Search

Racism is a key modifiable determinant of health that contributes to health inequities in Aotearoa and elsewhere. Experiences of racism occur within the health sector for workers, patients and their whānau (extended family) every day. This paper uses stories of racism from nurses – reworked into vignettes – to examine the dynamics of racism to generate possible micro, meso and macro anti‐racism interventions. A critical qualitative design was utilised, informed by kaupapa Māori approaches. The five vignettes in this paper were sourced from a pair of caucused focus groups with nine senior Māori (Indigenous peoples of Aotearoa) and Tauiwi (non‐Māori) nurses held in Auckland Aotearoa in 2019. The vignettes were lightly edited and then critically analysed by both authors to identify sites of racism and generate ideas for anti‐racism interventions. The vignettes illustrate five key themes in relation to racism. These include (i) mono‐cultural practice, (ii) everyday micro‐aggressions; (iii) complexity and the costs of racism, (iv) Pākehā (white settler) privilege and (v) employment discrimination. From analysing these themes, a range of evidence‐based micro, meso and macro‐level anti‐racism interventions were derived. These ranged from engaging in reflective practice, education initiatives, monitoring, through to collective advocacy. Vignettes are a novel way to reveal sites of racism to create teachable moments and spark reflective practice and more active engagement in anti‐racism interventions. When systematically analysed vignettes can be utilised to inform and refine anti‐racist interventions. Being able to identify racism is essential to being able to effectively counter racism. [ABSTRACT FROM AUTHOR]

This paper synthesises findings from two research projects with organisations involved in arts for youth well-being. Since 2017, Aotearoa New Zealand's government has recognised the importance of the arts for well-being. However, the sector in Aotearoa has historically lacked recognition and support and this paper identifies a number of challenges that remain entrenched in the funding system. Study One used an online survey to understand the approaches, aspirations and challenges of 19 organisations involved in youth arts for well-being. Study Two used ethnographic methods with three youth arts organisations to explore their experiences of the funding and policy context. Specific aspects of the funding system in Tāmaki Makaurau, Auckland, hinder the sustainable development of creatively rich, culturally responsive, inclusive and strengths-based practice that takes youth participation seriously. New approaches to resourcing youth arts for well-being are needed to better support good practice and sector development. [ABSTRACT FROM AUTHOR]

In New Zealand, people receiving care from specialist mental health and addiction services experience poorer health outcomes compared to the general population. Māori (Indigenous) specialist mental health and addiction service users experience disproportionate inequities. This study aims to: (1) Describe and understand mental health staff perspectives on the quality of care delivered to specialist mental health and addiction service users in their service – including specifically for Māori; and (2) Identify areas staff report as opportunities for quality improvement. In 2020, Southern District Health Board (now Te Whatu Ora – Southern) mental health staff were invited to participate in a cross‐sectional study assessing their perceptions of a range of service aspects. This paper presents quantitative and qualitative analyses about quality of care. Among the 319 staff who completed the questionnaire; 272 provided quality‐of‐care responses. Among these, 78% reported the quality of care delivered to service users as 'good' or 'excellent'; only 60% reported this for Māori service users. Participants identified individual, service and broader system level factors influencing the quality of care delivered to service users, including factors specific for Māori. This study has identified, for what appears to be the first time, empirical and concerning differences in staff ratings of the quality of care delivered to Māori and SMHAS users overall. Findings highlight the need for institutional and managerial prioritization of hauora Māori, and incorporating tikanga Māori and Te Tiriti into practice. [ABSTRACT FROM AUTHOR]

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]

Inclusive experiences for all children are foundational to New Zealand early childhood education, yet teacher beliefs and practices related to identification and referral processes may be delaying access to important early intervention support for children with disabilities. To better understand teachers' perspectives, past and present, this article details the findings from two studies conducted 14 years apart. Through comparison of findings from the work of Aspden and Baxter, this article explores teachers' beliefs and experiences related to identification and referral practices. In the original 2003 study, 50 early childhood teachers completed a paper-based postal survey, whereas in the 2017 replication, 78 early childhood teachers completed an online survey. Persistent concerns about teacher engagement with identification and referral processes were evident both past and present, particularly in relation to perceived parental reaction and beliefs about the adequacy of service provisions. Furthermore, the data revealed tensions between embracing a strengths-based approach and the need to identify children's disabilities. The findings provide insight into referral practices in the New Zealand early childhood context and suggest the need for ongoing teacher consultation in relation to policy and practice, the development of more formal referral policies and procedures, as well as enhanced professional support and development that targets teachers' need for knowledge of and connection with specialist agencies. [ABSTRACT FROM AUTHOR]

Purpose - Clinical governance policy initiatives have been introduced in many countries and health systems. How to assess development is an important question. The purpose of this paper is to describe and reflect upon the approach taken in New Zealand. Design/methodology/approach - New Zealand's clinical governance policy of 2009 and its implementation through its public health care system are outlined. The authors' assessments, in 2010 and 2012, of this policy are described and key findings summarised. Findings - The implementation of the policy was swift, with considerable commitment across the public health care system to this. The quantitative assessments found reasonable developmental progress between 2010 and 2012. Case studies undertaken in 2012 indicated various areas that policy makers should attend to or build upon in order to better support clinical governance development. Research limitations/implications - Key lessons from New Zealand's clinical governance experience, based on the assessments, include the need for: a well-defined definition of clinical governance; resource materials that can be used by those involved in clinical governance development; recognition that clinical governance development is complicated and takes time; and commitment to new leadership and organisational arrangements. Originality/value - This paper provides useful lessons for policy makers pursuing clinical governance development, derived from two rounds of assessment in New Zealand. [ABSTRACT FROM AUTHOR]

This study explores patterns of alcohol drinking within a representative New Zealand sample (2887 participants (1464 female, 1423 male)). Alcohol use and drinking patterns across the population are described. Multivariable logistic regressions document associations between alcohol use and drinking patterns and the likelihood of experiencing different health outcomes. Alcohol use, early drinking initiation, frequent drinking, and heavy episodic drinking (HED) are prevalent in New Zealand and vary in relation to gender, age, and socioeconomic characteristics. Those who reported alcohol-related problems were more likely to report poor mental health (AOR: 2.21; 95% CI: 1.42–3.46) and disability (AOR: 1.79, 95% CI: 1.06–3.00), and less likely to experience positive mental health (AOR: 0.28, 95% CI: 0.18–0.42). Those who reported HED were also less likely to experience good general health (AOR: 0.61, 95% CI: 0.47–0.81) and positive mental health (AOR: 0.67, 95% CI: 0.53–0.84). Younger age cohorts were more likely to engage in early drinking, and those who initiated regular drinking before age 18 were more likely to report HED and alcohol-related problems. Findings indicate that problem drinking and HED are not only associated with poor physical health, but also reduce the likelihood of individuals experiencing positive mental health. This provides information to enable public health practitioners to target alcohol prevention strategies at the entire population of drinkers. [ABSTRACT FROM AUTHOR]

Ageing does not reduce people's need to connect with family members, friends, and acquaintances, and neither does migration. For those older migrants living in a foreign land, connectedness with others plays a particularly important role in achieving a sense of belonging and sustaining their health and well‐being. This paper explores the issues of social isolation and loneliness among older Asian migrants in New Zealand. Data were collected from in‐depth semi‐structured interviews with Chinese‐ or Korean‐speaking migrants aged between 75 and 84 years (n = 10: all females), and from three focus groups consisting of Chinese‐ and Korean‐speaking migrants (n = 10: 7 females, 3 males) and Chinese professionals (n = 5: 3 females, 2 males) between June 2016 and December 2016. The qualitative data obtained were analysed applying a thematic analysis approach using NVivo software for group analysis by a multidisciplinary research team. The findings from the study show that older Asian migrants experienced high levels of isolation and loneliness at least at some points in their migrant lives. Most participants in this study were living alone or with only their spouse, and this living arrangement was likely to provide fertile ground for isolation and loneliness to grow in the context of later‐life migration. It was also observed that their lonely ageing ironically resulted from their efforts to preserve family relationships through avoiding being a burden, while allowing them a sort of space to maintain now barely connected lives. The participants revealed multiple ways of coping with lonely and isolated experiences in their limited social network, and these individual strategies allow us to make suggestions about how best to reduce older migrants' social isolation and loneliness in the New Zealand context and beyond. [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]

Introduction. Regular diabetic foot checks, at least annually, are important for early identification of risk factors and prevention of ulceration and amputation. To ensure this, most general practices in Aotearoa New Zealand (NZ) offer free annual diabetes reviews (ADRs) which include a comprehensive foot evaluation. However, attendance rates at these ADRs are low. Aim. To explore patients' perspectives on the barriers to attending ADRs and foot checks. Methods. Semi-structured interviews with people with type 2 diabetes who were overdue their ADR (n = 13; 7 women, 6 Māori) from two urban practices were conducted. Interviews were audio recorded and transcribed verbatim and then analysed using an inductive thematic analysis approach. Results. We identified three key themes demonstrating barriers to attendance: healthcareassociated factors (suboptimal clinician-patient relationship, not having a consistent general practitioner (GP)); patient-related factors (co-morbid health conditions, issues surrounding identity, and logistical issues); and systemic factors (COVID-19 pandemic, travel distance to the practice, unawareness of available foot care services). Participants' feedback focused on patient-centred approaches for improvements to service delivery, for example using online educational materials, and utilising culturally appropriate models of health including Te Whare Tapa Whā and Whānau Ora approach. Discussion. We identified several barriers to attendance, some of which are potentially modifiable. Addressing modifiable barriers and incorporating suggestions made by participants may improve access to the ADR and reduce non-attendance. Further participatory action research could explore these insights in ways that facilitate tino rangatiratanga (self-determination) and palpable action. [ABSTRACT FROM AUTHOR]

Aim The objective of this paper was to explore how present-day filial piety is understood among Koreans in geographically different settings. Methods Data were collected from qualitative interviews with 61 Korean participants in Australia, New Zealand and Korea and then thematically analysed and evaluated. Results The findings from this study show that filial piety for Koreans consists of family care and support, along with respect for parents. The norm of filial piety is regarded as an important aspect of intergenerational family relationships in current Korean culture, while its practice is perceived as increasingly eroded within a context of major socio-cultural and economic changes, including migration. Conclusion The results show that the tension between the social and economic aspects of filial piety often creates a 'bystander' attitude toward parents and provides fertile ground for the seeds of family conflict. [ABSTRACT FROM AUTHOR]

Worldwide, populations are ageing and consequently so are the consumer profiles for most organisations. Understanding how best to ensure satisfaction in interactions with older customers, patients, members of organisations, and so on is therefore increasingly important. This paper examines two research questions: (a) How satisfied or dissatisfied are older people with their customer service experience, and what are the factors associated with dissatisfaction? and (b) What prompts older people to want to change service providers? The research questions are addressed using a mixed-methods approach – quantitative analysis of observation logs, supported by illustrative quotes from focus groups. We find that on the whole older people are generally satisfied with their interactions with organisations, although a substantial minority of interactions lead to dissatisfaction or lower-than-expected satisfaction. Dissatisfaction with interactions is mostly associated with impersonal communications, including interactions that are not conducted face to face, and those that are one-off interactions rather than repeated interactions. Media and communications firms prompted the greatest levels of dissatisfaction among older consumers. Dissatisfied older consumers from our sample are more than 12 times more likely to report an intention to switch providers than satisfied consumers. This highlights the potential costs to organisations of poor customer interactions with older people. [ABSTRACT FROM PUBLISHER]

INTRODUCTION: Primary health care is critical, particularly in rural areas distant from secondary care services. AIM: To describe the development of Coast to Coast Health Centre (CTCHC) at Wellsford, north of Auckland, New Zealand and reflect on its achievements and ongoing challenges. METHODS: Interviews were conducted with staff and management of CTCHC and with other health service providers. Surveys of staff and a sample of enrolled patients were undertaken. Numerical data on service utilisation were obtained from the practice and from national datasets. RESULTS: The CTCHC provides a wide range of services, including after-hours care, maternity and radiology, across a network of electronically connected sites, as well as interdisciplinary training for a range of health students. General practitioner (GP) recruitment is problematic and nursing roles have been expanded. Staff report positively on the work environment. Consultation rates are higher than in comparable practices, especially consultations with nurses. Rates of hospital admission are relatively low. The development of the CTCHC was assisted by formation of a local primary health organisation (PHO) and by recognition by the local district health board (DHB). Issues with poor coordination of local services, and less service provision than is characteristic in urban areas, remain. Contracting processes with the DHB were complex and time-consuming. The merging of the local PHO into a larger PHO within the Waitemata DHB catchment inhibited progression towards more complete locality planning. DISCUSSION: A dedicated and locally controlled provider was able to generate a more than usually complete community health service for Wellsford and area. [ABSTRACT FROM AUTHOR]

Prevailing discourses condemn funerals as a costly distress purchase where funeral directors have greedily preyed upon funeral arrangers’ grief laden vulnerability. They explain funerals as distress purchases and so debt as the outcome of irrational decisions made while emotionally overwhelmed. These discourses ignore how people might use funeral purchases in dealing with the experience of death as they obscure rather than explain the emotionally infused decision-making that incurs funeral debt. This paper aims to shed light on this aspect of funeral purchases through a New Zealand-based empirical investigation of how intense feelings connect with decision-making associated with funeral cost and debt. The examination highlights that arranging a funeral, rather than being a hurried, ill-informed, choice-limited, emotionally overwhelming distress purchase, is a complex socio-emotional process that crystallises multiple affects into the culturally sanctioned emotion of responsibility, itself mobilised on class lines embedded in existing societal attitudes to debt and socio-economic structures. [ABSTRACT FROM PUBLISHER]

We surveyed New Zealand parents of autistic children to identify their perceived barriers and facilitators to accessing support services, including the influence of a family's level of financial resourcing. A total of 173 completed surveys were analysed. Service pathway factors were the greatest barrier experienced by participants, whereas facilitators related to providers tended to be most helpful. Lower family income was associated with a higher number of reported barriers. Both lower family income and having a child who identified their gender as non-binary were predictive of rating the extent of barriers higher. Parents of younger or of non-speaking autistic children on average reported a greater number of facilitators. Implications of these results for support service delivery and potential areas for future research are discussed. Parents might have problems in getting support services for their autistic child due to certain barriers. However, there might also be things that can ease or facilitate parents' access to support services. In this study, New Zealand parents were asked about their experiences in getting support services for their autistic child. We also looked at differences in reported barriers and facilitators based on several demographic factors with a focus on family level of financial resourcing. A total of 173 parents completed a survey. The results suggested that parents experienced several barriers, particularly related to service pathways. Facilitators were also experienced, predominantly related to providers. Financial resourcing predicted the number of parent-reported barriers. Both lower level of family financial resourcing and having a non-binary child predicted parents' rating of the extent of barriers. Child age and level of speech were predictors for reports of experiencing a higher number of facilitators, with parents of younger children or of non-speaking autistic children reporting a greater number of facilitators. We discuss how these results may be useful to support service delivery and identify areas for future research. [ABSTRACT FROM AUTHOR]

Quality of life (QoL) in people living with HIV (PLHIV) is reportedly worse than in people without HIV, with many factors impacting on this. We aimed to investigate QoL in PLHIV in New Zealand (NZ). In-person interviews were conducted including socio-demographic, health, social connectedness, and stigma-related questions. QoL was measured using the 13-question PozQoL Scale – summed to give a score between 13 and 65. Univariate linear regression was used to investigate factors associated with differences in PozQoL scores. PLHIV (n = 188) of different ethnicities from throughout NZ participated. The mean age was 47 years; 65% were men; 61% were men who have sex with men; 61% had been living with HIV for ≥10 years. The mean summary PozQoL score was 47.16. Factors associated with a lower mean PozQol included no sex in the last 12 months (−9.03), inability to meet basic needs (−7.47), ever (−6.49) or recently (−5.03), experiencing stigma or discrimination, mental health condition (−5.74), HIV diagnosis <5 years (−5.48), poor health (−5.43), being unemployed (−5.02), not having support (−4.71), and greater internalised stigma (−2.81). Improving QoL will require investment in peer support and community welfare programmes to better support PLHIV, and stigma reduction campaigns targeting the broader community. [ABSTRACT FROM AUTHOR]

It is important to understand how consumers (person with stroke/family member/carer) and health workers perceive stroke care services. Consumers and health workers from across New Zealand were surveyed on perceptions of stroke care, access barriers, and views on service centralisation. Quantitative data were summarised using descriptive statistics whilst thematic analysis was used for free-text answers. Of 149 consumers and 79 health workers invited to complete a survey, 53 consumers (36.5%) and 41 health workers (51.8%) responded. Overall, 40/46 (87%) consumers rated stroke care as 'good/excellent' compared to 24/41 (58.6%) health workers. Approximately 72% of consumers preferred to transfer to a specialised hospital. We identified three major themes related to perceptions of stroke care: 1) 'variability in care by stage of treatment'; 2) 'impact of communication by health workers on care experience'; and 3) 'inadequate post-acute services for younger patients'. Four access barrier themes were identified: 1) 'geographic inequities'; 2) 'knowing what is available'; 3) 'knowledge about stroke and available services'; and 4) 'healthcare system factors'. Perceptions of stroke care differed between consumers and health workers, highlighting the importance of involving both in service co-design. Improving communication, post-hospital follow-up, and geographic equity are key areas for improvement. Provision of detailed information on stroke recovery and available services in the community is recommended. Improvements in the delivery of post-hospital stroke care are required to optimise stroke care, with options including routine phone follow up appointments and wider development of early supported discharge services. Stroke rehabilitation services should continue to be delivered 'close to home' to allow community integration. Telehealth is a likely enabler to allow specialist urban clinicians to support non-urban clinicians, as well as increasing the availability and access of community rehabilitation. [ABSTRACT FROM AUTHOR]

In 2020, a government-funded healthy school lunch program was introduced in a quarter of New Zealand schools, selected due to high levels of socio-economic barriers. This study assesses the impact of the introduction of the school lunch program from family (whānau), student and school principal perspectives. Across four schools, we conducted five focus groups (two with secondary students and three with family members) and four school principal interviews. Participating schools represented a range of contexts: primary and secondary, schools with cooks in on-site kitchens and schools receiving meals delivered by external caterers. Thematic analysis was used to develop themes describing the health, wellbeing and nutritional impact of the program. Family participants were 82% Indigenous Māori and self-identified as having 'borderline' (73.5%) or no financial security (8.8%). Seven positive impact themes were identified: improved food security, enhanced equity, increased appreciation of healthy foods for students, enhanced mana (wellbeing) for all, reduced financial hardship/stress for families, opportunities for nutritional learning and recognition that appreciation and uptake happen over time. Four negative impact themes were identified: low uptake that created food waste, perception that healthy food is not palatable for students, lack of knowledge of the program and loss of agency for students. This is the largest intervention in nutrition and food security for children implemented in New Zealand since the 1930's. The first 2 years have offered wellbeing and financial benefits for students and families, particularly when school environments promote uptake. More involvement of students and family members in the program planning is essential. [ABSTRACT FROM AUTHOR]

Summary: Background: Data on body mass index (BMI) in infants and toddlers worldwide are lacking, relative to older age groups. Objectives: To describe the growth (weight, length/height, head circumference, and BMI z‐score) of New Zealand children under the age of 3 years, and examine differences by sociodemographic characteristics (sex, ethnicity, and deprivation). Methods: Electronic health data were collected by Whānau Āwhina Plunket, who provide free 'Well Child' services for approximately 85% of newborn babies in New Zealand. Data from children under the age of 3, who had their weight and length/height measured between 2017 and 2019, were included. The prevalence of BMI (WHO child growth standards) ≤2nd, ≥85th, and ≥95th percentiles were determined. Results: Between 12 weeks and 27 months of age, the percentage of infants ≥85th BMI percentile increased from 10.8% (95% CI, 10.4%–11.2%) to 35.0% (34.2%–35.9%). The percentage of infants with high BMI (≥95th percentile) also increased, particularly between 6 months (6.4%; 95% CI, 6.0%–6.7%) and 27 months (16.4%; 15.8%–17.1%). By contrast, the percentage of infants with low BMI (≤2nd percentile) appeared steady between 6 weeks and 6 months, and declined at older ages. The prevalence of infants with a high BMI appears to increase substantially from 6 months across sociodemographic characteristics, with a widening prevalence gap by ethnicity occurring from 6 months, mirroring that of infants with a low BMI. Conclusions: The number of children with high BMI increases rapidly between 6 months and 27 months of age, suggesting this is an important timeframe for monitoring and preventive action. Future work should investigate the longitudinal growth trajectories of these children to determine if any particular patterns predict later obesity and what strategies could effectively change them. [ABSTRACT FROM AUTHOR]

The burden of health inequities borne by Indigenous peoples can be overwhelming, especially when mothers and newborns' lives are at stake and health services seem slow to invest in responsiveness. In Aotearoa (New Zealand), urgent action is required to eliminate persistent systemic inequities for Māori (Indigenous) whānau (family collectives that extend beyond the household). This Kaupapa Māori (by Māori, for Māori) qualitative study aimed to explore the views of health practitioners identified as champions by whānau of preterm Māori infants. Ten health practitioners were interviewed and asked about their involvement with the whānau, their role in explanations and communication, and their thoughts on whānau coping. Interview data were analysed using interpretative phenomenological analysis. Three superordinate themes were identified: working together in partnership, a problem shared is a problem halved, and sacred space. Collaboration between health practitioners and with whānau was important to the champions and central to their goal of enabling whānau autonomy. This was built on a foundation of connectivity, relationships, and a full appreciation that childbirth is a sacred time that is potentially disrupted when an infant is born prematurely. The values- and relationship-based practices of these champions protected and uplifted whānau. They showed that health practitioners have important roles in both the elimination of inequities and the sustaining of Māori self-determination. This championship is an exemplar of what culturally safe care looks like in day-to-day practice with Māori and is a standard that other health practitioners should be held to. [ABSTRACT FROM AUTHOR]

INTRODUCTION: New Zealand general practice mainly functions as small businesses, usually owned by a single or small group of doctors. Consequently, owners often have to balance the provision of patient care with varying funding priorities, changing patient needs and the pressures of running a sustainable business. Such balancing inevitably leads to tensions developing between these factors. AIM: To explore and understand these tensions and responses to them, by examining the business performance measurements used by general practice. METHODS: For this study, the unit of analysis and focus were individual practices, but qualitative semi-structured interviews with general practitioners (GPs) and practice managers were used to gather the data. RESULTS: All participating practices had some form of governance or board review, where high-level aggregated business performance data were presented. More sophisticated business performance measures were evident in the larger, more developed practices and in practices functioning as community trusts. Examples of such measures included doctor utilisation and efficiency, appraisal of risk, patient satisfaction with services and responses to changes in patient demand. DISCUSSION: As the number of general practices based on the traditional model decrease, a corresponding increase is likely in the establishment and development of 'super practices' based on a corporatized, multi-service, single-location model. Consequently, service delivery will become increasingly complex and will drive a need for increased sophistication in how general practice measures its business performance, thus ensuring a balance between highquality, safe patient care and the maintenance of a sustainable business. [ABSTRACT FROM AUTHOR]

Background: Internationally, efforts are being made to promote equity in palliative and end-of-life care for Indigenous peoples. There is a need to better understand the experiences of Indigenous service users and staff. Aim: To explore the views of Māori health practitioners and whānau (family group) caregivers regarding barriers and enablers to culturally safe palliative and end-of-life care. Design: A Kaupapa Māori qualitative study. Setting/participants: Interviews were conducted with 103 participants from four areas of the North Island of Aotearoa New Zealand. Participants comprised bereaved whānau (family) of Māori with a life limiting illness and Māori health practitioners. Results: Māori health practitioners undertake cultural and connecting work to promote culturally safe palliative and end-of-life care for Māori patients and their whānau. This work is time-consuming and emotionally and culturally demanding and, for most, unpaid and unrecognised. Non-Māori staff can support this work by familiarising themselves with te reo Māori (the Māori language) and respecting cultural care customs. However, achieving culturally safe end-of-life care necessitates fundamental structural change and shared decision-making. Conclusions: Our findings indicate that efforts to support equitable palliative care for Indigenous people should recognise, and support, the existing efforts of health practitioners from these communities. Colleagues from non-Indigenous populations can support this work in a range of ways. Cultural safety must be appropriately resourced and embedded within health systems if aspirations of equitable palliative and end-of-life care are to be realised. [ABSTRACT FROM AUTHOR]

Background: A high proportion of unwanted or unplanned pregnancies may be alcohol-exposed due to contraception failure or non-use. Nevertheless, data on contraception and alcohol use in the context of the risk of alcohol-exposed pregnancies are sparse. Objectives: To describe contraception use and alcohol consumption in sexually active non-pregnant women and investigate the factors associated with less effective contraception methods. Study Design: A cross-sectional national survey of women aged 18–35 years. Methods: Data from non-pregnant women who were sexually active (n = 517) were analysed. Descriptive statistics were used to report demographics, consumption, and contraception measures. Logistic regression was used to investigate the factors associated with less effective contraception among drinkers. Results: The majority of participants were younger (46%), of NZ European ethnicity (78%), not in a permanent relationship (54%), with some or completed tertiary education (79%), employed (81%) and not users of the community services card (82%). Twenty-five percent of women were smokers, 94% consumed alcohol, and 72% binged at least 'monthly or less'. Most women used the pill (56%), and 20% of drinking women were using a contraception method with a 10% or more annual failure rate after 1 year of use. Women who binged 'weekly or more often' had similar odds of using less effective contraception as women who 'never' binged (p > 0.05). Younger Māori or Pacific women (odds ratio = 5.99; 95% confidence interval of odds 1.15 – 31.2; p = 0.033) and women who had no tertiary education (odds ratio = 1.75; 95% confidence interval of odds 0.00 – 3.06; p = 0.052) had higher odds of using less effective contraception. Conclusion: With 20% of women at risk of an alcohol-exposed pregnancy, public health measures to address alcohol consumption and the effective use of contraception are critical to reducing the risk for alcohol-exposed pregnancies in NZ. [ABSTRACT FROM AUTHOR]

Introduction. Rheumatic fever is a preventable illness caused by untreated Group A Streptococcus (GAS) infection. Despite reductions in most high-income countries, rheumatic fever rates remain a concern in Aotearoa New Zealand. Pacific and Māori people are inequitably affected, with risk of initial hospitalisation due to rheumatic fever 12- and 24-fold more likely, respectively, compared to non-Māori and non-Pacific people. Aim. This scoping review aims to explore the range of interventions and initiatives in New Zealand seeking to prevent GAS and rheumatic fever, with a particular focus on Pacific and Māori. Methods. Databases Scopus, Medline, EMBASE and CINAHL, along with grey literature sources, were searched to broadly identify interventions in New Zealand. Data were screened for eligibility and the final articles were charted into a stocktake table. Results. Fifty-eight studies were included, reporting 57 interventions. These targeted school-based throat swabbing, awareness and education, housing, secondary prophylaxis, improving primary care guidelines and diagnosis of sore throats and skin infections. Some interventions reported short-term outcomes of improvements in awareness, a reduction in rheumatic fever risk and fewer hospitalisations. Evaluation outcomes were, however, lacking for many initiatives. Pacific and Māori people primarily served only in an advisory or delivery capacity, rather than as partners in co-design or leadership from the beginning. Discussion. Although positive outcomes were reported for some interventions identified in this review, rheumatic fever rates have not shown any long-term reduction over time. Co-designing interventions with affected communities could ensure that strategies are better targeted and do not contribute to further stigma. [ABSTRACT FROM AUTHOR]

Introduction. Gout in Aotearoa New Zealand (NZ) remains an equity issue. The prevalence in Pacific and Māori people is one of the highest internationally. Although Pacific and Māori experience earlier onset and higher burden of gout, which can severely impact their quality of life, their management of it is often sub-optimal. Aim. To conduct a scoping review of the NZ literature for interventions to improve the uptake/management of allopurinol for gout and their evaluation. Methods. Databases Medline, Scopus, Embase, and CINAHL Plus and the grey literature were searched systematically to identify all NZ intervention studies aiming to improve allopurinol uptake for gout treatment. Interventions included: if they were delivered in NZ, aimed to improve allopurinol uptake, and were provided in English. A narrative approach was used to extract and synthesise data. Results. Eighteen peer-reviewed and grey literature publications met the search criteria. Interventions clustered into three domains: multifaceted or multipractitioner; gout app; and online booklets or fact sheets. Serum urate levels improved in multi-faceted or multi-practitioner interventions only, whereas the gout app only improved patients' awareness and understanding of gout and medications. Online fact sheets and booklets need more active utilisation from health professionals to improve gout health literacy. Discussion. Most gout interventions in NZ use multifaceted or multi-practitioner approaches. Although most interventions successfully controlled serum urate levels and improved equitable access for gout patients to urate-lowering therapy, these interventions did not sustain retention, completion, and engagement for certain population groups, particularly Pacific and Māori, who experience a higher burden of gout. [ABSTRACT FROM AUTHOR]

Background: Injuries can have detrimental impacts on mental health, even after physical recovery. In our Prospective Outcomes of Injury Study (POIS), 25% of participants experienced psychological distress (assessed using the Kessler 6) three months after a sentinel injury event (SIE), declining to 16% at 24 months post-SIE. Internationally, studies of hospitalised patients found distress persisted beyond 24 months post-injury and remained higher than the general population. However, most studies only assessed distress at one timepoint, relied on long-term recall, or were limited to small samples or specific injury types. Therefore, we aim to describe the prevalence of psychological distress 12 years post-SIE and to investigate pre-injury, injury-related and early post-injury characteristics associated with long-term distress. Methods: POIS is a longitudinal cohort study of 2856 New Zealanders injured between 2007 and 2009, who were on the national injury insurer, Accident Compensation Corporation entitlement claims' register. Of these, 2068 POIS participants completed an interview at 24 months and agreed to further contact. They were invited to a follow-up interview 12 years post-SIE which included the Kessler-6 (K6), the psychological distress outcome of interest. Data about a range of pre-injury, injury-related and early (3 months) post-injury characteristics were collected via earlier interviews or administrative data sources (e.g. hospital discharge data). Results: Twelve years post-SIE, 1543 (75%) people were re-interviewed and 1526 completed the K6; n = 177 (12%) reported psychological distress. Multivariable modified Poisson regression models found pre-injury characteristics were associated with an increased risk of clinically relevant distress at 12 years, i.e. having inadequate income, identifying as Māori, Pacific or Asian and having one mental health condition. Early post-injury psychological distress and dissatisfaction with social relationships also increased risk. However, being older was associated with a reduced risk of distress. Conclusion: Clinically relevant distress persists long-term post-injury among adults with varying injury severity, types and causes, and at higher prevalence than in the general population. Early identification of injured people at risk of long-term psychological distress provides opportunities for timely interventions to reduce psychological distress. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This study explored whether changes in risk and protective factors of intimate partner violence (IPV) can account for the noted reduction in 12-month IPV prevalence in New Zealand between 2003 and 2019. Changes in relational mobility over time were also explored. Data from two population-based surveys of 18-64 year-old ever-partnered women in New Zealand that were conducted according to identical procedures in 2003 (n=2764) and 2019 (n=944) were used. Changes in a variety of potential risk and protective factors over time and their possible contribution to IPV reduction were assessed. The findings indicated that there was no change in the prevalence of the strongest risk and protective factors of IPV victimisation and perpetration over time (e.g. partner concurrent relationship, previous exposure to violence for both respondent and partner, and partner's problematic alcohol/drug use). However, a combination of factors including decline in women's problematic alcohol or drug use, decline in the number of children within families, and increases in the proportion of women and partners with a qualification higher than secondary education are likely to be associated with the reduction in IPV prevalence. A greater degree of relational mobility, demonstrated through a greater proportion of women who left their abusive partner permanently and increased numbers of relationships that women had, was also observed between two study years. Overall, these results indicate that changes in 12-month IPV prevalence over time are likely to be linked with changes that increase women's autonomy and ability to move out of violent relationships. To achieve sustained reductions in IPV, more comprehensive and planned efforts are needed to address other underlying and exacerbating causes, including problematic alcohol/drug use and previous exposure to violence during childhood and adulthood. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The number of general practitioners (GPs) providing maternity care in New Zealand has declined dramatically since legislative changes of the 1990s. The Ministry of Health wants GPs to provide maternity care again. AIM: To investigate New Zealand general practice registrars' perspectives on GPs' role in maternity care; specifically, whether maternity services should be provided by GPs, registrars' preparedness to provide such services, and training opportunities available or required to achieve this. METHODS: An anonymous online questionnaire was distributed to all registrars enrolled in The Royal New Zealand College of General Practitioners' (RNZCGP's) General Practice Education Programme (GPEP) in 2012, via their online learning platform OWL. RESULTS: 165 of the 643 general practice registrars responded (25.7% response rate). Most (95%) believe that GPs interested and trained in maternity care should consider providing antenatal, postnatal or shared care with midwives, and 95% believe women should be able to access maternity care from their general practice. When practising as a GP, 90% would consider providing antenatal and postnatal care, 47.3% shared care, and 4.3% full pregnancy care. Professional factors including training and adequate funding were most important when considering providing maternity care as a GP. DISCUSSION: Ninety-five percent of general practice registrars who responded to our survey believe that GPs should provide some maternity services, and about 90% would consider providing maternity care in their future practice. Addressing professional issues of training, support and funding are essential if more GPs are to participate in maternity care in New Zealand. [ABSTRACT FROM AUTHOR]

Introduction New Zealand's Asian population is growing and diverse. Kidney failure is a major health burden and 10% of dialysis population is identified as Asian ethnicity. There is currently no information about their experience on haemodialysis. This study aimed to understand their perspectives in order to help improve dialysis experience. Methods Thirteen Asian haemodialysis patients were recruited and took part in semi-structured interviews in Counties Manukau Health. All interviews were recorded, transcribed and reviewed. Themes were developed based on common experiences. Findings Four key themes emerged from the data -- the impact of illness, how culture and language are integral to health, the importance of family, and personal relationships with health professionals. Some experiences were associated with being on dialysis and their overall health status and the major time commitment associated with dialysis visits. Others were related more specifically to cultural factors, including reliance on support from extended family, and access to familiar food. Language barriers were also an important factor, especially for the participants living in aged care facilities. All the participants highly valued the input from dietitians, doctors and staff from dialysis units. Discussion Asian dialysis patients face a range of challenges on dialysis. Particular challenges included language difficulties and accessing cultural support. Developing an increasingly culturally and linguistically diverse workforce could lead to improved care of this population. [ABSTRACT FROM AUTHOR]

Pacific youth in New Zealand have a disproportionately high risk for gambling and gang involvement compared with New Zealand European youth. Limited evidence indicates that youth gang involvement is associated with problem gambling; no research shows if it is associated with gambling. We conducted exploratory secondary analyses of data from 1063 Pacific youth and their mothers using data from two time points (age nine and 14 years) from a longitudinal cohort study. Gang involvement at age nine years was significantly associated with gambling at age 14 years, with adjusted odds of 2.25 (95% CI [1.16, 4.37]). Of confounders, having a mother with a partner and Cook Islands ethnicity appeared protective against gambling at age 14 years. Despite some study limitations, as youth gambling can lead to subsequent adult problem gambling, our findings highlight the importance of understanding why Pacific youth join gangs, to inform public health policies to reduce the potential for future development of harmful behaviors. [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]

Aim: Over the past decade, paradoxes have emerged in the skin cancer prevention and sunburn reduction literature. These include that individuals with higher sun protection knowledge; lower positive attitudes towards tanning; and who are users of sunscreen have higher odds of sunburn. It is also possible that sunburn paradoxes may be associated with those whose sunburn was unintended. New Zealand and Australia have, by far, the highest age standardised incidence rates of melanoma skin cancer in the world, and this study examines the extent to which sunburn and unintended sunburn is associated with the sunburn paradox variables. Method: Sun Exposure Survey data New Zealanders aged 15 + years were gathered by the New Zealand Health Promotion Agency in 2016. Results: Linkages were examined between sunburn, unintended sunburn and the paradox variables: sun protection knowledge, attitudes towards tanning and use of sunscreen. Sunburn was associated with higher respondent sun protection knowledge. No statistically significant associations were found between unintended sunburn and the paradox variables. Conclusion: This research indicates that in a well-designed study of a sample representative of the New Zealand population, the sun protection knowledge sunburn paradox still exists. Despite a high level of sun protection knowledge, many people still become sunburned. Therefore, it is important to examine this paradox further in order to find ways to reduce sunburn frequency among New Zealanders. Potential ways to reduce sunburn are discussed. [ABSTRACT FROM AUTHOR]

Objective: To ascertain former students' perceptions of and influences from a final‐year pre‐registration, rurally located, clinically based, 5 week interprofessional program on their subsequent work and career in the health professions. Design: Online survey delivered 5 years post‐program (4 years post‐graduation). Setting: The Tairāwhiti interprofessional education program was first undertaken in 2012/2013 by students from six health professional degree programs (dentistry, dietetics, medicine, nursing, pharmacy and physiotherapy) in the Tairāwhiti region, New Zealand. Participants: Health professionals who attended the Tairāwhiti interprofessional education program in 2012/2013 as students were invited to participate; 70 of 86 (81%) responded in 2017/2018. Results: Five years on, most respondents (91%;64/70) were working as health professionals, with a fifth (23%;15/64) working overseas. Of those currently practising in New Zealand, 51% (24/47) were working in hospital practice and 49% (23/47) in the community, with 56% (27/48) working in metropolitan areas and 44% (21/48) in regional/rural locations. Of the 51 respondents who provided free‐text comments about perceived influences of program participation, the majority described positive influences on their clinical practice as health professionals or their subsequent career choices. Five themes emerged from the free‐text data: 'made me a better clinician'; 'made me consider rural/regional work'; 'collaborating for care'; 'choosing an area of practice to work in,' and 'little or no impact.' Conclusion: This work reports positive influences on subsequent careers among respondents who had previously participated as final‐year students in a rurally located IPE program, particularly with respect to interprofessional working, rural health, and contextual and cultural influences. [ABSTRACT FROM AUTHOR]

Background: The prevalence of CAM use is increasing. This integrative review investigated New Zealand healthcare professionals' practice of, attitudes toward, and knowledge about complementary and alternative medicine (CAM). Methods: Literature search was conducted in four databases from inception to April 2020. Studies were included if they reported results from primary data collection on practice of, attitudes toward, or knowledge about CAM amongst New Zealand healthcare professionals. Results: Eleven studies (two of 'high-quality', seven of 'moderate-quality', and two of 'low-quality') were identified with 2060 healthcare professionals including general practitioners (GPs), nurses, midwives, pharmacists, physiotherapists, and medical specialists. New Zealand healthcare professionals were generally positive regarding CAM use, but have concerns on the scientific evidence, regulation, safety, financial costs of CAM, and encourage an evidence-based CAM practice and stronger CAM regulation. Findings indicated that around 25% of GPs practise CAM, and 82.3% refer patients to CAM practitioners. When treating pregnant women, 48.4% of physiotherapists practise acupuncture, and 37.3% of midwives recommend CAM. GPs believe that acupuncture is the most helpful CAM modality, and most commonly practiced and referred patients to acupuncture. Up to 58% of GPs and Plunket nurses wanted to receive further education on CAM, and up to 66.7% GPs favour the idea CAM should be included in medical curriculums. Conclusions: Nine of the 11 included studies were of moderate to high quality, thus enhancing the reliability of the review findings. In order to better manage CAM in New Zealand New Zealand clinical settings, there is a need to invest in CAM research and education, and enhance CAM regulation. This review is a first step in developing an evidence base to offer insights for further development of effective CAM policies regarding safety, efficacy, regulation and integration in New Zealand. [ABSTRACT FROM AUTHOR]

Background Complementary medicines are a popular healthcare choice among patients/consumers, and most pharmacies sell these products. Pharmacists are well-placed to advise on complementary medicines, but their training and practices for these products are not optimal. Pharmacists' professional practices for complementary medicines ought to be influenced by professional codes of ethics and standards. Objective To examine community pharmacists' perspectives on complementary medicines in New Zealand, including motivations and justifications for selling these products, and professional and ethical issues complementary medicines raise for pharmacists. Setting Community pharmacists in New Zealand. Method Qualitative, semi-structured interviews with 27 New Zealand practising community pharmacists identified through purposive and convenience sampling. Main outcome measure Participants' views, experiences, and professional practices for complementary medicines. Results Participants struggled to clearly describe products they considered complementary medicines. Perspectives towards these products ranged from strongly supportive to somewhat sceptical; none was strongly opposed. Participants had several motivations for selling complementary medicines, particularly consumer demand and profits. Participants acknowledged ethical issues concerning complementary medicines, including lack of evidence of efficacy and pharmacists' limited training/knowledge. Few referred explicitly to complementary-medicines-related statements in the Pharmacy Council of New Zealand's Code of Ethics, or indicated these guided their practice. Conclusion Participants sold complementary medicines despite having limited knowledge on these products and concerns about efficacy; participants justified this as they believe they are providing an holistic option for patients, and/or ensuring complementary medicines do no harm. Participants were mindful of ethical/professional issues regarding complementary medicines, but were not necessarily aware of, or guided by, explicit statements in the Pharmacy Council of New Zealand's Code of Ethics. [ABSTRACT FROM AUTHOR]

Issues: Non-medical cannabis policies are changing, including towards legalisation-with-regulation frameworks. New Zealand will hold a public referendum on cannabis legalisation in 2020. We reviewed data on cannabis use and health/social harms; policy reform options; experiences with and outcomes of reforms elsewhere; and other relevant considerations towards informing policy choices in the upcoming referendum.Approach: Relevant epidemiological, health, social, criminal justice and policy studies and data were identified and comprehensively reviewed.Key Findings: Cannabis use is common (including in New Zealand) and associated with risks for health and social harms, mainly concentrated in young users; key harms are attributable to criminalisation. 'Decriminalisation' reforms have produced ambivalent results. Existing cannabis legalisation frameworks vary considerably in main parameters. Legalisation offers some distinct advantages, for example regulated use, products and user education, yet outcomes depend on essential regulation parameters, including commercialisation, and policy ecologies. While major changes in use are not observed, legalisation experiences are inconclusive to date, including mixed health and social outcomes, with select harms increasing and resilient illegal markets. It is unclear whether legalisation reduces cannabis exposure or social harms (e.g. from enforcement) for youth.Implications/conclusions: No conclusive overall evidence on the outcomes of legalisation elsewhere exists, nor is evidence easily transferable to other settings. Legalisation offers direct social justice benefits for adults, yet overall public health impacts are uncertain. Legalisation may not categorically improve health or social outcomes for youth. Legalisation remains a well-intended, while experimental policy option towards more measured and sensible cannabis control and overall greater policy coherence, requiring close monitoring and possible adjustments depending on setting-specific outcomes. [ABSTRACT FROM AUTHOR]

Euthanasia or assisted dying (EAD) remains a highly contentious issue internationally. Although polls report that a majority New Zealanders support EAD, there are concerns about the framing of the polling questions, and that those responding to the questions do not know enough about the situations described, the options available and the potential implications of EAD policy. One way to address these concerns is through a citizens' jury, which is a method of learning how a group of people view an issue following informed deliberation. This citizens' jury was conducted to learn whether a group of 15 New Zealanders thought the law should be changed to allow some form of EAD and the reasons for their view, having been informed about the issue, heard arguments for and against, and having deliberated together. The jury met for two and a half days. They did not reach a consensus, but become polarized in their positions, with several changing their positions to either strong opposition or strong support. The reasons why people support or oppose EAD were not reducible to particular principles or arguments, but reflected an integrated assessment of a range of considerations, informed by personal priorities and experiences. These results suggest that views on EAD may change in response to informed deliberation that the EAD debate involves a range of value judgments and is not likely to be resolved through deliberation alone. These results may inform international debate on EAD policy. [ABSTRACT FROM AUTHOR]

Objectives: The incidence of multimorbidity (MM) and its correlates among older adults remain poorly understood. This study aimed to examine the socio-demographic and lifestyle factors associated with MM in New Zealand.Methods: People aged 55-70 years were invited to participate in a population-based cohort study, the Health Work and Retirement Study, in 2006. Those who accepted the invitation and completed the baseline questionnaire were followed up on a biennial basis. Data on socio-demographic factors, health and lifestyle behaviours, and diagnoses of chronic diseases were obtained from baseline and 6 waves of follow-up. Generalised estimating equations (GEE) adjusted for both time-constant and time-varying factors were used to model factors associated with the onset of MM.Results: A total of 1,673 participants (with 0 or 1 chronic condition) contributed to an overall 8,616 person-years of observation. There were 590 new cases of MM over 10 years of follow-up, corresponding to an overall incidence of 68.5 per 1,000 person-years. The results of the age- and sex-adjusted GEE analysis showed that age, ethnicity, living alone, obesity, hypertension, and having 1 chronic condition at baseline were significant predictors of MM onset. Higher education, income, physical activity, and regular alcohol consumption were protective factors. In a fully adjusted model, marital status (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.01 to 1.37; p=0.039), hypertension (OR, 1.23; 95% CI, 1.02 to 1.48; p=0.032) and having 1 chronic condition at baseline (OR, 2.92; 95% CI, 2.33 to 3.67; p<0.001) remained significant.Conclusions: The higher incidence of MM among Māori people, socioeconomically disadvantaged groups, those with low physical activity, and obese individuals highlights the importance of targeted prevention strategies. [ABSTRACT FROM AUTHOR]

Indigenous children have a long history of overrepresentation in child protection systems. This exploratory, mixed methods study examined practitioner perceptions of risk in response to client ethnic group (n = 67). A staged online survey elicited responses to a blinded vignette. Half the sample received the vignette as a Pākehā (White) family and the other half as Māori (Indigenous). Apart from this, family descriptions were identical. Respondents rated their perceptions of the children's risk and related constructs and stated what decisions they would make. Qualitative perceptions of risk, safety, problem causes, and plan goals were elicited. The quantitative findings showed family ethnicity had a moderate effect on perceptions of risk, safety, and decisions. The Māori family was perceived as higher risk than the Pākehā family and had more decisions made about them. Stage 2 of the survey showed the most marked effects (d = 0.484 risk, 0.487 safety; p = 0.06). Qualitative responses showed similar constructions of risk, safety, problems, and plan goals regardless of ethnicity. Structural factors associated with ethnicity were not considered to contribute to the family's social problems. Results suggest a combination of unconscious bias and a "colour blind" approach to practice may contribute to ethnic inequalities. Implications for education, research, and practice are discussed. [ABSTRACT FROM AUTHOR]

Pregnancy has always been a life-changing event for women and their families, but societal concern about pregnancy and motherhood has become intense in the digital age. The role of health promotion agencies and others supplying health-related resources about lifestyle behaviours is both important and in need of scrutiny. Ever increasing advice for pregnant women, their families and health professionals, abounds. This study of decision making during pregnancy investigated how women made everyday decisions during pregnancy about food and drink, as well as dietary supplements and medications, alcohol and recreational drugs. This qualitative interview study was a side-arm to a double-blind randomized, placebo-controlled trial conducted with pregnant women in Wellington New Zealand, 2013–2016. Data from interviews with 20 women were analysed using inductive thematic analysis. In relation to decision-making about lifestyle behaviours, five themes emerged—Information about food; Wanted and unwanted advice; Worry, anxiety and indecision; Making daily decisions about food; Changes in decision making over time. Participating women talked more about food selection and restriction advice than any other lifestyle topic. Analysis demonstrated concern about information accuracy and overload from multiple, diverse sources. Women described learning how to assess resource credibility, how to develop decision-making skills, and who to trust. The study raises important questions about how the health information environment, despite best intentions, can be confusing or potentially harmful. The study underlines the continued importance of the role health professionals have in not only interpreting information to discuss individualized advice, but also in empowering pregnant women to develop lifestyle-related decision-making skills. [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]

Limited research exists of teenagers’ involvement in the response phase of a natural disaster. There is little, for example on volunteering, and of specifically what motivates teenagers to volunteer and the activities they participate in. Therefore, this study investigated teenagers’ involvement and perceptions of volunteering following the 2010-2011 Canterbury, New Zealand, earthquakes. Six focus groups were conducted with 31 teenagers aged 16-18 who had experienced the earthquakes. The data were analyzed using thematic analysis leading to four themes, namely sense of control, sense of purpose, shift in perspective, and restrictions. Findings emphasize the importance of organizing youth-focused volunteer groups, due to volunteering potentially reducing teenagers’ psychological distress postdisaster. [ABSTRACT FROM AUTHOR]

Although in vitro fertilization (IVF) has offered hope to those struggling with infertility, it has also had some unintended consequences, including the fate of embryos that may be “surplus” to requirement following IVF treatment. The number of embryos in storage across the world is high, creating a dilemma for patients who need to make disposal decisions, as well as presenting an administrative and practical dilemma for clinics. Research has suggested that patients’ views of the status of their embryo/s may affect their disposal decisions, and yet the nature of the links between views of the embryo and decisions to either donate or discard remain unclear. In this article, we engage in a discursive analysis of literature on disposal decisions. We discuss the range of ways in which embryos may be constructed, and demonstrate how these discourses make available or constrain particular action possibilities, and offer particular subject positions for patients. The analysis highlights the complexity of the relationship between embryo status and decision making, and may assist clinicians in supporting and guiding patients’ decisions. [ABSTRACT FROM AUTHOR]

In New Zealand, embryo donation (ED) is “open,” allowing offspring to access genetic information. Donors and recipients meet prior to donation. Drawing on interviews with 15 recipients, 22 donors, and nine counselors, this article discusses how ED may be constructed as a form of gifting. This discourse may evoke expectations that recipients will express gratitude for the gift, including through honoring contact agreements. Donation becomes a relational practice of obligations and counter-obligations. However, the gift discourse may not adequately capture the emotional sacrifice experienced by donors. Donors describe significant attachment to their embryos, ambiguity about relinquishment, and interest in offsprings’ welfare. Furthermore, embryos may be constructed as inalienable bodily gifts resulting in children with whom the donors share immutable social ties. A discourse of ED as mutual exchange, collaboration, and extended family building may be more useful to donors and recipients in managing ED. [ABSTRACT FROM AUTHOR]

Background: The health status of Indigenous populations of Australia and New Zealand (NZ) Māori manifests as life expectancies substantially lower than the total population. Accurate assessment of time trends in mortality and life expectancy allows evaluation of progress in reduction of health inequalities compared to the national or non-Indigenous population. Methods: Age-specific mortality and life expectancy (at birth) (LE) for Indigenous populations (Australia from 1990 and NZ from 1950); and all Australia and non-Māori NZ (from 1890), males (M) and females (F), were obtained from published sources and national statistical agency reports. Period trends were assessed for credible estimates of Indigenous LE, and the LE gap compared to the total population for Australia, and non-Māori for NZ. Period trends in premature adult mortality, as cumulative probability of dying over 15-59 years, were assessed similarly. The relative contribution of differences in age-specific mortality to the LE gap between Indigenous and the all-Australia population, and the non-Māori NZ, was estimated for each country by sex for the most recent period: 2010-2012 for Australia, 2012-2014 for NZ. Results: LE increased for all populations, although LE gaps between Indigenous and all Australia showed little change over time. LE gaps between NZ Māori and non-Māori increased significantly from the early 1980s to the mid-1990s, and since then have fallen again. Recent LE gaps in Australia (M 12.5; F 12.0 years in 2010-2012) were larger than in NZ (M 7.3; F 6.8 years in 2012-2014). Premature adult mortality (15-59 years) improved for all populations, but mortality ratios show little change since 2000, with Indigenous at 3½-4 times that of all Australians, and Māori 2-3 times that of non-Māori. Using decomposition analysis, the age interval contributing most strongly to differences in LE between Indigenous and all Australia was 35-59 years, but between Māori and non-Māori it was 60-74 years. Conclusion: In Australia and NZ, Indigenous LE and adult mortality are improving in absolute terms, but not relative to the entire or non-Indigenous populations, causing gaps in life expectancy to persist. [ABSTRACT FROM AUTHOR]

Aim: To explore kaumātua attitudes towards physician aid-in dying, to gain a clear understanding of how such attitudes may influence and shape their expectations of medical care at the end of life and to assist health professionals in Aotearoa/New Zealand to address the healthcare needs of older Māori near the end of life. Design: A kaupapa Māori consistent approach was undertaken. A systematic narrative technique was employed for the qualitative data analysis. Data were triangulated through independent data coding by three researchers (two of whom identified as Māori researchers), to ensure a robust and consistent method of analysis as well as adhering to a kaupapa Māori research approach. Setting/participants: Recruitment of participants was through kaumātua of Te Kupenga Hauora Māori (Māori leadership within the Faculty of Medical and Health Sciences), University of Auckland and local Auckland marae. Focus group or individual interviews (as per their preference) were undertaken with 20 Kaumātua from the Auckland region. Results: Five closely interrelated themes were identified from kaumātua narratives regarding physician aid-in dying. These were (1) attitudes and understandings of physician aid-in dying, (2) influence of power, (3) significance of kawa, (4) whānau relationships and the (5) significance of wairua. Conclusion: The study demonstrated that for these kaumātua, medical practices that hasten death such as physician aid-in dying are 'not all just about the dying'. Tikanga and kawa are important processes and concepts to understand during death and dying, and whānau are central to such processes being respected by those involved in the dying process. These factors are so closely intertwined that they cannot be considered in separation of each other. [ABSTRACT FROM AUTHOR]

Social dominance orientation ( SDO) is conceived as an individual's level of support for group-based hierarchy in general that causes support for more specific group hierarchies. According to social dominance theory, group differences in SDO underpin ideological and behavioural group differences related to specific group hierarchies. Using representative 5-year longitudinal panel data from New Zealand ( N = 3,384), we test whether SDO mediates effects of sex and ethnicity on legitimizing myths ( LMs) relating to gender and ethnic hierarchy over time. The SDO mediation hypothesis is supported in the case of hostile sexism. However, it is unsupported in the case of benevolent sexism and LMs relating to ethnic hierarchy, where there was no cross-lagged effect of SDO. Moreover, being in the dominant ethnic group is associated with more legitimization of ethnic hierarchy but less legitimization of gender hierarchy, which is inconsistent with the notion of a general orientation underpinning group differences in legitimation. There was mixed evidence for a reverse path whereby specific LMs mediate group differences in SDO across time. We argue for the need to find alternative ways to theorize ideological consensus and difference between groups. [ABSTRACT FROM AUTHOR]

Background: Indigenous Australians and New Zealanders have a significantly shorter life expectancy than non-Indigenous people, mainly due to differences in prevalence of chronic diseases. Physical activity helps in the prevention and management of chronic diseases, however, activity levels are lower in Indigenous than in non-Indigenous people. Objective: To synthesise the literature on the effects of physical activity interventions for Indigenous people in Australia and New Zealand on activity levels and health outcomes. Methods: The Cochrane Library, MEDLINE, SPORTSDiscus and PsycINFO were searched for peer-reviewed articles and grey literature was searched. Interventions targeted Indigenous people in Australia or New Zealand aged 18+ years and their primary or secondary aim was to increase activity levels. Data were extracted by one author and verified by another. Risk of bias was assessed independently by two authors. Data were synthesised narratively. Results: 407 records were screened and 13 studies included. Interventions included individual andgroupbasedexercise programs and community lifestyle interventions of four weeks to two years. Six studies assessed physical activity via subjective (n =4) or objective (n = 2) measures, with significant improvements in one study. Weight and BMI were assessed in all but one study, with significant reductions reported in seven of 12 studies. All five studies that used fitness tests reported improvements, as did four out of eight measuring blood pressure and seven out of nine in clinical markers. Conclusions: There was no clear evidence for an effect of physical activity interventions on activity levels, however, there were positive effects on activity related fitness and health outcomes. [ABSTRACT FROM AUTHOR]

Background: A growing number of studies document the association between maternal experiences of racial discrimination and adverse children's outcomes, but our understanding of how experiences of racial discrimination are associated with pre- and post-natal maternal mental health, is limited. In addition, existent literature rarely takes into consideration racial discrimination experienced by the partner. Methods: We analysed data from the Growing Up in New Zealand study to examine the burden of lifetime and past year experiences of racial discrimination on prenatal and postnatal mental health among Māori, Pacific, and Asian women in New Zealand (NZ), and to study the individual and joint contribution of mother's and partner's experiences of lifetime and past year racial discrimination to women's prenatal and postnatal mental health. Results: Our findings show strong associations between lifetime and past year experiences of ethnically-motivated interpersonal attacks and unfair treatment on mother's mental health. Māori, Pacific, and Asian women who had experienced unfair treatment by a health professional in their lifetime were 66 % more likely to suffer from postnatal depression, compared to women who did not report these experiences. We found a cumulative effect of lifetime experiences of ethnically-motivated personal attacks on poor maternal mental health if both the mother and the partner had experienced a racist attack. Conclusions: Experiences of racial discrimination have severe direct consequences for the mother's mental health. Given the importance of mother's mental health for the basic human needs of a healthy child, racism and racial discrimination should be addressed. [ABSTRACT FROM AUTHOR]