein Street, Newtown, Wellington, New Zealand
| | - James Stanley
- Dean's Department, University of Otago, Wellington, 23a Mein St, Newtown, Wellington, New Zealand
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Charania (Indian) NA, Bhatia (Indian) A, Brown (Ngāpuhi, Ngāti Hau) S, Leaumoana (Samoan, Tongan) T, Qi (Han Chinese) H, Sreenivasan (Indian) D, Tautolo (Samoan, Cook Island Māori) ES(D, Clark (Ngāpuhi) TC. " I haven't even taken them to the doctors, because I have that fear of what to expect": a qualitative description study exploring perceptions and experiences of early childhood healthcare among ethnically diverse caregivers in Aotearoa New Zealand. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 40:100882. [PMID: 37711844 PMCID: PMC10498306 DOI: 10.1016/j.lanwpc.2023.100882] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 06/07/2023] [Accepted: 08/07/2023] [Indexed: 09/16/2023]
Abstract
Background Equity underpins Aotearoa New Zealand's publicly funded healthcare system; however, ethnic inequality persists. This qualitative study explored the perceptions and experiences of ethnically diverse parents accessing health services for their children. Methods A qualitative description methodology informed interviews and focus groups that were conducted with caregivers of preschool aged children who identified as being of Māori, Pacific, Asian and/or European ethnicity (n = 145). Data were analysed following a reflexive thematic analytic approach. Findings Five themes were constructed. Hierarchies of knowledge and trust Caregivers relied on multiple sources of health information and particularly trusted providers or other caregivers who had children. Relational versustransactional health encounters Caregivers were often disappointed that health providers did not build trusting relationships to support positive experiences. Bad mother vibe Mothers often felt judged by providers when accessing care and felt pressure to conform. The 'slow burn' of waiting Caregivers were often frustrated by how slow and fragmented the health system was, which was particularly distressing if their child was unwell or required referral. Navigating complexity Caregivers had to be proactive and assertive to ensure their child received care amidst the numerous barriers they faced, including discrimination and bias. While many commonalities were shared by ethnicity, unique to Indigenous Māori caregivers were the ongoing colonial traumas that impacted their ability to trust the healthcare system. Interpretation A non-judgemental, competent, and culturally sensitive approach by healthcare professionals and services may help foster trusting relationships and positive health encounters. Strategies to improve trust, ease of access and navigation are needed to mitigate existing complexity, fragmentation, and counter-intuitive nature of the NZ healthcare system. Caregivers require more autonomy over decisions about their child's care and availability of services that reflect their cultural values. Policies are required to alleviate the indirect costs of accessing healthcare, prioritising of whānau/family-centred care, and addressing pervasive racism and bias within the system. Funding Health Research Council of New Zealand (19/263) .
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Affiliation(s)
- Nadia A. Charania (Indian)
- Department of Public Health, Auckland University of Technology, Auckland, New Zealand
- Migrant and Refugee Health Research Centre, Auckland University of Technology, Auckland, New Zealand
| | - Anjali Bhatia (Indian)
- Department of Public Health, Auckland University of Technology, Auckland, New Zealand
- Migrant and Refugee Health Research Centre, Auckland University of Technology, Auckland, New Zealand
| | | | | | | | - Dharshini Sreenivasan (Indian)
- Department of Public Health, Auckland University of Technology, Auckland, New Zealand
- New Zealand Work Research Institute, Auckland University of Technology, Auckland, New Zealand
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Kim MJ, Wilkins K, Gorman B. Healthcare satisfaction at the intersections of sexual orientation and race/ethnicity. ETHNICITY & HEALTH 2023; 28:601-618. [PMID: 35803900 DOI: 10.1080/13557858.2022.2096207] [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] [Received: 02/14/2022] [Accepted: 06/26/2022] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Existing scholarship has consistently demonstrated disparities in healthcare experience based on sexual identity. However, relatively little research has considered intersections with race/ethnicity, despite that intersection with other characteristics may complicate healthcare experiences and satisfaction among sexual minorities. This study aims to address such a gap by examining healthcare satisfaction across the intersections of sexual and racial/ethnic identity. DESIGN Utilizing data on U.S. adults included in the 2013-2018 Behavioral Risk Factor Surveillance System (BRFSS) (n = 372,766), we investigate levels of satisfaction with care among a range of groups simultaneously embodying two identities. RESULTS Findings from ordered logistic regression models show that among adults who identify as heterosexual, the odds of reporting high satisfaction with care are lower among Blacks, Asians, and Native Americans. Among sexual minority adults, the likelihood of reporting high satisfaction with care is consistently lower among Native American gay and lesbian adults compared to gays and lesbians of other race/ethnicity or Native American and White heterosexuals, indicating heightened vulnerability to poorer healthcare experience among this multiple minority group. CONCLUSION While levels of satisfaction with care tend to be generally high across groups, future research should endeavor to investigate the driving factors that lower the odds of high healthcare satisfaction among those with intersecting minority identities.
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Affiliation(s)
- Min Ju Kim
- Department of Sociology, Rice University, Houston, TX, USA
| | - Kiana Wilkins
- Department of Sociology, Rice University, Houston, TX, USA
| | - Bridget Gorman
- Department of Sociology, Rice University, Houston, TX, USA
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Tutone S, Fuimaono-Asafo A, Wilson A, Harwood M, Love R, Rahiri JL. The Surgical Sisterhood - The Experiences of wāhine Māori and Pasifika Aspiring Surgeons. QUALITATIVE HEALTH RESEARCH 2023; 33:106-116. [PMID: 36538013 DOI: 10.1177/10497323221144929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The establishment of a culturally diverse surgical workforce, largely on the basis of gender, has been highly promoted in Australasia in the last decade. Despite this, discussions of gender diversity in surgery have largely excluded Indigenous women. This study presents the experiences of wāhine Māori and Pasifika doctors in Aotearoa, who formed a surgical sisterhood to support them towards applying for advanced surgical training. Utilising mana wāhine and Masi methodologies, semi-structured interpersonal interviews were undertaken with five wāhine who formed the surgical sisterhood. Following transcription and analysis of all interviews, four key themes were identified. These were mana wāhine, unity, our why and change on the horizon. These themes illustrate the complex and varied experiences of wāhine Māori and Pasifika and how they have navigated their surgical pathways amidst multiple layers of discrimination towards being in a position to apply for advanced surgical training.
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Affiliation(s)
- Senitila Tutone
- Department of Surgery, 1406Waitematā District Health Board, Auckland, New Zealand
| | | | - Ailsa Wilson
- Department of Orthopaedics, 8458Capital and Coast District Health Board
| | - Matire Harwood
- Department of General Practice and Primary Health Care, 1415the University of Auckland, Auckland, New Zealand
| | - Rachelle Love
- Department of Otorhinolaryngology, 63588Canterbury District Health Board, Christchurch, New Zealand
| | - Jamie-Lee Rahiri
- Department of Surgery, 89490Taranaki Base Hospital, New Plymouth, New Zealand
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Vaka S, Hamer HP, Mesui-Henry A. The effectiveness of ūloa as a model supporting Tongan people experiencing mental distress. Int J Ment Health Nurs 2022; 31:1438-1445. [PMID: 35872607 PMCID: PMC9796273 DOI: 10.1111/inm.13044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 01/01/2023]
Abstract
This article is based on a larger research project, which investigates the effectiveness of a culturally appropriate model, namely ūloa, when working with Tongan people. Ūloa is a communal method of fishing in Tonga, which includes all members of the community. A previous paper described the three phases of ūloa: presenting the concept to health providers and community groups; phase two amended the model based on phase one. This paper reports on phase three and findings related to the increased awareness of ūloa model within the mental health services and to raise awareness of how to work with Pacific people and adjust the health service to suit the needs of this population to test its effectiveness. Using reflexive thematic analysis, results highlighted a number of patterns both across the groups, described as napanapangamālie (harmony, balance), ngāue fakataha (working together/oneness), and toutai (fisher). These findings continue to support that the conventional biomedical approach employed in the mental health services overlooks elements of Tongan constructions of mental illness and the intersections between Tongan and biopsychosocial themes. Care that is based only on the 'medicine' rather than bringing the spiritual aspect into care planning (fake leaves) will not serve the needs of the Tongan community.
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Affiliation(s)
- Sione Vaka
- Department of Nursing, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | | | - Anau Mesui-Henry
- Department of Nursing, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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Kidd J, Came H, McCreanor T. Using vignettes about racism from health practice in Aotearoa to generate anti-racism interventions. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4020-e4027. [PMID: 35302269 PMCID: PMC10078765 DOI: 10.1111/hsc.13795] [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] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/02/2021] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
Racism is a key modifiable determinant of health that contributes to health inequities in Aotearoa and elsewhere. Experiences of racism occur within the health sector for workers, patients and their whānau (extended family) every day. This paper uses stories of racism from nurses - reworked into vignettes - to examine the dynamics of racism to generate possible micro, meso and macro anti-racism interventions. A critical qualitative design was utilised, informed by kaupapa Māori approaches. The five vignettes in this paper were sourced from a pair of caucused focus groups with nine senior Māori (Indigenous peoples of Aotearoa) and Tauiwi (non-Māori) nurses held in Auckland Aotearoa in 2019. The vignettes were lightly edited and then critically analysed by both authors to identify sites of racism and generate ideas for anti-racism interventions. The vignettes illustrate five key themes in relation to racism. These include (i) mono-cultural practice, (ii) everyday micro-aggressions; (iii) complexity and the costs of racism, (iv) Pākehā (white settler) privilege and (v) employment discrimination. From analysing these themes, a range of evidence-based micro, meso and macro-level anti-racism interventions were derived. These ranged from engaging in reflective practice, education initiatives, monitoring, through to collective advocacy. Vignettes are a novel way to reveal sites of racism to create teachable moments and spark reflective practice and more active engagement in anti-racism interventions. When systematically analysed vignettes can be utilised to inform and refine anti-racist interventions. Being able to identify racism is essential to being able to effectively counter racism.
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Affiliation(s)
- J. Kidd
- Faculty of Health and Environment SciencesAuckland University of TechnologyAucklandNew Zealand
| | - H. Came
- Faculty of Health and Environment SciencesAuckland University of TechnologyAucklandNew Zealand
| | - T. McCreanor
- Te Rōpū WhārikiMassey UniversityAucklandNew Zealand
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12
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Location dynamics of general practitioners in France. SSM Popul Health 2022; 19:101240. [PMID: 36203471 PMCID: PMC9530612 DOI: 10.1016/j.ssmph.2022.101240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/23/2022] Open
Abstract
Background For several years now, the socio-political context in France has widened the territorial divide between metropolitan France and peripheral France. Access to healthcare is part of this divide, which harms small and medium-sized towns as well as rural fringes. This article focuses on these geographic dynamics in access to healthcare, with a focus on self-employed general practitioners (GPs), who are essential links in the care pathway as referring physicians. Methods This paper uses data from French public statistics from 2007 to 2017 to build spatial panels and to highlight the territorial factors that explain the dynamics of the locations of GPs. Results Over the period under review, the density of GPs has decreased and territorial disparity has increased. There is no trend towards a worsening of this isolation of either the periphery or deprived cantons with regard to the density of GPs in these areas. However, we note a clear trend towards the grouping together of different types of care within cantons, leading to a tendency towards the polarization of the healthcare supply in the territories of mainland France, which implies another type of geographical difficulty. Conclusion The increase in territorial disparities in accessibility to GPs does not really seem to correspond to the classical divides in France, but rather raises the issue of intra-metropolis and intra-periphery disparities. There is a worsening of access to general practitioners between 2007 and 2017. Territorial inequalities in access to general practitioners have also increased. Spatial dynamics are studied with spatial panels. There is a tendency for doctors to group together in the same cantons. GPs seem particularly attracted by the availability of services.
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Breaux RD, Rooks RN. The intersectional importance of race/ethnicity, disability, and age in flu vaccine uptake for U.S. adults. SSM Popul Health 2022; 19:101211. [PMID: 36052156 PMCID: PMC9425074 DOI: 10.1016/j.ssmph.2022.101211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 10/31/2022] Open
Abstract
Improving vaccination rates among marginalized populations is an important priority among public policy makers and healthcare providers in the United States of America (U.S.). Racial/ethnic minorities have a long history of reduced vaccination rates relative to white Americans (Khan, Hall, Tanner, & Marlow, 2018), while people with disabilities (PWD) have varied rates of vaccine use (Diab & Johnston, 2004; O'Neill, Newall, Antolovich, Lima, & Danchin, 2019). Yet, little is known about vaccine use among individuals who belong to both groups. This study examines the intersectional effects of race/ethnicity and disability on flu vaccine use. We used the 2015-2018 National Health Interview Survey to examine the odds of flu vaccine use by race/ethnicity, disability, and their interaction among adults aged 18+ in the U.S. non-institutionalized, civilian population stratified by age groups. For each unit increase in disability scores, we found a significant race-by-disability interaction for young black adults (18-39 years) who had higher odds of getting the flu vaccine compared to white adults in the same age group. A significant interaction occurred for middle-aged Hispanic vs. white adults (40-64 years) who had higher odds of getting the flu vaccine as their disability scores increased. Black vs. white adults were less likely to get the flu vaccine across all age groups irrespective of disability and other covariates, while results were more mixed among other racial/ethnic groups. Additionally, people with disabilities had higher odds of flu vaccination. Further, race/ethnicity had a moderating effect on the relationship between disability and flu vaccination and an interaction effect occurred between disability and certain racial/ethnic groups when stratified by age.
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Affiliation(s)
- Rebecca D Breaux
- University of Colorado Denver, 1224 5th Street, HUB, Denver, CO, 80204, USA
| | - Ronica N Rooks
- University of Colorado Denver, 3023C North Classroom, P.O. Box 173364, Campus Box 188, Denver, CO, 80217-3364, USA
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14
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Hamed S, Bradby H, Ahlberg BM, Thapar-Björkert S. Racism in healthcare: a scoping review. BMC Public Health 2022; 22:988. [PMID: 35578322 PMCID: PMC9112453 DOI: 10.1186/s12889-022-13122-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Racism constitutes a barrier towards achieving equitable healthcare as documented in research showing unequal processes of delivering, accessing, and receiving healthcare across countries and healthcare indicators. This review summarizes studies examining how racism is discussed and produced in the process of delivering, accessing and receiving healthcare across various national contexts. METHOD The PRISMA guidelines for scoping reviews were followed and databases were searched for peer reviewed empirical articles in English across national contexts. No starting date limitation was applied for this review. The end date was December 1, 2020. The review scoped 213 articles. The results were summarized, coded and thematically categorized in regards to the aim. RESULTS The review yielded the following categories: healthcare users' experiences of racism in healthcare; healthcare staff's experiences of racism; healthcare staff's racial attitudes and beliefs; effects of racism in healthcare on various treatment choices; healthcare staff's reflections on racism in healthcare and; antiracist training in healthcare. Racialized minorities experience inadequate healthcare and being dismissed in healthcare interactions. Experiences of racism are associated with lack of trust and delay in seeking healthcare. Racialized minority healthcare staff experience racism in their workplace from healthcare users and colleagues and lack of organizational support in managing racism. Research on healthcare staff's racial attitudes and beliefs demonstrate a range of negative stereotypes regarding racialized minority healthcare users who are viewed as difficult. Research on implicit racial bias illustrates that healthcare staff exhibit racial bias in favor of majority group. Healthcare staff's racial bias may influence medical decisions negatively. Studies examining healthcare staff's reflections on racism and antiracist training show that healthcare staff tend to construct healthcare as impartial and that healthcare staff do not readily discuss racism in their workplace. CONCLUSIONS The USA dominates the research. It is imperative that research covers other geo-political contexts. Research on racism in healthcare is mainly descriptive, atheoretical, uses racial categories uncritically and tends to ignore racialization processes making it difficult to conceptualize racism. Sociological research on racism could inform research on racism as it theoretically explains racism's structural embeddedness, which could aid in tackling racism to provide good quality care.
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Affiliation(s)
- Sarah Hamed
- Department of Sociology, Uppsala University, Uppsala, Sweden.
| | - Hannah Bradby
- Department of Sociology, Uppsala University, Uppsala, Sweden
| | - Beth Maina Ahlberg
- Department of Sociology, Uppsala University, Uppsala, Sweden.,Skaraborg Institute for Research and Development, Skövde, Sweden
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Chan KKS, Fung WTW. Differential Impact of Experienced and Anticipated Discrimination on Sleep and Health Among Sexual Minorities. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3053-3063. [PMID: 34617190 DOI: 10.1007/s10508-021-01981-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 02/16/2021] [Accepted: 03/06/2021] [Indexed: 06/13/2023]
Abstract
For many lesbian, gay, and bisexual (LGB) individuals, stigma may represent a psychosocial stressor that can disrupt sleep and impair health. The present study tested a stigma model of sleep health to examine whether experienced and anticipated discrimination, as well as associated primal threat, would affect sleep quality and, in turn, physical and mental health among LGB individuals. A total of 401 LGB individuals (201 women and 200 men; mean age = 27.48 years) from Hong Kong, China, provided cross-sectional questionnaire data on experienced and anticipated discrimination, primal threat, sleep disturbance, and self-rated physical and mental health. Path analyses showed that experienced and anticipated discrimination were associated with higher primal threat, which was, in turn, associated with greater sleep disturbance and then poorer physical and mental health. Bootstrap analyses further revealed that experienced and anticipated discrimination had significant indirect effects on sleep disturbance via primal threat and on physical and mental health via primal threat and sleep disturbance. In addition, multi-group analyses demonstrated that the mediation model held across women and men and across lesbian/gay and bisexual individuals. Theoretically, our findings highlighted the importance of considering the differential effects of experienced and anticipated discrimination, as well as the contributive role of primal threat, on the sleep quality and health status of LGB individuals. Practically, our findings pointed to the necessity of developing community-based stigma reduction programs and individual-oriented stigma coping interventions in order to facilitate LGB individuals to reduce discrimination-related primal threat and thereby improve sleep and health.
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Affiliation(s)
- Kevin Ka Shing Chan
- Department of Psychology, The Education University of Hong Kong, Tai Po, Hong Kong.
- Centre for Psychosocial Health, The Education University of Hong Kong, Tai Po, Hong Kong.
| | - Winnie Tsz Wa Fung
- Department of Psychology, The Education University of Hong Kong, Tai Po, Hong Kong
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Liu SY, Pabayo R, Muennig P. Perceived Discrimination and Increased Odds of Unmet Medical Needs Among US Children. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2021; 51:364-370. [PMID: 33709808 DOI: 10.1177/0020731421997087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our study examines the association between perceived discrimination due to race and unmet medical needs among a nationally representative sample of children in the United States. We used data from the 2016-2017 National Survey of Children's Health, a population-based cross-sectional survey of randomly selected parents or guardians in the United States. We compared results from the coarsened exact matching (CEM) method and survey-weighted logistic regression to assess the robustness of the results. Using self-reported measures from caregivers, we find that ∼2.7% of US children have experienced racial discrimination with prevalence varying significantly by race. While <1% of non-Hispanic whites have experienced some measure of racism, this increases to 8.8% among non-Hispanic blacks. Perceived discrimination was associated with significantly greater odds of unmet medical needs in the adjusted, survey-weighted multivariate-adjusted model (adjusted odds ratio [OR] = 2.4 and 95% confidence interval [CI] = 1.2, 4.9) as well as in the CEM-model estimate (OR = 2.8 and 95% CI = 1.8, 4.0). Children who have experienced perceived discrimination had higher odds of unmet medical needs. Awareness of discrimination among children may help inform future intervention development that addresses unmet medical needs during childhood.
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Affiliation(s)
- Sze Yan Liu
- 8087Montclair State University, Montclair, NJ, USA
| | - Roman Pabayo
- 3158University of Alberta, School of Public Health, Edmonton, AB, Canada
| | - Peter Muennig
- 33638Columbia Mailman School of Public Health, New York, NY, USA
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Mahabir DF, O'Campo P, Lofters A, Shankardass K, Salmon C, Muntaner C. Experiences of everyday racism in Toronto's health care system: a concept mapping study. Int J Equity Health 2021; 20:74. [PMID: 33691682 PMCID: PMC7943708 DOI: 10.1186/s12939-021-01410-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/14/2021] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND In Canada, there is longstanding evidence of health inequities for racialized groups. The purpose of this study is to understand the effect of current health care policies and practices on racial/ethnic groups and in particular racialized groups at the level of the individual in Toronto's health care system. METHODS This study used a semi-qualitative study design: concept mapping. A purposive sampling strategy was used to recruit participants. Health care users and health care providers from Toronto and the Greater Toronto Area participated in all four concept mapping activities. The sample sizes varied according to the activity. For the rating activity, 41 racialized health care users, 23 non-racialized health care users and 11 health care providers completed this activity. The data analysis was completed using the concept systems software. RESULTS Participants generated 35 unique statements of ways in which patients feel disrespect or mistreatment when receiving health care. These statements were grouped into five clusters: 'Racial/ethnic and class discrimination', 'Dehumanizing the patient', 'Negligent communication', 'Professional misconduct', and 'Unequal access to health and health services'. Two distinct conceptual regions were identified: 'Viewed as inferior' and 'Unequal medical access'. From the rating activity, racialized health care users reported 'race'/ethnic based discrimination or everyday racism as largely contributing to the challenges experienced when receiving health care; statements rated high for action/change include 'when the health care provider does not complete a proper assessment', 'when the patient's symptoms are ignored or not taken seriously', 'and 'when the health care provider belittles or talks down to the patient'. CONCLUSIONS Our study identifies how racialized health care users experience everyday racism when receiving health care and this is important to consider in the development of future research and interventions aimed at addressing institutional racism in the health care setting. To support the elimination of institutional racism, anti-racist policies are needed to move beyond cultural competence polices and towards addressing the centrality of unequal power social relations and everyday racism in the health care system.
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Affiliation(s)
- Deb Finn Mahabir
- Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, Ontario, M5T 1P8, Canada.
| | - Patricia O'Campo
- MAP Centre for Urban Health Solutions, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada
| | - Aisha Lofters
- Women's College Hospital, 76 Grenville St., Toronto, M5S 1B2, Canada
| | - Ketan Shankardass
- Department of Health Sciences, Wilfrid Laurier University, 75 University Avenue West, Waterloo, Ontario, N2L 3C5, Canada
| | - Christina Salmon
- Knowledge Translation Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada
| | - Carles Muntaner
- Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, Ontario, M5T 1P8, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Ontario, M5T 3M7, Canada
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Leitch S, Smith A, Crengle S, Stokes T. The views of New Zealand general practitioners and patients on a proposed risk assessment and communication tool: a qualitative study using Normalisation Process Theory. Implement Sci Commun 2021; 2:16. [PMID: 33568225 PMCID: PMC7877107 DOI: 10.1186/s43058-021-00120-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 02/01/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Communicating risks of medication harm and obtaining informed consent is difficult due to structural barriers, language and cultural practices, bias and a lack of resources appropriately tailored for the health literacy of most patients. A decision support tool was proposed to alert prescribers of risk and provide tailored information for patients to facilitate informed decision-making with patients and their whānau (family) around medication use. Patient and prescriber co-design was used to ensure the tool was designed to best meet the needs of end-users and avoid increasing health inequity. This paper describes the first stage of the co-design process. METHOD Normalisation Process Theory (NPT) was used to prospectively evaluate the tool. Semi-structured interviews were held with fifteen patients (five Māori, five Pasifika and five NZ European) and nine general practitioners (two Māori and seven European). RESULTS Three themes were identified, which related to the three NPT concepts most relevant to developing the tool. Theme 1 (coherence: meaning and sense making by participants) explored participants' understanding of prescribing safety, medication harm and risk, which is based on experience. Patients want as much information as possible about their medications and risk, but doctors find it difficult to communicate that information. Theme 2 related to the NPT concept of cognitive participation (commitment and engagement by participants) explored what participants thought about a prescribing decision support tool. Participants were cautiously optimistic, but worried about potential harm arising from its use. They also identified requirements for the tool and features to avoid. Theme 3 describes the collective action required for successful implementation of the tool; namely, culturally safe and trustworthy doctor-patient relationships. CONCLUSION Patients and general practitioners provided different perspectives when prospectively evaluating the proposed risk assessment and communication tool. This co-design research identified important pre-requisites for the tool and features to avoid and novel ideas for the proposed tool. Overall participants supported the development of the proposed risk assessment and communication tool, but identified the important role that doctor-patient relationships would play to ensure successful implementation. The use of Māori and Pacific languages in the proposed tool may enhance engagement and understanding.
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Affiliation(s)
- Sharon Leitch
- University of Otago Medical School, Dunedin, New Zealand.
| | - Alesha Smith
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Sue Crengle
- University of Otago Medical School, Dunedin, New Zealand
| | - Tim Stokes
- University of Otago Medical School, Dunedin, New Zealand
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Observations by and Conversations with Health Workers and Hospital Personnel Involved in Transferring Māori Patients and Whānau to Waikato Hospital in Aotearoa New Zealand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238833. [PMID: 33261108 PMCID: PMC7731209 DOI: 10.3390/ijerph17238833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/06/2020] [Accepted: 11/23/2020] [Indexed: 12/17/2022]
Abstract
The predominant focus of Aotearoa New Zealand's public health system on biomedical models of health has left little room for meaningful engagement with holistic indigenous approaches. Culturally appropriate provision and support are recognized for their relevance and importance during hospital transferals. Hospital staff involved in transfers to one of New Zealand's trauma centers share their observations of whānau Māori engagement during an admission away from their home base. Sixteen key informants share their experiences, which are presented as strategies and challenges to whānau engagement. Three main themes highlight challenges within the health system that make it difficult for hospital staff to engage whānau in the desired ways and as often as both parties would like. Key informants described services and practices that are not designed with patients and their whānau in mind; instead they are designed by clinicians around the needs of administrative systems. As employees within the public health system, key informants felt powerless to challenge dominant settings. Nevertheless, employees managed to circumnavigate processes. Our findings highlight the need for continued decolonization and anti-racism work within public health settings.
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20
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Cunningham R, Stanley J, Haitana T, Pitama S, Crowe M, Mulder R, Porter R, Lacey C. The physical health of Māori with bipolar disorder. Aust N Z J Psychiatry 2020; 54:1107-1114. [PMID: 32929981 DOI: 10.1177/0004867420954290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS There is very little empirical evidence about the relationship between severe mental illness and the physical health of Indigenous peoples. This paper aims to compare the physical health of Māori and non-Māori with a diagnosis of bipolar disorder in contact with NZ mental health services. METHODS A cohort of Māori and non-Māori with a current bipolar disorder diagnosis at 1 January 2010 were identified from routine mental health services data and followed up for non-psychiatric hospital admissions and deaths over the subsequent 5 years. RESULTS Māori with bipolar disorder had a higher level of morbidity and a higher risk of death from natural causes compared to non-Māori with the same diagnosis, indicating higher levels of physical health need. The rate of medical and surgical hospitalisation was not higher among Māori compared to non-Māori (as might be expected given increased health needs) which suggests under-treatment of physical health conditions in this group may be a factor in the observed higher risk of mortality from natural causes for Māori. CONCLUSION This study provides the first indication that systemic factors which cause health inequities between Māori and non-Māori are compounded for Māori living with severe mental illness. Further exploration of other diagnostic groups and subgroups is needed to understand the best approach to reducing these inequalities.
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Affiliation(s)
- Ruth Cunningham
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Tracy Haitana
- Department of the Dean, Māori/Indigenous Health Institute (MIHI), University of Otago, Christchurch, New Zealand
| | - Suzanne Pitama
- Department of the Dean, Māori/Indigenous Health Institute (MIHI), University of Otago, Christchurch, New Zealand
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Cameron Lacey
- Department of the Dean, Māori/Indigenous Health Institute (MIHI), University of Otago, Christchurch, New Zealand
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Lee CHJ, Sibley CG. Ethnic disparities in vaccine safety attitudes and perceptions of family doctors/general practitioners. Vaccine 2020; 38:7024-7032. [PMID: 32981781 DOI: 10.1016/j.vaccine.2020.09.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 12/30/2022]
Abstract
Ethnic groups have disparate perceptions of and experiences with family doctors/General Practitioners (GP), yet little is known about differences in GP influence on vaccine safety perceptions across ethnic groups in New Zealand. Using data from the 2017 New Zealand Attitudes and Values Study survey (N = 17,072), the current study investigates the correlation between vaccine safety agreement and GP satisfaction, perceived GP cultural similarity, GP cultural respect, healthcare access and diverse demographic factors among Māori, Pacific, Asian and European New Zealanders. Europeans expressed greater positive perceptions of GPs and high vaccine safety agreement (74.7%) relative to other ethnic groups (Asian: 72.3%; Pacific: 65.8%; Māori: 59.4%). Increased GP satisfaction, healthcare access and education were key correlates of higher vaccine safety agreement among Europeans. Increased GP satisfaction, healthcare access and being non-religious were key correlates among Māori. Higher vaccine safety agreement was significantly and strongly associated with being non-religious, born overseas and having a partner among Pacific peoples. Among Asian peoples, men, younger, more educated individuals, and those with greater perceived GP cultural respect showed higher agreement. Our findings highlight important ethnic differences in the shaping of vaccine attitudes and inform the development of tailored interventions for specific ethnic groups.
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Affiliation(s)
- Carol H J Lee
- School of Psychology, University of Auckland, New Zealand.
| | - Chris G Sibley
- School of Psychology, University of Auckland, New Zealand
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22
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Montayre J, Ho MH. Factors Associated With ED Use Among New Asian Immigrants in New Zealand: A Cross-Sectional Analysis of Secondary Data. J Emerg Nurs 2020; 47:157-166.e4. [PMID: 32962840 DOI: 10.1016/j.jen.2020.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION New Zealand has an ethnically diverse population and continues to host immigrants from different countries. The present study aimed to examine the factors associated with ED use among new Asian immigrants in New Zealand. METHODS A secondary analysis of 2016-2017 New Zealand Health Survey database. Univariate and multivariate logistic regression models were employed. A total of 414 new Asian immigrants were identified. RESULTS Asthma, diabetes, chronic pain, anxiety, hypertension, body mass index, waist measurement, perceived health status, and distress were associated with a significantly increased likelihood to ED visits. The multivariate logistic regression analysis revealed that asthma (adjusted odds ratio = 5.29, 95% confidence interval, 1.26-22.24) and perceived health status (adjusted odds ratio = 0.81, 95% confidence interval, 0.66-0.99) were factors associated with ED use among new Asian immigrants. CONCLUSION Asthma and perceived health status were the 2 key factors associated with ED use among new Asian immigrants in New Zealand. ED use among new Asian immigrants encompassed both chronic health conditions and mental health indicators.
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Wild CE, Rawiri NT, Willing EJ, Hofman PL, Anderson YC. Determining barriers and facilitators to engagement for families in a family-based, multicomponent healthy lifestyles intervention for children and adolescents: a qualitative study. BMJ Open 2020; 10:e037152. [PMID: 32895279 PMCID: PMC7478027 DOI: 10.1136/bmjopen-2020-037152] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES Recruitment and retention in child and adolescent healthy lifestyle intervention services for childhood obesity is challenging, and inequalities across social groups are persistent. This study aimed to understand the barriers and facilitators to engagement in a multicomponent assessment-and-intervention healthy lifestyle programme for children and their families, based in the home and community. DESIGN Qualitative interview-based study of past users (n=76) of a family-based multicomponent healthy lifestyle programme in a mixed urban-rural region of New Zealand. Semistructured, home-based interviews were conducted and thematically analysed with peer debriefing for validity. PARTICIPANTS Families were selected through stratified random sampling to include a range of levels of engagement, including those who declined their referral, with equal numbers of interviews with Indigenous and non-Indigenous families. RESULTS Three interactive and compounding determinants were identified as influencing engagement in Whānau Pakari: acute and chronic life stressors, societal norms of weight and body size and historical experiences of healthcare. These determinants were present across societal, system and healthcare service levels. A negative referral experience to Whānau Pakari often resulted in participants declining further input or disengaging from the programme. A fourth domain, respectful and compassionate healthcare, was identified as a mitigator of these three themes, facilitating participant engagement despite previous negative experiences. CONCLUSIONS While participant engagement in healthy lifestyle programmes is affected by determinants which appear to operate outside immediate service provision, the programme is an opportunity to acknowledge past instances of stigma and the wider challenges of healthy lifestyle change. The experience of the referral to Whānau Pakari is important for setting the scene for future engagement in the programme. Respectful, compassionate care is critical to enhanced retention in multidisciplinary healthy lifestyle programmes and ongoing engagement in healthcare services overall.
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Affiliation(s)
| | - Ngauru T Rawiri
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Esther J Willing
- Kōhatu - Centre for Hauora Māori, University of Otago, Dunedin, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Starship Children's Health, Auckland, New Zealand
| | - Yvonne C Anderson
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand
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McLeod M, Gurney J, Harris R, Cormack D, King P. COVID-19: we must not forget about Indigenous health and equity. Aust N Z J Public Health 2020; 44:253-256. [PMID: 32628335 PMCID: PMC7361596 DOI: 10.1111/1753-6405.13015] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Melissa McLeod
- Department of Public Health, University of Otago, Wellington, New Zealand,Correspondence to: Ricci Harris, Eru Pōmare Māori Health Research Centre, Department of Public Health, University of Otago, PO Box 7343, Wellington 6242, New Zealand
| | - Jason Gurney
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Ricci Harris
- Eru Pōmare Māori Health Research Centre, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Donna Cormack
- Eru Pōmare Māori Health Research Centre, Department of Public Health, University of Otago, Wellington, New Zealand,Te Kupenga Hauora Māori, The University of Auckland, New Zealand
| | - Paula King
- Eru Pōmare Māori Health Research Centre, Department of Public Health, University of Otago, Wellington, New Zealand
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Ferdinand A, Lambert M, Trad L, Pedrana L, Paradies Y, Kelaher M. Indigenous engagement in health: lessons from Brazil, Chile, Australia and New Zealand. Int J Equity Health 2020; 19:47. [PMID: 32731870 PMCID: PMC7393707 DOI: 10.1186/s12939-020-1149-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/27/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Given the persistence of Indigenous health inequities across national contexts, many countries have adopted strategies to improve the health of Indigenous peoples. Governmental recognition of the unique health needs of Indigenous populations is necessary for the development of targeted programs and policies to achieve universal health coverage. At the same time, the participation of Indigenous peoples in decision-making and program and policy design helps to ensure that barriers to health services are appropriately addressed and promotes the rights of Indigenous peoples to self-determination. Due to similar patterns of Indigenous health and health determinants across borders, there have been calls for greater global collaboration in this field. However, most international studies on Indigenous health policy link Anglo-settler democracies (Canada, Australia, Aotearoa/New Zealand and the United States), despite these countries representing a small fraction of the world's Indigenous people. AIM This paper examines national-level policy in Australia, Brazil, Chile and New Zealand in relation to governmental recognition of differential Indigenous health needs and engagement with Indigenous peoples in health. The paper aims to examine how Indigenous health needs and engagement are addressed in national policy frameworks within each of the countries in order to contribute to the understanding of how to develop pro-equity policies within national health care systems. METHODS For each country, a review was undertaken of national policies and legislation to support engagement with, and participation of, Indigenous peoples in the identification of their health needs, development of programs and policies to address these needs and which demonstrate governmental recognition of differential Indigenous health needs. Government websites were searched as well as the following databases: Google, OpenGrey, CAB Direct, PubMed, Web of Science and WorldCat. FINDINGS Each of the four countries have adopted international agreements regarding the engagement of Indigenous peoples in health. However, there is significant variation in the extent to which the principles laid out in these agreements are reflected in national policy, legislation and practice. Brazil and New Zealand both have established national policies to facilitate engagement. In contrast, national policy to enable engagement is relatively lacking in Australia and Chile. Australia, Brazil and New Zealand each have significant initiatives and policy structures in place to address Indigenous health. However, in Brazil this is not necessarily reflected in practice and although New Zealand has national policies these have been recently reported as insufficient and, in fact, may be contributing to health inequity for Māori. In comparison to the other three countries, Chile has relatively few national initiatives or policies in place to support Indigenous engagement or recognise the distinct health needs of Indigenous communities. CONCLUSIONS The adoption of international policy frameworks forms an important step in ensuring that Indigenous peoples are able to participate in the formation and implementation of health policy and programs. However, without the relevant principles being reflected in national legislature, international agreements hold little weight. At the same time, while a national legislative framework facilitates the engagement of Indigenous peoples, such policy may not necessarily translate into practice. Developing multi-level approaches that improve cohesion between international policy, national policy and practice in Indigenous engagement in health is therefore vital. Given that each of the four countries demonstrate strengths and weaknesses across this causal chain, cross-country policy examination provides guidance on strengthening these links.
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Affiliation(s)
- Angeline Ferdinand
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Parkville, Australia.
| | - Michelle Lambert
- Ngāi Tahu Māori Health Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Leny Trad
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Leo Pedrana
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Yin Paradies
- Alfred Deakin Institute for Citizenship and Globalisation, Faculty of Arts and Education, Deakin University, Burwood, Australia
| | - Margaret Kelaher
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Parkville, Australia
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Gurney JK, Campbell S, Turner S, Scott N. Addressing cancer inequities for indigenous populations: The New Zealand story. J Cancer Policy 2020. [DOI: 10.1016/j.jcpo.2019.100209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Rahiri JL, Tuhoe J, Gillon A, MacCormick AD, Hill A, Harwood M. Enhancing responsiveness to Māori in a publicly funded bariatric service in Aotearoa New Zealand. ANZ J Surg 2019; 90:508-513. [PMID: 31840367 DOI: 10.1111/ans.15610] [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: 08/13/2019] [Revised: 11/09/2019] [Accepted: 11/15/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Health equity is a fundamental right afforded to all regardless of ethnicity. However, in New Zealand (NZ), health inequities are most compelling for Indigenous Māori who experience inadequate access to services, poorer quality of care and poor health outcomes as a result. Bariatric surgery is the most effective intervention for weight loss and remission of obesity-related disease where all other interventions have been exhausted. This Kaupapa Māori qualitative study presents Māori perspectives of bariatric surgery from the largest public bariatric centre in NZ and offers solutions for enhancing bariatric service responsiveness to Māori. METHODS This qualitative study was informed by Kaupapa Māori methodology and involved a general inductive thematic analysis of 31 semi-structured interviews with Māori patients who had bariatric surgery at Counties Manukau Health in South Auckland, NZ. RESULTS Four key themes were identified following analysis: (i) Kaupapa Māori standards of health; (ii) bariatric mentors; (iii) bariatric psychologists; and (iv) community-integrated support. These themes offer four tangible solutions for optimizing bariatric pathways for Māori from the perspectives of Māori bariatric patients. CONCLUSION Kaupapa Māori, community-centred and greater non-surgeon aspects of bariatric supportive mechanisms comprise key areas of opportunity for public bariatric pathways in NZ. Surgical leadership is required to advance health equity and service responsiveness to Māori.
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Affiliation(s)
- Jamie-Lee Rahiri
- South Auckland Clinical Campus, The University of Auckland, Middlemore Hospital, Auckland, New Zealand
| | - Jason Tuhoe
- Tokoroa Family Health, Tokoroa Hospital, Tokoroa, New Zealand
| | - Ashlea Gillon
- Department of General Practice and Primary Care, The University of Auckland, Auckland, New Zealand
| | - Andrew D MacCormick
- South Auckland Clinical Campus, The University of Auckland, Middlemore Hospital, Auckland, New Zealand
| | - Andrew Hill
- South Auckland Clinical Campus, The University of Auckland, Middlemore Hospital, Auckland, New Zealand
| | - Matire Harwood
- Department of General Practice and Primary Care, The University of Auckland, Auckland, New Zealand
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Came HA, Herbert S, McCreanor T. Representations of Māori in colonial health policy in Aotearoa from 2006-2016: a barrier to the pursuit of health equity. CRITICAL PUBLIC HEALTH 2019. [DOI: 10.1080/09581596.2019.1686461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- H. A. Came
- School of Public Health and Psychosocial Health, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - S. Herbert
- Te Kupenga Hauora Māori, University of Auckland, Auckland, New Zealand
| | - T. McCreanor
- Te Rōpū Whāriki, Massey University, Auckland, New Zealand
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Dawson P, Jaye C, Gauld R, Hay-Smith J. Barriers to equitable maternal health in Aotearoa New Zealand: an integrative review. Int J Equity Health 2019; 18:168. [PMID: 31666134 PMCID: PMC6822457 DOI: 10.1186/s12939-019-1070-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 10/04/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this review was to examine the literature for themes of underlying social contributors to inequity in maternal health outcomes and experiences in the high resource setting of Aotearoa New Zealand. These 'causes of the causes' were explored and compared with the international context to identify similarities and New Zealand-specific differences. METHOD A structured integrative review methodology was employed to enable a complex cross disciplinary analysis of data from a variety of published sources. This method enabled incorporation of diverse research methodologies and theoretical approaches found in the literature to form a unified overall of the topic. RESULTS Six integrated factors - Physical Access, Political Context, Maternity Care System, Acceptability, Colonialism, and Cultural factors - were identified as barriers to equitable maternal health in Aotearoa New Zealand. The structure of the maternal health system in New Zealand, which includes free maternity care and a woman centred continuity of care structure, should help to ameliorate inequity in maternal health and yet does not appear to. A complex set of underlying structural and systemic factors, such as institutionalised racism, serve to act as barriers to equitable maternity outcomes and experiences. Initiatives that appear to be working are adapted to the local context and involve self-determination in research, clinical outreach and community programmes. CONCLUSIONS The combination of six social determinants identified in this review that contribute to maternal health inequity is specific to New Zealand, although individually these factors can be identified elsewhere; this creates a unique set of challenges in addressing inequity. Due to the specific social determinants in Aotearoa New Zealand, localised solutions have potential to further maternal health equity.
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Affiliation(s)
- Pauline Dawson
- Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Chrys Jaye
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Robin Gauld
- Otago Business School, University of Otago, Dunedin, New Zealand
- Centre for Health Systems and Technology, University of Otago, Dunedin, New Zealand
| | - Jean Hay-Smith
- Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand
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Dicker B, Todd VF, Tunnage B, Swain A, Conaglen K, Smith T, Brett M, Laufale C, Howie G. Ethnic disparities in the incidence and outcome from out-of-hospital cardiac arrest: A New Zealand observational study. Resuscitation 2019; 145:56-62. [PMID: 31585186 DOI: 10.1016/j.resuscitation.2019.09.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 09/22/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND New Zealand (NZ) has an ethnically diverse population. International studies have demonstrated significant differences in health equity by ethnicity; however, there is limited evidence in the context of out-of-hospital cardiac arrest in NZ. We investigated whether heath disparities in incidence and outcome of out-of-hospital cardiac arrest exist between NZ ethnic groups. METHOD A retrospective observational study was conducted using NZ cardiac arrest registry data for a 2-year period. Ethnic cohorts investigated were the indigenous Māori population, Pacific Peoples and European/Others. Incidence rates, population characteristics and outcomes (Return of Spontaneous Circulation sustained to hospital handover and thirty-day survival) were compared. RESULTS Age-adjusted incidence rates per 100,000 person-years were higher in Māori (144.4) and Pacific Peoples (113.5) compared to European/Others (93.8). Return of spontaneous circulation sustained to hospital handover was significantly lower in Māori (adjusted OR 0.74, 95% CI 0.64-0.87, p < 0.001). Survival to thirty-days was lower for both Māori (adjusted OR 0.61, 95% CI 0.48-0.78, p < 0.001) and Pacific Peoples (adjusted OR 0.52, 95% CI 0.37-0.72, p < 0.001). A higher proportion of events occurred in all age groups below 65 years old in Māori and Pacific Peoples (p < 0.001), and a higher proportion of events occurred among women in Māori and Pacific Peoples (p < 0.001). CONCLUSIONS There are significant differences in health equity by ethnicity. Both Māori and Pacific Peoples have higher incidence of out-of-hospital cardiac arrest and at a younger age. Māori and Pacific Peoples have lower rates of survival to thirty-days. Our results provide impetus for targeted health strategies for at-risk ethnic populations.
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Affiliation(s)
- Bridget Dicker
- Paramedicine Department, Auckland University of Technology, Auckland, New Zealand; Clinical Audit and Research, St John New Zealand, Auckland, New Zealand.
| | - Verity F Todd
- Paramedicine Department, Auckland University of Technology, Auckland, New Zealand; Clinical Audit and Research, St John New Zealand, Auckland, New Zealand
| | - Bronwyn Tunnage
- Paramedicine Department, Auckland University of Technology, Auckland, New Zealand; Clinical Audit and Research, St John New Zealand, Auckland, New Zealand
| | - Andy Swain
- Paramedicine Department, Auckland University of Technology, Auckland, New Zealand
| | - Kate Conaglen
- Paramedicine Department, Auckland University of Technology, Auckland, New Zealand
| | - Tony Smith
- Clinical Audit and Research, St John New Zealand, Auckland, New Zealand
| | - Michelle Brett
- Clinical Audit and Research, St John New Zealand, Auckland, New Zealand
| | - Chris Laufale
- Clinical Audit and Research, St John New Zealand, Auckland, New Zealand
| | - Graham Howie
- Paramedicine Department, Auckland University of Technology, Auckland, New Zealand; Clinical Audit and Research, St John New Zealand, Auckland, New Zealand
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Manhire-Heath R, Cormack D, Wyeth E. '…but I just prefer to treat everyone the same…': general practice receptionists talking about health inequities. Aust J Prim Health 2019; 25:430-434. [PMID: 31506160 DOI: 10.1071/py19026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 07/11/2019] [Indexed: 11/23/2022]
Abstract
General practice receptionists are positioned at the beginning of a patient's journey within the healthcare system, yet their influence on a patient's experience is unknown. The limited data on, and research involving, general practice receptionists both in New Zealand and internationally is evidence of this. This research undertook an exploration of the discourses used by a group of general practice receptionists in Wellington, New Zealand to discover how they talk about, and represent, health inequities. Eight in-depth semi-structured interviews were conducted, guided by Social Constructionism and Decolonising Theory. Three reoccurring patterns of discourse were identified: discourses about the social determinants of health; discourses about Māori culture and behaviour; and discourses about egalitarianism. Further, narratives that could be seen as deficit-focussed or victim-blaming were identified. Racism was not directly discussed by participants as a health determinant. The findings support the need for training guided by cultural safety and anti-racism principles to be available for all general practice receptionists.
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Affiliation(s)
- Rowan Manhire-Heath
- Department of Public Health, University of Otago, Wellington, c/o Health Improvement and Equity Directorate, Hawke's Bay District Health Board, Private Bag 9014, Hastings 4153, New Zealand; and Corresponding author.
| | - Donna Cormack
- Te Ropu Rangahau Hauora a Eru Pomare, University of Otago, Wellington, PO Box 7343, Newtown, Wellington 6242, New Zealand
| | - Emma Wyeth
- Ngai Tahu Maori Health Research Unit, Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
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Stanley J, Harris R, Cormack D, Waa A, Edwards R. The impact of racism on the future health of adults: protocol for a prospective cohort study. BMC Public Health 2019; 19:346. [PMID: 30922286 PMCID: PMC6437906 DOI: 10.1186/s12889-019-6664-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Racial discrimination is recognised as a key social determinant of health and driver of racial/ethnic health inequities. Studies have shown that people exposed to racism have poorer health outcomes (particularly for mental health), alongside both reduced access to health care and poorer patient experiences. Most of these studies have used cross-sectional designs: this prospective cohort study (drawing on critical approaches to health research) should provide substantially stronger causal evidence regarding the impact of racism on subsequent health and health care outcomes. METHODS Participants are adults aged 15+ sampled from 2016/17 New Zealand Health Survey (NZHS) participants, sampled based on exposure to racism (ever exposed or never exposed, using five NZHS questions) and stratified by ethnic group (Māori, Pacific, Asian, European and Other). Target sample size is 1680 participants (half exposed, half unexposed) with follow-up survey timed for 12-24 months after baseline NZHS interview. All exposed participants are invited to participate, with unexposed participants selected using propensity score matching (propensity scores for exposure to racism, based on several major confounders). Respondents receive an initial invitation letter with choice of paper or web-based questionnaire. Those invitees not responding following reminders are contacted for computer-assisted telephone interview (CATI). A brief questionnaire was developed covering current health status (mental and physical health measures) and recent health-service utilisation (unmet need and experiences with healthcare measures). Analysis will compare outcomes between those exposed and unexposed to racism, using regression models and inverse probability of treatment weights (IPTW) to account for the propensity score sampling process. DISCUSSION This study will add robust evidence on the causal links between experience of racism and subsequent health. The use of the NZHS as a baseline for a prospective study allows for the use of propensity score methods during the sampling phase as a novel approach to recruiting participants from the NZHS. This method allows for management of confounding at the sampling stage, while also reducing the need and cost of following up with all NZHS participants.
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Affiliation(s)
- James Stanley
- Department of Public Health, University of Otago, Wellington, 23a Mein Street, Newtown, Wellington, New Zealand
| | - Ricci Harris
- Eru Pōmare Māori Health Research Centre, University of Otago, Wellington, 23a Mein Street, Newtown, Wellington, New Zealand
| | - Donna Cormack
- Eru Pōmare Māori Health Research Centre, University of Otago, Wellington, 23a Mein Street, Newtown, Wellington, New Zealand
| | - Andrew Waa
- Eru Pōmare Māori Health Research Centre, University of Otago, Wellington, 23a Mein Street, Newtown, Wellington, New Zealand
| | - Richard Edwards
- Department of Public Health, University of Otago, Wellington, 23a Mein Street, Newtown, Wellington, New Zealand
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