Examining the barriers and facilitators for Māori accessing injury and rehabilitation services: a scoping review protocol

Māori experiences of physical rehabilitation in Aotearoa New Zealand: a scoping review

PURPOSE

The purpose of this review was to explore what is currently known about Māori experiences of physical rehabilitation services in Aotearoa New Zealand.

METHODS

A scoping review was undertaken following steps described by the Joanna Briggs Institute. Databases and grey literature were searched for qualitative studies that included descriptions of Māori consumer experiences in their encounters with physical rehabilitation. Data relating to study characteristics were synthesised. Qualitative data were extracted and analysed using reflexive thematic analysis.

RESULTS

Fourteen studies were included in this review. Four themes were generated that describe Māori experiences of rehabilitation. The first theme captures the expectations of receiving culturally unsafe care that become a reality for Māori during rehabilitation. The second theme describes whānau as crucial for navigating the culturally alien world of rehabilitation. The third theme offers solutions for the incorporation of culturally appropriate Māori practices. The final theme encompasses solutions for the provision of rehabilitation that empowers Māori.

CONCLUSIONS

This scoping review highlights ongoing inequities experienced by Māori when engaging with rehabilitation services. Strategies for facilitating culturally safe rehabilitation for Māori have been proposed. It is essential that rehabilitation clinicians and policymakers implement culturally safe approaches to rehabilitation with a view to eliminating inequities in care provision and outcomes for Māori.

Ethnic variation in access to publicly funded care for unintentional injuries in older adults in Aotearoa New Zealand: a retrospective study

BACKGROUND

Māori (the Indigenous people of Aotearoa New Zealand (NZ)) are more likely to experience injury than non-Māori, but less likely to have effective access to publicly funded injury care services. It is unknown if this pattern extends into older age. This retrospective study analysed Accident Compensation Corporation (ACC; national no-fault injury compensation scheme) claims data to investigate ethnic variation in unintentional injury claims and related costs for older adults (≥50 years).

METHODS

Injury claims data for older adults residing in two regions of NZ between January 2014 and December 2018 were reviewed. Age-standardised claims rates (per person year) standardised rate ratios were calculated and compared between Māori and non-Māori. ACC claim costs (medical treatment; earning-related compensation) were estimated, with total and average costs per claim compared between the two groups.

RESULTS

There were 149 275 ACC claims (18 369 Māori; 130 906 non-Māori) among 64 238 individuals (9284 Māori; 54 954 non-Māori). The age-standardised rate of ACC claims for unintentional injury was 46% higher among non-Māori (95% CI 44% to 48%) than Māori. The ACC spend for non-Māori was NZ$155 277 962 compared with NZ$30 446 673 for Māori. Māori had a significantly higher average cost per claim (NZ$1658 vs NZ$1186, p<0.001).

CONCLUSIONS

Results of this study highlight differences in the manner in which different groups of older adults access injury compensation in NZ, indicating the need to invest in injury prevention initiatives that target older Māori, as well as initiatives supporting improved ACC access for older Māori.

"None of us are lying": an interpretive description of the search for legitimacy and the journey to access quality health services by individuals living with Long COVID

BACKGROUND

Understanding of Long COVID has advanced through patient-led initiatives. However, research about barriers to accessing Long COVID services is limited. This study aimed to better understand the need for, access to, and quality of, Long COVID services. We explored health needs and experiences of services, including ability of services to address needs.

METHODS

Our study was informed by the Levesque et al.'s (2013) "conceptual framework of access to health care." We used Interpretive Description, a qualitative approach partly aimed at informing clinical decisions. We recruited participants across five settings. Participants engaged in one-time, semi-structured, virtual interviews. Interviews were transcribed verbatim. We used reflexive thematic analysis. Best practice to ensure methodological rigour was employed.

RESULTS

Three key themes were generated from 56 interviews. The first theme illustrated the rollercoaster-like nature of participants' Long COVID symptoms and the resulting impact on function and health. The second theme highlighted participants' attempts to access Long COVID services. Guidance received from healthcare professionals and self-advocacy impacted initial access. When navigating Long COVID services within the broader system, participants encountered barriers to access around stigma; appointment logistics; testing and 'normal' results; and financial precarity and affordability of services. The third theme illuminated common factors participants liked and disliked about Long COVID services. We framed each sub-theme as the key lesson (stemming from all likes and dislikes) that, if acted upon, the health system can use to improve the quality of Long COVID services. This provides tangible ways to improve the system based directly on what we heard from participants.

CONCLUSION

With Long COVID services continuously evolving, our findings can inform decision makers within the health system to better understand the lived experiences of Long COVID and tailor services and policies appropriately.