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This paper synthesises critique from Māori patients with Bipolar Disorder (BD) and their whānau to identify barriers and propose changes to improve the structure and function of the New Zealand mental health system. A qualitative Kaupapa Māori Research methodology was used. Twenty-four semi-structured interviews were completed with Māori patients with BD and members of their whānau. Structural, descriptive and pattern coding was completed using an adapted cultural competence framework to organise and analyse the data. Three key themes identified the impact of structural features of the New Zealand mental health system on health equity for Māori with BD. Themes involved the accessibility, delivery and scope of the current health system, and described how structural features influenced the quality, utility and availability of BD services for Māori patients and whānau. Structural barriers in the existing design, and potential changes to improve the accessibility, delivery and scope of BD services for Māori, were proposed including a redesign of operational, environmental, staffing, and navigation points (information, transition, fatigue) to better meet the needs of Māori with BD. A commitment to equity when implementing structural change is needed, including ongoing evaluation and refinement. This paper provides specific recommendations that should be considered in health service redesign to ensure the New Zealand mental health system meets the needs of Māori patients with BD and their whānau. [ABSTRACT FROM AUTHOR]

Objectives.New Zealand has a unique tool, Te Tiriti o Waitangi, the Treaty of Waitangi, for addressing health disparities. Indigenous Māori have compromised health status compared to other groups. This paper investigates ways in which public health units (PHUs) and non-governmental organisations (NGOs) use Te Tiriti o Waitangi in service delivery to Māori. Design.A nationwide telephone survey of primary health providers (n=162) was conducted in 2014-15. Participants were asked about effectiveness and monitoring of their service delivery to Māori. Results.PHUs reported actively working with Māori, and Te Tiriti o Waitangi to reduce health disparities. Direct Māori engagement with development and delivery of programmes was viewed as essential. Strategies included designated PHU staff in positions of responsibility, formal partnerships with Māori, and providing operational and strategic guidance. Some PHUs supported development of cultural competencies. NGO responsiveness to Māori was variable. Some NGOs described prioritising service delivery and programmes for Māori. Others reported the focus of their service was European or other non-Māori ethnicities. Lack of resources or past difficulties engaging with Māori were barriers. Conclusion.Public health has an ethical commitment to reduce health disparities. Advancing Te Tiriti obligations in everyday practice has the potential to address inequalities. [ABSTRACT FROM AUTHOR]

Objective: To understand what motivates sedentary indigenous and ethnic minority men to become more physically active. Design: We use thematic analysis to present data from a qualitative study exploring 23 sedentary indigenous Māori (New Zealand) men's experiences of completing a 12-week exercise intervention to improve their metabolic health. Results: Four themes emerged: The Bros – having fellowship and mutual motivation; Being better informed about exercise; Impacting overall wellbeing; and Disseminating the findings beyond the study Exercise interventions informed by indigenous Māori cultural values and knowledge increased its relevance to their daily lives. The motivation for these indigenous men was more culturally-based external factors than an inherent desire to lose weight. Conclusion: Indigenous and minority men in many developed countries have high morbidity and premature mortality related to sedentary lifestyles. The low uptake of physical activities possibly relates to focusing more on outcomes such as weight loss which lacks cultural relevance. When offering health promotion interventions for marginalized populations these findings highlight the importance of culturally tailoring interventions to the unique sources of motivation for each group to increase activity to improve their efficacy. [ABSTRACT FROM AUTHOR]

Objective: The aim was to investigate the prevalence of self-reported sleep complaints in New Zealand adults and determine the independent association of sleep complaints with adverse health outcomes. Design: We used 2002/03 New Zealand Health Survey data (n = 12,500 adults, ≥15 years). The prevalence of self-reported sleep complaints was estimated by ethnicity. The relationship between sleep complaints and mental health, physical health and health risk behaviors were investigated using multivariable logistic regression models. Results: The prevalence of each sleep complaint measure was highest for the indigenous Māori population (23.6% reported ‘any’ sleep complaint; 10.3% reported multiple sleep complaints). Reporting ‘any’ sleep complaint was associated with higher odds of poorer mental health, diagnosed high blood pressure, diagnosed diabetes, diagnosed heart disease, poor/fair self-rated health, obesity, current smoking, and hazardous drinking. Conclusion: The higher prevalence of sleep complaints among Māori and the consistent association with poor health suggests a potential role for suboptimal sleep in ethnic health inequities. [ABSTRACT FROM AUTHOR]

Objectives: Māori, the indigenous peoples of Aotearoa (New Zealand), continue to exhibit the highest rate of smoking of any ethnic group in the nation. Clarifying the present day factors which perpetuate Māori smoking has become matter of some urgency.Design: We investigate links between subjective elements of Māori identity, demographic factors and perceived discrimination with smoking status in a national probability sample of self-identified Māori (N = 667).Results: Our results suggest that core aspects of Māori identity and cultural engagement were not significantly linked with smoking. However, the extent to which participants felt they were perceived as prototypically Māori (measured as Perceived Appearance) was reliably associated with smoking. The effect of Perceived Appearance held when adjusting for perceived experiences of discrimination and other standard demographic indicators.Conclusion: Our analysis indicates that simply feeling that one is more visibly Māori is associated with an increased likelihood of smoking. This may reflect how Māori negotiate the larger systemic forces of racism present in New Zealand society. [ABSTRACT FROM AUTHOR]

Objectives. To document and explore the experience of migrant care workers providing health and social care to the elderly in institutional care settings and in the homes of the elderly in the community in New Zealand with a particular focus on the affective components of care work. Design. This qualitative study involved conducting face-to-face, open-ended, semi-structured interviews with 29 migrant care workers in the eldercare sector in the cities of Auckland and Wellington, New Zealand. Participants were recruited through various agencies focusing on aged care and engaged with migrant eldercare workers and snowballing through participant referral. Sample size was determined when saturation was reached. The interviews were audio recorded, transcribed verbatim, themes were identified and then analysed drawing on a body of theoretical work in the fields of emotional anthropology and moral geography and the international empirical literature addressing migrant eldercare workers. Results. As with the international research in this field we found that these workers were vulnerable to exploitation, the workforce is largely feminised and stereotypical understandings of racial groups and national characteristics informed recruitment and the workplace experience. Here attributing gradients of affect to particular migrant groups in the workforce was the main mechanism employed to establish worker worth and difference. Identifying with these gradients of affect enabled these eldercare workers to demonstrate that they met the moral and ethical requirements of permanent residency and ultimately citizenship. Eldercare workers in the home were vulnerable to ‘blurred emotional boundaries’ and care recipient demand for greater emotional commitment. The migrant eldercare workers in this study all shared vulnerable residential status and many feared they would never obtain permanent residency or citizenship. All had family who remained in the Philippines and towards whom they had an obligation to substitute care support. Conclusion. Central to understanding how this labour force issue is experienced by both caregivers and the elderly is the notion ofsubjective proximityand how emotional and moral trajectories serve to mediate the connection between the eldercare worker and workplace, the Filipino migrant eldercare relationship with employers, agencies and institutions; and, the transnational nature of this mobility and social and actual citizenship. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine relationships between body mass index (BMI) and cardiovascular risk factors in 279 Europeans and 231 Polynesian Pacific Islanders in New Zealand. METHODS: Participants were recruited from Seventh-Day Adventist church meetings or camps, and were surveyed by self-administered questionnaire. Blood pressure, weight and height were measured. Fasting blood samples were analysed for lipids, glucose and fructosamine. RESULTS: Age-adjusted BMI was higher in Pacific Islanders than in Europeans: 32.8(0.3) versus 25.6(0.3); means(SE); p = 0.0001). In Europeans, BMI was positively associated with systolic and diastolic blood pressures, triglycerides, total cholesterol, LDL cholesterol and fasting blood glucose, and negatively associated with HDL cholesterol. In Pacific Islanders, BMI was associated only with systolic and diastolic blood pressures, and with HDL cholesterol. These associations were stronger in Europeans than in Pacific Islanders. CONCLUSIONS: In this group of Pacific Islanders, the association between BMI and cardiovascular risk factors was weaker than in Europeans. This suggests that either BMI is a poor measure of adiposity in Pacific Islanders, or that adiposity may be less strongly linked to cardiovascular disease in Pacific Islanders. [ABSTRACT FROM AUTHOR]