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Introduction. Gender affirming hormone therapy (GAHT) is an important aspect of health care for many transgender and non-binary (TNB) people, but little is known about the long-term outcomes for TNB people in Aotearoa New Zealand (NZ). Pathways to access GAHT are shifting from secondary care towards primary care, so this is an opportune time to commence local research on long-term health and wellbeing outcomes for people initiating GAHT. Aim. This paper aims to report on the key findings from four meetings held to inform the design of a prospective cohort study to follow the journey of people initiating GAHT in primary and secondary care settings in NZ. Methods. We worked with a community advisory group of six TNB young people and sought input from 14 health care providers involved in the care of TNB people initiating GAHT (GPs, secondary care doctors, and mental health providers). Semi-structured interview schedules were used to guide discussions. Template analysis was used to initially code data based on themes identified from the interview schedule and new themes from discussions were added. Results. Participants shared ideas about recruitment and data collection priorities for baseline and follow-up surveys. These included understanding the journey to starting hormone therapy (information-seeking, decision-making), access to services for GAHT initiation, appropriateness of information provision, receipt of the first prescription, goals for and experience of GAHT, and the unique needs of non-binary people. Discussion. Input from a TNB advisory group and health care professionals has informed the development of a survey that will be used to understand the experience of, and outcomes for, people starting GAHT in NZ. Findings from this planned prospective cohort study have the potential to improve access to GAHT for TNB people who wish to pursue this option. [ABSTRACT FROM AUTHOR]

Aim: Develop evidence‐based recommendations for managers to support primary healthcare nurses to thrive at work. Design: A mixed‐methods sequential explanatory design. Methods: National data were collected in 2020 via an e‐survey based on a meta‐analysis of antecedents of thriving from 213 primary healthcare nurses across New Zealand. Structural equation modelling analysis identified the key factors supporting primary healthcare nurses to thrive. This informed a second open‐ended e‐survey in 2022 of 19 nurses from one primary healthcare organization. The thematic analysis provided recommendations for improving management strategies to support thriving primary healthcare nurses. Results: The vitality component of thriving significantly reduced burnout and intention to leave organization and profession. In contrast, the learning component of thriving had a significant positive effect on burnout. The key factors that support thriving at work are empowering leadership and perceived organizational supports (decreases burnout and intention to leave organization and profession through enhanced vitality). Recommendations for improving thriving were made in eight key areas: communication, effective management, professional development, scope of practice, autonomy, effective orientation, reward and work–life balance. Conclusions: Vitality is important in reducing burnout and turnover intentions. While learning was identified as increasing burnout, professional development and training for managers were identified as essential. Hence, the vitality dimension of the thriving at work construct should be studied at the dimension level, but more research is needed into the impact of learning on thriving over time. Primary healthcare nurses have identified that empowering leadership and perceived organizational support are critical factors in supporting them to thrive, and they provide specific recommendations for managers to improve these factors in the clinical setting. No Patient or Public Contribution: This study collected data from Registered Nurses only. What Is Already Known: A plethora of existing research focuses on resilience in nurses rather than thriving at work.Enabling employees to thrive at work contributes to improved well‐being and sustainable organizational performance. What This Paper Adds: Empowering leadership and perceived organizational support are the key factors that support primary healthcare nurses to thrive at work.The vitality dimension of the thriving at work construct should be studied at the dimension level, and further research is needed into the impact of learning on thriving over time.Primary healthcare nurses recommend that managers focus on improving communication, management efficiency, professional development, scope of practice, autonomy, orientation, reward and work–life balance. [ABSTRACT FROM AUTHOR]

Introduction. New Zealand health training institutions have an important role in supporting health workforce training programmes in the Pacific Region. Aim. To explore the experience of Pacific Island country-based doctors from the Cook Islands, Niue, and Samoa, studying in New Zealand’s University of Otago distance-taught Rural Postgraduate programme. Methods. Document analysis (16 documents) was undertaken. Eight semi-structured interviews were conducted with Pacific Island country-based students. Thematic analysis of the interviews was undertaken using the framework method. The two data sources were analysed separately, followed by a process to converge and corroborate findings. Results. For Pacific Island countries with no previous option for formal general practice training, access to a recognised academic programme represented a milestone. Immediate clinical relevance and applicability of a generalist medical curriculum with rural remote emphasis, delivered mainly at a distance, was identified as a major strength. Although technologies posed some issues, these were generally easily solved. The main challenges identified related to the provision of academic and other support. Traditional university support services and resources were campus focused and not always easily accessed by this group of students who cross educational pedagogies, health systems and national borders to study in a New Zealand programme. Study for individuals worked best when it was part of a recognised and supported Pacific in-country training pathway. Discussion. The University of Otago’s Rural Postgraduate programme is accessible, relevant and achievable for Pacific Island country-based doctors. The programme offers a partial solution for training in general practice for the Pacific region. Student experience could be improved by tailoring and strengthening support services and ensuring their effective delivery. [ABSTRACT FROM AUTHOR]

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]

Self‐determination and dignity are guaranteed rights for disabled persons under the United Nations Convention on the Rights of Persons with Disabilities. However, such rights have been slow to eventuate for Māori (Indigenous people of Aotearoa New Zealand). This paper brings together systematic fashion publications that currently exist regarding blindness and Māori, centring throughout Māori understandings of disability and blindness. We employed a structured approach alongside PRISMA protocols and reflexive dialogue. Included publications were quantitative data reviews, surveys, qualitative studies, literature reviews and works of fiction. For our analysis, we formulated a matrix that drew from Kaupapa Māori, applied community psychology and disability rights literature. This meant we made explicit where research practices included—and excluded—self‐determination, democratic participation and inclusion of both disabled and Māori. Our review highlights inconsistency across disciplines regarding self‐determination and democratic participation by both Māori and disabled key stakeholders. Our approach can be utilised across disciplines as a tool for considering the ways in which researchers uphold Indigenous self‐determination, disability rights and data sovereignty. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement. [ABSTRACT FROM AUTHOR]

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]

Homophobia is an enduring issue within schooling contexts internationally. This paper attempts to rethink homophobia from the perspective of heterosexual students' accounts of bearing witness to it. Within the existing literature it has been LGBTQ students who have held the responsibility for naming and recounting homophobia. This paper re-orients this conventional account by positioning heterosexual students as its narrators to see what this might reveal about homophobia's operation at school. While this strategy does not disrupt the 'othering' and 'victimization' of LGBT youth in these stories, it has other effects. When heterosexual students name homophobia as unjust, it is possible to see the instability of the victim/perpetrator binary that typically structures these accounts. Narratives of participants in this study did not fit neatly into this binary, revealing its inability to capture the complexity of homophobia's operation. To have any hope of effectively addressing homophobia at school, we need to move beyond the victim/perpetrator binary. This is because it masks some of homophobia's more nuanced moves, such as targeting difference, rather than sexual identity exclusively. [ABSTRACT FROM AUTHOR]

There have been growing concerns that social distancing and stay-at-home mandates have exacerbated loneliness for older people. Empirical evidence about older people's experiences of loneliness and COVID-19 have quantified this phenomena without considering how older people themselves define and understand loneliness. This paper explores how older New Zealanders conceptualized and experienced loneliness under 'lockdown' stay-at-home measures. This multi-methods qualitative study combines data from letters (n = 870) and interviews (n = 44) collected from 914 people aged over 60 and living in Aotearoa, New Zealand during the COVID-19 pandemic. We conducted a reflexive thematic analysis to conceptualise this data. We identify three interconnected ways in which older people conceptualised and experienced loneliness: (1) feeling disconnected relating to lack of emotional closeness to another often resulting from being physically separated from others and not being able to touch; (2) feeling imprisoned relating to separation from preferred identities and activities and was frequently associated with boredom and frustration; and (3) feeling neglected which often related to feeling let down by generalised and idealised forms of support, such as one's neighbourhood and health care system. Older New Zealanders experienced lockdown loneliness in three interconnected ways rather than as a stable and homogenous experience. Māori, Pacific, Asian and New Zealand European older people often discussed loneliness in different ways; attesting to loneliness being a culturally-mediated concept shaped by expectations around desirable social interaction. We conclude the paper with implications for research and policy. [ABSTRACT FROM AUTHOR]

Risk identification has been at the heart of media coverage of the COVID-19 pandemic. Less consideration has been paid to the way that the media itself has (re)produced these risk categories, and how this has changed over the course of the pandemic. The aim of this article is to understand how risk has been constructed in the Aotearoa, New Zealand news media over the course of the COVID-19 pandemic. This paper reports findings from a longitudinal media analysis of mainstream news media articles (n = 388) published in the first week of March 2020, March 2021 and March 2022. Underpinned by a socio-cultural theoretical understanding of risk, we conducted a reflexive thematic analysis of the 22 most relevant articles from a week of coverage during each month of March. Our analysis identified three key themes by which we characterise the discussions of risk as these developed from 2020 to 2022: (1) Subjects of risk; (2) Spaces of risk; and (3) The nation facing risk. We conclude that the dominant frame surrounding risk was one of mutual risk and solidarity. We suggest future policies around pandemic risk mitigation must attend to both the range of competing risks as well as the different epistemologies (including scientific and indigenous worldviews) informing risk. We suggest that researchers, policy makers and reporters involve the voices of those 'at risk' into their publications. This analysis shows the value of taking a sociocultural analysis of risk as it is framed within a particular national-cultural context. [ABSTRACT FROM AUTHOR]

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Background: The emergence of the COVID‐19 and the resulting global pandemic has ushered in far‐reaching changes for countries across the world, not least of which are changes to their education systems. With traditional location‐based exams no longer possible at universities, the uptake of online proctored exams (OPE) has occurred at a pace not seen prior to the pandemic. Students' experiences of online proctored exams during the pandemic are reasonably well‐understood in terms of digital access and ease of use of the technology. However, less is known about students' perceptions of digital confidence and competence to complete an online exam, both of which are important digital equity considerations. Objectives: This study investigates students' digital confidence and competence to undertake online proctored exams to determine whether issues of equity exist for students. Methods: This study reports the results of a survey (N = 761) of one university's students' experiences of end‐of‐semester online proctored exams in New Zealand. Results: Most students were positive about online exams, felt reasonably confident to complete an exam, and had the necessary digital access (i.e., devices, internet) and competence to succeed. However, digital inequalities were found between students' perceptions of digital competence based on ethnicity. While more time learning online equated to increasing self‐reported digital competence for most ethnic groups, this was not the case for Pacific learners. Takeaways: Perceptions of low digital competence can contribute to digital inequalities. Educators can support learners to develop positive perceptions of digital competence by teaching digital literacy skills. Lay Description: What is already known about this topic: Online proctored exams (OPE) have replaced many traditional exams because of the pandemic.Research on the use of online proctored exams during the pandemic suggests some acceptance among students.Apart from access related issues, little is known about digital inequalities associated with online exams. What this paper adds: Most participants were positive about OPE and felt reasonably confident to successfully complete them.Confident students were more likely to report that the exam software was easy to use.Perceptions of digital competence differed based on ethnicity.Marginalized groups were more likely to experience digital inequalities than other groups. Implications for practice and/or policy: Digital inequality is about more than issues of digital access (i.e., devices, internet).Provide differentiated technical support for students who express low digital competence.Teaching online exam digital literacy skills might increase perceptions of digital competence. [ABSTRACT FROM AUTHOR]

Drawing on the findings from a longitudinal study of vulnerable young people's transitions to adulthood, this paper explores the ideas of shame and recognition. The young people, aged between 12 and 17 years at the first interview, had experienced chronic exposure to adversity from an early age (abuse, violence, mental health issues, addictions, and expulsion from school). They were clients of statutory and non‐governmental services: child welfare, juvenile justice, remedial education, and mental health services. This paper draws on the qualitative phase of the study (n = 107); young people and a trusted other, nominated by the young person, participated in three annual qualitative interviews. Interviews focused on young people's experiences of services, key transitions, their relationships, and the strategies they used to locate support and resources. Experiences of shame, misrecognition, and seeking recognition emerged as dominant themes in the young people's accounts, and these are explored in this paper. The paper concludes with a discussion on responsive social work interventions that generate a deeper understanding of young people's experiences of shame and misrecognition. Central to this practice are critical and relational social work practices that actively support young people to achieve recognition. [ABSTRACT FROM AUTHOR]

Dementia-related sleep changes can lead to disruptions among families living with dementia which can jeopardise carers' wellbeing and ability to provide support. This research explores and represents the sleep of family caregivers across the trajectory of caring, before, during, and after the key period of their care recipient moving into residential care. The focus of this paper is viewing dementia caregiving as a trajectory, characterised by care needs which change over time. Semi-structured interviews were conducted with 20 carers whose family member with dementia had transitioned into residential care within the prior 2 years. Themes constructed from these interviews indicated that sleep was linked to earlier life course patterns as well as to significant moments of transition in the caregiving journey. As dementia progressed, carers' sleep progressively worsened in relation to the less predictable nature of dementia-symptoms, difficulty maintaining routines, and constant responsibilities creating a state of high alert. Carers attempted to facilitate better sleep and wellbeing for their family member, often sacrificing their own self-care. Around the care transition period, some cares reported not realising how sleep deprived they were; for others the busy momentum continued. After the transition, many carers acknowledged that they were exhausted, although many had not realised this while providing home-based care. Post-transition, many carers reported ongoing sleep disruptions associated with poor sleep habits established whilst caring, insomnia or nightmares and grief. Carers were optimistic that their sleep would improve with time and many were enjoying sleeping according to their own preferences. The sleep experience of family carers is unique and includes tensions between their essential need for sleep and the experience of care as self-sacrifice. Findings have implications for timely support and interventions for families living with dementia. [ABSTRACT FROM AUTHOR]

Māori health providers emerged in Aotearoa/New Zealand in the 1980s as a mechanism to achieve self‐determination for Māori communities. However, the contracts funding Māori health providers limit expressions of self‐determination and fail to reflect Te Tiriti O Waitangi, the founding treaty of Aotearoa/New Zealand. Significant health reforms are proposed in Aotearoa/New Zealand, including the creation of a Māori Health Authority that will commission services from Māori health providers. This paper aims to critique the government contracts provided to Māori health providers in the light of the health reforms. A discourse analysis was undertaken on contracts held by a Māori health provider. The study was informed by a Kaupapa Māori congruent methodology that centralised Māori knowledge. The contractural language utilised a variety of discursive techniques that ultimately limit the power of Māori health providers. These discursive techniques included the redefinition of Māori concepts of self‐determination, the use of rhetoric that was not matched by action, reshaping Māori health priorities to reflect the funders' priorities and the application of a deficit lens to Māori health issues. The discursive techniques present in these contracts is consistent with previous work demonstrating a failure of funders to centralise Māori knowledge and ways of being. Success of the proposed health reforms and the Māori Health Authority should require dismantling of non‐Māori ways of commissioning and contracting, otherwise there is the continued risk of discriminatory contracting practices limiting the expression of self‐determination for Māori health providers. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Dietetic service delivery in primary health care is an emerging area of dietetic practice in New Zealand. AIM: This paper aims to describe the dietetic services being delivered in this setting and dietitians' perceptions of the factors that have an effect on their ability to deliver an optimal service. METHODS: Individual, qualitative, semi-structured, face-to-face interviews were conducted with 12 primary healthcare dietitians from a range of age, ethnicity and professional backgrounds. Interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis. RESULTS: Participants were delivering a range of services including: providing nutrition care directly to patients, helping to upskill other primary health care professionals in nutrition, and delivering health promotion initiatives to their local community. Three key factors were identified that participants perceived as having an effect on their ability to deliver effective dietetic services in primary health care: being part of a multidisciplinary general practice team, having flexible service delivery contracts appropriate for the setting and that supported integration, and having an adequate level of dietetic experience. DISCUSSION: Dietitians working in primary health care recognise the importance of being well integrated into a multidisciplinary general practice team. This enables them to deliver more collaborative and coordinated nutrition care alongside their colleagues, to benefit patient care. Establishing flexible dietetic service delivery contracts, which support integration and take into account funding and workforce capacity requirements, may help ensure that the unique skill set of a dietitian is utilised to best effect. [ABSTRACT FROM AUTHOR]

There is a growing interest in English-speaking jurisdictions, including Australia, North America, Canada, the United Kingdom and New Zealand, about the prevention of sexual abuse perpetrated by children against other children. The aim of this review was to identify opportunities for research, policy and practice which could enhance the prevention agenda relating to the perpetration of sexual abuse by children through conducting a Critical Interpretive Synthesis. Eleven electronic databases were searched in the period from 22 April to 23 May 2013 and included: SocINDEX, Social Services Abstracts, Applied Social Sciences Index and Abstracts, Family and Society Studies Worldwide, Project Muse, PsychINFO, Family and Society Plus, Jstor, Expanded Academic ASAP, Web of Science and Google Scholar. Key individual journals were also searched, including Child Abuse and Neglect and the Journal of Interpersonal Violence, as well as the grey literature. The search was guided by the research question: How could the prevention agenda relating to sexual abuse perpetrated by children be enhanced? The systematic literature search yielded 3323 titles, and 34 of these papers were included in the final synthesis. The authors identified five domains operating in the evidence base: characteristics, causes, communications, interventions and treatments. A synthesising construct emerged from the review: prevention-enhancing interactions. This construct referred to the potential for enhancing the prevention agenda which exists as the evidence domains interact with one another, and with the public health model of prevention. The authors consider this review to be a timely contribution to the current agenda pertaining to sexual abuse perpetrated by children. It provides researchers, policy makers and practitioners in the field with an evidence-informed conceptualisation of opportunities for enhancing prevention work. [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]

The necessity of developing effective and innovative primary prevention strategies is a pressing objective in stemming the harm caused by the production and consumption of child sexual exploitation material (CSEM). Digital media interventions – including search engine advertisements – hold promise as prevention tools to deflect potential users away from CSEM and redirect them to therapeutic services. This study aimed to establish an evidence base for effective advertising in this context by creating mock-up helpline advertisements and testing them in focus groups and interviews with staff and clients of New Zealand's major treatment service providers for harmful sexual behavior. Prior to testing these advertisements in situ (on online platforms), this paper reports on a foundational creative and qualitative investigation of effective advertisements – what imagery, text, and design features are most likely to succeed in diverting people away from seeking CSEM and encouraging them to reach out to a helpline? The findings of this study offer deeper understanding of the mindset, emotions, and barriers to reaching out that are experienced by onset CSEM users, as well as suitability of certain imagery and text for advertising in this context, and thereby contribute to strengthening primary prevention efforts in combatting CSEM consumption. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Medication does not always resolve a serious mood episode, and there is evidence that it needs to be combined with an evidence‐based psychotherapy to promote symptomatic and functional recovery.There is little known about what people with serious mood disorders want from mental health services to manage their mood. What the paper adds to existing knowledge?: Participants in this study wanted a framework other than the medical model for understanding and managing their mood.Their motivation to commence psychotherapy was based on a sense of having hit rock bottom and a need for understanding what was happening in order to better manage their mood. Introduction: There is little known about the motivations for people to participate in psychotherapy for depression. Aim: To explore why people, with a diagnosis of major depressive episode, chose to take part in a psychotherapy study and what they expected it to involve. Method: This was a qualitative study of participants' motivations and understandings of psychotherapy for depression. Data were collected using semi‐structured interviews and analysed using thematic analysis. Findings: Eight females and eight males with an age range from 21 years to 55 years were recruited. Three themes were identified that described why participants chose to participate in psychotherapy: medication was not enough, a turning point and making sense of experience. The participants chose to participate in psychotherapy after finding that medication was insufficient and this combined with a sense of crisis motivated them to engage in psychotherapy in order to learn to manage their mood differently. Discussion: The participants recognized that they wanted a framework other than a medical model with its reliance on medication, in order to make sense of their experiences and develop new self‐management strategies. Implications for Practice: Our study suggests that some people experiencing a serious mood disorder access psychotherapy after "hitting rock bottom" and finding insufficient help from medications. Mental health nurses need to be aware people do not always want a medical model approach to treatment of serious mood disorders and they need to provide the opportunity of engaging in a psychotherapeutic framework in order to better understand and manage their mood. [ABSTRACT FROM AUTHOR]

There is widespread and growing support and requirement for researchers and larger organisations to collaborate with communities. This ensures that social, educational, or health programmes are relevant and acceptable and address the needs of groups that experience inequity. There is limited research about the processes and approaches that impact successful collaboration. The aim of this study was to identify the best‐practice processes used to develop and sustain collaborative partnerships between community members and formal organisations in Aotearoa New Zealand. Using a qualitative case study methodology and guidance from our community advisory group, we selected three effective collaborations with groups that experienced inequity in Aotearoa New Zealand. We examined these by reviewing their publicly available documents and conducting focus group discussions and interviews with key stakeholders. We coded and analysed transcriptions thematically to develop case study summaries of findings and then conducted cross‐case analysis to identify themes inherent in the data. Seven themes emerged from the data: (1) work together under Te Tiriti to ensure that collaborations are built on the articles of this founding document of Aotearoa New Zealand; (2) start before the beginning by forming strong relationships with diverse and representative community members; (3) walk the talk by using critically reflexive processes built on shared values and equal power relations; (4) use pencils not pens to implement ensuring an iterative project process; (5) recognise all contributions and especially the value of lived experience and local knowledge; (6) journey at a pace that allows all to participate; and (7) listen twice, talk once to give priority to hearing quieter voices. These seven practices can be utilised by other collaborative initiatives to increase genuine and power‐shared participation. These participatory processes can make sure that collaborative projects respect local knowledge, indigenous culture, and respond iteratively to community needs. [ABSTRACT FROM AUTHOR]

Introduction. Rural hospitals provide secondary care for much of the rural New Zealand population. Little is known about community perspectives of the health and social contribution. Aim. This descriptive qualitative study aimed to explore community views on the role of their rural hospital in a low socioeconomic rural district with a high Māori and Pacific population. Methods. Semi-structured individual and focus group interviews were conducted with rural community members about the perceived role of their rural hospital. Iterative thematic analysis was undertaken. Results. In total, 22 participants were interviewed. Thematic analysis yielded four themes: (i) rural hospitals as a safety net – providing access to emergency care and mitigating limited primary care access; (ii) providing personalised, culturally aware care; (iii) facilitating family/whanau support; and (iv) doing the best with limited resources. The latter included pragmatism about resource constraints, but a preference for the hospital to remain open. Discussion. Rural hospitals contribute to community safety by enhancing access to emergency care and mitigating difficulties in access to primary care. The local contextual knowledge of rural hospital providers allows personalised, family-centred and culturally-responsive care. Despite service centralisation, rural hospitals are wanted by their communities. Rural health planners should consider how to maximise the breadth of locally-provided services to reduce the impacts of travel and transfer for care [ABSTRACT FROM AUTHOR]

Introduction. International research suggests free online postal self-sampling for sexually transmitted infection (STI) testing is an acceptable alternative to clinic-based testing. A userpays online STI testing service exists in Aotearoa New Zealand, but acceptability among priority populations is unknown. Aim. To explore Māori and Pacific young people’s perspectives on online postal self-sampling for STI testing (as prospective service users). Methods. Four wānanga (knowledge-sharing forum) were held between November 2022 and May 2023 with Māori and Pacific participants aged 15–24 years who were recruited via youth-focused community organisations. Three facilitators guided discussions about STI testing and use of an online service. Inductive thematic analysis was used to analyse data generated from audio-recorded discussions, group work notes and facilitator field notes. Results. None of the 38 participants were aware of online STI testing and all considered it cost-prohibitive. Perceptions of online testing were mixed, and discussion about concerns outweighed perceived benefits. Three themes were identified: (i) potential to support autonomy (perceived benefits and positive features of self-sample collection kits); (ii) barriers and process-related concerns; and (iii) tailoring online STI testing to young people’s needs (facilitating engagement with online testing). Discussion. For online STI testing to be an accessible alternative to clinic-based testing for priority populations, cost, low awareness and other barriers in the testing pathway need to be addressed. Clinician follow-up on positive results and free treatment would be critical to ensure the cycle of best practice care is completed. Regardless of where testing is accessed, investment is needed to support young people’s knowledge of when, why and how to access a sexual health check. [ABSTRACT FROM AUTHOR]

Introduction: Across Aotearoa (New Zealand), there are chronic shortages of qualified Māori (Indigenous peoples of Aotearoa) health practitioners and systemic ethnic health inequities. This study, focussing on the discipline of occupational therapy, explores Māori graduates' recollections of the institutional barriers that impacted on their study in this field over a 25‐year period. Methods: This qualitative study interviewed seven Māori occupational therapy graduates using pūrākau—an innovative Māori narrative inquiry method. Pūrākau (stories) were collected in 2018 via kanohi ki te kanohi (face to face) semi‐structured interviews. They were analysed using the kaupapa Māori (Māori philosophical) framework of Pū‐Rā‐Ka‐Ū which draws on traditional Māori mātauranga (knowledge). Findings: The institutional barriers identified were (1) cultural dissonance, (2) cultural (in)competency and (3) the limitations of (Western) pastoral care. Conclusion: This study highlighted how racism is embedded within the Western tertiary education system. To create a safe learning environment for Māori students, tertiary education institutions require a planned approach to address racism within policy, procedures, the curriculum, teaching and professional staff. [ABSTRACT FROM AUTHOR]

It is well documented that Health care assistants (HCAs) provide the most hands‐on care to residents in aged care facilities, and play a critical role in the provision of care to dementia residents. Over the last 25 years, a philosophy of person‐centred care has become the preferred approach to care and this has meant that HCAs are encouraged to get to know the resident very well. This paper reports the experiences of HCAs in caring for people at end‐of‐life, identifies the skills required for their work and examines the education provided against these skills. Semi‐structured interviews were conducted in 49 facilities (n = 34) across New Zealand and data analysed thematically, with the aim of critically examining the adequacy of education for health care assistants which meets their needs within a person‐centred environment. The results confirm that the skills include traditional tasks of care (showering, feeding, toileting, and dressing) but the increasingly important communication and de‐escalation skills, both verbal and non‐verbal, have become central to their care skills. Education provided has not sufficiently shifted focus to include these more complex skills. Provision of educations that acknowledges the increased complexities of their role needs to be provided. As well, facilities need to be challenged to reconsider the HCA's position in the facility care tem. [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]

Access to economic resources influences the material conditions of life for older people, as well as the freedoms and capacities of older people to achieve the kind of lives they value. Security is one aspect of later life valued by older people. Ontological security provides a sense of order and continuity and needs to be understood in terms of the situated life experiences and circumstances of older people. The study reported in this paper analysed 145 qualitative interviews with New Zealanders aged 63–93 in order to explore how participants understand ontological security. Varying levels of access to economic resources were associated with differing abilities of participants to manage the unpredictability of everyday life. Among the wealthy, security was strongly connected to the freedoms provided by ample financial resources. Contrary to what might be expected, those with the lowest levels of economic resources did not express higher levels of insecurity, but instead drew upon life experiences of managing and making do to construct a trajectory of security. Those with mid-range levels of economic resources expressed most insecurity, including anxiety over changing economic conditions and concerns over their ability to manage reductions in economic resources. In discussing the implications of this, the paper highlights the need to recognise ways in which access to economic resources intersect with life circumstances, past experiences and future social expectations to provide opportunities for all older people to pursue security as they strive to age well. [ABSTRACT FROM PUBLISHER]

Accessible summary: What is known of the subject: Consumer participation in mental health services is an expectation articulated through mental health policy.Consumers as researchers could contribute significantly to mental health services. Barriers to participation are significant and limit consumer involvement. What the paper adds to existing knowledge: Enhanced understandings of collaborative relationships between consumer and nonconsumer researchers.Researchers from the health disciplines find value in consumer involvement in mental health research.These researchers can support and facilitate consumer research by being allies to consumer researchers. What are the implications for practice: Understanding the role of allies is necessary to strengthen their capacity to support consumer researchers.Involving consumers in mental health research is likely to lead to improved practice. Introduction: Australia and New Zealand mental health policy requires consumer participation in all aspects of mental health services. Systemic participation informs and improves the quality of mental health services. Collaboration with consumer researchers should be similarly required. Enhanced understandings of collaborations are needed. Aim: To enhance understanding of the perspectives and experiences of nonconsumer researchers in working collaboratively with consumers as researchers. Method: This qualitative exploratory study involved interviews with nonconsumer mental health researchers who have worked collaboratively with consumers in research. Interviews were conducted with participants from Australia and New Zealand. Results: "Allyship" emerged as a major theme. This describes nonconsumer researchers playing an actively supportive role to facilitate opportunities for the development and growth of consumer research roles and activities. Seven subthemes were identified: establishing and supporting roles, corralling resources, guiding navigation of university systems, advocacy at multiple levels, aspiring to coproduction and consumer‐led research, extending connections and partnerships, and desire to do better. Discussion: Allyship may have an important role to play in the broader consumer research agenda and requires further consideration. Implications for practice: Embedding meaningful consumer participation within mental health services requires active consumer involvement in research. Allies can play an important facilitative role. [ABSTRACT FROM AUTHOR]

A crucial development resulting from consumer involvement in mental health services has been engagement as active participants in mental health research, often conducted in collaboration with mental health researchers representing the health disciplines (referred to in this paper as 'other' researchers). Despite progress in mental health consumer research, unequal power relations continue to pose a major barrier. Although power issues are discussed in the literature, there is little research from the perspective of other mental health researchers who have collaborated with consumers on research projects. This qualitative study explored other mental health researchers' perspectives on the role of power in collaborative research with consumers. Semi-structured interviews were completed with 11 other mental health researchers. Thematic analysis of the transcript version of interview recordings was conducted. The findings were grounded in 'the table' as a literal and metaphorical site of power relations. The umbrella theme was prominence and presence (of consumers) at the table, followed by subthemes on barriers (tokenism, undermined potential) and surmounting them through reworking power (critical mass and openness to power dynamics). Overall it was found that while there continue to be significant power-related barriers to further building of robust collaborative research with consumers in mental health, there are several avenues that should be considered, much more assertively, to disrupt and transcend them. [ABSTRACT FROM AUTHOR]

Objectives Smoking during pregnancy is harmful for the woman and the unborn child, and the harms raise risks for the child going forward. Indigenous women often have higher rates of smoking prevalence than non-indigenous. Exercise has been proposed as a strategy to help pregnant smokers to quit. Māori (New Zealand Indigenous) women have high rates of physical activity suggesting that an exercise programme to aid quitting could be an attractive initiative. This study explored attitudes towards an exercise programme to aid smoking cessation for Māori pregnant women. Methods Focus groups with Māori pregnant women, and key stakeholder interviews were conducted. Results Overall, participants were supportive of the idea of a physical activity programme for pregnant Māori smokers to aid smoking cessation. The principal, over-arching finding, consistent across all participants, was the critical need for a Kaupapa Māori approach (designed and run by Māori, for Māori people) for successful programme delivery, whereby Māori cultural values are respected and infused throughout all aspects of the programme. A number of practical and environmental barriers to attendance were raised including: cost, the timing of the programme, accessibility, transport, and childcare considerations. Conclusions A feasibility study is needed to design an intervention following the suggestions presented in this paper with effort given to minimising the negative impact of barriers to attendance. [ABSTRACT FROM AUTHOR]

Young people in statutory care and protection interact with social workers, who hold potential to provide a supportive adult role in their lives. Many however, run away at an early age and end up on the street trading sex for money or other favours. There is potential to improve outcomes for young people in care if the relationship between young people and their social workers is better addressed. This paper uses data from a qualitative study of 14 young people who traded sex and who had experienced interactions with social workers. A thematic analysis identified three themes: the rigidity of social work practice; contesting the family situation; and resisting the at-risk label. We argue that to have any impact on outcomes for young people in care, social workers need to prioritise relationship-building above the need to conform to organizational protocols and guidelines. Such guidelines assist the social worker in assessing whether family situations pose high risk for a young person, but the 'at-risk' label is contested by young people, which results in a lack of trust and a barrier to relationship building. [ABSTRACT FROM AUTHOR]

Introduction. From a coronavirus disease (COVID-19) pandemic perspective, Aotearoa New Zealand (NZ) rural residents formed an at-risk population, and disparities between rural and urban COVID-19 vaccination coverage have been found. Aim. To gain insight into factors contributing to the urban-rural COVID-19 vaccination disparity by exploring NZ rural health providers' experiences of the vaccine rollout and pandemic response in rural Māori and Pasifika communities. Methods. Rural health providers at four sites participated in individual or focus group semi-structured interviews exploring their views of the COVID-19 vaccine rollout. Thematic analysis was undertaken using a framework-guided rapid analysis method. Results. Twenty interviews with 42 participants were conducted. Five themes were identified: Pre COVID-19 rural situation, fragile yet resilient; Centrally imposed structures, policies and solutions - urban-centric and Pakehā focused; Multiple logistical challenges - poor/no consideration of rural context in planning stages resulting in wasted resource and time; Taking ownership - rural providers found geographically tailored, culturally anchored and locally driven solutions; Future directions - sustained investment in rural health services, including funding long-term integrated (rather than 'by activity') health services, would ensure success in future vaccine rollouts and other health initiatives for rural communities. Discussion. In providing rural health provider perspectives from rural areas serving Māori and Pasifika communities during the NZ COVID-19 vaccine rollout, the importance of the rural context is highlighted. Findings provide a platform on which to build further research regarding models of rural health care to ensure services are designed for rural NZ contexts and capable of meeting the needs of diverse rural communities. [ABSTRACT FROM AUTHOR]

This article draws on the free-text commentaries from trans-Tasman studies that used the MISSCARE questionnaire to explore the reasons why nurses miss care. In this paper, we examine the idea that nurses perpetuate a self-effacing approach to care, at the expense of patient care and professional accountability, using what they describe as the art of nursing to frame their claims of both nursing care and missed nursing care. We use historical dialogue alongside a paradigmatic analysis to examine why nurses allow themselves to continue working within settings that put their professional/personal selves aside in an attempt to deliver care within constraints that make completing care an impossible task. The findings suggest an ambivalence and conflict confront nurses attempting to provide care within the New Public Management environment. This can be seen in the tensions that draw a line between care as an art, and care as a financial target, juxtaposed with the inherent clash of values arising from the way nursing care is conceptualised within two contradictory paradigms. [ABSTRACT FROM AUTHOR]

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

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]

Despite international efforts, stigma is still a significant issue for people living with HIV/AIDS (PLWHA). This paper explores the stigma encountered in health interactions, focusing on strategies PLWHA use to manage and reduce it. It is hoped that our findings will improve future interactions by contributing towards a more understanding practitioner–patient relationship. The data have been drawn from a small qualitative study conducted in Christchurch, New Zealand. Fourteen participants took part in semi-structured face-to-face interviews in 2013 and 11 of these participants were then interviewed again in 2014. Codes and themes were developed through inductive thematic analysis of the interview transcripts. Our findings identified that whilst the majority of participants had positive experiences, nearly all had faced stigma during their health interactions. Most of these encounters were due to healthcare workers holding exaggerated fears of transmission or not maintaining confidentiality and privacy. The main way that participants managed this stigma was through seeking control in their interactions. This overarching strategy could be further divided into three key themes: selective disclosure of their HIV status, self-advocacy and developing their HIV knowledge. We discuss these findings in the context of the current literature, comparing our results to strategies that have been previously identified in social settings. [ABSTRACT FROM AUTHOR]

Living with human immunodeficiency virus (HIV) in the industrialised world has for over a decade been conceptualised as living with a chronic illness. People living with HIV now are amongst the first to live and age with the virus. Drawing on a qualitative longitudinal study in a low-incidence area in a low-incidence country, this paper investigates the nuanced ways that people negotiate this condition. While it has been argued that HIV is a condition like any other chronic disease, our thematic analysis reveals some similarities and particularities around living with the condition. In comparing themselves to others with the condition, high levels of diversity of experience were identified that extended well beyond length of time from diagnosis. In comparing their illness with other illnesses, the location, for example, of their specialist service within a clinic for those with acute sexually transmitted diseases was identified as problematic. The work involved in maintaining a coherent sense of self in the face of existing and shifting challenges as a result of their infection was a second strong theme. The final theme involved flux and flex work in the ways people sought to gain and maintain control over various aspects of their lives. All of these experiences are mediated by place; that is the experience is not the same as that of those who live where there is a much higher incidence of infection. The work involved in negotiating this condition in low-incidence environments deserves more attention, but aspects of these findings are significant in higher incidence contexts as well; in particular, passivity in face of infection as one ages and the potential for medication refusal as a means of maintaining control over life and death. [ABSTRACT FROM PUBLISHER]

The incidence of diabetes in people with an intellectual disability, although unknown, is indicated to be higher than the general population. Given the challenges individuals with intellectual disability may face, this population is often dependent upon key workers to manage their health and well-being. One aim of a wider study on the self-management of diabetes by people with intellectual disability was to explore how key workers supported their self-management. That aim was the focus of this paper. Between 2009 and 2010, 17 staff from five residential intellectual disability services and two supported independent living services within New Zealand, consented to a semi-structured interview. Transcripts of the interviews were analysed using Thomas' General Inductive Approach. Three overarching themes emerged; having knowledge and understanding, being lifestyle police and ensuring future well-being. While knowledge, skills and perspectives varied, all participants were committed to ensuring that the lifestyle of the person concerned was compatible with the management of their diabetes. A range of perspectives existed between the expectations they had of themselves, colleagues and the individual with diabetes. There was an identified need for initial and ongoing education of permanent and casual staff and the people themselves with diabetes in collaboration with health and disability services to build confidence and promote self-management practices. In so doing, the impacts of this long-term condition may be reduced and the health outcomes improved for people with intellectual disability. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Youth health outcomes are poor in New Zealand and have a life-long impact on individuals, wha-nau (family) and society. Little is known about how young people view their experiences of general practice care despite it being the most common place to access health care. AIM: This study sought to explore young peoples' experiences of care in a selected, youth-friendly general practice. METHODS: In-depth individual interviews with six young people. RESULTS: Four themes were identified from young peoples' narratives in relation to their experiences of general practice care: going to the doctor is not easy for a young person; the attributes of staff make all the difference; specific youth-friendly consultation practices help young people; and a youth-friendly physical environment can help young people access services and feel safe. DISCUSSION: Even though the study general practice had explicitly instituted youth-friendly initiatives, including offering no-charge consultations and specialist staffmembers, young people still described considerable barriers to attendance. Many barriers are practice-based and could bemodified by staff training, provision of further youth care staff roles and consideration of environmental changes. Other barriers such as waiving prescription costs need government funding. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Routinely following an evidence-based clinical pathway of care for bacterial sexually transmitted infections (STIs) such as chlamydia or gonorrhoea is important to help reduce the spread of infections, prevent reinfections and avoid associated health complications. AIM: To develop an easy-to-use tool for routine use by primary care clinicians to ensure best practice management of patients tested for and diagnosed with chlamydia or gonorrhoea. METHODS: The tool (a MedTech Advanced Form) was developed in consultation with seven primary care clinicians and included different tabs for use during the STI care pathway (testing, treatment, advice, partner notification and follow up) with clickable links to relevant online resources. The tool was trialled over 3 months by 19 clinicians in three Wellington primary care clinics - two youth health and a student health service. Outcome measures were frequency of use, completeness of fields related to best practice care and clinician acceptance of the tool (from focus group feedback). RESULTS: The tool was used for approximately one in four patients who were tested during the trial period, with 'forgetting' reported as the mostcommonreason for non-use. Clinician views about the tool were favourable, with most indicating they would like to continue use and would recommend it to colleagues. Documentation of best practice care was excellent; fields to record reasons for testing, discussion of sexual history, provision of treatment and advice given were used for most patients for whom the form was completed. CONCLUSIONS: Inclusion of this STI management tool in the electronic patient records system appeared to improve primary care clinicians' delivery and documentation of best practice sexual health care at a practice level. Wider use of a modified version of this tool could facilitate more comprehensive best practice management of bacterial STIs. [ABSTRACT FROM AUTHOR]

Internationally, the COVID-19 pandemic resulted in changes to services as governments funneled health-related funding and resources into stopping the spread of COVID-19. At the same time, older people were singled out as an "at-risk" group, which prompted caution from both older people and governments to limit their exposure to COVID-19. It remains unclear what the impact this has had on older people's routine health and social care access, and how older people themselves viewed these changes. This analysis investigates older people's understanding and experiences of using health and social care services under the COVID-19 lockdown restrictions in 2020. This analysis draws from a wider, letter-writing study that received 748 letters from 854 participants aged 70 years and older who were living in New Zealand during the COVID-19 lockdowns. Just over half of letter writers described access to health and social care services. Informed by Penchansky and Thomas' 5 A's of the access framework, we conducted a thematic analysis of this subsample of letters (n = 404). This analysis identified four broad categories relating to access to health and social care services under COVID-19 lockdown restrictions: (a) the system-wide strangeness of physically accessing services, (b) accommodation of services, (c) availability of resources and personnel, and (d) enhanced quality of those included by services. Rather than passively accepting changes, older people adapted to restrictions by drawing on their available materials and social resources. We conclude this analysis with suggestions for improving future interventions and policies to better older people's access to health and social care during times of crisis. [ABSTRACT FROM AUTHOR]

Aims: Investigated the experiences of Māori (the Indigenous peoples of Aotearoa, New Zealand) patients and whānau (extended family network) engaging with acute hospital inpatient services and their priorities for a Māori-centred model of relational care. Design: A qualitative Māori-centred research design using a Thought Space Wānanga (learning through in-depth group discussion, deliberation and consideration) approach. Methods: Two wānanga were conducted between May 2022 and June 2022, with 13 Māori patients who had been acutely hospitalized within the past 12 months and their whānau members. The first wānanga utilized storytelling and journey mapping to collect data. The second wānanga refined the initial themes. Wānanga were audiorecorded and then inductively coded and developed into themes. Results: Thirteen patients and whānau attended the first wānanga, while 10 patients and whānau participated in the second wānanga). Four themes were developed: (1) Whakawhanaungatanga (establishing connections and relationships), (2) Whakamana (uplifting the status and esteem of Māori), (3) Whakawhitiwhiti kōrero (the importance of communicating, discussing and deliberating) and (4) Kotahitanga (working together with purpose) all provide insights into the importance of effectively engaging and connecting with Māori patients and whānau when acutely hospitalized. Conclusions: The experiences and priorities of Māori patients and whānau affirm the international literature, suggesting that Indigenous relational concepts are critical to building relationships, connections and trust. Despite existing healthcare models for working with Indigenous peoples, their poor application contributes to sub-optimal healthcare experiences at all points of their healthcare journey. A relational mode of practice focused on engagement and forming connections better meets the needs of Indigenous peoples engaging with inpatient health services. Implications for the profession and/or patient care: Despite the existence of Indigenous models of care, Indigenous peoples consistently report a lack of engagement and connection when accessing inpatient health services. Without establishing relationships, applying models of care is challenging. Impact (Addressing): • What problem did the study address? Internationally, healthcare systems are consistently ill-equipped to deliver culturally safe care for Indigenous and marginalized peoples, evident in ongoing health inequities. Like other reports of Indigenous experiences of health services, Māori express dissatisfaction with care delivery in an acute inpatient setting. This study investigated Māori patients and whānau experiences engaging with acute hospital inpatient services and their priorities for a Māori-centred model of relational care. • What were the main findings? Māori patients and whānau recounted negative experiences with healthcare professionals lacking effective relationships and trust. Satisfaction occurred when engagement with health care professionals resembled Indigenous cultural rituals of encounter that considered their holistic, collective and dynamic worldviews. Previous models of relational care, while helpful, are not Indigenous and so do not address their needs, such as engagement as a mode of practice (how) to achieve this. • Where and on whom will the research have an impact? This research impacts Indigenous peoples' health outcomes, particularly Māori, and nurses and clinicians working and interacting within acute inpatient and other hospital settings. Indigenous research methods support co-constructing knowledge for translation into practical outcomes through transformational practices, policies and theory development. Reporting method: We used the Consolidated Criteria for Strengthening the Reporting of Health Research Involving Indigenous Peoples (CONSIDER) statement (see File S2—CONSIDER Checklist) and the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines (see File S3—COREQ Checklist). [ABSTRACT FROM AUTHOR]

Background: Digital contact tracing (DCT) was a central component of the global response to containing COVID‐19. Research has raised concerns that DCT could exacerbate inequities, yet the experiences of diverse communities at greater risk from COVID‐19 are typically underrepresented. Methods: The present study aimed to understand the perceived barriers to the adoption of the app amongst Māori, Pasifika, and disabled people. Focus groups and interviews were undertaken with Māori, Pasifika, and disability sector stakeholders and community participants. Results: Participants (n = 34) generally expressed willingness to utilise DCT and support its adoption within the communities. Simultaneously, participants revealed how the app could marginalise community members who struggled with the usability and those distrusting of the government's COVID‐19 interventions. Conclusions: The findings highlight how addressing communication inequality can assist in the development of contact‐tracing responses that are both effective and equitable. The study provides insights about the role of information and communication technologies as health resources. Patient or Public Contribution: Consulting with members of the target communities was central throughout the present study, including recommendations for potential participants, participation in interviews and sharing early findings for feedback. This study reports on focus groups and interviews with individuals from Māori and disability sectors. [ABSTRACT FROM AUTHOR]

Maternal mental health plays a vital role in the overall wellbeing of mothers, children, families, whānau (core support network) and communities. However, many mothers face mental health challenges during the transition to parenthood. In this study, we used an online story-sharing platform to collect the experiences of mothers who have faced unmet needs while using the Well Child Tamariki Ora (WCTO) service in Aotearoa New Zealand. From the 420 submitted stories, 125 stories related to mental health need while using the WCTO service. Using thematic analysis, we identified three main themes that highlighted the experiences of mothers with the service. This includes (1) making it seem that I'm coping: Mothers' fear of being judged; (2) i wish I had connected with my WCTO nurse: Fostering meaningful relationships to facilitate personal information sharing; and (3) beyond the baby: Mothers desire for recognition and support during WCTO visits. These findings point to several missed opportunities for WCTO providers to inquire about mental health and offer support needed by mothers. To address this, a relational approach to care would prioritise families and whānau as the focus of care rather than just monitoring the development of babies. [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]

Introduction. In Aotearoa New Zealand (NZ), type 2 diabetes (T2D) is predominantly managed in primary care. Despite established guidelines, patients are often suboptimally managed, with inequitable health outcomes. To date, few NZ studies have evaluated the primary care management of T2D at the time of diagnosis. Aim. This study aims to explore the provision of education and delivery of care to patients at the time of diagnosis, which is a crucial time in the disease trajectory. Methods. Participants were recruited from a Māori health provider in the Waikato District, and diagnosed with T2D after January 2020. Patients were texted a link to opt into a survey (larger study) and then registered interest by providing contact details for an interview (current study). Semi-structured interviews were conducted and were audio recorded, transcribed, and thematically analysed. Results. In total, 11 participants aged 19-65 years completed the interviews (female n = 9 and male n = 20); the comprised Māori (n = 5), NZ European (n = 5) and Asian (n = 1) participants. Three overarching themes were identified, including: (1) ineffective provision of resources and education methods; (2) poor communication from healthcare practitioners; and (3) health system barriers. Discussion. Evidently, there are difficulties in primary care diabetes mellitus diagnosis and management. Improvements could include locally relevant resources tailored to patients' experiences and cultural identities. Utilising whānau support and a non-clinical workforce, such as health navigators/kaiāwhina, will drastically address current workforce issues and assist patient self-management. This will allow improved diagnosis experiences and better health outcomes for patients and whānau. [ABSTRACT FROM AUTHOR]

Purpose: Many psychiatrists and trainees in Aotearoa New Zealand used telepsychiatry during COVID-19 lockdowns, despite minimal experience and training in the area. Research on a culturally safe telepsychiatry framework is lacking in Aotearoa. This study aims to provide a better understanding of telepsychiatry in the Aotearoa context and identify potential gaps with the current practice, with a focus on exploring telepsychiatry use with Maori, Pacific peoples and Asians. Design/methodology/approach: This qualitative study was guided by the principles of the Kaupapa Maori methodology and the "Give Way Rule" from Pan-Pacific studies, to ensure culturally appropriate analysis and outcomes. Semi-structured interviews were conducted with a sample of psychiatrists and trainees recruited from Aotearoa members of the Royal Australian and New Zealand College of Psychiatrists. The qualitative data were then analysed using general inductive thematic analysis to identify the major themes. Findings: In total, 18 participants were interviewed. Three key themes were identified: cultural safety such as preparation for a telepsychiatry session, cultural practices and equity issues; clinical practice such as continuity of care, patient selection and limitations; and process of running a telepsychiatry service. Originality/value: The analysis of the main themes gives both practical ideas for providing a culturally safe telepsychiatry appointment, as well as a wider base for developing a telepsychiatry service that works particularly for Maori, Pacific and Asians mental health users. Issues around resources and expertise in the field are lacking and further frameworks to support infrastructure and training are needed. [ABSTRACT FROM AUTHOR]

Introduction: The usual output following health consultations from paediatric services is a clinical letter to the referring professional or primary care provider, with a copy sent to the patient's caregiver. There is little research on how patients and caregivers perceive the letter content. We aimed to: first understand child, young people and caregiver experiences of and preferences for receiving a health feedback letter about the child/young person's health measures within a healthy lifestyle programme; and second to provide a set of recommendations for designing letters to children, young people and their families within a healthy lifestyle programme. Methods: This qualitative study, informed by Kaupapa Māori principles, included focus groups of children aged 5–11 years and young people aged 12–18 years who were participants in a healthy lifestyle programme in Taranaki, Aotearoa New Zealand and of their respective caregivers (total n = 47). Discussions were audio‐recorded, transcribed and analysed using thematic analysis. Findings: Key themes were identified: letters sometimes acted as 'discourses of disempowerment'—some participants experienced a lack of safety, depersonalisation with medical jargon and 'feeling like a number'. Participants described the need for acknowledgement and affirmation in written communication—health feedback should include validation, choice regarding content, respectful tone and a strengths‐based approach to health messages. Interpretation: Letters to referrers, copied to families, can be perceived as disempowering, and participant and caregiver perspectives of content should be considered. This study challenges conventional practice in communicating health feedback with broader implications for written communication in healthcare. We propose separate letters aimed at the child/young person and their caregiver that offer choice in the information they receive. The administrative burden of multiple letters can be mitigated by advances in digital health. Patient Contribution: This study originated in response to feedback from service users that current health feedback was not meeting their needs or expectations. Patient perspectives, especially from children, are rarely considered in the generation of clinic letters from health professionals. Participants were child participants in the community‐based clinical service and their caregivers, and care was taken to represent the demographic backgrounds of service users. Collection and interpretation of Māori data were led by researchers who were local community members to ensure prioritisation and preservation of participant voice. Where possible, results are illustrated in the text by direct quotes from participants, whose identities are protected with a pseudonym. [ABSTRACT FROM AUTHOR]

Examining the concepts underpinning the reasoning processes of social worker's decision‐making provides important insights into how social work practice is undertaken. This paper examines one of the major discourses used by social workers in decision reasoning in a non‐governmental organization child protection context in Aotearoa/New Zealand: family maintenance. This study found that family maintenance as a concept was strongly privileged by social workers. This resulted in attempts to preserve families and created a hierarchy of preferred decision outcomes. A preference for family maintenance was supported by legal, moral, psychological and Māori cultural concepts. This pattern of constructs underpinned the ‘weighing up of harms’ when considering removal, and generally reflected a child welfare orientation. In addition to this, it was found that ‘family’ was broadly defined, and could include people who had a relationship with the children, or Māori definitions of extended family, in addition to legal ones. [ABSTRACT FROM AUTHOR]

Little is known about how mental health services consider the parenting role and the well‐being of children when assessing parents with acute mental illness. This paper investigated how crisis mental health services addressed child well‐being in the Wellington region, New Zealand. This mixed‐method case study included: (i) an audit of the electronic clinical records of all adults presenting to the crisis assessment team; (ii) interviews with 22 key informants; and (iii) a documentary review. We found that data about children were not systematically collected. Less than half of (49 of the 104) the records of patients who were parents included information on their child's well‐being; only six (6%) contained a specified plan for action. The focus for services was the adult patient. Key informants were unclear about their role. They identified inadequate training and institutional support, inflexible funding models and limited availability or inappropriateness of referral services as problems. They saw a need for children to become more visible, for collaborative working to improve the use of existing services and for new funding models, resources and roles. Existing national policy documents contained little guidance and no practice guidelines were in use. These were lost opportunities to improve support for the parenting role and promote child well‐being. [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]