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Health literacy is a social determinant of health, with lower levels linked to suboptimal health outcomes. There is a gap in the literature regarding the value of health literacy assessment among Aboriginal and Torres Strait Islander peoples and best methods with which to perform such assessments in general practice.Literature was reviewed to determine what is known regarding health literacy of Aboriginal and Torres Strait Islander peoples, the availability of assessment tools and the implications for general practice.Despite its effect on health outcomes, the health literacy of Aboriginal and Torres Strait Islander peoples is poorly understood, with no validated assessment tools specifically tailored to this population. Culturally insensitive screening of health literacy has potentiality to disaffect; thus, practitioners should consider assessments aligned with Indigenous methodologies such as conversational or yarning approaches or the use of a small number of screening questions. Practitioners are encouraged to adopt a universal precautions approach and use culturally appropriate conversational styles to optimise communication and healthcare outcomes.

Background Atrial fibrillation (AF), the most common cardiac arrhythmia in the general population, has significant healthcare burden. Little is known about AF in octogenarians. Objective To describe the prevalence and incidence rate of AF in New Zealand (NZ) octogenarians and the risk of stroke and mortality at 5-year follow-up. Design Longitudinal Cohort Study. Setting Bay of Plenty and Lakes health regions of New Zealand. Subjects Eight-hundred-seventy-seven (379 indigenous Māori, 498 non-Māori) were included in the analysis. Methods AF, stroke/TIA events and relevant co-variates were established annually using self-report and hospital records (and ECG for AF). Cox proportional-hazards regression models were used to determine the time dependent AF risk of stroke/TIA. Results AF was present in 21% at baseline (Māori 26%, non-Māori 18%), the prevalence doubled over 5-years (Māori 50%, non-Māori 33%). 5-year AF incidence was 82.6 /1000-person years and at all times AF incidence for Māori was twice that of non-Māori. Five-year stroke/TIA prevalence was 23% (22% in Māori and 24% non- Māori), higher in those with AF than without. AF was not independently associated with 5-year new stroke/TIA; baseline systolic blood pressure was. Mortality was higher for Māori, men, those with AF and CHF and statin use was protective. In summary, AF is more prevalent in indigenous octogenarians and should have an increased focus in health care management. Further research could examine treatment in more detail to facilitate ethnic specific impact and risks and benefits of treating AF in octogenarians.

The Ethiopian education system has been very dynamic over recent years, with a series of large-scale education program interventions, such as the Second Phase of General Education Quality Improvement Project (GEQIP-II) that aimed to improve student learning outcomes. Despite the large-scale programs, empirical studies assessing how such interventions have worked and who benefited from the reforms are limited. This study aims to understand the impact of the reform on Grade 4 students’ maths learning outcomes over a school year using two comparable Grade 4 cohort students from 33 common schools in the Young Lives (YL, 2012-13) and RISE (2018-19) surveys. We employ matching techniques to estimate the effects of the reform by accounting for baseline observable characteristics of the two cohorts matched within the same schools. Results show that the RISE cohort started the school year with a lower average test score than the YL cohort. At the start of Grade 4, the Average Treatment Effect on the Treated (ATT) is lower by 0.36 SD (p

Additional file 1: STable 1. number of participants prescribed with anticoagulant over 5 years follow-up. STable 2a. Multivariate Cox regression analysis for 5-year new stroke outcome in octogenarians (excluding recurrent stroke). STable 2b. Multivariate Cox regression analysis for 5-year new stroke outcome in octogenarians (excluding recurrent stroke). STable 3a. Multivariate Cox regression analysis for 5-year mortality of octogenarians. STable 3b. Multivariate Cox regression analysis for 5-year mortality of octogenarians.

This paper aims to understand the impact of the Second Phase of Ethiopian General Education Quality Improvement Project (GEQIP-II) reform on Grade 4 students’ maths learning outcomes over a school year using two comparable Grade 4 cohort students from 33 common schools in the Young Lives (YL, 2012-13) and RISE (2018-19) surveys.

We describe a collaboration between Māori (Indigenous people of Aotearoa/New Zealand) and Tauiwi (non-Māori) researchers on a software engineering project. Te Tiriti o Waitangi (The Treaty of Waitangi) provides the basis for Māori to lead research that involves Māori as participants or intends to impact Māori outcomes. Through collaboration, an extension of the traditional four-step software design process was created, culminating in a nine-step integrated process that included Kaupapa Māori (Māori ideology) principles. The collaboration experience for both Māori and Tauiwi highlighted areas of misunderstanding within the research context based on differing worldviews and our ability to navigate and work through this. This article provides context, guiding principles, and recommended research processes where Māori and Tauiwi aim to collaborate.

Vietnam has achieved near-universal access to compulsory schooling over the past two decades. However, inequalities between ethnic majority and minority students are stark at post-compulsory levels...

In this Insight Note, we explore the possible explanations for the decline in learning levels among primary school pupils in relation to the General Education Quality Improvement Programme (GEQIP) reforms that wereintended to improve quality and equity in the Ethiopian basic education system. We examine the extent to which mathematics learning levels for Grade 4 pupils have declined over time, despite the implementation of reforms to improve them, as well as the lessons that may be drawn from this. We also examine whether there is any difference in the benefits of the educational reforms for pupils from disadvantaged backgrounds (i.e., from rural areas, emerging regions, and from the lowest socio-economic background). We make use of a unique longitudinal dataset on 33 schools in six regions of Ethiopia covering the period 2012 to 2019.

Primary school enrolment in Ethiopia has more than doubled over the past two decades. In spite of this impressive achievement, and as in many low and middle-income countries that have experienced rapid expansion, the Ethiopian education system is characterised by a ‘learning crisis’ in which many children are leaving school without basic numeracy and literacy skills. In this paper, we explore the relationship between low learning levels and the features of an education system characterised by a sudden increase in learners from disadvantaged backgrounds, including ‘first generation learners’, or students whose parents have never been to school. Using unique longitudinal school survey data, we examine whether first generation learner status represents an additional layer of disadvantage in the Ethiopian education system; the relationship between first generation learner status and learning outcomes; and the educational trajectories of first generational learners through primary school. Based on these findings, we consider the implications of a rising tide of access for Ethiopia as it seeks to provide equitable, quality education for all by 2030.

Objective To determine the association between dietary protein intake and change in grip strength (GS) over time among Māori and non-Māori of advanced age. Methods Protein intake was estimated from 2×24h multiple pass recall (MPR) in 554 participants, and GS was measured yearly over five years. Anthropometric, physical activity and health data were collected. Results The median weight-adjusted protein intake was low (for Māori and non-Māori men 1.05 and 0.98g/kg/day; for Māori and non-Māori women 0.87 and 0.91g/kg/day, respectively). There was a general decrease in GS over five years (mean % change of -2.38 ± 15.32 and -4.49 ± 21.92 for Māori and non-Māori women and -5.47 ± 16.09 and -1.81 ± 13.16 for Māori and non-Māori men yearly). Intake of protein was not related to GS at any of the five-year assessment points nor was it related to change over time. Conclusion Protein intake was low in this cohort of octogenarians and was not protective against loss of GS over five years.

To provide knowledge and recommendations for researchers, health professionals and policymakers on navigating between science and mātauranga (knowledge) Māori when using co-design methodologies.It is well known that the health system in Aotearoa/New Zealand does not provide culturally responsive services, programmes or approaches. Indigenous, remote and vulnerable populations that are not well served by medical and scientific models would be better served by the underlying premise of co-design methodology. However, co-design is a Western methodology. Mahitahi is presented here as a culturally responsive method of co-design that builds approaches by utilising the worldview of the people that the health system most needs to have impact upon. Co-design and mahitahi have synergies, and working at the interface between Western and Māori knowledge systems can provide innovative solutions that draw on the strengths of both approaches.Authors will outline the benefit co-design processes have for improving health outcomes for remote and vulnerable populations. Mahitahi will be described and the synergies with co-design emphasised with important distinctions also highlighted. The use of Indigenous knowledge systems, using Māori as the case example, will be outlined.Recommendations will be provided to guide researchers, health professionals and policy makers when planning a co-design approach with remote and vulnerable communities.

We examined the importance of understanding and incorporating cultural context within Aotearoa/New Zealand when engaging in clinical research and practice. This paper reports on the qualitative findings of a mixed methods study aimed at determining what effect a cardiac risk reduction exercise and lifestyle management programme, embedded within a kaupapa Māori methodological approach, had on Māori participants. This methodology saw participants able to redevelop a western model cardiac risk reduction programme by introducing a Māori worldview. Our study revealed how the kaupapa Māori approach empowered participants to examine and evaluate not only their own health and lifestyle choices, but those of family and the wider community. Combining biomedical and kaupapa Māori components into the programme was found to benefit participants’ mental, physical, spiritual and family well-being.

ObjectiveThe Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS) was established to investigate the drivers of secondary events after first-time acute coronary syndrome (ACS), including addressing inequitable outcomes by ethnicity. Herein, the first clinical outcomes and prognostic modelling approach are reported.MethodsFirst, in 28 176 New Zealanders with first-time ACS from a national registry, a clinical summary score for predicting 1-year death/cardiovascular readmission was created using Cox regression of 20 clinical variables. This score was then calculated in the 2015 participant MENZACS study to represent clinical risk. In MENZACS, Cox regression was used to assess N-terminal pro-B-type natriuretic peptide (NT-proBNP) as a prognostic marker for death/cardiovascular readmission in four models, adjusting for (1) age and sex; (2) age, sex, ethnicity; (3) clinical summary score; (4) clinical summary score and ethnicity.ResultsOf the 2015 MENZACS participants (mean age 61 years, 79% male, 73% European, 14% Māori, 5% Pacific people), 2003 were alive at discharge. Of the 2003, 416 (20.8%) experienced all-cause death/cardiovascular readmission over a median of 3.5 years. In a simple model, age, male sex, Māori ethnicity and NT-proBNP levels were significant predictors of outcome. After adjustment for the clinical summary score, which includes age and sex, NT-proBNP and ethnicity were no longer statistically significant: log2(NT-proBNP) hazard ratio (HR) 1.03, 95% confidence interval (95% CI) 0.98 to 1.08, p=0.305; Māori ethnicity HR 1.26, 95% CI 0.97 to 1.62, p=0.084.ConclusionsIn 2015 patients with first-time ACS, recurrent events were common (20.8%). Increasing NT-proBNP levels and Māori ethnicity were predictors of death/cardiovascular readmission, but not after adjustment for the 20 clinical risk factors represented by the clinical summary score.Trial registration numberACTRN12615000676516.

While critical thinking is widely regarded as a key outcome of higher education, research has shown that in practice it is only developed when certain conditions are in place, relating to the pedag...

EastPack was a New Zealand cooperative providing post-harvest services for its kiwifruit and avocado growers. EastPack was New Zealand’s largest kiwifruit postharvest company with a packing capacity of more than 40 million trays 1 of kiwifruit. It was forecasted that New Zealand kiwifruit volumes would increase by about 50% by 2025. While this was great news for the growers and Zespri – the marketer, it presented a challenge to post-harvest operators like EastPack since they would need to increase their capacity in order to cope with this growth. EastPack needed to develop strategies to manage the strong kiwifruit growth prospects, fund capacity expansion and ensure its growers remained at the heart of their growth.

Background Maintaining independence is of key importance to older people. Ways to enable health strategies, strengthen and support whanāu (family) at the community level are needed. The Ageing Well through Eating, Sleeping, Socialising and Mobility (AWESSOM) programme in Aotearoa/New Zealand (NZ) delivers five integrated studies across different ethnicities and ages to optimise well-being and to reverse the trajectory of functional decline and dependence associated with ageing. Methods Well-being, independence and the trajectory of dependence are constructs viewed differently according to ethnicity, age, and socio-cultural circumstance. For each AWESSoM study these constructs are defined and guide study development through collaboration with a wide range of stakeholders, and with reference to current evidence. The Compression of Functional Decline model (CFD) underpins aspects of the programme. Interventions vary to optimise engagement and include a co-developed whānau (family) centred initiative (Ngā Pou o Rongo), the use of a novel LifeCurve™App to support behavioural change, development of health and social initiatives to support Pacific elders, and the use of a comprehensive oral health and cognitive stimulation programme for cohorts in aged residential care. Running parallel to these interventions is analysis of large data sets from primary care providers and national health databases to understand complex multi-morbidities and identify those at risk of adverse outcomes. Themes or target areas of sleep, physical activity, oral health, and social connectedness complement social capital and community integration in a balanced programme involving older people across the ability spectrum. Discussion AWESSoM delivers a programme of bespoke yet integrated studies. Outcomes and process analysis from this research will inform about novel approaches to implement relevant, socio-cultural interventions to optimise well-being and health, and to reverse the trajectory of decline experienced with age. Trial registration The At-risk cohort study was registered by the Australian New Zealand Clinical Trials registry on 08/12/2021 (Registration number ACTRN 12621001679875).

Refereed/Peer-reviewed

India’s informal economy accounts for more than half the country’s GDP but is characterised by low levels of skills, and considerable barriers to skills development for workers. The Government of I...

To date, there is little research focusing on the role of culture and Indigenous ways of knowing in Western science-dominated high performance sporting environments. This paper takes inspiration from the emerging field of Postcolonial Science Studies and feminist Indigenous scholars to explore how Aotearoa (New Zealand) Black Ferns Sevens players from Māori and Samoan descent make meaning of their bodies within Westernized high performance sporting spaces. Drawing upon a thematic analysis of semi-structured interviews with 18 members of the Black Ferns Sevens squad, we illustrate how players navigate divergent cultural value systems within and across various aspects of the high performance sport environment, including training, nutrition, menstruation, and the everyday quantification of their bodies. This paper also reveals some of the important considerations, learnings, and vulnerabilities experienced during this cross-cultural research collaboration, and highlights the need for more research by/with/for Indigenous women in high performance sport environment.

Māori in Aotearoa have higher incidence, prevalence and mortality from chronic disease. The dominant narrative in Aotearoa about the reasons for Māori ill health neglects to acknowledge the history of colonisation and failures of the health system, alongside the holistic view of health taken by Māori focusing on collective, whānau-based outcomes. In this article, we review health interventions for chronic disease that have a kaupapa Māori philosophical basis. Our findings demonstrate that there is no clear process in health service design, delivery, research and funding that values and understands mātauranga Māori. Western knowledge systems are inadequate for collecting and presenting Māori knowledge. Overall, we highlight that the tension between acknowledging that a “by Māori, for Māori” approach is best, and the difficulty in defining appropriate evidence collection methodology and outcome measures when funders and policy makers continue to require Western-centric interventions is an obstacle to improving Māori health outcomes.

Addressing Indigenous rights and interests in genetic resources has become increasingly challenging in an open science environment that promotes unrestricted access to genomic data. Although Indigenous experiences with genetic research have been shaped by a series of negative interactions, there is increasing recognition that equitable benefits can only be realized through greater participation of Indigenous communities. Issues of trust, accountability and equity underpin Indigenous critiques of genetic research and the sharing of genomic data. This Perspectives article highlights identified issues for Indigenous communities around the sharing of genomic data and suggests principles and actions that genomic researchers can adopt to recognize community rights and interests in data.

This paper is intended to inform the work of the Intellectual Leadership Team of the Research on Improving Systems of Education (RISE) programme. It draws on data and analysis from the Young Lives project to compare four education systems at various stages of development with respect to the transition from meeting the challenge of providing for ‘mass access’ to that of providing for ‘mass learning’. Success in making this transition, that is, escaping a low-level equilibrium of educational quality in the longer term and once resources are no longer severely constrained by access expansion, is crucial if the benefits of the extension of the right to basic education are to be realised in less developed nations. The paper examines learning outcomes in Peru, Vietnam, Ethiopia and India in the light of indicative frameworks for analysing progress with respect to ‘education quality’ at the systems-level. It intends to contribute to broader aims of RISE in terms of the emerging field of education systems analysis, making use of the insights from Young Lives.

Although te reo Māori is an official language of Aotearoa New Zealand, translation of research material such as information sheets, consent forms and questionnaires into te reo Māori remains highly variable. Translation tends to occur in research projects where Māori lead the work and that exclusively focus on Māori communities and topics. Translations are not offered or undertaken as a matter of course for all research. As a team of Māori and Indigenous researchers working within the health sector, we believe that there are important questions that need to be explored around the practice of using Indigenous languages, rich in similes and metaphors, to convey English/Western concepts/constructs/ideologies. In this paper, we draw on the story of one project to deconstruct and challenge the hegemonic terms through which translation of research material occurs. We explore the messages that translated material sends to potential research participants. We contend that the choice about whether to translate research material into te reo Māori is one that should be undertaken within a robust decision-making framework that considers the reasons for a translation and its impact on the participants. Translation should not be undertaken primarily to attract Māori participants, but should reliably signal that the research is being undertaken in a way that honours a Māori worldview.

Background/Introduction Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and it is increasing in prevalence and incidence globally. True prevalence is underestimated because silent/asymptomatic AF is frequent and under-detected, but can cause stroke. Guidelines recommend opportunistic screening for AF in patients aged ≥65 years old. A growing body of evidence from hospital and community-based studies in Australia, New Zealand, Canada and United States indicates this age limit is lower for Indigenous people. Screening for AF meets the World Health Organisation (WHO) criteria for successful routine screening, yet little is known about successful implementation of AF screening in Indigenous communities in developed countries. Purpose The aim of this study is to use a realist approach to identify what works, how, for whom and under what circumstances for AF screening of Indigenous communities in Australia, Canada, New Zealand and United States. Methods In the realist review, eight databases were searched for studies targeted at AF screening in Indigenous communities. Realist analysis was used to identify context-mechanism-outcome configurations across 11 included records (reporting on 5 studies). Snowball referencing and grey literature were used to iteratively incorporate evidence to enhance the refined programme theory that was the product of the realist analysis. Results The realist review included studies using multiple screening strategies such as using tools to increase screening, using different screening environments and training screeners to provide culturally centred care. The realist analysis identified a number of mechanisms that can improve AF screening in Indigenous communities. The contextual factors enabling AF screening programs in Indigenous communities include wider community engagement, opportunistic non-clinical settings, using portable and easy to use devices, increasing knowledge, motivation and confidence in screening amongst Indigenous healthcare workers as well as improving follow-up protocols for abnormal results tailored to screen setting. Barriers to effective AF screening include time-poor working environments, conflicting cultural issues, navigating communication of abnormal results and logistical issues with device use (Figure 1). Conclusion(s) Since the life-course risk for AF in Indigenous population is different, a modified screening strategy needs to be put in place. This realist review provides lessons learned for successful implementation of AF screening programs for Indigenous communities. In order to tackle the gap in cardiovascular burden in Indigenous people, this study calls for action to develop AF screening guidelines for Indigenous populations and provides a guide for policy makers about timely and effective AF screening programs for Indigenous communities. Funding Acknowledgement Type of funding sources: None.

Vietnam’s strong performance on the 2012 and 2015 PISA assessments has led to interest in what explains the strong academic performance of Vietnamese students. Analysis of the PISA data has not shed much light on this issue. This paper analyses a much richer data set, the Young Lives data for Ethiopia, India (Andhra Pradesh and Telangana), Peru and Vietnam, to investigate the reasons for the strong academic performance of 15-year-olds in Vietnam. Differences in observed child and household characteristics explain 37-39% of the gap between Vietnam and Ethiopia, while observed school variables explain only about 3-4 additional percentage points (although an important variable, math teachers’ pedagogical skills, is not available for Ethiopia). Differences in observed child and household characteristics explain very little of the gaps between Vietnam and India and between Vietnam and Peru, yet one observed school variable has a large explanatory effect: primary school math teachers’ pedagogical skills. It explains about 10-12% of the gap between Vietnam and India, raising the overall explained portion to 14-21% of the gap. For Peru, it explains most (65-84%) of the gap.

Background In New Zealand (NZ) approximately 10,000 people experience an acute coronary syndrome (ACS) annually. Little is known about the diets of people who present with first ACS. Methods The Multi-Ethnic NZ study of Acute Coronary Syndromes (MENZACS) is a multi-centre, longitudinal cohort study of patients with first-time ACS. At baseline, patients complete a validated short food frequency questionnaire (FFQ) asking about dietary intakes in the 12 months preceding their event. Participants are followed up for rehospitalisation and mortality. Results Here we present the dietary intakes of the 2,015 participants enrolled into MENZACS. We excluded 90 participants who did not start the FFQ and 42 participants who had extreme energy intakes. For men (n = 1489), the median energy intake was 8637 kJ, and the median percentage of energy from carbohydrate, protein, fat, and saturated fat were 40.3%, 17.9%, 34.7% and 17.8%, respectively. For women (n = 394), the median energy intake was 7499 kJ, and the median percentage of energy from carbohydrate, protein, fat and saturated fat were 40.3%, 18.4%, 35.6%, and 18.0%, respectively. Conclusions Both men and women reported high saturated fat intakes in the year preceding their first ACS. Future work will examine dietary predictors of rehospitalisation and mortality, as well as analyse baseline blood samples for Lipoprotein(a) and lipidomics. Key messages Patients in hospital with first time ACS are able to complete a short food frequency questionnaire, with little missing data.

Ethiopia has succeeded in rapidly expanding access to primary education over the past two decades. However, learning outcomes remain low among primary school children and particularly among girls and children from disadvantaged backgrounds. Starting with a systematic review of quantitative studies on the determinants of learning outcomes among primary school children in Ethiopia, this study then examined key determinants of students’ numeracy achievement over the 2018-19 school year. The study focused on Grade 4 children (N=3,353) who are part of an on-going longitudinal study. The two questions that guided this study are: what are the key determinants of numeracy achievement at Grade 4 in primary schools in Ethiopia, and how does our current empirical study contribute to understanding achievement differences in numeracy among primary school children in Ethiopia? We employed descriptive and inferential statistics to examine factors that determine differences in numeracy scores at the start and end of the school year, as well as determinants of numeracy scores at the end of the school year conditional on achievement at the start of the school year. We examined differences across gender, region, and rural-urban localities. We also used ordinary least squares and school ‘fixed effects’ approaches to estimate the key child, household and school characteristics that determine numeracy scores in Grade 4. The findings revealed that boys significantly outperformed girls in numeracy both at the start and end of the 2018/19 school year, but the progress in numeracy scores over the school year by boys was similar to that of girls. Besides, students in urban localities made a slightly higher progress in numeracy over the school year compared to their rural counterparts. Students from some regions (e.g., Oromia) demonstrated higher progress in numeracy over the school year relative to students in other regions (e.g., Addis Ababa). Key child (e.g., age, health, hours spent per day studying at home) and school- and teacher-related characteristics (e.g., provision of one textbook per subject for each student, urban-rural school location, and teachers’ mathematics content knowledge) were found to be significantly associated with student progress in numeracy test scores over the school year. These findings are discussed based on the reviewed evidence from the quantitative studies in Ethiopia.

In this paper we reflect on discussions with people of advanced age in Āotearoa New Zealand, and draw on theoretical frameworks of resilience and place in old age, to explore insights about the ways older people maintain quality of life and health. Twenty community-dwelling people of advanced age (85+) were recruited in 2015–16 from a large multidisciplinary longitudinal study of advanced age. These twenty participated in interviews about health in advanced age, impact of illnesses, interactions with clinicians, access to information, support for managing health, and perceptions of primary care, medications, and other forms of assistance. We use a positioning theory framework drawing on thematic and narrative analysis to understand the dynamic ways people in advanced age position themselves and the ways they age well through speech acts and storylines. People in advanced age saw themselves as challenged, rather than threatened, by adversities, and positioned themselves as able to draw on a lifetime of experience and resourcefulness and collaborations with supporters to deal with challenges. Key strategies include downplaying illness and resisting biomedical discourses of complexity, positioning embodied selves as having agency, and creative adaptation in the face of loss. People in advanced age exhibit resilience, maintaining wellbeing, autonomy and good physical and mental quality of life even while living with challenges such as functional decline and multi-morbidities. These findings have significance for supporters of older people, emphasising the need to move away from a narrow focus on problems to working together WITH people in advanced age to offer a more holistic approach that encourages and enhances adaptation and flexibility, rather than rigid and counterproductive coping patterns.

The concept of ‘approaches to learning’ (Marton, 1976) has long assumed a position of central importance in the analysis of student learning outcomes. However, constructing effective measures of students’ approaches to learning is a complex task, and it is an empirical question whether such measures transfer well across contexts. In this paper, we examine the functioning of a moderately modified version of one of the most commonly used assessment of approaches to learning – the revised two-factor Study Process Questionnaire (R-SPQ2F) – in three African contexts (Ghana, Kenya and Botswana). We first present confirmatory factor analysis, which demonstrates that the modified R-SPQ2F functions in these contexts as intended by the developers of the instrument. We then consider the potential utility of the R-SPQ2F in these contexts by examining its relationship with student background characteristics, educational experiences at universities and learning outcomes.

Background Frailty is a multidimensional geriatric syndrome associated with functional loss. The Senior Chef (SC, nutrition) and SAYGO (strength and balance exercise) programmes are well accepted among older adults but the impact of each, or a combination of both, on the frailty syndrome in pre-frail older adults is unknown. Aims To determine the effectiveness and cost-effectiveness of a complex intervention consisting of the SC and/or SAYGO programmes to prevent progression of frailty in pre-frail older adults. Methods A multi-centre randomised controlled assessor-blinded study. The four intervention groups are SC, an 8-week nutrition education and cooking class; SAYGO, a 10-week strength and balance exercise class; SC plus SAYGO, and a social group (Control). Community-dwelling adults aged 75+ (60 + Māori and Pasifika) in New Zealand are recruited through health providers. Participants are not terminally ill or with advanced dementia, and have a score of 1 or 2 on the FRAIL questionnaire. Baseline assessments are completed using standardised questionnaires prior to randomisation. Four follow-up assessments are completed: immediately after intervention, 6, 12 and 24 months post-intervention. The primary outcome is frailty score, secondary outcomes are falls, physical function, quality of life, food intake, physical activity, and sustainability of the strategy. Study outcomes will be analysed using intention-to-treat approach. Cost analyses will be completed to determine if interventions are cost effective relative to the control group. Discussion This trial is designed to be a real world rigorous assessment of whether the two intervention strategies can prevent progression of frailty in older people. If successful, this will generate valuable information about effectiveness of this nutrition and exercise strategy, and provide insights for their implementation. Trial registration Australian and New Zealand Clinical Trials Registry number—ACTRN12614000827639.

Introduction We assessed the sensitivity and specificity of the Modified Mini–Mental State Examination (3MS) in predicting dementia and cognitive impairment in Māori (indigenous people of New Zealand) and non-Māori octogenarians. Methods A subsample of participants from Life and Living in Advanced Age: a Cohort Study in New Zealand were recruited to determine the 3MS diagnostic accuracy compared with the reference standard. Results Seventy-three participants (44% Māori) completed the 3MS and reference standard assessments. The 3MS demonstrated strong diagnostic accuracy to detect dementia with areas under the curve of 0.87 for Māori and 0.9 for non-Māori. Our cutoffs displayed ethnic variability and are approximately 5 points greater than those commonly applied. Cognitive impairment yielded low accuracy, and discriminatory power was not established. Discussion Cutoffs that are not age or ethnically appropriate may compromise the accuracy of cognitive screens. Consequently, older age and indigeneity increase the risk of mislabeled cognitive status., Highlights • The cutoffs between Māori and non-Māori octogenarians differed. • Dementia versus no dementia had good discriminant validity. • Applying the typical cutoff would likely lead to misclassification of cognitive function.

Objective Evaluate user experiences of an exercise-based cardiac telerehabilitation intervention (REMOTE-CR) that provided near universal access to real-time remote coaching and behavioral support from exercise specialists. Design Secondary analysis (12-week follow-up) of a parallel group, single blind, randomized controlled noninferiority trial (ACTRN12614000843651). Setting Community-based cardiac rehabilitation. Participants Adults (N=162) with coronary heart disease who were eligible for outpatient cardiac rehabilitation. Eighty-two of 162 trial participants were randomized to receive REMOTE-CR; 67 completed usability and acceptability assessment at 12-week follow-up. Intervention REMOTE-CR comprised 12 weeks of individualized exercise prescription, real-time physiological monitoring, coaching, and behavioral support, delivered via a bespoke telerehabilitation platform. Outcomes Ease of use, satisfaction with the technology platform and intervention content, and demand for real-world implementation as an alternative to traditional center-based programs were assessed at 12-week follow-up. Results Components of usability and acceptability were positively evaluated by most participants (44-66 of 67, 66%-99%). Fifty-eight of 67 (87%) would choose REMOTE-CR if it was available as a usual care service, primarily because it provides convenient and flexible access to real-time individualized support from exercise specialists. Technology challenges were rare and had little effect on user experiences or demand for REMOTE-CR. Conclusions REMOTE-CR can extend the reach and impact of existing cardiac rehabilitation services by overcoming traditional participation barriers while preserving expert oversight. Adoption of emerging technologies should be accelerated to support dynamic, engaging, individualized intervention delivery models, but optimizing overall cardiac rehabilitation participation rates will require multiple delivery models that are tailored to satisfy diverse participant preferences.

To assess how well the NZ COVID Tracer QR (Quick Response) code poster is displayed by Dunedin businesses and other venues in which groups of people gather indoors, and to calculate the proportions of visitors to those venues who scan the QR code poster.We randomly selected 10 cafes, 10 restaurants, 10 bars, five churches, and five supermarkets and visited them at their busiest times. We evaluated the display of QR code posters using a six-item assessment tool that was based on guidance provided to businesses and services by the Ministry of Health, and we counted the number of people who entered each venue during a one-hour period and the number who scanned the QR code poster.All six criteria for displaying QR code posters were met at half of the hospitality venues, four of five churches, and all supermarkets. Scanning proportions were low at all venues (median 10.2%), and at 12 (30%) no visitors scanned; eight of these venues were bars.This audit provides a snapshot of the display and scanning of QR code posters in a city with no managed isolation and quarantine facilities and where no COVID-19 cases have been detected for 10 months.

Co-designed research is gaining prominence within the health care space. Community engagement is a key premise of co-design and is also particularly vital when carrying out kaupapa Māori research. Kaupapa Māori describes a “by Māori, for Māori” approach to research in Aotearoa/New Zealand. This article discusses the research process of Hā Ora: a co-design project underpinned by a kaupapa Māori approach. The objective was to explore the barriers to early presentation and diagnosis of lung cancer, barriers identified by Māori. The team worked with four rural Māori communities, with whom we aimed to co-design local interventions that would promote earlier diagnosis of lung cancer. This article highlights and unpacks the complexities of carrying out community- engaged co-design with Māori who live in rural communities. In particular, we draw attention to the importance of flexibility and adaptability in the research process. We highlight issues pertaining to timelines and budgets, and also the intricacies of involving co-governance and advisory groups. Overall, through this article, we argue that health researchers need to prioritise working with and for participants, rather than on them, especially when working with Māori communities.

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Human capital development, including the expansion and improvement of schooling, has played a crucial role in Vietnam’s strong and relatively inclusive economic growth in recent years. Universal access to primary and lower secondary education have been achieved, but progression to upper secondary remains, for the most part, rationed by entrance examinations and the payment of fees. Both supply and access have improved strongly at upper secondary level since the 1990s, in line with rising demand for higher skilled school-leavers. However, it is less clear whether access to upper secondary schooling, and its wider social and economic benefits, is provided equitably. In this paper we employ a unique longitudinal dataset to examine the patterns of both access and attainment in upper secondary education in Vietnam. We consider their implications for equitable educational progression and the extent to which, in light of these patterns, the system can be described as meritocratic.

BACKGROUND Mobile health technologies have the potential to improve the reach and delivery of interventions for promoting long-term secondary prevention of coronary heart disease. OBJECTIVE This study aims to determine the effectiveness of an SMS text messaging intervention (Text4HeartII) for improving adherence to medication and lifestyle changes over and above usual care in people with coronary heart disease at 24 and 52 weeks. METHODS A two-arm, parallel, randomized controlled trial was conducted in New Zealand. Participants with a recent acute coronary syndrome were randomized to receive usual cardiac services alone (control, n=153) or a 24-week SMS text message program for supporting self-management plus usual cardiac services (n=153). The primary outcome was adherence to medication at 24 weeks, defined as a medication possession ratio of 80% or more for aspirin, statin, and antihypertensive therapy. Secondary outcomes included medication possession ratio at 52 weeks, self-reported medication adherence, adherence to healthy lifestyle behaviors, and health-related quality of life at 24 and 52 weeks. RESULTS Participants were predominantly male (113/306, 80.3%) and European New Zealanders (210/306, 68.6%), with a mean age of 61 years (SD 11 years). Groups were comparable at baseline. National hospitalization and pharmacy dispensing records were available for all participants; 92% (282/306, 92.1%) of participants completed a 24-week questionnaire and 95.1% (291/306) of participants completed a 52-week questionnaire. Adherence with 3 medication classes were lower in the intervention group than in the control group (87/153, 56.8% vs 105/153, 68.6%, odds ratio 0.60, 95% CI 0.38-0.96; P=.03) and 52 weeks (104/153, 67.9% vs 83/153, 54.2%; odds ratio 0.56, 95% CI 0.35-0.89; P=.01). Self-reported medication adherence scores showed the same trend at 52 weeks (mean difference 0.3; 95% CI 0.01-0.59; P=.04). Moreover, self-reported adherence to health-related behaviors was similar between groups. CONCLUSIONS Text4HeartII did not improve dispensed medication or adherence to a favorable lifestyle over and above usual care. This finding contrasts with previous studies and highlights that the benefits of text interventions may depend on the context in which they are used. CLINICALTRIAL Australian New Zealand Clinical Trials Registry ACTRN12616000422426; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370398. INTERNATIONAL REGISTERED REPORT RR2-10.1186/s13063-018-2468-z