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Odgers S, Thomas Y, Tokolahi E. Mothering occupations: A review identifying mothering occupations. Aust Occup Ther J 2024; 71:352-363. [PMID: 38105621 DOI: 10.1111/1440-1630.12921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/16/2023] [Accepted: 11/25/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION This review aimed to retrieve and collate a list of culturally relevant mothering occupations in the New Zealand context with mothers positioned as experts of their experience. Mothering occupations influence wellbeing and this study aimed to better inform on the daily occupations mothers participate in that contribute to feelings of maternal confidence. METHODS Two main sources were used to identify mothering occupations: A systematic search of mothering literature, and participant additions. The first step involved mothering literature being searched, collated and condensed. The second step involved presenting the compiled list of mothering occupations to a panel of mothers for review and to invite additions. Mothers were asked to consider the occupations they participate in that evoke feelings of confidence and mastery in their mothering. Fifteen mothers with infants 12 to 18 months old were recruited, eight contributed to the mothering occupations list. RESULTS A list of 203 items was collated then condensed based on the inclusion criteria for the participant group, and was tracked in a table. The list was reduced to 36 items. Eight participants added to the mothering occupations list, bringing the total number of items to 47. Mothers indicated through their contributions to the list that some types of mothering occupations are more relevant to them when considering feelings of maternal confidence and mastery. The mothers of this study indicated that connecting with their infant, their culture and nature are of high value to them. CONCLUSION Developing a list of culturally relevant and relatable mothering occupations is a significant undertaking, highlighting the subjective experiences of mothers. Mothering occupations are vast and influenced by context. Mothers valuing some types of occupation more in relation to maternal confidence indicates a role for occupational therapy with this population to support with engagement and participation in occupations that promote wellbeing.
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Affiliation(s)
- Sorcha Odgers
- School of Occupational Therapy, Otago Polytechnic, Dunedin, New Zealand
- Department of Occupational Therapy, School of Primary and Allied Health Care, Frankston, VIC, Australia
| | - Yvonne Thomas
- School of Occupational Therapy, Otago Polytechnic, Dunedin, New Zealand
| | - Ema Tokolahi
- School of Occupational Therapy, Otago Polytechnic, Hamilton Campus, Hamilton, New Zealand
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Andrews A, Fraser-Irwin C, Herbison K, Han DY, Evans HM, Roberts AJ. Ethnicity and socio-economic deprivation in children with intestinal failure in New Zealand: Disparities in incidence, but not in outcomes. J Paediatr Child Health 2024; 60:132-138. [PMID: 38655775 DOI: 10.1111/jpc.16550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 01/10/2024] [Accepted: 04/14/2024] [Indexed: 04/26/2024]
Abstract
AIMS The New Zealand National Intestinal Failure and Rehabilitation Service (NZ-NIFRS) was established in October 2015 to gather longitudinal data on the aetiology, clinical course and outcomes of children with intestinal failure (IF). One main objective is to achieve health equity for patients with IF in NZ. METHODS Clinical outcomes (enteral autonomy, parenteral nutrition (PN) dependence, death or intestinal transplantation) for IF patients diagnosed from October 2015 to 2018 were analysed; comparisons were made by ethnicity and socio-economic status (SES) using published 'prioritised-ethnicity' health data and the NZ index of deprivation, respectively. The Cox proportional-hazards model was used to assess time to enteral autonomy. RESULTS Of the 208 patients (55.77% male, 43.75% preterm), 170 (81.73%) achieved enteral autonomy and 14 (6.73%) remained PN dependent. Pacific and Māori children accounted for 12.98% and 27.88% of the patient cohort, respectively, compared to 9.46% and 25.65% of the NZ paediatric population. More significantly, IF patients with a high NZ socio-economic deprivation score were overrepresented, with 35.92% in the highest deprivation quintile and 10.19% in the least deprived quintile, compared to 23.53% and 20.31%, respectively, of the NZ paediatric population. There were no significant differences in primary clinical outcomes for any patients based on ethnicity or SES. CONCLUSION While disparities in ethnicity and social deprivation do exist in the incidence of IF in NZ children, clinical outcomes are similar for children regardless of ethnicity or SES. NZ-NIFRS has achieved one of its core objectives: to achieve health equity for all patients with IF nationwide.
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Affiliation(s)
- Amy Andrews
- New Zealand National Intestinal Failure & Rehabilitation Service (NZ-NIFRS), Auckland, New Zealand
- Department of Paediatric Gastroenterology, Starship Child Health, Auckland, New Zealand
| | - Cate Fraser-Irwin
- New Zealand National Intestinal Failure & Rehabilitation Service (NZ-NIFRS), Auckland, New Zealand
| | - Kim Herbison
- New Zealand National Intestinal Failure & Rehabilitation Service (NZ-NIFRS), Auckland, New Zealand
- Department of Paediatric Gastroenterology, Starship Child Health, Auckland, New Zealand
| | - Dug Y Han
- Clinical Research Office, Te Toka Tumai - Auckland, Auckland, New Zealand
| | - Helen M Evans
- New Zealand National Intestinal Failure & Rehabilitation Service (NZ-NIFRS), Auckland, New Zealand
- Department of Paediatric Gastroenterology, Starship Child Health, Auckland, New Zealand
- Department of Paediatrics, University of Auckland, Auckland, New Zealand
| | - Amin J Roberts
- New Zealand National Intestinal Failure & Rehabilitation Service (NZ-NIFRS), Auckland, New Zealand
- Department of Paediatric Gastroenterology, Starship Child Health, Auckland, New Zealand
- Department of Paediatrics, University of Auckland, Auckland, New Zealand
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Lawrie FA, Mitchell YA, Barrett-Young A, Clifford AE. Birth by emergency caesarean delivery: Perspectives of Wāhine Māori in Aotearoa New Zealand. J Health Psychol 2024:13591053231218667. [PMID: 38166570 DOI: 10.1177/13591053231218667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024] Open
Abstract
In Aotearoa New Zealand, wāhine Māori (Māori women) are overrepresented in several negative post-natal outcomes, including negative outcomes related to caesarean deliveries. We aimed to understand the experiences of wāhine Māori who had experienced a caesarean delivery and to identify how healthcare systems can better meet the needs of wāhine Māori during pre- and post-natal care. Using kaupapa Māori principles, thematic analysis of one-on-one interviews identified eight themes covering a range of issues related to overall wellbeing. Bodily autonomy and choice were discussed by all participants, as was the need for mental wellbeing to be a larger focus of perinatal care. Participants also shared positive encounters with midwives and nurses, as well as a desire to incorporate religious and cultural practices within perinatal care. The caesarean delivery birthing stories of wāhine Māori highlighted the importance of Māori health models in understanding and providing culturally-affirming healthcare to wāhine Māori across Aotearoa.
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Hobbs M, Marek L, Young A, Willing E, Dawson P, McIntyre P. Examining spatial variation for immunisation coverage in pregnant women: A nationwide and geospatial retrospective cohort study in Aotearoa New Zealand. Soc Sci Med 2023; 335:116228. [PMID: 37722144 DOI: 10.1016/j.socscimed.2023.116228] [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: 11/21/2022] [Revised: 08/03/2023] [Accepted: 09/05/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Maternal influenza and pertussis immunisation is crucial for protecting mothers during pregnancy and their babies in the first weeks of life against severe disease. We examined geospatial variation in maternal immunisation coverage among pregnant women in Aotearoa New Zealand and its health equity implications. METHOD We constructed a retrospective cohort including all pregnant women who delivered between 01 January 2013 and 31 December 2020 using administrative health datasets. Our outcomes were receipt of influenza or pertussis vaccine in any one of three relevant national databases (e.g. National Immunisation Register, Proclaims, or Pharmaceutical collection) during the eligible pregnancy. RESULTS Data from our retrospective cohort study show significant regional variation in maternal immunisation coverage for both influenza and pertussis from 2013 to 2020. Maximal coverage was around 50% in the best performing regions, which means that half of the women who were pregnant (183,737 women) were not protected. In addition, we found significant spatio-temporal variation and clustering of immunisation coverage. Our findings are interactively available to explore here: https://geohealthlab.shinyapps.io/hapumama/ CONCLUSION: Our study is one of the first to examine spatial variation in maternal vaccination coverage in pregnant women at a national level over space and time. This provides powerful tools to measure the impact of interventions to improve coverage at national and regional levels, with specific reference to inequities between ethnic groups, likely applicable to similar settings internationally.
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Affiliation(s)
- M Hobbs
- Faculty of Health, Te Kaupeka Oranga, University of Canterbury, Te Whare Wānanga o Waitaha, Christchurch, Otautahi, Aotearoa, New Zealand; GeoHealth Laboratory, Te Taiwhenua o te Hauora, Geospatial Research Institute Toi Hangarau, University of Canterbury, Te Whare Wānanga o Waitaha, Christchurch, Otautahi, Aotearoa, New Zealand.
| | - L Marek
- GeoHealth Laboratory, Te Taiwhenua o te Hauora, Geospatial Research Institute Toi Hangarau, University of Canterbury, Te Whare Wānanga o Waitaha, Christchurch, Otautahi, Aotearoa, New Zealand
| | - A Young
- School of Pharmacy, He Rau Kawakawa, University of Otago, Te Whare Wānanga o Ōtākou, Dunedin, Ōtepoti, Aotearoa, New Zealand
| | - E Willing
- Kōhatu Centre for Hauora Maori I Division of Health Sciences I Te Whare Wānanga o Ōtākou, University of Otago I Dunedin, Aotearoa, New Zealand
| | - P Dawson
- Women's & Children's Health, Dunedin School of Medicine, University of Otago, Te Whare Wānanga o Ōtākou, Dunedin, Ōtepoti, Aotearoa, New Zealand
| | - P McIntyre
- Women's & Children's Health, Dunedin School of Medicine, University of Otago, Te Whare Wānanga o Ōtākou, Dunedin, Ōtepoti, Aotearoa, New Zealand
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Abstract
A transformative approach to maternal health promotion should be mother-centred, context-driven and grounded in lived experiences. Health promotion can achieve this by drawing on its disciplinary roots to extend and reorient maternal health promotion towards an approach of non-stigmatizing and equitable health promotion that has mothers' well-being at the centre, particularly giving credit to marginalized, 'non-normative' maternities. This article draws on data from 18 workshops EN conducted across Aotearoa New Zealand, including 268 maternal health stakeholders. Drawing on design thinking, participants reimagined what a maternal health promotion approach informed by the Ottawa Charter action areas could comprise. The five themes included building connected systems close to home, developing mothering/parenting skills, addressing upstream determinants, mother-centred care and funding, and creating a collective mothering village. We discuss how these areas could better meet the unique challenges of transitioning to motherhood. Rather than focussing only on individual behaviours, many ideas reveal broader environmental and structural determinants. We link the themes to current literature and advance the agenda for centring the maternal in maternal health promotion.
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Affiliation(s)
| | - Anna Reed
- School of Health, Te Herenga Waka—Victoria University of Wellington, PO Box 600, Wellington 6140, New Zealand
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Lewycka S, Dasgupta K, Plum A, Clark T, Hedges M, Pacheco G. Determinants of ethnic differences in the uptake of child healthcare services in New Zealand: a decomposition analysis. Int J Equity Health 2023; 22:13. [PMID: 36647134 PMCID: PMC9841674 DOI: 10.1186/s12939-022-01812-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 12/19/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND There are persistent ethnic gaps in uptake of child healthcare services in New Zealand (NZ), despite increasing policy to promote equitable access. We examined ethnic differences in the uptake of immunisation and primary healthcare services at different ages and quantified the contribution of relevant explanatory factors, in order to identify potential points of intervention. METHODS We used data from the Growing Up in New Zealand birth cohort study, including children born between 2009 and 2010. Econometric approaches were used to explore underlying mechanisms behind ethnic differences in service uptake. Multivariable regression was used to adjust for mother, child, household, socioeconomic, mobility, and social factors. Decomposition analysis was used to assess the proportion of each ethnic gap that could be explained, as well as the main drivers behind the explained component. These analyses were repeated for four data time-points. RESULTS Six thousand eight hundred twenty-two mothers were enrolled during the antenatal survey, and children were followed up at 9-months, 2-years and 4-years. In univariable models, there were ethnic gaps in uptake of immunisation and primary care services. After adjusting for covariates in multivariable models, compared to NZ Europeans, Asian and Pacific children had higher timeliness and completeness of immunisation at all time-points, while indigenous Māori had lower timeliness of first-year vaccines despite high intentions to immunise. Asian and Pacific mothers were less likely to have their first-choice lead maternity caregiver (LMC) than NZ Europeans mothers, and Māori and Asian mothers were less likely to be satisfied with their general practitioner (GP) at 2-years. Healthcare utilisation was strongly influenced by socio-economic, mobility and social factors including ethnic discrimination. In decomposition models comparing Māori to NZ Europeans, the strongest drivers for timely first-year immunisations and GP satisfaction (2-years) were household composition and household income. Gaps between Pacific and NZ Europeans in timely first-year immunisations and choice of maternity carer were largely unexplained by factors included in the models. CONCLUSIONS Ethnic gaps in uptake of child healthcare services vary by ethnicity, service, and time-point, and are driven by different factors. Addressing healthcare disparities will require interventions tailored to specific ethnic groups, as well as addressing underlying social determinants and structural racism. Gaps that remain unexplained by our models require further investigation.
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Affiliation(s)
- Sonia Lewycka
- grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK ,grid.414273.70000 0004 0469 2382Oxford University Clinical Research Unit, National Hospital for Tropical Diseases, 78 Giai Phong, Dong Da District, Hanoi, Vietnam
| | - Kabir Dasgupta
- grid.252547.30000 0001 0705 7067Faculty of Business, Economics and Law, NZ Work Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Alexander Plum
- grid.252547.30000 0001 0705 7067Faculty of Business, Economics and Law, NZ Work Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Terryann Clark
- grid.9654.e0000 0004 0372 3343School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand ,Mahitahi Hauora Primary Health Entity, Whangārei, New Zealand
| | - Mary Hedges
- grid.252547.30000 0001 0705 7067Faculty of Business, Economics and Law, NZ Work Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Gail Pacheco
- grid.252547.30000 0001 0705 7067Faculty of Business, Economics and Law, NZ Work Research Institute, Auckland University of Technology, Auckland, New Zealand
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Ahmed MK, Scretching D, Lane SD. Study designs, measures and indexes used in studying the structural racism as a social determinant of health in high income countries from 2000-2022: evidence from a scoping review. Int J Equity Health 2023; 22:4. [PMID: 36609274 PMCID: PMC9817325 DOI: 10.1186/s12939-022-01796-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/22/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Globally, structural racism has been well documented as an important social determinant of health (SODH) resulting in racial inequality related to health. Although studies on structural racism have increased over the years, the selection of appropriate designs, measures, and indexes of measurement that respond to SODH has not been comprehensively documented. Therefore, the lack of evidence seems to exist. This scoping review was conducted to map and summarize global evidence on the use of various designs, measures, and indexes of measurement when studying structural racism as a social determinant of health. METHODS We performed a scoping review of global evidence from 2000 to 2022 published in 5 databases: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, Web of Science, ProQuest, and relevant grey literature on structural racism. We conducted a systematic search using keywords and subject headings around 3 concepts. We included peer reviewed original research/review articles which conceived the framework of social determinants of health (SODH) and studied structural racism. RESULTS Our review identified 1793 bibliographic citations for screening and 54 articles for final review. Articles reported 19 types of study design, 87 measures of exposure and 58 measures of health outcomes related to structural racism. 73 indexes or scales of measurement were used to assess health impacts of structural racism. Majority of articles were primary research (n = 43/54 articles; 79.6%), used quantitative research method (n = 32/54 articles; 59.3%) and predominantly conducted in the United States (n = 46/54 articles; 85.2.6%). Cross-sectional study design was the most used design (n = 17/54 articles; 31.5%) followed by systematic review (n = 7/54 articles; 13.0%) and narrative review (n = 6/54 articles; 11.1%). Housing and residential segregation was the largest cluster of exposure with the highest impact in infant health outcome. CONCLUSIONS Our review found several key gaps and research priorities on structural racism such as lack of longitudinal studies and availability of structural or ecological data, lack of consensus on the use of consolidated appropriate measures, indexes of measurement and appropriate study designs that can capture complex interactions of exposure and outcomes related to structural racism holistically.
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Affiliation(s)
- Md Koushik Ahmed
- grid.264484.80000 0001 2189 1568Department of Public Health, Falk College of Sports and Human Dynamics, Syracuse University, 150 Crouse Dr, 430 White Hall, Syracuse, NY 13244 USA
| | - Desiree Scretching
- grid.264484.80000 0001 2189 1568School of Information Studies, Syracuse University, 343 Hinds Hall, Syracuse, NY 13244 USA
| | - Sandra D. Lane
- grid.264484.80000 0001 2189 1568Department of Public Health, Falk College of Sports and Human Dynamics, 439 White Hall, Syracuse University, Syracuse, NY 13244 USA
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Burns A, DeAtley T, Short SE. The maternal health of American Indian and Alaska Native people: A scoping review. Soc Sci Med 2023; 317:115584. [PMID: 36521232 PMCID: PMC9875554 DOI: 10.1016/j.socscimed.2022.115584] [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: 07/22/2021] [Revised: 11/21/2022] [Accepted: 11/26/2022] [Indexed: 11/30/2022]
Abstract
Indigenous people in the United States experience disadvantage in multiple domains of health. Yet, their maternal health receives limited research attention. With a focus on empirical research findings, we conduct a scoping review to address two questions: 1) what does the literature tell us about the patterns and prevalence of maternal mortality and morbidity of American Indian and Alaska Native (AI/AN) people? and 2) how do existing studies explain these patterns? A search of CINAHL, Embase and Medline yielded 4757 English-language articles, with 66 eligible for close review. Of these, few focused specifically on AI/AN people's maternal health. AI/AN people experience higher levels of maternal mortality and morbidity than non-Hispanic White people, with estimates that vary substantially across samples and geography. Explanations for the maternal health of AI/AN people focused on individual factors such as poverty, cultural beliefs, and access to healthcare (e.g. lack of insurance). Studies rarely addressed the varied historical and structural contexts of AI/AN tribal nations, such as harms associated with colonization and economic marginalization. Research for and by Indigenous communities and nations is needed to redress the effective erasure of AI/AN people's maternal health experiences and to advance solutions that will promote their health and well-being.
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Affiliation(s)
- Ailish Burns
- Department of Sociology, Brown University, 108 George St Box 1916, Providence RI, 02912, USA; Population Studies and Training Center, Brown University, 68 Waterman St Box 1836, Providence RI, 02912, USA.
| | - Teresa DeAtley
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA
| | - Susan E Short
- Department of Sociology, Brown University, 108 George St Box 1916, Providence RI, 02912, USA; Population Studies and Training Center, Brown University, 68 Waterman St Box 1836, Providence RI, 02912, USA
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Jardine M, Topping C, Jansen RM. Connecting hapū māmā (pregnant women) early to a lead maternity carer: striving for equity using the Best Start-Pregnancy Tool. J Prim Health Care 2022; 14:326-332. [PMID: 36592764 DOI: 10.1071/hc22043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/08/2022] [Indexed: 01/05/2023] Open
Abstract
Introduction In Aotearoa New Zealand, lead maternity carers (LMCs) provide maternity care through pregnancy and birth, until 6 weeks' postpartum. An early LMC connection in pregnancy is associated with better maternal and perinatal health outcomes. However, hapū māmā (pregnant women) may experience barriers to engaging with LMC, delaying screening, risk assessments, and education. These barriers contribute to inequitable health outcomes for Māori māmā and pēpi (Māori mothers and babies). A pro-equity approach to maternity care is warranted. Aim To investigate the LMC plan at the first point of contact with a primary care provider once pregnancy is confirmed, as well as selected risk factors to maternal and perinatal health for Māori and non-Māori hapū māmā. Methods Data entered by primary care providers into the Best Start-Pregnancy Tool were analysed for 482 pregnant women from November 2020 to December 2021. Results Most hapū māmā planned for midwifery care. About one-third of hapū māmā had engaged with a midwife before their first GP visit after a confirmed pregnancy. Māori hapū māmā were more likely to present with risk factors to maternal and perinatal health than non-Māori hapū māmā. Discussion Primary healthcare providers have an expectation to connect hapū māmā to a LMC by 10 weeks' gestation. More research is needed to identify how to best support Māori hapū māmā to access a LMC early in pregnancy. The Best Start Kōwae is an accessible online tool (currently in an implementation phase) for primary care providers and LMCs that promotes equitable health outcomes for Māori māmā and pēpi.
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Affiliation(s)
- Marie Jardine
- Te Kupenga Hauora Maori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Chloe Topping
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Gauld N, Martin SNP, Sinclair OTR, Dumble F, Petousis-Harris H, Grant CC. Mapping the maternal vaccination journey and influencing factors for Māori women in Aotearoa New Zealand: a qualitative study. J Prim Health Care 2022; 14:352-362. [PMID: 36592768 DOI: 10.1071/hc21166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 08/31/2022] [Indexed: 01/05/2023] Open
Abstract
Introduction Uptake of maternal vaccinations (MVs) is suboptimal in Aotearoa New Zealand, particularly for Māori. Aim To describe Māori women's journeys regarding maternal pertussis and influenza vaccinations and explore influences on uptake. Methods Semi-structured interviews were conducted in Waikato, Aotearoa New Zealand, with pregnant or recently pregnant Māori women, and separately with Māori healthcare professionals (HCPs) to understand women's decisions regarding MVs and enablers and barriers to uptake. Results Nine women and nine HCPs were interviewed. Verbal communications from midwives, general practice and pharmacy strongly influenced women's journeys. Women's decisions appeared largely straight-forward, with influences including awareness, knowledge, underlying beliefs and previous MVs. Enablers for MV uptake included HCPs' discussions, pro-vaccination beliefs, and accessibility. Barriers for MV uptake included poverty (and transport), lack of awareness, insufficient knowledge of benefits, late presentation to the midwife and other commitments or challenges in the women's lives affecting prioritisation of the vaccine. Misconceptions, seasonality, and lower HCP emphasis impaired influenza vaccination uptake. Discussion With multiple barriers to accessing MVs, HCPs who see pregnant women are the primary resource to improve awareness, knowledge, and access through kōrero (discussions) with the woman and, where possible, being able to administer the vaccinations. These HCPs need to be well-informed, aware of likely concerns women may have and how to address them, encourage these discussions and preferably be trusted.
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Affiliation(s)
- Natalie Gauld
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, and School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | | | | | - Felicity Dumble
- Public Health, Waikato District Health Board, Waikato, New Zealand
| | - Helen Petousis-Harris
- Department of General Practice, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Cameron C Grant
- Department of Paediatrics: Child and Youth Health, The University of Auckland, and Starship Children's Health, Auckland, New Zealand
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11
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Young A, Charania NA, Gauld N, Norris P, Turner N, Willing E. Knowledge and decisions about maternal immunisation by pregnant women in Aotearoa New Zealand. BMC Health Serv Res 2022; 22:779. [PMID: 35698133 PMCID: PMC9192336 DOI: 10.1186/s12913-022-08162-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal vaccinations for influenza and pertussis are recommended in New Zealand to protect mothers and their infant from infection. However, maternal immunisation coverage in New Zealand is suboptimal. Furthermore, there is unacceptable inequitable maternal immunisation rates across the country with Māori and Pacific women having significantly lower maternal immunisation rates than those of other New Zealanders. METHODS This research set out to explore what pregnant/recently pregnant Māori and Pacific women knew about immunisation during pregnancy and what factors influenced their decision to be vaccinated. A semi-structured interview guide was developed with questions focusing on knowledge of pertussis and influenza vaccination during pregnancy and decision-making. Māori and Pacific women aged over 16 years were purposively sampled and interviewed in Dunedin and Gisborne, New Zealand between May and August 2021. Interviews were analysed following a directed qualitative content approach. Data were arranged into coding nodes based on the study aims (deductive analysis) informed by previous literature and within these participant experiences were inductively coded into themes and subthemes. RESULTS Not all women were aware of maternal vaccine recommendations or they diseases they protected against. Many underestimated how dangerous influenza and pertussis could be and some were more concerned about potential harms of the vaccine. Furthermore, understanding potential harms of infection and protection provided by vaccination did not necessarily mean women would choose to be vaccinated. Those who decided to vaccinate felt well-informed, had vaccination recommended by their healthcare provider, and did so to protect their and their infant's health. Those who decided against vaccination were concerned about safety of the vaccines, lacked the information they needed, were not offered the vaccine, or did not consider vaccination a priority. CONCLUSIONS There is a lack of understanding about vaccine benefits and risks of vaccine-preventable diseases which can result in the reinforcement of negative influences such as the fear of side effects. Furthermore, if vaccine benefits are not understood, inaccessibility of vaccines and the precedence of other life priorities may prevent uptake. Being well-informed and supported to make positive decisions to vaccinate in pregnancy is likely to improve vaccine coverage in Māori and Pacific Island New Zealanders.
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Affiliation(s)
- Amber Young
- Division of Health Sciences , Kōhatu-Centre for Hauora Māori, Otago Medical School, University of Otago, PO Box 56 , 9054, Dunedin, New Zealand.
| | - Nadia A Charania
- Department of Public Health, School of Public Health and Interdisciplinary Studies, Auckland University of Technology, Auckland, New Zealand
| | - Natalie Gauld
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.,School of Pharmacy, University of Auckland, Auckland, New Zealand
| | - Pauline Norris
- Va'a o Tautai - Centre for Pacific Health, University of Otago, Dunedin, New Zealand
| | - Nikki Turner
- Immunisation Advisory Centre, Department of General Practice and Primary Care, University of Auckland, Auckland, New Zealand
| | - Esther Willing
- Division of Health Sciences , Kōhatu-Centre for Hauora Māori, Otago Medical School, University of Otago, PO Box 56 , 9054, Dunedin, New Zealand
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12
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Dawson P, Auvray B, Jaye C, Gauld R, Hay-Smith J. Social determinants and inequitable maternal and perinatal outcomes in Aotearoa New Zealand. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455065221075913. [PMID: 35109729 PMCID: PMC8819758 DOI: 10.1177/17455065221075913] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Aotearoa New Zealand has demonstrable maternal and perinatal health inequity.
We examined the relationships between adverse outcomes in a total population
sample of births and a range of social determinant variables representing
barriers to equity. Methods: Using the Statistics New Zealand Integrated Data Infrastructure suite of
linked administrative data sets, adverse maternal and perinatal outcomes
(mortality and severe morbidity) were linked to socio-economic and health
variables for 97% of births in New Zealand between 2003 and 2018 (~970,000
births). Variables included housing, economic, health, crime and family
circumstances. Logistic regression examined the relationships between
adverse outcomes and social determinants, adjusting for demographics
(socio-economic deprivation, education, parity, age, rural/urban residence
and ethnicity). Results: Māori (adjusted odds ratio = 1.21, 95% confidence interval = 1.18–1.23) and
Asian women (adjusted odds ratio 1.39, 95% confidence interval = 1.36–1.43)
had poorer maternal or perinatal outcomes compared to New Zealand
European/European women. High use of emergency department (adjusted odds
ratio = 2.68, 95% confidence interval = 2.53–2.84), disability (adjusted
odds ratio = 1.98, 95% confidence interval = 1.83–2.14) and lack of
engagement with maternity care (adjusted odds ratio = 1.89, 95% confidence
interval = 1.84–1.95) had the strongest relationship with poor outcomes. Conclusion: Maternal health inequity was strongly associated with a range of
socio-economic and health determinants. While some of these factors can be
targeted for interventions, the study highlights larger structural and
systemic issues that affect maternal and perinatal health.
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13
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Leitch S, Zeng J, Smith A, Stokes T. Medication risk management and health equity in New Zealand general practice: a retrospective cross-sectional study. Int J Equity Health 2021; 20:119. [PMID: 33975606 PMCID: PMC8111894 DOI: 10.1186/s12939-021-01461-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite an overt commitment to equity, health inequities are evident throughout Aotearoa New Zealand. A general practice electronic alert system was developed to notify clinicians about their patient's risk of harm due to their pre-existing medical conditions or current medication. We aimed to determine whether there were any disparities in clinician action taken on the alert based on patient ethnicity or other demographic factors. METHODS Sixty-six New Zealand general practices from throughout New Zealand participated. Data were available for 1611 alerts detected for 1582 patients between 1 and 2018 and 1 July 2019. The primary outcome was whether action was taken following an alert or not. Logistic regression was used to assess if patients of one ethnicity group were more or less likely to have action taken. Potential confounders considered in the analyses include patient age, gender, ethnicity, socio-economic deprivation, number of long term diagnoses and number of long term medications. RESULTS No evidence of a difference was found in the odds of having action taken amongst ethnicity groups, however the estimated odds for Māori and Pasifika patients were lower compared to the European group (Māori OR 0.88, 95 %CI 0.63-1.22; Pasifika OR 0.88, 95 %CI 0.52-1.49). Females had significantly lower odds of having action taken compared to males (OR 0.76, 95 %CI 0.59-0.96). CONCLUSIONS This analysis of data arising from a general practice electronic alert system in New Zealand found clinicians typically took action on those alerts. However, clinicians appear to take less action for women and Māori and Pasifika patients. Use of a targeted alert system has the potential to mitigate risk from medication-related harm. Recognising clinician biases may improve the equitability of health care provision.
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Affiliation(s)
- Sharon Leitch
- Department of General Practice and Rural Health, Otago Medical School - Dunedin Campus, University of Otago, Dunedin, New Zealand.
| | - Jiaxu Zeng
- Department of Preventive and Social Medicine, Otago Medical School - Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Alesha Smith
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Tim Stokes
- Department of General Practice and Rural Health, Otago Medical School - Dunedin Campus, University of Otago, Dunedin, New Zealand
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14
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Hickey S, Roe Y, Ireland S, Kildea S, Haora P, Gao Y, Maypilama EL, Kruske S, Campbell S, Moore S, Maidment SJ, Heinemann K, Hartz D, Adcock A, Storey F, Bennett M, Lambert C, Sibanda N, Lawton B, Cram F, Stevenson K, Lavoie J, Edmonds L, Geller S, Bourrassa C, Smylie J, Van Wagner V, Bourgeois C, Dion Fletcher C, King A, Briggs M, Worner F, Wellington C, Carson A, Nelson C, Watego K, Brown-Lolohea K, Colman K, Currie J, Lowell A, West R, Chamberlain C, Geia L, Sherwood J. A call for action that cannot go to voicemail: Research activism to urgently improve Indigenous perinatal health and wellbeing. Women Birth 2021; 34:303-305. [PMID: 33935005 DOI: 10.1016/j.wombi.2021.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 03/28/2021] [Indexed: 11/19/2022]
Abstract
In this call to action, a coalition of Indigenous and non-Indigenous researchers from Australia, Aotearoa New Zealand, United States and Canada argue for the urgent need for adequately funded Indigenous-led solutions to perinatal health inequities for Indigenous families in well-resourced settler-colonial countries. Authors describe examples of successful community-driven programs making a difference and call on all peoples to support and resource Indigenous-led perinatal health services by providing practical actions for individuals and different groups.
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Affiliation(s)
- Sophie Hickey
- Molly Wardaguga Research Centre, Charles Darwin University, Australia.
| | - Yvette Roe
- Molly Wardaguga Research Centre, Charles Darwin University, Australia
| | - Sarah Ireland
- Molly Wardaguga Research Centre, Charles Darwin University, Australia
| | - Sue Kildea
- Molly Wardaguga Research Centre, Charles Darwin University, Australia
| | - Penny Haora
- Molly Wardaguga Research Centre, Charles Darwin University, Australia
| | - Yu Gao
- Molly Wardaguga Research Centre, Charles Darwin University, Australia
| | | | - Sue Kruske
- Molly Wardaguga Research Centre, Charles Darwin University, Australia
| | - Sandy Campbell
- Molly Wardaguga Research Centre, Charles Darwin University, Australia
| | - Suzanne Moore
- Molly Wardaguga Research Centre, Charles Darwin University, Australia
| | | | - Kayla Heinemann
- Molly Wardaguga Research Centre, Charles Darwin University, Australia
| | - Donna Hartz
- Molly Wardaguga Research Centre, Charles Darwin University, Australia
| | - Anna Adcock
- Te Tātai Hauora O Hine - Centre for Women's Health Research, Te Wāhanga Tātai Hauora-Wellington Faculty of Health, Te Herenga Waka-Victoria University of Wellington, Aotearoa New Zealand
| | - Francesca Storey
- Te Tātai Hauora O Hine - Centre for Women's Health Research, Te Wāhanga Tātai Hauora-Wellington Faculty of Health, Te Herenga Waka-Victoria University of Wellington, Aotearoa New Zealand
| | - Matthew Bennett
- Te Tātai Hauora O Hine - Centre for Women's Health Research, Te Wāhanga Tātai Hauora-Wellington Faculty of Health, Te Herenga Waka-Victoria University of Wellington, Aotearoa New Zealand
| | - Charles Lambert
- Te Tātai Hauora O Hine - Centre for Women's Health Research, Te Wāhanga Tātai Hauora-Wellington Faculty of Health, Te Herenga Waka-Victoria University of Wellington, Aotearoa New Zealand
| | - Nokuthaba Sibanda
- Te Tātai Hauora O Hine - Centre for Women's Health Research, Te Wāhanga Tātai Hauora-Wellington Faculty of Health, Te Herenga Waka-Victoria University of Wellington, Aotearoa New Zealand
| | - Beverley Lawton
- Te Tātai Hauora O Hine - Centre for Women's Health Research, Te Wāhanga Tātai Hauora-Wellington Faculty of Health, Te Herenga Waka-Victoria University of Wellington, Aotearoa New Zealand
| | | | | | - Josée Lavoie
- Faculty of Health Sciences, University of Manitoba, Canada
| | - Liza Edmonds
- Southern District Health Board, Aotearoa New Zealand; Otago Medical School, University of Otago, Aotearoa New Zealand
| | - Stacie Geller
- Center for Research on Women & Gender, Department of Obstetrics & Gynecology, University of Illinois, United States
| | | | - Janet Smylie
- Well Living House Action Research Centre for Indigenous Infant, Child and Family Health and Wellbeing, St. Michael's Hospital, Dalla Lana School of Public Health, University of Toronto, Canada
| | | | - Cheryllee Bourgeois
- School of Midwifery, Ryerson University, Canada; Seventh Generation Midwives Toronto, Canada
| | - Claire Dion Fletcher
- School of Midwifery, Ryerson University, Canada; Seventh Generation Midwives Toronto, Canada
| | | | - Melanie Briggs
- Waminda South Coast Women's Health and Welfare Aboriginal Corporation, Australia
| | - Faye Worner
- Waminda South Coast Women's Health and Welfare Aboriginal Corporation, Australia
| | - Cleone Wellington
- Waminda South Coast Women's Health and Welfare Aboriginal Corporation, Australia
| | | | | | | | | | - Kady Colman
- Institute for Urban Indigenous Health, Australia
| | - Jody Currie
- Aboriginal and Torres Strait Islander Community Health Service Brisbane Limited, Australia
| | - Anne Lowell
- Northern Institute, Charles Darwin University, Australia
| | - Roianne West
- Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, Australia
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15
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Neely E, Dixon L, Bartle C, Raven B, Aspin C. Providing maternity care for disadvantaged women in Aotearoa New Zealand: The impact on midwives. Women Birth 2021; 35:144-151. [PMID: 33858787 DOI: 10.1016/j.wombi.2021.03.014] [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: 12/08/2020] [Revised: 03/22/2021] [Accepted: 03/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Health inequities and socio-economic disadvantage are causes for concern in Aotearoa New Zealand. Becoming pregnant can increase a woman's vulnerability to poverty, with the potential for an increase in multiple stressful life events. Providing midwifery care to women living in socio-economic deprivation has been found to add additional strains for midwives. Exploring the perspectives of the midwives providing care to women living with socio-economic deprivation can illuminate the complexities of maternity care. AIM To explore the impact on midwives when providing care for socio-economically disadvantaged women in Aotearoa New Zealand. METHOD Inductive thematic analysis was used to analyse an open-ended question from a survey that asked midwives to share a story around maternal disadvantage and midwifery care. FINDINGS A total of 214 stories were received from midwives who responded to the survey. Providing care to disadvantaged women had an impact on midwives by incurring increased personal costs (time, financial and emotional), requiring them to navigate threats and uncertainty and to feel the need to remedy structural inequities for women and their wider families. These three themes were moderated by the relationships midwives held with women and affected the way midwives worked across the different maternity settings. CONCLUSION Midwives carry a greater load when providing care to socio-economically deprived women. Enabling midwives to continue to provide the necessary support for women living in socio-economic deprivation is imperative and requires additional resources and funding.
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Affiliation(s)
- Eva Neely
- School of Health, Victoria University of Wellington, PO Box 600, Wellington 6140, New Zealand; Maternity Equity Action, Hawkes Bay, New Zealand.
| | - Lesley Dixon
- New Zealand College of Midwives, 376 Manchester Street, Richmond, Christchurch 8014, New Zealand.
| | - Carol Bartle
- New Zealand College of Midwives, 376 Manchester Street, Richmond, Christchurch 8014, New Zealand.
| | - Briony Raven
- Maternity Equity Action, Hawkes Bay, New Zealand.
| | - Clive Aspin
- School of Health, Victoria University of Wellington, PO Box 600, Wellington 6140, New Zealand.
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16
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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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17
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"Ashamed, Silent and Stuck in a System"-Applying a Structural Violence Lens to Midwives' Stories on Social Disadvantage in Pregnancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249355. [PMID: 33327578 PMCID: PMC7765080 DOI: 10.3390/ijerph17249355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 01/12/2023]
Abstract
Historical and enduring maternal health inequities and injustices continue to grow in Aotearoa New Zealand, despite attempts to address the problem. Pregnancy increases vulnerability to poverty through a variety of mechanisms. This project qualitatively analysed an open survey response from midwives about their experiences of providing maternity care to women living with social disadvantage. We used a structural violence lens to examine the effects of social disadvantage on pregnant women. The analysis of midwives’ narratives exposed three mechanisms by which women were exposed to structural violence, these included structural disempowerment, inequitable risk and the neoliberal system. Women were structurally disempowered through reduced access to agency, lack of opportunities and inadequate meeting of basic human needs. Disadvantage exacerbated risks inequitably by increasing barriers to care, exacerbating the impact of adverse life circumstances and causing chronic stress. Lastly, the neoliberal system emphasised individual responsibility that perpetuated inequities. Despite the stated aim of equitable access to health care for all in policy documents, the current system and social structure continues to perpetuate systemic disadvantage.
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