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In this paper, whānau Māori highlight how a Kaupapa Māori-centred intervention (the Harti Hauora Tamariki tool, hereafter Harti tool) has improved interactions with health services. The Harti tool is undergoing a randomised control trial (RCT) at Waikato Hospital in New Zealand. As part of the RCT, the authors engaged in a series of qualitative interviews with whānau members of tamariki Māori (children aged 0–5 years) admitted to Waikato Hospital's paediatric ward. Whānau who met at least one criteria for New Zealand's domains of deprivation were included. Using a Kaupapa Māori approach to the study, participants shared their views on barriers and facilitators to accessing health resources and primary care services. The interviews conducted highlight how the Harti tool, when administered in a culturally appropriate and respectful manner that prioritised relationship-building, enabled better connection to healthcare services. Prevalent in our analysis were connections to wider determinants of health and ways to reduce existing health inequities. To conclude the paper, how the Harti tool has enhanced feelings of being in control of health, with the potential to reduce the likelihood of a hospital readmission, is highlighted. [ABSTRACT FROM AUTHOR]

Critically reflecting on researcher–community partnerships is a key component in implementing chronic condition interventions in Indigenous communities. This paper draws on the results and learnings from a process evaluation that measures how well two research–community partnerships have followed the He Pikinga Waiora (HPW) Implementation Framework while co-designing chronic condition interventions in primary care. The HPW framework is centred on Indigenous self-determination and knowledge surrounded by community engagement, cultural centredness, systems thinking and integrated knowledge translation. The evaluation included in-depth interviews and online surveys with 10 team members. The findings demonstrate that the HPW framework was followed well, with strengths particularly in community engagement and relationship building. Areas for improvement included systems thinking and integrated knowledge translation to support sustainability of the interventions. The need for partnerships to use process evaluation results to support critical reflection is asserted, which helps build strong trust and synergy, power sharing and effective and sustainable implementation practices. It is concluded that the HPW framework is well suited to evaluating implementation of health interventions in primary care as it assists in the facilitation of better collaboration between researchers and Indigenous communities, and encourages the implementation team to reflect on power and privilege. [ABSTRACT FROM AUTHOR]

Family members continue to be used as interpreters in medical consultations despite the well-known risks. This paper examines participant perceptions of this practice in three New Zealand clinics chosen for their frequent use of interpreters and their skill in using them. It is based on a detailed study of 17 video-recorded interpreted consultations and 48 post-consultation interviews with participants (5 doctors, 16 patients and 12 interpreters, including 6 family members). All participants expressed satisfaction with the communication. Analysis of the interviews explored what participants liked or valued about family member interpreters (FMIs). Key themes were the FMIs' personal relationship and knowledge, patient comfort, trust, cultural norms, time efficiency and continued help outside the consultation. General practitioners (GPs) expressed awareness of potential risks and how to manage them, in contrast to patients and FMIs. Although the use of professional interpreters needs to be strongly promoted, a well-informed decision to use a family member is appropriate in some situations. GPs need to be well trained in how to assess and manage the risks. Rather than striving for 'best practice' (i.e. universal use of professional interpreters), it is better to aim for 'good practice' where a considered judgement is made about each situation on an individual basis. [ABSTRACT FROM AUTHOR]

This paper reports on the cost-effectiveness of pedometer-based versus time-based Green Prescriptions in improving physical activity and health-related quality of life (EQ-5D) in a randomised controlled trial of 330 low-active, community-based adults aged 65 years and over. Costs, measured in $NZ (NZ$1=A$0.83, December 2008), comprised public and private health care costs plus exercise-related personal expenditure. Based on intention-to-treat data at 12-month follow up, the pedometer group showed a greater increase in weekly leisure walking (50.6 versus 28.1min for the time-based group, adjusted means, P=0.03). There were no significant between-group differences in costs. The incremental cost-effectiveness ratios, for the pedometer-based versus time-based Green Prescription, per 30min of weekly leisure walking and per quality-adjusted life year were, (i) when including only community care costs, $115 and $3105, (ii) when including only exercise and community care costs, $130 and $3500, and (iii) for all costs, -$185 and -$4999, respectively. The cost-effectiveness acceptability curves showed that the pedometer-based compared with the time-based Green Prescription was statistically cost-effective, for the above cost categories, at the following quality-adjusted life year thresholds: (i) $30000; (ii) $30500; and (iii) $16500. The additional program cost of converting one sedentary adult to an active state over a 12-month period was $667. The outcomes suggest the pedometer-based Green Prescription may be cost-effective in increasing physical activity and health-related quality of life over 12 months in previously low-active older adults. [ABSTRACT FROM AUTHOR]

Former quota refugees are known to have higher health and social care needs than the general population in resettlement countries. However, migrants with a refugee-like background (refugee-like migrants) in New Zealand are not currently offered systematic government-sponsored induction or health services. This study explored the experiences of New Zealand health and social care providers in general practice. Staff at two Wellington region general practices with known populations of refugee-like migrants and former quota refugees were approached to participate in an exploratory qualitative study. Semistructured audio-recorded interviews and focus groups were undertaken. Deductive and inductive analyses were used to identify key themes. Twelve interviews were undertaken with professionals with backgrounds in clinical pharmacy, cross-cultural work, general practice medicine, primary care nursing, reception and social work. Key themes from the interviews were communication challenges, organisational structure and teamwork, considerations to best meet core health and support needs, and the value of contextual knowledge. Healthcare workers perceived many similarities between working with refugee-like migrants and working with former quota refugees. Even though communication challenges were addressed, there were still barriers affecting the delivery of core health and support services. Primary care practices should focus on organisational structure to provide high-quality, contextually informed, interprofessional team-based health and social care. Migrants, especially family members of former refugees, may have similar health and social experiences to former refugees. Health and social care professionals should take these experiences into account when planning and providing care. Little is known about how professionals specifically interact with such migrants, so we examined the experiences of primary care professionals, finding key themes for successful care. This expands on research into the health of former refugees, emphasising the importance of also considering the health needs of migrating family. [ABSTRACT FROM AUTHOR]