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Caldwell HA, Yusuf J, Carrea C, Conrad P, Embrett M, Fierlbeck K, Hajizadeh M, Kirk SF, Rothfus M, Sampalli T, Sim SM, Tomblin Murphy G, Williams L. Strategies and indicators to integrate health equity in health service and delivery systems in high-income countries: a scoping review. JBI Evid Synth 2024; 22:949-1070. [PMID: 38632975 PMCID: PMC11163892 DOI: 10.11124/jbies-23-00051] [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] [Indexed: 04/19/2024]
Abstract
OBJECTIVE The objective of this review was to describe how health service and delivery systems in high-income countries define and operationalize health equity. A secondary objective was to identify implementation strategies and indicators being used to integrate and measure health equity. INTRODUCTION To improve the health of populations, a population health and health equity approach is needed. To date, most work on health equity integration has focused on reducing health inequities within public health, health care delivery, or providers within a health system, but less is known about integration across the health service and delivery system. INCLUSION CRITERIA This review included academic and gray literature sources that described the definitions, frameworks, level of integration, strategies, and indicators that health service and delivery systems in high-income countries have used to describe, integrate, and/or measure health equity. Sources were excluded if they were not available in English (or a translation was not available), were published before 1986, focused on strategies that were not implemented, did not provide health equity indicators, or featured strategies that were implemented outside the health service or delivery systems (eg, community-based strategies). METHODS This review was conducted in accordance with the JBI methodology for scoping reviews. Titles and abstracts were screened for eligibility followed by a full-text review to determine inclusion. The information extracted from the included studies consisted of study design and key findings, such as health equity definitions, strategies, frameworks, level of integration, and indicators. Most data were quantitatively tabulated and presented according to 5 secondary review questions. Some findings (eg, definitions and indicators) were summarized using qualitative methods. Most findings were visually presented in charts and diagrams or presented in tabular format. RESULTS Following review of 16,297 titles and abstracts and 824 full-text sources, we included 122 sources (108 scholarly and 14 gray literature) in this scoping review. We found that health equity was inconsistently defined and operationalized. Only 17 sources included definitions of health equity, and we found that both indicators and strategies lacked adequate descriptions. The use of health equity frameworks was limited and, where present, there was little consistency or agreement in their use. We found that strategies were often specific to programs, services, or clinics, rather than broadly applied across health service and delivery systems. CONCLUSIONS Our findings suggest that strategies to advance health equity work are siloed within health service and delivery systems, and are not currently being implemented system-wide (ie, across all health settings). Healthy equity definitions and frameworks are varied in the included sources, and indicators for health equity are variable and inconsistently measured. Health equity integration needs to be prioritized within and across health service and delivery systems. There is also a need for system-wide strategies to promote health equity, alongside robust accountability mechanisms for measuring health equity. This is necessary to ensure that an integrated, whole-system approach can be consistently applied in health service and delivery systems internationally. REVIEW REGISTRATION DalSpace dalspace.library.dal.ca/handle/10222/80835.
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Affiliation(s)
- Hilary A.T. Caldwell
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Joshua Yusuf
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Cecilia Carrea
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Patricia Conrad
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | | | - Katherine Fierlbeck
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- MacEachen Institute for Public Policy and Governance, Dalhousie University, Halifax, NS, Canada
- Dalhousie Libraries, Dalhousie University, Halifax, NS, Canada
| | - Mohammad Hajizadeh
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Sara F.L. Kirk
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Melissa Rothfus
- Department of Political Science, Dalhousie University, Halifax, NS, Canada
| | | | - Sarah Meaghan Sim
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health, Halifax, NS, Canada
| | | | - Lane Williams
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
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Matheson A, Wehipeihana N, Gray R, Walton M, Uia T, Lindberg K, Shanthakumar M, Lopez MI, Reidy J, Firestone R, Ellison-Loschmann L. Building a systems-thinking community workforce to scale action on determinants of health in New Zealand. Health Place 2024; 87:103255. [PMID: 38710122 DOI: 10.1016/j.healthplace.2024.103255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/08/2024]
Abstract
This article describes findings from the evaluation of Healthy Families NZ (HFNZ), an equity-driven, place-based community health initiative. Implemented in nine diverse communities across New Zealand, HFNZ aims to strengthen the systems that can improve health and well-being. Findings highlight local needs and priorities including the social mechanisms important for reorienting health and policy systems towards place-based communities. Lessons encompass the importance of local lived experience in putting evidence into practice; the strength of acting with systems in mind; the need for relational, learning, intentional, and well-resourced community organisation; examples of how to foster place-based 'community-up' leadership; and how to enable responsiveness between communities and local and national policy systems. A reconceptualisation of scaling in the context of complexity and systems change is offered, which recognises that relationships and agency are key to making progress on the determinants of health.
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Affiliation(s)
- Anna Matheson
- School of Health, Te Herenga Waka - Victoria University of Wellington, Kelburn 6012, Wellington, New Zealand.
| | - Nan Wehipeihana
- Weaving Insights, PO Box 147, Levin 5540, Horowhenua, New Zealand
| | - Rebecca Gray
- School of Health, Te Herenga Waka - Victoria University of Wellington, Kelburn 6012, Wellington, New Zealand
| | - Mat Walton
- Institute of Environmental Science and Research Limited (ESR), Kenepuru Science Centre: 34 Kenepuru Drive, Kenepuru, Porirua 5022, PO Box 50348, Porirua 5240, New Zealand
| | - Tali Uia
- School of Health, Te Herenga Waka - Victoria University of Wellington, Kelburn 6012, Wellington, New Zealand
| | - Kirstin Lindberg
- Environmental Health Intelligence New Zealand, Massey University, Wallace Street, Mount Cook, Wellington 6021, New Zealand
| | - Mathu Shanthakumar
- Environmental Health Intelligence New Zealand, Massey University, Wallace Street, Mount Cook, Wellington 6021, New Zealand
| | - Maite Irurzun Lopez
- Health Services Research Centre, Te Herenga Waka, Victoria University of Wellington, Kelburn 6012, Wellington, New Zealand
| | - Johanna Reidy
- School of Health, Te Herenga Waka - Victoria University of Wellington, Kelburn 6012, Wellington, New Zealand
| | - Riz Firestone
- Centre for Hauora and Health, Massey University, Wallace Street, Mount Cook, Wellington 6021, New Zealand
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Gustafson P, Lambert M, Bartholomew K, Ratima M, Aziz YA, Kremer L, Fusheini A, Carswell P, Brown R, Priest P, Crengle S. Adapting an equity-focused implementation process framework with a focus on ethnic health inequities in the Aotearoa New Zealand context. Int J Equity Health 2024; 23:15. [PMID: 38280997 PMCID: PMC10822165 DOI: 10.1186/s12939-023-02087-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/20/2023] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND Health intervention implementation in Aotearoa New Zealand (NZ), as in many countries globally, usually varies by ethnicity. Māori (the Indigenous peoples of Aotearoa) and Pacific peoples are less likely to receive interventions than other ethnic groups, despite experiencing persistent health inequities. This study aimed to develop an equity-focused implementation framework, appropriate for the Aotearoa NZ context, to support the planning and delivery of equitable implementation pathways for health interventions, with the intention of achieving equitable outcomes for Māori, as well as people originating from the Pacific Islands. METHODS A scoping review of the literature to identify existing equity-focused implementation theories, models and frameworks was undertaken. One of these, the Equity-based framework for Implementation Research (EquIR), was selected for adaptation. The adaptation process was undertaken in collaboration with the project's Māori and consumer advisory groups and informed by the expertise of local health equity researchers and stakeholders, as well as the international implementation science literature. RESULTS The adapted framework's foundation is the principles of Te Tiriti o Waitangi (the written agreement between Māori rangatira (chiefs) and the British Crown), and its focus is whānau (extended family)-centred implementation that meets the health and wellbeing aspirations, priorities and needs of whānau. The implementation pathway comprises four main steps: implementation planning, pathway design, monitoring, and outcomes and evaluation, all with an equity focus. The pathway is underpinned by the core constructs of equitable implementation in Aotearoa NZ: collaborative design, anti-racism, Māori and priority population expertise, cultural safety and values-based. Additionally, the contextual factors impacting implementation, i.e. the social, economic, commercial and political determinants of health, are included. CONCLUSIONS The framework presented in this study is the first equity-focused process-type implementation framework to be adapted for the Aotearoa NZ context. This framework is intended to support and facilitate equity-focused implementation research and health intervention implementation by mainstream health services.
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Affiliation(s)
- Papillon Gustafson
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, PO Box 56, Dunedin, Aotearoa, New Zealand, 9054
| | - Michelle Lambert
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, PO Box 56, Dunedin, Aotearoa, New Zealand, 9054
| | - Karen Bartholomew
- Te Whatu Ora Waitematā and Te Toka Tumai Auckland, Auckland, Aotearoa, New Zealand
| | - Mihi Ratima
- Taumata Associates, Hāwera, Aotearoa, New Zealand
| | - Yasmin Abdul Aziz
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, PO Box 56, Dunedin, Aotearoa, New Zealand, 9054
| | - Lisa Kremer
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, PO Box 56, Dunedin, Aotearoa, New Zealand, 9054
| | - Adam Fusheini
- Preventive and Social Medicine, University of Otago, Dunedin Campus, Dunedin, Aotearoa, New Zealand
| | | | - Rachel Brown
- National Hauora Coalition, Auckland, Aotearoa, New Zealand
| | - Patricia Priest
- Preventive and Social Medicine, University of Otago, Dunedin Campus, Dunedin, Aotearoa, New Zealand
| | - Sue Crengle
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, PO Box 56, Dunedin, Aotearoa, New Zealand, 9054.
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Gustafson P, Abdul Aziz Y, Lambert M, Bartholomew K, Rankin N, Fusheini A, Brown R, Carswell P, Ratima M, Priest P, Crengle S. A scoping review of equity-focused implementation theories, models and frameworks in healthcare and their application in addressing ethnicity-related health inequities. Implement Sci 2023; 18:51. [PMID: 37845686 PMCID: PMC10578009 DOI: 10.1186/s13012-023-01304-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/14/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Inequities in implementation contribute to the unequal benefit of health interventions between groups of people with differing levels of advantage in society. Implementation science theories, models and frameworks (TMFs) provide a theoretical basis for understanding the multi-level factors that influence implementation outcomes and are used to guide implementation processes. This study aimed to identify and analyse TMFs that have an equity focus or have been used to implement interventions in populations who experience ethnicity or 'race'-related health inequities. METHODS A scoping review was conducted to identify the relevant literature published from January 2011 to April 2022 by searching electronic databases (MEDLINE and CINAHL), the Dissemination and Implementation model database, hand-searching key journals and searching the reference lists and citations of studies that met the inclusion criteria. Titles, abstracts and full-text articles were screened independently by at least two researchers. Data were extracted from studies meeting the inclusion criteria, including the study characteristics, TMF description and operationalisation. TMFs were categorised as determinant frameworks, classic theories, implementation theories, process models and evaluation frameworks according to their overarching aim and described with respect to how equity and system-level factors influencing implementation were incorporated. RESULTS Database searches yielded 610 results, 70 of which were eligible for full-text review, and 18 met the inclusion criteria. A further eight publications were identified from additional sources. In total, 26 papers describing 15 TMFs and their operationalisation were included. Categorisation resulted in four determinant frameworks, one implementation theory, six process models and three evaluation frameworks. One framework included elements of determinant, process and evaluation TMFs and was therefore classified as a 'hybrid' framework. TMFs varied in their equity and systems focus. Twelve TMFs had an equity focus and three were established TMFs applied in an equity context. All TMFs at least partially considered systems-level factors, with five fully considering macro-, meso- and micro-level influences on equity and implementation. CONCLUSIONS This scoping review identifies and summarises the implementation science TMFs available to support equity-focused implementation. This review may be used as a resource to guide TMF selection and illustrate how TMFs have been utilised in equity-focused implementation activities.
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Affiliation(s)
- Papillon Gustafson
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, Dunedin, Aotearoa, PO Box 56, 9054, New Zealand
| | - Yasmin Abdul Aziz
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, Dunedin, Aotearoa, PO Box 56, 9054, New Zealand
| | - Michelle Lambert
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, Dunedin, Aotearoa, PO Box 56, 9054, New Zealand
| | - Karen Bartholomew
- Te Whatu Ora Waitematā and Te Toka Tumai Auckland, Auckland, Aotearoa, New Zealand
| | - Nicole Rankin
- Evaluation and Implementation Science Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Adam Fusheini
- Preventive and Social Medicine, University of Otago, Dunedin Campus, Dunedin, Aotearoa, New Zealand
| | - Rachel Brown
- National Hauora Coalition, Auckland, Aotearoa, New Zealand
| | | | - Mihi Ratima
- Taumata Associates, Hāwera, Aotearoa, New Zealand
| | - Patricia Priest
- Preventive and Social Medicine, University of Otago, Dunedin Campus, Dunedin, Aotearoa, New Zealand
| | - Sue Crengle
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, Dunedin, Aotearoa, PO Box 56, 9054, New Zealand.
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Kovanur Sampath K, Ann-Rong Y, Haggie M, Tapara T, Brownie S. Exploring the option of student-run free health clinics to support people living with type 2 diabetes mellitus: a scoping review. Front Public Health 2023; 11:1128617. [PMID: 37533530 PMCID: PMC10392832 DOI: 10.3389/fpubh.2023.1128617] [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: 12/20/2022] [Accepted: 06/27/2023] [Indexed: 08/04/2023] Open
Abstract
Diabetes is a major cause of morbidity and premature mortality worldwide and now identified as a 'public health emergency' and a 'modern and preventable pandemic'. Indigenous populations are disproportionately affected by type 2 diabetes mellitus (T2DM) and associated complications. Student run free clinics (SRFCs) may play an important role in the prevention and management of T2DM. The primary objective of this scoping review was to investigate the opportunity for curriculum enhancement through the role and effectiveness of SRFCs in managing T2DM. Electronic databases such as PubMed, CINAHL, Science Direct and Cochrane Library were searched from inception to October 2022. Identified records from database literature searches were imported into Covidence®. Two independent reviewers screened and extracted the data. The research team collectively created a data charting table/form to standardize data collection. A narrative synthesis was used to summarize the evidence. Six studies (total of 319 participants) that met our eligibility criteria were included in this scoping review. SRFCs can provide high-quality diabetic care, especially for uninsured and economically weaker population. Preliminary evidence further indicate that shared medical appointments and telehealth may facilitate diabetic care especially during times where access to care may be difficult (e.g., COVID lockdown). However, no study included in the review explored or discussed family centred/culturally sensitive interventions. Hence, such interventions should be made part of the curriculum in the future with students in SRFCs exposed to such an approach.
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Affiliation(s)
- Kesava Kovanur Sampath
- Waikato Institute of Technology – Te Pukenga, Hamilton, New Zealand
- University of Canberra, Canberra, ACT, Australia
| | - Yan Ann-Rong
- University of Canberra, Canberra, ACT, Australia
| | - Marrin Haggie
- Waikato Institute of Technology – Te Pukenga, Hamilton, New Zealand
| | - Timi Tapara
- Tu Tonu Rehabilitation Ltd., Hamilton, New Zealand
| | - Sharon Brownie
- University of Canberra, Canberra, ACT, Australia
- Swinburne University, Melbourne, VIC, Australia
- Griffith University, Gold Coast, QLD, Australia
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Mack M, Savila F, Bagg W, Harwood M, Swinburn B, Goodyear-Smith F. Interventions to prevent or manage obesity in Māori and Pacific adults: a systematic review and narrative synthesis. ETHNICITY & HEALTH 2023; 28:562-585. [PMID: 35608909 DOI: 10.1080/13557858.2022.2078482] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Obesity and its sequelae are an increasing problem, disproportionally affecting Māori and Pacific peoples, secondary to multifactorial systemic causes, including the effects of colonisation and the impact of globalisation. There is limited synthesised evidence on interventions to address obesity in these populations. The objective of this review is to identify evaluated interventions for prevention and management of obesity amongst Māori and Pacific adults, assess the effectiveness of these interventions, and identify enablers and barriers to their uptake. DESIGN Systematic review of databases (Medline, PubMed, EMBASE, CINAHL, Scopus, CENTRAL), key non-indexed journals, and reference lists of included articles were searched from inception to June 2021. Eligibility criteria defined using a Population, Intervention, Control, Outcome format and study/publication characteristics. Quantitative and qualitative data were extracted and analysed using narrative syntheses. Study quality was assessed using modified GRADE approach. RESULTS From the 8190 articles identified, 21 were included, with 18 eligible for quantitative and five for qualitative analysis. The studies were heterogenous, with most graded as low quality. Some studies reported small but statistically significant improvements in weight and body mass index. Key enablers identified were social connection, making achievable sustainable lifestyle changes, culturally-centred interventions and incentives including money and enjoyment. Barriers to intervention uptake included difficulty in maintaining adherence to a programme due to intrinsic programme factors such as lack of social support and malfunctioning or lost equipment. CONCLUSIONS Normal weight trajectory is progressive increase over time. Modest weight loss or no weight gain after several years may have a positive outcome in lowering progression to diabetes, or improvement of glycaemic control in people with diabetes. We recommend urgent implementation of Māori and Pacific-led, culturally-tailored weight loss programmes that promote holistic, small and sustainable lifestyle changes delivered in socially appropriate contexts.
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Affiliation(s)
- Michaela Mack
- Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
| | - F Savila
- Pacific Health, School of Population Health, University of Auckland, Auckland, New Zealand
| | - W Bagg
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - M Harwood
- Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
| | - B Swinburn
- Department of Epidemiology & Biostatistics, University of Auckland, Auckland, New Zealand
| | - F Goodyear-Smith
- Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
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Urquhart L, Roberts (Dunghutti) K, Gibbs (Muruwari) C, Fisher K, Brown LJ, Duncanson K. Experiences of co-designing research about a rural Aboriginal well-being program: Informing practice and policy. Aust J Rural Health 2022; 30:747-759. [PMID: 36250967 PMCID: PMC10092418 DOI: 10.1111/ajr.12924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/10/2022] [Accepted: 09/11/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The objective of this study was to explore data and Aboriginal and non-Aboriginal researchers' experiences and reflexivity in co-designing research about a rural Aboriginal well-being program to inform practice and policy. SETTING Gumbaynggirr, Birpai, Kamilaroi and Awabakal countries located in regional and rural New South Wales, Australia. PARTICIPANTS Rural and regionally located research team who co-designed processes to challenge the status quo about a critically framed, rural-based Aboriginal well-being research project. DESIGN Researchers drew on data from a research project in an interpretive cycle of collaborative Yarning. Data included 90 published articles, 12 Yarning transcripts and 26 reflective journal text sets, as well as researcher experiences and reflexivity. RESULTS The Duguula Gayirray (Yarning together), Yandaarray (walking together) and Duguula Nguraljili (sharing together) co-design practice model was developed to represent key actions in the context of an Aboriginal well-being program in a rural context. Actions were supported by seven interpersonal ways of being and were underpinned by respectful relationships between community and researchers. DISCUSSION Duguula Gayirray, Yandaarray and Duguula Nguraljili are critical to co-design practice and are grounded in respectful relationships. Our experiences led us to critique our perceptions of power sharing, equitable partnerships and collaborative knowledges towards opportunity for collective research co-design. CONCLUSION Duguula Gayirray, Yandaarray and Duguula Nguraljili transformed our understanding of achieving liberation from dominant western research in the context of a rurally located Australian Aboriginal well-being program. This study contributes to progression of Aboriginal health research practice and policy recommendations, enabling real cultural change in health care with rurally located Aboriginal communities.
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Affiliation(s)
- Lisa Urquhart
- Department of Rural Health, College of Health, Medicine and WellbeingThe University of NewcastleCoffs HarbourNew South WalesAustralia
| | | | | | - Karin Fisher
- Department of Rural Health, College of Health, Medicine and WellbeingThe University of NewcastleTamworthNew South WalesAustralia
| | - Leanne J. Brown
- Department of Rural Health, College of Health, Medicine and WellbeingThe University of NewcastleTamworthNew South WalesAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
| | - Kerith Duncanson
- Centre of Research Excellence in Digestive HealthUniversity of NewcastleCallaghanNew South WalesAustralia
- College of Health, Medicine and WellbeingThe University of NewcastleCallaghanNew South WalesAustralia
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Talevski J, Kulnik ST, Jessup RL, Falls R, Cvetanovska N, Beauchamp A. Use of co-design methodology in the development of cardiovascular disease secondary prevention interventions: A scoping review. Health Expect 2022; 26:16-29. [PMID: 36366855 PMCID: PMC9854329 DOI: 10.1111/hex.13633] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/29/2022] [Accepted: 10/02/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION There is growing evidence to support the use of co-design in developing interventions across many disciplines. This scoping review aims to examine how co-design methodology has been used in the development of cardiovascular disease (CVD) secondary prevention interventions within health and community settings. METHODS We searched four academic databases for studies that used the co-design approach to develop their intervention. Studies were included if consumers (adults with CVD) and key stakeholders (e.g. clinicians, service providers) were involved in the co-design process. The review focused on methodology rather than traditional study outcomes; therefore, co-design processes and activities were extracted and evaluated against a selected co-design framework. RESULTS Twenty-two studies were included in this review. Studies were implemented across various settings with consumers and stakeholder groups most frequently consisting of patients and healthcare professionals, respectively. Most studies specifically stated that they used a 'co-design' approach (n = 10); others used terms such as participatory action research (n = 3), user-centred design (n = 3) and community-based participatory research (n = 2). Although there was variability in terminology, co-design processes, and participants, all studies adhered to the key principles of consumer engagement. Predominant co-design activities included semistructured interviews, focus groups, co-design/development workshops and advisory group meetings. Intervention effectiveness was assessed in eight studies showing mixed results. CONCLUSIONS This review provides an overview of how the co-design approach has previously been used in the development of CVD secondary prevention interventions. These findings provide methodological considerations that can guide researchers and healthcare services when implementing co-design to develop feasible and acceptable interventions that can improve outcomes for CVD populations. PATIENT OR PUBLIC CONTRIBUTION No patients, service users, caregivers, people with lived experience or members of the public were involved in this scoping review. This review article was written by academics who have undertaken a significant amount of co-design work with consumers and stakeholders.
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Affiliation(s)
- Jason Talevski
- Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition SciencesDeakin UniversityGeelongVictoriaAustralia,School of Rural HealthMonash UniversityWarragulVictoriaAustralia,Australian Institute for Musculoskeletal Science (AIMSS)The University of Melbourne and Western HealthSt AlbansVictoriaAustralia
| | - Stefan T. Kulnik
- Ludwig Boltzmann Institute for Digital Health and PreventionSalzburgAustria,Faculty of Health, Social Care and EducationKingston University and St George's University of LondonLondonUK
| | - Rebecca L. Jessup
- School of Rural HealthMonash UniversityWarragulVictoriaAustralia,Academic and Research Collaborative in HealthLa Trobe UniversityBundooraVictoriaAustralia,Allied Health Research, Northern HealthEppingVictoriaAustralia
| | - Roman Falls
- Western Centre for Health Research and Education, Sunshine HospitalSt AlbansVictoriaAustralia
| | - Natali Cvetanovska
- School of Rural HealthMonash UniversityWarragulVictoriaAustralia,Office of Research, Northern HealthEppingVictoriaAustralia
| | - Alison Beauchamp
- School of Rural HealthMonash UniversityWarragulVictoriaAustralia,Australian Institute for Musculoskeletal Science (AIMSS)The University of Melbourne and Western HealthSt AlbansVictoriaAustralia,Victorian Heart InstituteMonash UniversityClaytonVictoriaAustralia
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Palu E, MacMillan DF, McBride DKA, Thomson DR, Zarora R, Simmons D. Effects of lifestyle interventions on weight amongst Pasifika communities: A systematic review and meta-analysis. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 25:100483. [PMID: 35669931 PMCID: PMC9162936 DOI: 10.1016/j.lanwpc.2022.100483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Pasifika populations experience high incidence and prevalence of obesity and T2DM. However, no international review of lifestyle intervention studies amongst Pasifika communities exists. This study seeks to identify the effect and translatability of lifestyle strategies on weight amongst Pasifika populations. METHODS Lifestyle studies involving ≥90% adult Pasifika participants measuring weight change were eligible for inclusion. Database searching was carried out up to December 2021. Databases searched were MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCOhost) and ProQuest Central. Risk of bias was assessed using RoB2 (RCTs) and the National Heart, Lung and Blood Institute (NHLBI) quality assessment tool. Meta-analysis and meta-regression used a bivariate random-effects model. Strategies were coded against pre-identified components of the newly proposed Cultural and Sustainability Assessment of Intervention (CSAI) framework. FINDINGS Twenty-three studies (n = 4258 participants) met inclusion and exclusion criteria. Thirty-two lifestyle strategies targeting weight loss (WL) and 7 targeting weight maintenance (WM) were extracted. Meta-analysis estimates small but significant effect of -0.26 standard deviations (95% CI -0.51 to -0.02), with RCTs demonstrating a non-significant effect of -0.23 standard deviations (95% CI -0.49 to 0.035). Culturally relevant strategies included community and peer support facilitators and team-based activities. The CSAI identified 14 out of 23 studies with low cultural competency and sustainability scores (<60%). INTERPRETATION Qualitative and quantitative analysis show tailored lifestyle interventions has had an estimated small but beneficial effect on WL amongst Pasifika communities. Potential for tailored interventions design to incorporate psychosocial and behavioural considerations. The CSAI has the potential for systematically identifying cultural and sustainability components of efficacy in interventions. FUNDING This review was funded under Western Sydney University's Postgraduate Research Scholarship.
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Savila F, Bagg W, Swinburn B, van der Werf B, Letele D, Bamber A, Harding T, Goodyear-Smith F. Study protocol for evaluating Brown Buttabean Motivation (BBM): a community-based, Pacific-driven approach to health. BMC Public Health 2022; 22:630. [PMID: 35361189 PMCID: PMC8970058 DOI: 10.1186/s12889-022-12979-3] [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: 02/10/2022] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Buttabean Motivation (BBM) is a Pacific-led organisation which aims to reduce obesity amongst Pacific and Māori people in New Zealand enabling them to choose a healthy and active life-style for the duration of their lives, their children, their wider family and the community. BBM offers a holistic approach to weight loss, recognising that mental health, family and cultural factors all play essential and critical role in nutrition and physical activity patterns. This study aims to evaluate the effectiveness of BBM for sustained health and wellbeing outcomes among its predominantly Pacific and Māori participants for both general BBM members and those with morbid obesity attending the 'From the Couch' programme. METHODS Quasi-experimental pre-post quantitative cohort study design with measured or self-reported weight at various time intervals for both cohorts. Weight will be analysed with general linear mixed model for repeated measures, and compared with a prediction model generated from the literature using a mixed method meta-analysis. The secondary outcome is change in pre- and post scores of Māori scale of health and well-being, Hua Oranga. DISCUSSION Multiple studies have shown that many diet and physical activity programmes can create short-term weight loss. The fundamental question is whether BBM members maintain weight loss over time. In New Zealand, Pacific and Māori engagement in health enhancing programmes remains an important strategy for achieving better health and wellbeing outcomes, and quality of life. Internationally, the collectivist cultures of indigenous and migrant and minority populations, living within dominant individualist western ideologies, have much greater burdens of obesity. If BBM members demonstrate sustained weight loss, this culturally informed community-based approach could benefit to other indigenous and migrant populations. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry ACTRN12621000931875 (BBM general members) First submitted 10 May 2021, registration completed 15 July 2021. ACTRN12621001676808 7 (From the Couch) First submitted 28 October 2021, registration completed 7 December 2021.
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Affiliation(s)
| | - Warwick Bagg
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Boyd Swinburn
- Population Nutrition and Global Health, University of Auckland, Auckland, New Zealand
| | - Bert van der Werf
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Dave Letele
- BBM, Unit 11 613-615 Great South Road, Manukau, Auckland, New Zealand
| | - Anele Bamber
- BBM, Unit 11 613-615 Great South Road, Manukau, Auckland, New Zealand
| | - Truely Harding
- Faculty of Medical & Health Science, University of Auckland, Auckland, New Zealand
| | - Felicity Goodyear-Smith
- Department of General Practice & Primary Health Care, General Practice & Primary Health Care, University of Auckland, PB 92129, Auckland, 1142, New Zealand.
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Predictors of diabetes risk in urban and rural areas in Colombia. Heliyon 2022; 8:e08653. [PMID: 35024487 PMCID: PMC8732783 DOI: 10.1016/j.heliyon.2021.e08653] [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: 07/09/2021] [Revised: 11/22/2021] [Accepted: 12/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background Nutritional habits low in fruits and vegetables and sedentary lifestyle are associated with a higher risk of developing Type 2 Diabetes (T2D). However, it is important to assess differences between urban and rural areas. This study aimed to analyze the associations between the risk of developing T2D and setting in the Colombian north coast in 2017. Methods This cross-sectional study included 1,005 subjects. Data was collected by interviewing self-identified members of an urban community and a rural-indigenous population. The interaction terms were evaluated as well as the confounders. Then, adjusted binary logistic regressions were used to estimate the odds ratio (OR) and 95% Confidence Intervals (CI). Results subjects with a high risk of T2D are more likely to belong to the urban setting (OR = 1.908; 95%CI = 1.201–2.01) compared with those with lower T2D after adjusting for age, Body Mass Index (BMI), physical activity, history of high levels of glycemia, and diabetes in relatives. Conclusions Urban communities are more likely to have T2D compared with rural-indigenous populations. These populations have differences from the cultural context, including personal, and lifestyle factors.
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Urquhart L, Fisher K, Duncanson K, Roberts K, Munro S, Gibbs C, Brown L. First Nation Peoples' nutrition and exercise group programmes: transforming success through the lifeworld. Int J Qual Stud Health Well-being 2021; 16:1990197. [PMID: 34749597 PMCID: PMC8583907 DOI: 10.1080/17482631.2021.1990197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 10/28/2022] Open
Abstract
PURPOSE Previous literature has applied system-focused structures to understand the success of First Nations Peoples' nutrition and exercise group programmes. Existing system-focused measures have included biomedical outcomes, access and service utilization. By broadening the focus of programme success beyond the system, we can evaluate programmes from a First Nations Peoples' lifeworld perspective. Critical hermeneutics and yarning using a lens of Habermas' Theory of Communicative Action to the literature has the potential to transform understandings of "success" in First Nations Peoples' nutrition and exercise group programmes. METHODS In this literature interpretation, we explored the critical success factors from a lifeworld perspective, giving scope to go beyond a system perspective to include a cultural, social or personal perspective. RESULTS Our yarning led us to understand that there is a communicative relationship between explicit system structures and implicit lifeworld concepts that are critical success factors for First Nations nutrition and exercise group programmes. We have developed a set of reflective questions to guide others in considering a lifeworld perspective. CONCLUSIONS Our findings represent a shift away from success measured by the dominant power structure to respect the lifeworld culture, knowledges and values of First Nations Peoples towards shared understanding and mutual decision-making.
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Affiliation(s)
- Lisa Urquhart
- Department of Rural Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Coffs Harbour, New South Wales, Australia
| | - Karin Fisher
- Department of Rural Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Tamworth, New South Wales, Australia
| | - Kerith Duncanson
- The Priority Research Centre for Digestive Health and Neurogastroenterology, Callaghan, New South Wales, Australia
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Karen Roberts
- Galambila Aboriginal Health Service, Coffs Harbour, New South Wales, Australia
| | - Simon Munro
- Department of Rural Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Tamworth, New South Wales, Australia
| | - Clinton Gibbs
- Mid North Coast Local Health District, Port Macquarie, New South Wales, Australia
| | - Leanne Brown
- Department of Rural Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Tamworth, New South Wales, Australia
- The Priority Research Centre for Digestive Health and Neurogastroenterology, Callaghan, New South Wales, Australia
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Norman K, Chepulis L, Burrows L, Lawrenson R. Adult obesity management in New Zealand general practice: a review. J Prim Health Care 2021; 13:249-259. [PMID: 34588109 DOI: 10.1071/hc20135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 08/02/2021] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Obesity is an important issue that leads to further health complications, increases the strain on the national health system and lowers quality of life. There is little available information on obesity management to guide best practice in general practice, despite 32% of New Zealand adults reported to be obese. AIM To review obesity management in New Zealand general practice. METHODS We searched six online databases for peer-reviewed research about adult obesity management. Inclusion criteria were original research, a New Zealand adult sample aged 25-64 years with a body mass index (BMI) >30 (or >25 BMI if participants had comorbidities) with weight loss (kg) as a measurable outcome. RESULTS Eleven articles were identified: nine studies reported statistically significant weight loss from baseline, and two studies reported no significant weight loss. Three studies used a Kaupapa Māori approach. Weight loss results ranged from 0.56 to 12.1 kg. Weight loss interventions varied in strategy and suitability for individual patients. DISCUSSION We found that there are effective weight loss interventions available for primary health-care professionals to refer to. Although most interventions did produce some weight loss, patients may need more comprehensive interventions that include a combination of diet, exercise and behaviour modifications in culturally appropriate ways. Future research should aim to identify and mitigate potential barriers to obesity management in primary care, as well as develop comprehensive, multileveled interventions that are effective for the local population.
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Affiliation(s)
- Kimberley Norman
- University of Waikato, Gate 1, Knighton Road, Hillcrest, Hamilton 3240, New Zealand; and Corresponding author.
| | - Lynne Chepulis
- University of Waikato, Gate 1, Knighton Road, Hillcrest, Hamilton 3240, New Zealand
| | - Lisette Burrows
- University of Waikato, Gate 1, Knighton Road, Hillcrest, Hamilton 3240, New Zealand
| | - Ross Lawrenson
- University of Waikato, Gate 1, Knighton Road, Hillcrest, Hamilton 3240, New Zealand; and Waikato District Health Board, Hamilton, New Zealand
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