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Co-designed health initiatives are gaining popularity in Aotearoa (New Zealand). However, emerging research identifies potential pitfalls for Indigenous populations, particularly Māori (Indigenous Peoples of Aotearoa), when Kaupapa Māori principles are ignored. Using the Indigenous He Pikinga Waiora Implementation (HPW) framework as a guide, this paper provides an autoethnographic reflective account of the co-design process that led to the development and implementation of the Whirihia holistic assessment tool for the Kaupapa Māori antenatal wānanga (workshop) Whirihia Te Korowai Aroha. The co-design process resulted in a culturally appropriate and responsive holistic assessment tool that provided a quality health needs assessment pathway for māmā hapū (pregnant women) and their whānau (family). This reflective account provides examples of key considerations that align to the HPW framework in the hope that it will afford some guidance for fellow emerging researchers who wish to undertake ethical co-designed health research with Māori (and non-Māori) communities and organisations. Glossary of Māori words: Aotearoa: New Zealand; hapū: sub-tribes; hapūtanga: pregnancy; hui: meeting; ipu: clay pot; iwi: tribe; Kaupapa Māori: Māori ideology incorporating the knowledge, skills, attitudes and values of Māori society; māmā: mothers; māmā hapū: pregnant women; Māori: Indigenous people of Aotearoa; Pākehā: non-Māori (most often New Zealand European); pēpi: infant; pono: true, valid, honest, genuine; pōwhiri: welcome ceremony; te ao Māori: Māori world view; te reo Māori: Māori language; tika: correct, accurate, appropriate; tikanga: values and beliefs; wahakura: woven flax basket that can be used in the parental bed; waiata: song; wānanga: workshop; whakawhānau: birth; whakawhanaungatanga: relationship/connections; whānau family; whenua: afterbirth; land. [ABSTRACT FROM AUTHOR]

Purpose: During the COVID-19 pandemic, the NZ COVID Tracer App (NZCTA) was released as a digital intervention to support contact tracing processes in Aotearoa New Zealand. This paper examines whether NZCTA met the data governance requirements of the Indigenous Māori people. Māori are an interesting case study as they have unique Treaty and data sovereignty rights, and a higher risk of COVID-related mortality. Methods: The NZCTA was assessed against 24 criteria drawn from the Māori Data Governance Model. The assessment drew on documentary sources and the authors' knowledge of NZCTA and contact tracing process. Each criteria was assessed as 'met', 'partially met' or 'not met'. Results: Our retrospective assessment showed a mixed performance against the Māori Data Governance Model, with NZCTA only fulfilling seven of the 24 model criteria and failing to meet nine. Conclusion: There is significant room for improvement in future digital health interventions for Māori. Much work remains to be done in the Aotearoa public sector to uphold Māori data sovereignty and address systemic barriers to genuine partnership with Māori. [ABSTRACT FROM AUTHOR]

Despite increased attention being given to Indigenous rights, decolonization, and reconciliation in a broader business setting, the engagement of business, marketing, and consumer studies with Indigenous cultures and peoples is negligible. Although Indigenous and First Nations peoples have a significant position in the social sciences, there is no specific body of marketing or consumer knowledge that is dedicated to Indigenous knowledge and practices, even though there is a growing interest in more inclusive and transformative marketing. This paper reports on current research on Indigenous worldviews and marketing, with a continuum of Indigenous research being presented which is particularly informed by Māori experiences in Aotearoa New Zealand. Several appropriate research methods for advancing Indigenous knowledge are presented. The paper concludes by noting the potential contributions that Indigenous knowledge may provide and some of the challenges faced. [ABSTRACT FROM AUTHOR]

Introduction: Community-driven research in primary healthcare (PHC) may reduce the chronic disease burden in Indigenous peoples. This systematic review assessed the cultural safety of reports of research on PHC use by Indigenous peoples from four countries with similar colonial histories., Methods: Medline, CINAHL and Embase were all systematically searched from 1st January 2002 to 4th April 2023. Papers were included if they were original studies, published in English and included data (quantitative, qualitative and/or mixed methods) on primary healthcare use for chronic disease (chronic kidney disease, cardiovascular disease and/or diabetes mellitus) by Indigenous Peoples from Western colonial countries. Study screening and data extraction were undertaken independently by two authors, at least one of whom was Indigenous. The baseline characteristics of the papers were analyzed using descriptive statistics. Aspects of cultural safety of the research papers were assessed using two quality appraisal tools: the CONSIDER tool and the CREATE tool (subset analysis). This systematic review was conducted in accordance with the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool., Results: We identified 35 papers from Australia, New Zealand, Canada, and the United States. Most papers were quantitative (n = 21) and included data on 42,438 people. Cultural safety across the included papers varied significantly with gaps in adequate reporting of research partnerships, provision of clear collective consent from participants and Indigenous research governance throughout the research process, particularly in dissemination. The majority of the papers (94%, 33/35) stated that research aims emerged from communities or empirical evidence. We also found that 71.4% (25/35) of papers reported of using strengths-based approaches by considering the impacts of colonization on reduced primary healthcare access., Conclusion: Research on Indigenous PHC use should adopt more culturally safe ways of providing care and producing research outputs which are relevant to community needs by privileging Indigenous voices throughout the research process including dissemination. Indigenous stakeholders should participate more formally and explicitly throughout the process to guide research practices, inclusive of Indigenous values and community needs., (© 2024. The Author(s).)

Background: People living in rural and remote communities commonly experience significant health disadvantages. Geographical barriers and reduced specialist and generalist services impact access to care when compared with metropolitan context. Innovative models of care have been developed for people living with chronic diseases in rural areas with the goal of overcoming these inequities. The aim of this paper was to describe the characteristics and outcomes of studies investigating innovative models of care for people living with chronic disease in rural areas of developed countries where a metropolitan comparator was included.Methods: An integrative systematic review was undertaken. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was used to understand the empirical and theoretical data on clinical outcomes for people living with chronic disease in rural compared with metropolitan contexts and their models of care in Australia, New Zealand, United States, Canada and the United Kingdom.Results: Literature searching revealed 620 articles published in English between 1st January 2000 and 31st March 2019. One hundred sixty were included in the review including 68 from the United States, 59 from Australia and New Zealand (5), 21 from Canada and 11 from the United Kingdom and Ireland. 53% (84) focused on cardiovascular disease; 27% (43) diabetes mellitus; 8% (12) chronic obstructive pulmonary disease; and 13% (27) chronic kidney disease. Mortality was only reported in 10% (16) of studies and only 18% (29) reported data on Indigenous populations.Conclusions: This integrated review reveals that the published literature on common chronic health issues pertaining to rural and remote populations is largely descriptive. Only a small number of publications focus on mortality and comparative health outcomes from health care models in both urban and non-urban populations. Innovative service models and telehealth are together well represented in the published literature but data on health outcomes is relatively sparse. There is significant scope for further directly comparative studies detailing the effect of service delivery models on the health outcomes of urban and rural populations. We believe that such data would further knowledge in this field and help to break the deadly synergy between increased rurality and poorer outcomes for people with chronic disease. [ABSTRACT FROM AUTHOR]

Background: Primary healthcare services have principal responsibility for providing child and youth wellbeing and mental health services, but have lacked appropriate measurement instruments to assess the wellbeing of Indigenous children and youth or to evaluate the effectiveness of programs and services designed to meet their needs. This review assesses the availability and characteristics of measurement instruments that have been applied in primary healthcare services in Canada, Australia, New Zealand and the United States (CANZUS countries) to assess the wellbeing of Indigenous children and youth. Methods: Fifteen databases and 12 websites were searched in December 2017 and again in October 2021. Pre-defined search terms pertained to Indigenous children and youth, CANZUS country names, and wellbeing or mental health measures. PRISMA guidelines were followed, with eligibility criteria guiding screening of titles and abstracts, and selected full-text papers. Results are presented based on the characteristics of documented measurement instruments assessed according to five desirability criteria: development for Indigenous youth populations, adherence to relational strength-based constructs, administration by child and or youth self-report, reliability and validity, and usefulness for identifying wellbeing or risk levels. Results: Twenty-one publications were found that described the development and or use by primary healthcare services of 14 measurement instruments, employed across 30 applications. Four of the 14 measurement instruments were developed specifically for Indigenous youth populations, four focused solely on strength-based wellbeing concepts but none included all Indigenous wellbeing domains. Conclusion: There is a diversity of measurement instruments available, but few fit our desirability criteria. Although it is possible that we missed relevant papers and reports, this review clearly supports the need for further research to develop, refine or adapt instruments cross-culturally to measure the wellbeing of Indigenous children and youth. [ABSTRACT FROM AUTHOR]

This paper discusses changes taking place in the delivery of work-integrated learning (WIL) in a Faculty of Māori and Indigenous Development in Auckland, New Zealand. WIL in the faculty utilized a model adopted from a business school which did not recognize key aspects of the students' lives and expectations, in particular the strong connection that Māori students can have with their communities. Over time the nature of the WIL experience is moving to a model based on Māori values. Indigenous models must be relevant to and driven by a community's underlying values, as many students feel primary responsibility to their community, and second to the academy. This paper is part of an ongoing reflection on how WIL placements in Te Ara Poutama at Auckland University of Technology can fulfil wide-ranging expectations of students and their communities and help develop a coherent Indigenous framework for WIL. [ABSTRACT FROM AUTHOR]

Indigenous children and young people (hereafter youth) across CANZUS nations embody a rich diversity of cultures and traditions. Despite the immense challenges facing these youth, many harness cultural and personal strengths to protect and promote their wellbeing. To support this for all youth, it is critical to understand what contributes to their wellbeing. This review aims to identify components contributing to wellbeing for Indigenous youth in CANZUS nations. Five databases were searched from inception to August 2022. Papers were eligible if they: focused on Indigenous youth in CANZUS nations; included views of youth or proxies; and focused on at least one aspect of wellbeing. We identified 105 articles for inclusion (Canada n = 42, Australia n = 27, Aotearoa New Zealand n = 8, USA n = 28) and our analysis revealed a range of thematic areas within each nation that impact wellbeing for Indigenous youth. Findings highlight the unique challenges facing Indigenous youth, as well as their immense capacity to harness cultural and personal strengths to navigate into an uncertain future. The commonalities of Indigenous youth wellbeing across these nations provide valuable insights into how information and approaches can be shared across borders to the benefit of all Indigenous youth and future generations., Competing Interests: The authors declare no conflict of interest.

Worldwide, large amounts of administrative data are collected within official statistics systems on Indigenous Peoples. These data are primarily used for government and state policy purposes as opposed to by Indigenous Peoples to support Indigenous agendas (Taylor & Kukutai, 2017). In Aotearoa me Te Waipounamu New Zealand, Māori need high quality data to develop evidence-based policies and programs and to monitor government policies that impact on Māori. In this methodological paper, we describe uses of administrative data for Māori and current barriers to its use. We outline the development of a novel administrative data infrastructure and future longitudinal study. By explicating our Indigenous initiated, designed and controlled data project, we make a methodological contribution to Indigenous Data Sovereignty and Kaupapa Māori (Māori worldview) epidemiology. [ABSTRACT FROM AUTHOR]

Globally, there is growing recognition of the benefits that indigenous peoples can bring to ecology and conservation, drawing on deep spiritual and cultural ties to the environment. The contribution of indigenous peoples and their knowledges is now widely acknowledged as critical to successful efforts to mitigate anthropogenic impacts. In New Zealand, matauranga spans all aspects of indigenous Maori knowledge and is conceptualised, developed and maintained through practice and connection. We searched all issues of the Proceedings of the New Zealand Ecological Society and the New Zealand Journal of Ecology from 1953 to 2018 to identify and highlight papers that feature research partnerships with Maori and/or acknowledge and explore matauranga Maori in a meaningful way. There were only three, republished here in this virtual issue. Although there has been a recent increase in studies that incorporate matauranga Maori published in other journals, we argue that substantive commitment to community partnerships and bicultural research has not been realized in ecological research. Working with interdisciplinary knowledge including matauranga will be critical to halt further biodiversity loss and improve outcomes for the environment and people, in New Zealand and worldwide. Matauranga Maori has much to contribute to positive biodiversity and ecological outcomes, but it will require institutional and systemic support of scientific researchers to develop authentic partnerships with Maori communities to transform research practices. [ABSTRACT FROM AUTHOR]

Introduction: Healthcare organisations serve clients from diverse Indigenous and other ethnic and racial groups on a daily basis, and require appropriate client-centred systems and services for provision of optimal healthcare. Despite advocacy for systems-level approaches to cultural competence, the primary focus in the literature remains on competency strategies aimed at health promotion initiatives, workforce development and student education. This paper aims to bridge the gap in available evidence about systems approaches to cultural competence by systematically mapping key concepts, types of evidence, and gaps in research. Methods: A literature search was completed as part of a larger systematic search of evaluations and measures of cultural competence interventions in health care in Canada, the United States, Australia and New Zealand. Seventeen peer-reviewed databases, 13 websites and clearinghouses, and 11 literature reviews were searched from 2002 to 2015. Overall, 109 studies were found, with 15 evaluating systems-level interventions or describing measurements. Thematic analysis was used to identify key implementation principles, intervention strategies and outcomes reported. Results: Twelve intervention and three measurement studies met our inclusion criteria. Key principles for implementing systems approaches were: user engagement, organisational readiness, and delivery across multiple sites. Two key types of intervention strategies to embed cultural competence within health systems were: audit and quality improvement approaches and service-level policies or strategies. Outcomes were found for organisational systems, the client/practitioner encounter, health, and at national policy level. Discussion and implications: We could not determine the overall effectiveness of systems-level interventions to reform health systems because interventions were context-specific, there were too few comparative studies and studies did not use the same outcome measures. However, examined together, the intervention and measurement principles, strategies and outcomes provide a preliminary framework for implementation and evaluation of systems-level interventions to improve cultural competence. Identified gaps in the literature included a need for cost and effectiveness studies of systems approaches and explication of the effects of cultural competence on client experience. Further research is needed to explore the extent to which cultural competence improves health outcomes and reduces ethnic and racially-based healthcare disparities. [ABSTRACT FROM AUTHOR]

Despite the health improvements afforded to non-Indigenous peoples in Canada, Aotearoa (New Zealand) and the United States, the Indigenous peoples in these countries continue to endure disproportionately high rates of mortality and morbidity. Indigenous peoples' concepts and understanding of health and wellbeing are holistic; however, due to their diverse social, political, cultural, environmental and economic contexts within and across countries, wellbeing is not experienced uniformly across all Indigenous populations. We aim to identify aspects of wellbeing important to the Indigenous people in Canada, Aotearoa and the United States. We searched CINAHL, Embase, PsycINFO and PubMed databases for papers that included key Indigenous and wellbeing search terms from database inception to April 2020. Papers that included a focus on Indigenous adults residing in Canada, Aotearoa and the United States, and that included empirical qualitative data that described at least one aspect of wellbeing were eligible. Data were analysed using the stages of thematic development recommended by Thomas and Harden for thematic synthesis of qualitative research. Our search resulted in 2669 papers being screened for eligibility. Following full-text screening, 100 papers were deemed eligible for inclusion (Aotearoa (New Zealand) n = 16, Canada n = 43, United States n = 41). Themes varied across countries; however, identity , connection , balance and self-determination were common aspects of wellbeing. Having this broader understanding of wellbeing across these cultures can inform decisions made about public health actions and resources.

Since few decades ago, the use of traditional insignias on commercial products has been increasing, across the globe. In particular, the use of indigenous insignias on commercial products of non-indigenous origin is often in countries such as USA, Canada, Australia or New Zealand where there are larger indigenous communities. Either as offensive or exploitative the respective practice is unacceptable for indigenous people. Appropriation of traditional insignias by non-indigenous people - i.e. registering indigenous names and symbols as trademarks for commercial products of non-indigenous origin has been considered as particularly unacceptable practice. The aim of the paper is to assess whether the conventional trademark law system contains mechanisms that can combat inappropriate use of traditional insignias. In order to achieve respective goal, international and European sources in the field of trademark law, as well as specific national solutions, are analyzed. Research has revealed that conventional trademark law systems provide protection against misuse of traditional insignias only in exceptional occasions. Therefore, certain countries, where there are larger indigenous communities and public policies are focused on the prevention of offensive use of indigenous insignias, have introduced minor or larger intervention in their conventional trademark law systems to increase effectiveness when it comes to combating offensive uses of indigenous insignias. It is shown how in New Zealand the concept of cultural offense as an absolute ground for trademark refusal is introduced while in Canada official insignia as a special type of trademark is introduced. The impact of those interventions is considered and whether these could be relevant for the European union. Similar interventions applicable in the conventional European trademark law for the protection against inappropriate use of European indigenous and traditional indications are analyzed. [ABSTRACT FROM AUTHOR]

This paper aims to consider the various parts of what is required to achieve the best possible health outcomes from medicines in partnership with the person for whom they are prescribed. Specifically, it looks to highlight the process from an Indigenous view with respect to Māori in Aotearoa New Zealand, and claims a multi-dimensional approach is imperative. Attaining optimal use of medicines is necessary to help achieve health equity. There is an urgent need to understand and investigate models of care that achieve this optimal state. [ABSTRACT FROM AUTHOR]

Background: Indigenous peoples worldwide experience inequitable cancer outcomes, and it is unclear if this is underpinned by differences in or inadequate use of endocrine treatment (ET), often used in conjunction with other cancer treatments. Previous studies examining ET use in Indigenous peoples have predominately focused on the sub-national level, often resulting in small sample sizes with limited statistical power. This systematic review aimed to collate the findings ofarticles on ET utilisation for Indigenous cancer patients and describe relevant factors that may influence ET use. Methods: We conducted a systematic review and meta-analysis of studies reporting ET use for cancer among Indigenous populations worldwide. PubMed, Scopus, CINAHL, Web of Science, and Embase were searched for relevant articles. A random-effect meta-analysis was used to pool proportions of ET use. We also performed a subgroup analysis (such as with sample sizes) and a meta-regression to explore the potential sources of heterogeneity. A socio-ecological model was used to present relevant factors that could impact ET use. Results: Thirteen articles reported ET utilisation among Indigenous populations, yielding a pooled estimate of 67% (95% CI:54 − 80), which is comparable to that of Indigenous populations 67% (95% CI: 53 − 81). However, among studies with sufficiently sized study sample/cohorts (≥ 500), Indigenous populations had a 14% (62%; 95% CI:43 − 82) lower ET utilisation than non-Indigenous populations (76%; 95% CI: 60 − 92). The ET rate in Indigenous peoples of the USA (e.g., American Indian) and New Zealand (e.g., Māori) was 72% (95% CI:56–88) and 60% (95% CI:49–71), respectively. Compared to non-Indigenous populations, a higher proportion of Indigenous populations were diagnosed with advanced cancer, at younger age, had limited access to health services, lower socio-economic status, and a higher prevalence of comorbidities. Conclusions: Indigenous cancer patients have lower ET utilisation than non-Indigenous cancer patients, despite the higher rate of advanced cancer at diagnosis. While reasons for these disparities are unclear, they are likely reflecting, at least to some degree, inequitable access to cancer treatment services. Strengthening the provision of and access to culturally appropriate cancer care and treatment services may enhance ET utilisation in Indigenous population. This study protocol was registered on Prospero (CRD42023403562). [ABSTRACT FROM AUTHOR]

Research shows that the human-nature relationship positively impacts human well-being. Forest School (FS) practice offers young children a structured program of nature connection through activities, aiming to enhance their selfesteem and social skills. FS is now adapted in countries such as Australia, Canada and New Zealand where a unique cultural interface occurs between European settlers and Indigenous peoples. Responding to socio-cultural diversities, geographical contexts, and the traditional ecological knowledges, FS needs to go beyond play pedagogy and incorporate theoretical perspectives that promote human-nature relationship in local context-specific environments. We argue that the synergies between Western perspectives on affordances perceived in person-environment relationship and Indigenous place-based relationality perspective provide a more suitable approach for developing reciprocal relationships between FS participants and land/place/nature. We propose that the synergies between affordances perceived in FS and place-based relationality cultivated in participants will enhance social and emotional well-being. We call for specific research investigating such synergies supporting participant wellbeing. Future research on FS practice should be directed toward initiating and exploring co-designed studies by Indigenous and non-Indigenous researchers incorporating methodologies that study participant experience as well as evaluating the impact of FS programs embedding affordances and place-based relationality perspectives. [ABSTRACT FROM AUTHOR]

Major controversies in moral and political theory concern the rights, if any, Indigenous peoples should have over their traditional knowledge. Many scholars, including me, have tackled these controversies. This Article addresses a highly important practical issue: Can we come up with a solid framework for resolving disputes over actual or proposed intellectual property rights in traditional knowledge? Yes, we can. The framework suggested here starts with a preliminary distinction between control rights and income rights. It then moves to four categories that help to understand disputes: nature of the traditional knowledge under dispute; dynamics between named parties to disputes; unnamed Indigenous claimants; and the various normative systems (for example, custom, U.N. documents, treaties, statutes, administrative regulations) within which disputes are decided. Throughout, examples that inform the framework come principally from Indigenous peoples in the Pacific rim. Lastly the Article tests the framework against some disputes over traditional knowledge in Samoa and New Zealand. This framework is comprehensive and sensitive to context. It is flexible regarding which normative systems are best suited to settling disputes. A test run shows that the framework helps to resolve practical legal issues. [ABSTRACT FROM AUTHOR]

Background: Health assessment tools developed using mainstream or Western concepts have been widely used in clinical practice worldwide. However, even culturally adapted or culturally based tools may not be relevant in other social contexts if they are grounded in Western beliefs and perspectives. The application of mainstream assessment tools, when used in Indigenous populations, can lead to the inappropriate application of normative data and inaccurate or biased diagnosis of conditions as Indigenous concepts of health differ from Western biomedical concepts of health. Thus, considering the need for culturally meaningful, sensitive, safe, and unbiased health assessment approaches and instruments over recent years, tools have been developed or adapted by and with Indigenous populations in Australia, Aotearoa/New Zealand, Canada, and the United States. However, there is no existing systematic or scoping review to identify the methods and approaches used in adapting or developing health assessment tools for use with the Indigenous population in Australia, Aotearoa/New Zealand, Canada, and the United States. Methods: In response to these gaps, we are working with a First Nations Community Advisory Group in Northern Ontario, Canada, to undertake a scoping review following the 2020 JBI methodology for scoping reviews. A systematic search will be conducted in PubMed, APA PsychINFO, CINAHL, MEDLINE, Web of Science, Bibliography of Native North Americans, Australian Indigenous Health info data set, and Indigenous Health Portal. Two reviewers will independently screen all abstracts and full-text articles for inclusion using criteria co-developed with an advisory group. We will chart the extracted information and summarize and synthesize the data. The summarized findings will be presented to a Community Advisory Group, including First Nations community partners, an Elder, and community members, and their feedback will be incorporated into the discussion section of the scoping review. Discussion: This scoping review involves iterative consultation with the Indigenous and non-Indigenous scholars, First Nations Community Advisory Group, and community partners throughout the research process. This review aims to summarize the evidence on standard ethical approaches and practices used in Indigenous research while adapting or developing health assessment tools. It will inform the larger study focused on developing an Indigenous Functional Assessment tool. Further, it will seek whether the Indigenous ways of knowing and equitable participation of Indigenous people and communities are incorporated in the Indigenous research process. Systematic review registration: Open Science Framework https://osf.io/yznwk. [ABSTRACT FROM AUTHOR]

Purpose: The authors do not claim that the following represents the views of any one tribe but instead the culmination of the academic literature written on the topic. Marketing's current Western dominant social paradigm (DSP) is said to perpetuate "green", yet unsustainable practices. The DSP does not support strictly pro-environmental practices and its proposed alternative, the new environmental paradigm (NEP), lacks in-depth conceptualisation, especially concerning business and marketing activities. However, the two paradigms contrast so much that a shift from one to the other is vehemently argued against and conceptually rife with problems. This paper aims to expand upon the merits of the NEP using indigenous people's environmental philosophies – specifically the Māori people of New Zealand[1] – as examples of historically supported and successful sustainable philosophies. It conceptualises the Māori view to provide a more practical alternative to the DSP and includes propositions for marketing implementation of this perspective. Findings: By explicating both the DSP and NEP and reflecting on each through an indigenous Māori view, this paper provides propositions for a broadened paradigm that supports sustainability and its application for sustainable marketing. Research limitations/implications: The implications of this research are in the area of paradigm development and in providing an alternative paradigm to that of the DSP. This paper is the first to fully explicate parts of the NEP and considers a solution to the problems of changing the current DSP so drastically by broadening the NEP using a Māori worldview. Practical implications: The propositions and examples provided in this work give practical application of the newly presented paradigm for marketers influenced by indigenous belief systems. Originality/value: This paper is the first to explicate parts of the NEP and broaden its reach by integrating a Māori worldview as an alternative to drastically changing the current DSP. It does so by proposing that marketers embrace a middle ground that is influenced by indigenous belief systems. [ABSTRACT FROM AUTHOR]

There is a growing call for health researchers to address the inequities in healthcare experienced by indigenous populations by focusing on the development of culturally responsive research approaches. This article presents a contextual example from Aotearoa New Zealand (NZ) of how indigenous (Māori) knowledge and practices helped reimagine and enhance an existing qualitative descriptive research protocol exploring clinicians' perspectives of robotic rehabilitation for people with stroke. The intent was to develop a research design that upheld and valued mātauranga Māori (indigenous knowledge systems) alongside Western clinical sciences knowledge. To achieve this, a collaboration of non-indigenous (tauiwi) and indigenous researchers with experience in Qualitative and Kaupapa Māori (indigenous) methodologies, and clinical practice was formed. The researchers undertook a cyclical process of relationship building, engagement with mātauranga Māori, discussion and exploration of how indigenous knowledge and practices could inform and shape the existing study design. Key influences in adapting the research design were drawn from Māori ethical principles, Māori frameworks of health and wellbeing, and Māori cultural practices for clinical engagement. Drawing on indigenous knowledge and practices to develop a Māori-centred research method resulted in significant changes to the study design, methods, and interview approach. Focused development of a culturally responsive approach enabled the researchers to engage indigenous participants in a research process that was safe, respectful, and culturally appropriate. Transformation occurred within the researcher-participant relationship from one often characterised as transactional, to one of deeper connection and reciprocity, which facilitated a richer and more in-depth inquiry. The explicit valuing and integration of indigenous knowledge and practices in adapting the research method strengthened the cultural responsivity of the research. Central to the process was prioritising working in relational partnership. Non-indigenous researchers' self-reflection on their own culture, alongside being attuned to the influence of historical, political, and social contexts of the participants experiences proved essential. [ABSTRACT FROM AUTHOR]

Introduction: Genetics and genomics are of increasing importance in diagnosis and treatment of patients. We aimed to determine relevant genetics and genomics curricular content and learning objectives for contemporary New Zealand medical graduates. Methods: International and national undergraduate medical genetics curricula were identified and learning outcomes collated. Invited New Zealand subject experts (n = 58) contributed further learning objectives, with final pool of 73 learning objectives. A survey-based two-round Delphi process was used to gain consensus on the level of learning for each learning objective. Learning outcomes with consensus for learning greater than "in some depth" or "in detail" were included in the proposed curriculum. Results: The response rate for the Delphi rounds were 41% (n = 24/58) and 29% (n = 17/58) for Rounds 1 and 2, respectively. Experts reached consensus on retaining 58/60 (97%) of proposed learning objectives that were to be learned to at least "some depth". Learning objectives in interprofessional skills, pharmacogenetics, clinical reasoning and information management were retained but refined. Learning outcomes specifically related to Indigenous health included taking an appropriate genetic history, understanding cultural tenets connected to whakapapa (genealogy), an understanding of DNA samples and genomic data being taonga (sacred), the application of genetic data to Māori and other Indigenous populations and the role of genetics in colonisation and racism and their impact on healthcare. Conclusions: Learning objectives for contemporary medical genetics curricula should consider including those focusing on Indigenous health. Findings highlight the necessity of timely re-evaluation of medical curricula. [ABSTRACT FROM AUTHOR]

Enhancing health literacy can empower individuals and communities to take control over their health as well as improve safety and quality in healthcare. However, Indigenous health studies have repeatedly suggested that conceptualisations of health literacy are confined to Western knowledge, paradigms, and practices. The exploratory qualitative research design selected for this study used an inductive content analysis approach and systematic iterative analysis. Publicly available health literacy-related policy and practice documents originating from Australia, Canada, and New Zealand were analysed to explore the extent to which and the ways in which Indigenous knowledges are recognised, acknowledged, and promoted. Findings suggest that active promotion of Indigenous-specific health knowledges and approaches is limited and guidance to support recognition of such knowledges in practice is rare. Given that health services play a pivotal role in enhancing health literacy, policies and guidelines need to ensure that health services appropriately address and increase awareness of the diverse strengths and needs of Indigenous Peoples. The provision of constructive support, resources, and training opportunities is essential for Indigenous knowledges to be recognised and promoted within health services. Ensuring that Indigenous communities have the opportunity to autonomously conceptualise health literacy policy and practice is critical to decolonising health care. [ABSTRACT FROM AUTHOR]

• Historic exclusion and marginalisation of Indigenous peoples and knowledge contributed to the creation of path dependency in settler colonial societies. • Institutions that manage flood risk and rivers reflect hegemonic social values. • Inclusion of different types of knowledge into flood risk management can disrupt path dependency within institutions. Scholars frequently identify how path dependency serves to constrain the process of climate adaptation and is a key feature of maladaptation. Most studies, however, centre on theoretical, rather than empirical-based discussions of what path dependency is, how it occurs, and what factors assist in breaking path dependency. This paper provides a case study for the creation, maintenance, and attempts to break path dependency within the management of rivers in the Rangitāiki Plains of Aotearoa New Zealand from the 1890s until 2017. We deploy a historical institutionalist theorising on path dependency and institutional arrangements, while also incorporating ideas from indigenous and postcolonial scholarship, which extends current understandings of the factors that contribute towards path dependency at a local level. Through archival research, we demonstrate how successive generations of government policies and actions directed with a specific goal and underpinned by the hegemonic social values created a profoundly path dependent system of managing rivers and flood events. Increased flood vulnerability is one of the direct consequences of the plethora of freshwater engineering interventions which were (and are still) undertaken on the Rangitāiki Plains over the last century. The foundation of this path dependency, we argue, resides with the processes of indigenous dispossession and the marginalisation of Māori values from environmental governance and policy. Efforts to break path dependency, therefore, involve the formal recognition of Māori governance, values, and knowledge within policies, and the translation of Māori values into tangible actions that seek to destabilise Western command-and control approaches to flood risk management. [ABSTRACT FROM AUTHOR]

PURPOSE: This investigation was undertaken to define the barriers to indigenous peoples participating in biobanking and genomic research. METHODS: A literature review was conducted to identify studies reporting on the experience of indigenous peoples with biobanking, tissue banking, and genomic research. Studies pertaining to organ transplantation or blood donation for transfusion were excluded. The databases searched were MEDLINE, EMBASE, PubMed, Web of Science, and Google Scholar, with all literature available until the search date of June 1, 2018, included. The reference lists of all included papers, as well as related review articles, were manually searched to identify additional relevant studies. An inductive approach was used to identify common themes. RESULTS: Seventeen publications discussed the experiences of New Zealand Māori (n = 2), Aboriginal and Torres Strait Islanders (n = 3), Native Hawaiian (n = 4), Native Alaskan (n = 2), American First Nation (n = 2), or multiple ethnicities (n = 4). Across all indigenous peoples, four themes emerged: land, ancestors, culture, and bodily substances are powerfully interconnected and can act on each other; tissue and blood can provide important information (both Western and traditional) about a person; the ownership of specimens—custodians, trustees, or guardians; and the beneficence of the researchers and research team. CONCLUSION: Indigenous communities, like Western populations, are concerned with issues pertaining to handling, treatment, and ownership of tissue as well as knowledge gained from specimen analysis. Unlike many Western populations, indigenous communities have retained a strong sense of cultural connection to ancestors and traditional lands and view biologic specimens as inseparable from these things. [ABSTRACT FROM AUTHOR]

There is a profoundly troubling history of research being done on Indigenous peoples without regard for their priorities and accompanying calls to decolonize health research. Storytelling methods can privilege Indigenous voices in research. Indigenous people's knowledge systems have existed for millennium, where knowledge is produced and shared through stories. Our collaborative team of Indigenous and non-Indigenous researchers, and Indigenous Elders, patients, healthcare providers, and administrators, conducted a participatory, scoping review to examine how storytelling has been used as a method in Indigenous health research on Turtle Island (North America), Australia, and Aotearoa (New Zealand). We searched key databases and online sources for qualitative and mixed-methods studies that involved Indigenous participants and used storytelling as a method in health research. Reviewers screened abstracts/full texts to confirm eligibility. Narrative data were extracted and synthesized. An intensive collaboration was woven throughout and included gatherings incorporating Indigenous protocol, Elders' teachings on storytelling, and sharing circles. We included 178 articles and found a diverse array of storytelling approaches and adaptations, along with exemplary practices and problematic omissions. Researchers honoured Indigenous ways of knowing, being, and doing through careful preparation and community engagement to do storywork, inclusion of Indigenous languages and protocols, and Indigenous initiation and governance. Storytelling centered Indigenous voices, was a culturally relevant and respectful method, involved a healing process, and reclaimed Indigenous stories. But it could result in several challenges when researchers did not meaningfully engage with Indigenous peoples. These findings can guide respectful storytelling research that bridges divergent Indigenous and Western knowledge systems, to decolonize health research. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer is caused by high-risk types of human papillomavirus (HPV). Testing for high-risk HPV is a more sensitive screening method than cervical cytology for detecting cervical changes that may lead to cancer. Consistent with recent evidence of efficacy and acceptability, Aotearoa New Zealand plans to introduce HPV testing as the primary approach to screening, replacing cervical cytology, from mid-2023. Any equitable cervical screening programme must be effective across a diverse population, including women that the current programme fails to reach, particularly Māori and those in rural areas. Currently, we do not know the best model for implementing an equitable HPV self-testing screening programme. Methods: This implementation trial aims to assess whether a universal offer of HPV self-testing (offered to all people eligible for cervical screening) achieves non-inferior screening coverage (equal) to a universal offer of cervical cytology alone (the present programme). The study population is all people aged from 24.5 to 70 years due for cervical screening in a 12-month period (including those whose screening is overdue or who have never had screening). A range of quantitative and qualitative secondary outcomes will be explored, including barriers and facilitators across screening and diagnostic pathways. This study takes place in Te Tai Tokerau/Northland which covers a diverse range of urban and rural areas and has a large Indigenous Māori population. A total of fourteen practices will be involved. Seven practices will offer HPV self-testing universally to approximately 2800 women and will be compared to seven practices providing routine clinical care (offer of cervical cytology) to an approximately equal number of women. Discussion: This trial will answer important questions about how to implement an equitable, high-quality, effective national programme offering HPV self-testing as the primary screening method for cervical cancer prevention. Trial registration: Prospectively registered with the Australian New Zealand Clinical Trials Registry 07/12/2021: ACTRN12621001675819. [ABSTRACT FROM AUTHOR]

The article focuses on the Indigenous people of Aotearoa, known as Māori. It highlights the disparities and gaps between Māori and non-Māori in various aspects of life, including life expectancy, income, education, and representation in the prison population. It mentions the limited legal status of Te Tiriti and the dependence on political will and ad hoc recognition for the protection of Māori rights.

Background: Indigenous peoples of Canada, United States, Australia, and New Zealand experience disproportionately high rates of suicide as a result of the collective and shared trauma experienced with colonization and ongoing marginalization. Dominant, Western approaches to suicide prevention—typically involving individual-level efforts for behavioural change via mental health professional intervention—by themselves have largely failed at addressing suicide in Indigenous populations, possibly due to cultural misalignment with Indigenous paradigms. Consequently, many Indigenous communities, organizations and governments have been undertaking more cultural and community-based approaches to suicide prevention. To provide a foundation for future research and inform prevention efforts in this context, this critical scoping review summarizes how Indigenous approaches have been integrated in suicide prevention initiatives targeting Indigenous populations. Methods: A systematic search guided by a community-based participatory research (CBPR) approach was conducted in twelve electronic bibliographic databases for academic literature and six databases for grey literature to identify relevant articles. the reference lists of articles that were selected via the search strategy were hand-searched in order to include any further articles that may have been missed. Articles were screened and assessed for eligibility. From eligible articles, data including authors, year of publication, type of publication, objectives of the study, country, target population, type of suicide prevention strategy, description of suicide prevention strategy, and main outcomes of the study were extracted. A thematic analysis approach guided by Métis knowledge and practices was also applied to synthesize and summarize the findings. Results: Fifty-six academic articles and 16 articles from the grey literature were examined. Four overarching and intersecting thematic areas emerged out of analysis of the academic and grey literature: (1) engaging culture and strengthening connectedness; (2) integrating Indigenous knowledge; (3) Indigenous self-determination; and (4) employing decolonial approaches. Conclusions: Findings demonstrate how centering Indigenous knowledge and approaches within suicide prevention positively contribute to suicide-related outcomes. Initiatives built upon comprehensive community engagement processes and which incorporate Indigenous culture, knowledge, and decolonizing methods have been shown to have substantial impact on suicide-related outcomes at the individual- and community-level. Indigenous approaches to suicide prevention are diverse, drawing on local culture, knowledge, need and priorities. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Prior New Zealand studies suggest that only approximately two-thirds of patients who present with an acute coronary syndrome (ACS) are maintained on a statin/aspirin post-discharge. This could be due to sub-optimal initiation or poor longer-term adherence. AIM: To identify the pattern of statin/aspirin maintenance following ACS from initial prescription to 3 years post-discharge. METHODS: All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry data for consecutive New Zealand residents (2007-2011), who were hospitalised with ACS, were anonymously linked to national datasets to derive a medication possession ratio (MPR) to assess medication maintenance. An MPR ⩾ 0.8 is considered adequate maintenance. RESULTS: Of the 1846 patients discharged alive, 95% were prescribed a statin at discharge and 92% were dispensed a statin within 3 months, but only 75% had a MPR ⩾ 0.8 in the first year, and 67% in year 3. In the same cohort, 98% were prescribed aspirin and 88% were dispensed aspirin within the 3 months of discharge. In the first year, 72% had an aspirin MPR ⩾ 0.8 and 71% maintained this in year 3. Fifty-nine percent were maintained on both aspirin and a statin in the third year, but 20% were maintained on neither. Regression analysis identified the independent predictors of inadequate maintenance in the third year as age < 45 years, no prior statin, and Mā ori and Pacific ethnicity. CONCLUSION: Longer-term maintenance of evidenced-based secondary prevention medications after ACS is suboptimal despite high levels of initial prescribing and dispensing. Understanding the barriers to longer-term maintenance is required to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Historical analogies of environmental change and stress are a well-established method of examining vulnerability to the impacts of climate change. In our view historical analogies of social transformations can similarly illuminate what factors are conducive to transformation. In this paper we draw on the historical example of the environmental transformation of Aotearoa New Zealand from predominately woodlands into farmlands; a transformation which was inextricably linked with the social transformation of indigenous Māori society following European colonisation. The Aotearoa New Zealand case study illustrates how both incidental and purposeful transformations can be instigated by small groups of committed individuals working in formal or informal networks, but can also be imposed by outside experts who instituted widespread changes under notions of progress and improvement without local support or consent. Such transformations involved widespread changes to Indigenous governance regimes, agricultural systems, production and consumption patterns, lifestyles, values and worldviews, and inevitably involved both beneficial and negative outcomes for local peoples. We argue that thinking historically about transformational change provides an opportunity to assess the processes that shape both vulnerability and resilience, and the circumstances under which transformational change occurs, as well as the potential dangers of irreversible changes. [ABSTRACT FROM AUTHOR]

Globally, Indigenous Peoples suffer disproportionately higher rates and complications of diabetes and obesity than non-Indigenous people. Western health interventions combined with culturally appropriate Traditional approaches can reduce incidence, prevalence, and related co-morbidities. This literature review reports effective culturally relevant Traditional and Western diabetes and obesity prevention and management intervention programs for Indigenous populations in Australia, Canada, New Zealand, and the United States. Experiential, immediate, interactive, and low-cost programs, co-developed and delivered by local Indigenous people within the communities they live, are most effective in improving health and wellbeing. Key themes of success, Togetherness, Empowerment, and Local Familiarity, inform action for policy and practice changes adaptable for chronic disease prevention, treatment and self-management programs for Indigenous Peoples globally. [ABSTRACT FROM AUTHOR]

Background: Indigenous peoples in developed countries have reduced life expectancies, particularly from chronic diseases. The lack of access to and take up of palliative care services of Indigenous peoples is an ongoing concern. Objectives: To examine and learn from published studies on provision of culturally safe palliative care service delivery to Indigenous people in Australia, New Zealand (NZ), Canada and the United States of America (USA); and to compare Indigenous peoples' preferences, needs, opportunities and barriers to palliative care. Methods: A comprehensive search of multiple databases was undertaken. Articles were included if they were published in English from 2000 onwards and related to palliative care service delivery for Indigenous populations; papers could use quantitative or qualitative approaches. Common themes were identified using thematic synthesis. Studies were evaluated using Daly's hierarchy of evidence-for-practice in qualitative research. Results: Of 522 articles screened, 39 were eligible for inclusion. Despite diversity in Indigenous peoples' experiences across countries, some commonalities were noted in the preferences for palliative care of Indigenous people: to die close to or at home; involvement of family; and the integration of cultural practices. Barriers identified included inaccessibility, affordability, lack of awareness of services, perceptions of palliative care, and inappropriate services. Identified models attempted to address these gaps by adopting the following strategies: community engagement and ownership; flexibility in approach; continuing education and training; a whole-of-service approach; and local partnerships among multiple agencies. Better engagement with Indigenous clients, an increase in number of palliative care patients, improved outcomes, and understanding about palliative care by patients and their families were identified as positive achievements. Conclusions: The results provide a comprehensive overview of identified effective practices with regards to palliative care delivered to Indigenous populations to guide future program developments in this field. Further research is required to explore the palliative care needs and experiences of Indigenous people living in urban areas. [ABSTRACT FROM AUTHOR]

Only a few information and communication technology (ICT) work-integrated learning (WIL) projects involving universities and Indigenous partners are being reported and very little is known about the approaches that are followed. This article reports on successful student work placements in Indigenous communities when codeveloping software for the community. We provide two case studies of projects which involved work-integrated learning students and researchers from a university, as well as researchers and practitioners from Indigenous communities in New Zealand and Fiji. Two independent app development projects were the central focus of the collaborations with these two communities including placement students. The article describes the learning and insights from these WIL projects and provides recommendations for creating successful WIL opportunities with Indigenous communities. [ABSTRACT FROM AUTHOR]

Introduction: Current best practice recommends group-based pain management programmes for long-term improvements in persistent pain-related disability. However, there are barriers for people to access in-person delivered pain management programmes in Aotearoa. Aims: To develop a co-designed, culturally responsive, online group-based pain management programme (iSelf-help) for people with persistent pain. Methods: A modified participatory action research (PAR) framework was used to co-design contents and cultural-appropriateness of iSelf-help. The PAR team included: (1) seven end-users living with persistent pain, who had previously attended an in-person delivered group pain management programme, (2) two pain management clinicians, (3) two health researchers, (4) two digital health experts, and (5) a health literacy expert. Five meetings were held with the PAR group and a Nominal Group Technique was used to rank order the preferred features of content delivery. In parallel, to ensure cultural appropriateness of iSelf-help, three focus groups (n = 15) were held with Māori (the Indigenous population of Aotearoa) living with persistent pain in collaboration with a Māori community health trust. All contents were reviewed by a Māori Health literacy expert and core contents were translated into Te Reo (Māori language). All contents were finalised by iterative discussion among the PAR team and consultation with Māori stakeholders. The preliminary version of iSelf-help was pilot tested with the PAR group participants and Māori community members living with persistent pain and their feedback was included. The iterative co-design process occurred over a period of nine months. Results: The finalised version of iSelf-help included a total of 130 resources organised in to 12 content relevant online modules plus a dedicated welcoming page and an online community forum. Each module included: short videos, animations explaining main concepts, patient stories, written content to accompany visual content, podcasts of relaxation techniques, illustrated texts, and evidence-summaries. A dedicated module of videos demonstrating cardiovascular and strengthening exercises of varying intensity was also included. Conclusions: This is the first co-created, culturally appropriate, on-line group pain management programme for people with persistent pain, developed in Aotearoa. The next step is to evaluate the clinical and cost-effectiveness of iSelf-help compared to in-person delivered pain management programme. Plain English summary: Pain management programmes delivered in a group format are best practice to support people living with persistent non-cancer pain to live well. Some people can find accessing these programmes hard due to lack of referral, transportation costs and lack of trained health professionals. Further, people from Indigenous and non-Western backgrounds are poorly represented in these programmes despite having a high prevalence of persistent pain. One way of improving access is delivering services via technology. We aimed to co-design an online version of an existing hospital-based pain management programme (iSelf-help) and to ensure cultural appropriateness of the iSelf-help for Māori. Māori are the Indigenous population of Aotearoa (an accepted Māori word to describe New Zealand). We used a modified participatory action research (PAR) framework for our co-design process. This framework actively encouraged people with lived experience of pain and community partners to have a voice in the content design. The PAR team included: (1) seven end-users living with persistent pain, who had previously attended hospital-based pain management programme, (2) two pain management clinicians, (3) two health researchers, (4) two digital health experts, and (5) a health literacy expert. Five meetings were held with the PAR team. We used a Nominal Group Technique, whereby PAR team members ranked their preferences on content design and delivery, until concensus was reached. In parallel, three focus groups (n = 15) were held with Māori living with persistent pain in collaboration with a Māori community health trust. All contents were reviewed by a Māori Health literacy expert and core contents were translated into Te Reo (Māori language). The finalised version of iSelf-help included 130 resources, tested for accessibility, organised in to 12 online modules plus a dedicated welcoming page and an online community forum. Each module included: short videos, animations, patient stories, podcasts of relaxation techniques, illustrated texts, and evidence-summaries. This is the first co-created, culturally appropriate, on-line group pain management programme for people with persistent pain, developed in Aotearoa. We are currently evaluating if iSelf-help is acceptable to users, and clinically and cost effective as compared to the hospital-based pain management programme. [ABSTRACT FROM AUTHOR]

Objectives: Occupation is a poorly characterised risk factor for cardiovascular disease (CVD) with females and indigenous populations under-represented in most research. This study assessed associations between occupation and ischaemic heart disease (IHD) in males and females of the general and Māori (indigenous people of NZ) populations of New Zealand (NZ). Methods: Two surveys of the NZ adult population (NZ Workforce Survey (NZWS); 2004–2006; n = 3003) and of the Māori population (NZWS Māori; 2009–2010; n = 2107) with detailed occupational histories were linked with routinely collected health data and followed-up until December 2018. Cox regression was used to calculate hazard ratios (HR) for IHD and "ever-worked" in any of the nine major occupational groups or 17 industries. Analyses were controlled for age, deprivation and smoking, and stratified by sex and survey. Results: 'Plant/machine operators and assemblers' and 'elementary occupations' were positively associated with IHD in female Māori (HR 2.2, 95%CI 1.2–4.1 and HR 2.0, 1.1–3.8, respectively) and among NZWS males who had been employed as 'plant/machine operators and assemblers' for 10+ years (HR 1.7, 1.2–2.8). Working in the 'manufacturing' industry was also associated with IHD in NZWS females (HR 1.9, 1.1–3.7), whilst inverse associations were observed for 'technicians and associate professionals' (HR 0.5, 0.3–0.8) in NZWS males. For 'clerks', a positive association was found for NZWS males (HR 1.8, 1.2–2.7), whilst an inverse association was observed for Māori females (HR 0.4, 0.2–0.8). Conclusion: Associations with IHD differed significantly across occupational groups and were not consistent across males and females or for Māori and the general population, even within the same occupational groups, suggesting that current knowledge regarding the association between occupation and IHD may not be generalisable across different population groups. [ABSTRACT FROM AUTHOR]

Summary: Indigenous Australians are Australia's first ecologists and stewards of land, sea and freshwater Country. Indigenous biocultural knowledge, as coded in story, song, art, dance and other cultural practices, has accumulated and been refined through thousands of generations of Indigenous tribal groups who have distinct cultural responsibilities for their ancestral estates. European colonisation of Australia had and is still having severe impacts on Indigenous cultural practice, knowledge, people and Country. In contemporary ecology and environmental management, re‐recognition of the unique values of Indigenous biocultural knowledge and practice is occurring and increasingly being deployed alongside Western approaches in what has been described as cross‐cultural, two‐way or right‐way work. This article describes the development of cross‐cultural ecology and environmental approaches in Australia. We then provide an overview of 10 years of conference presentations associated with the annual Indigenous Ecological Knowledge symposiums of the Ecological Society of Australia (ESA). From 2010 to 2020, 173 people participated in the symposia from around Australia and Aotearoa (New Zealand), of which 62% were Indigenous Australians and 3% Maori. Most participants were from Indigenous Ranger groups followed by University staff, with a roughly even split of men and women. A total of 100 presentations were given and a word frequency analysis of the presentation titles revealed the dominant words (themes) were: Indigenous, management, Country, fire, working, knowledge and cultural. The increasing Indigenous participation in the ESA conferences was coincident with increasing Indigenous‐led projects across Australia, although we recognise that much more work needs to be done to increase Indigenous participation and control in Australian ecology and environmental management to move from cross‐cultural to Indigenous‐led approaches. [ABSTRACT FROM AUTHOR]

Objective: To understand motivators, facilitators and challenges to dietary change amongst a diverse sample of New Zealanders with prediabetes participating in a primary care nurse-led individualised dietary intervention. Design: A qualitative study involving semi-structured, face-to-face interviews with a stratified sample of adults with prediabetes and BMI ≥ 25 kg/m2, purposefully selected from a larger 2-year primary care-based prediabetes dietary intervention study. Thematic analysis was undertaken. A socio-ecological model guided interpretation. Setting: Hawke's Bay, Aotearoa/New Zealand, April 2018–March 2020. Participants: Fifty-eight people aged 28–69 years, with similar numbers of men and women, indigenous Māori and non-Māori, and those who had and had not regressed to normoglycaemia at 6 months. Results: Motivators for wanting to make dietary changes were determination not to progress to diabetes; wanting to be healthy and contribute to others and encouragement by others. Facilitators for adopting and maintaining changes were a strong desire to be healthy; personal determination and feeling supported. Challenges were compromised control over life and environmental factors; feeling unsupported by others; social occasions; financial constraints and living with other health conditions. Developing their own strategies to overcome challenges was empowering, enabling a sense of control. These factors were similar across demographic and glycaemic outcome groups. Conclusions: Influences on dietary change involved personal, interpersonal, organisational, environmental and policy factors. Although findings appeared similar across groups, dietary interventions need to address the specific ways motivators, facilitators and challenges manifest for individuals and social groups and be tailored accordingly within the context of the wider obesogenic and socio-economic environment. [ABSTRACT FROM AUTHOR]

Previous literature has applied system-focused structures to understand the success of First Nations Peoples' nutrition and exercise group programmes. Existing system-focused measures have included biomedical outcomes, access and service utilization. By broadening the focus of programme success beyond the system, we can evaluate programmes from a First Nations Peoples' lifeworld perspective. Critical hermeneutics and yarning using a lens of Habermas' Theory of Communicative Action to the literature has the potential to transform understandings of "success" in First Nations Peoples' nutrition and exercise group programmes. In this literature interpretation, we explored the critical success factors from a lifeworld perspective, giving scope to go beyond a system perspective to include a cultural, social or personal perspective. Our yarning led us to understand that there is a communicative relationship between explicit system structures and implicit lifeworld concepts that are critical success factors for First Nations nutrition and exercise group programmes. We have developed a set of reflective questions to guide others in considering a lifeworld perspective. Our findings represent a shift away from success measured by the dominant power structure to respect the lifeworld culture, knowledges and values of First Nations Peoples towards shared understanding and mutual decision-making. [ABSTRACT FROM AUTHOR]

Māori with diabetes are at a 65% greater risk of amputation compared to non-Māori with diabetes. Despite evidence to support the role of podiatrists in reducing diabetes-related lower limb amputations; the effectiveness of diabetes podiatry services at the community and secondary level to achieve this for Māori is largely unknown. Diabetes podiatry services need to be reorientated and be culturally applicable to Indigenous communities. Transforming diabetes podiatry services and practice may reduce Indigenous amputation rates and improve quality of life for an unserved community. [ABSTRACT FROM AUTHOR]

There have been library services for indigenous peoples in Latin America since at least the 1980s; they are small-scale, very specific experiences that, until recent times, have been poorly systematized and scarcely discussed. Throughout their brief but intense history – a story that has been replicated in many other countries around the world, from Canada to New Zealand – these services have faced a series of crossroads, contradictions and conflicts that they have not always been able to resolve, from the controversial label 'indigenous libraries' to their scope and the categories and methodologies they use. From a first-person perspective (the author was among the first library and information science professionals to work with this topic in Latin America and has been active in the field for the last 20 years), this article briefly reviews the state of affairs in South America, pointing out the main milestones in the history of these services in the region. It identifies some concepts and ideas that require urgent discussion from both a library and information science and interdisciplinary framework, and suggests some paths to explore in the near future. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to describe the epidemiology of statue attacks along with statue representativeness relative to modern day demographics in one case study country: New Zealand. Methods: We performed Internet searches for the existence of outdoor statues of named individuals and historical attacks in New Zealand (NZ), combined a national survey with field visits to all identified statues to examine for injuries and repairs. Results: Of the 123 statues identified, nearly a quarter (n = 28, 23%) had been attacked at least once (total of 45 separate attack events), with the number of attacks increasing from the 1990s. Attacks involved paint/graffiti (14% of all statues at least once), nose removal/damage (7%), decapitation (5%), and total destruction (2%). The risk of attack was relatively higher for statues of royalty (50%), military personnel (33%), explorers (29%), and politicians (25%), compared to other reasons for fame (eg, 0% for sports players). Statue subjects involved in colonialism or direct harm to Māori (Indigenous population), had 6.61 (95%CI: 2.30 to 19.9) greater odds (adjusted odds ratio) of being attacked than other subjects. Most of the statue subjects were of men (87%) and Europeans (93%). Other ethnicities were 6% Māori (comprising 15% of the population) and 1% each for Asian and Pacific peoples, who comprise 12% and 7% of the population respectively. Conclusions: This national survey found an association between statue attacks and the role of statue subjects in colonialism or direct harm to the Indigenous population. Furthermore, the demography of the statue subjects may represent historical and current social power relationships—with under-representation of women and non-European ethnic groups. [ABSTRACT FROM AUTHOR]

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Background: Long-term residential care (LTC) supports the most vulnerable and is increasingly relevant with demographic ageing. This study aims to describe entry to LTC and identify predictive factors for older Māori (indigenous people of New Zealand) and non-Māori.Methods: LiLACS-NZ cohort project recruited Māori and non-Māori octogenarians resident in a defined geographical area in 2010. This study used multivariable log-binomial regressions to assess factors associated with subsequent entry to LTC including: self-identified ethnicity, demographic characteristics, self-rated health, depressive symptoms and activities of daily living [ADL] as recorded at baseline. LTC entry was identified from: place of residence at LiLACS-NZ interviews, LTC subsidy, needs assessment conducted in LTC, hospital discharge to LTC, and place of death.Results: Of 937 surveyed at baseline (421 Māori, 516 non-Māori), 77 already in LTC were excluded, leaving 860 participants (mean age 82.6 +/- 2.71 years Māori, 84.6 +/- 0.52 years non-Māori). Over a mean follow-up of 4.9 years, 278 (41% of non-Māori, 22% of Māori) entered LTC; of the 582 who did not, 323 (55%) were still living and may yet enter LTC. In a model including both Māori and non-Māori, independent risks factors for LTC entry were: living alone (RR = 1.52, 95%CI:1.15-2.02), self-rated health poor/fair compared to very good/excellent (RR = 1.40, 95%CI:1.12-1.77), depressive symptoms (RR = 1.28, 95%CI:1.05-1.56) and more dependent ADLs (RR = 1.09, 95%CI:1.05-1.13). For non-Māori compared to Māori the RR was 1.77 (95%CI:1.39-2.23). In a Māori-only model, predictive factors were older age and living alone. For non-Māori, factors were dependence in more ADLs and poor/fair self-rated health.Conclusions: Non-Māori participants (predominantly European) entered LTC at almost twice the rate of Māori. Factors differed between Māori and non-Māori. Potentially, the needs, preferences, expectations and/or values may differ correspondingly. Research with different cultural/ethnic groups is required to determine how these differences should inform service development. [ABSTRACT FROM AUTHOR]

Commissioning agencies and social impact bonds are two examples of New Zealand's shift towards payment-foroutcomes funding mechanisms over the last decade, as the government attempted to improve both policy innovation and social outcomes. This article highlights that although the commissioning agencies have been more successful than social impact bonds, neither has completely achieved these goals of innovation and improved outcomes. This is particularly concerning given Indigenous Māori are disproportionately impacted by both policies. Discussion concludes by highlighting some of the problems associated with applying a payment-foroutcomes model to Indigenous Peoples, given these funding mechanisms are becoming increasingly popular in other settler nation states. [ABSTRACT FROM AUTHOR]

Similar to experiences of Indigenous peoples globally, Māori in the nation-state known as New Zealand (NZ) have been subjected to mass incarceration by the colonial state. Places of detention are dangerous environments for the spread of COVID-19. We are deeply concerned about the potential for disproportionate impacts of COVID-19 on Māori and other Indigenous peoples within these environments as many have health conditions and/or multiple comorbidities compounding the risks of severe illness and death from COVID-19. We call for the NZ government to honour te Tiriti o Waitangi obligations and uphold Indigenous rights contained within the United Nations Declaration on the Rights of Indigenous Peoples and other international rights instruments. A whole-of-government commitment to an equitable public health approach is required to: 1) rapidly reduce the numbers of Māori in sites of detention; 2) implement effective, timely, evidenced informed measures to reduce the risk of COVID-19, in line with World Health Organization recommendations; 3) prevent the torture and cruel, inhuman or degrading treatment or punishment of detained Māori during COVID-19; and, 4) eliminate double-celling. Although focused on NZ, the themes we highlight are likely of relevance for Indigenous peoples across the globe in our collective resistance to the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: The oral health of pre-schoolers is garnering international as a crisis as good oral health is a key precursor to positive health outcomes. Internationally, and within Aotearoa/New Zealand, responses been restricted to those based in a medical model and the commercialisation of oral health. Absent from existing commentary are the lived realities of parents/caregivers beliefs, attitudes and responsiveness, or lack of, to the oral health of pre-schoolers. Methods: The researcher undertook a discursive analysis of parents/caregivers narratives to understand the barriers to engaging in effective protective behaviours. The 15 focus groups were conducted in urban and rural locations across Aotearoa/New Zealand. Results: A discursive analysis revealed several pervasive discourses, including 'second chance' and 'enjoyment' discourses, and systems-related deficits that act as barriers to engaging in good oral healthcare practices. Conclusions: The analysis demonstrates the benefit of placing the lived experiences of parents/caregivers as central to the development of oral health interventions. There is a need to link oral health data with primary care data and to distribute accurate oral health information to support parents'/caregivers' decision making. This research reveals several pervasive discourses and systems-related deficits that provide a fertile ground for future public health responsiveness. [ABSTRACT FROM AUTHOR]

Background: Aotearoa/New Zealand has a population that is ageing and there are challenges to health and social outcomes related to related to key life transitions (e.g., retirement, change in health conditions, loss of spouse). Further, there are significant inequities between Māori (Indigenous people) and non-Māori in ageing outcomes. The purpose of this study was to test the impacts and cost effectiveness of a tuakana/teina (peer education) intervention on kaumātua (elders) receiving the intervention. This study was framed by a strengths-based approach based on the key cultural concept of mana motuhake (autonomy and self-actualisation).Methods: This study was grounded in principles of Kaupapa Māori and community-based participatory research to bring together a diverse group of stakeholders to co-develop and co-evaluate the intervention. The intervention had tuakana (peer educators) having conversations with up to six teina (recipients) and providing information related to health and social services. The research design was a pre- and post-test, clustered staggered design. Participants completed a baseline assessment of health and mana motuhake measures consistent with Māori worldviews along with two follow-up assessments (one after the first intervention group completed its activities and a second after the second intervention group completed its activities). Additionally, five focus groups and open-ended questions on the assessments were used to provide qualitative evaluation.Findings: A total of 180 kaumātua were recruited to the intervention with 121 completing it. The analysis revealed improvements over time in the expected direction on most of the variables. However, only three of the variables had statistically significant intervention effects: received support, tribal identity, and trouble paying bills. Qualitative results supported impacts of the intervention on mana motuhake, social connectedness, and tangible/information support related to services. Cost-effectiveness analysis showed that the intervention is cost effective, with a cost per QALY of less than the conventional threshold of three times gross domestic product per capita.Conclusions: The findings support the relevancy and importance of kaumātua knowledge to create a strengths-based approach to improve health and social outcomes. This study demonstrates that a contextually based and culturally safe age-friendly environments can facilitate engagement and participation by kaumātua for kaumātua.Trial Registry: Australia New Zealand Clinical Trial Registry (ACTRN12617001396314); Date Registered: 3 October 2017 (retrospectively registered); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373733&isClinicalTrial=False. [ABSTRACT FROM AUTHOR]

Background: Barriers to receiving optimal healthcare exist for Indigenous populations globally for a range of reasons. To overcome such barriers and enable greater access to basic and specialist care, developments in information and communication technologies are being applied. The focus of this scoping review is on web-based therapeutic interventions (WBTI) that aim to provide guidance, support and treatment for health problems. Objectives: This review identifies and describes international scientific evidence on WBTI used by Indigenous peoples in Australia, New Zealand, Canada and USA for managing and treating a broad range of health conditions. Eligibility criteria: Studies assessing WBTI designed for Indigenous peoples in Australia, Canada, USA and New Zealand, that were published in English, in peer-reviewed literature, from 2006 to 2018 (inclusive), were considered for inclusion in the review. Studies were considered if more than 50% of participants were Indigenous, or if results were reported separately for Indigenous participants. Sources of evidence: Following a four-step search strategy in consultation with a research librarian, 12 databases were searched with a view to finding both published and unpublished studies. Charting methods: Data was extracted, synthesised and reported under four main conceptual categories: (1) types of WBTI used, (2) community uptake of WBTI, (3) factors that impact on uptake and (4) conclusions and recommendations for practice. Results: A total of 31 studies met the inclusion criteria. The WBTI used were interactive websites, screening and assessment tools, management and monitoring tools, gamified avatar-based psychological therapy and decision support tools. Other sources reported the use of mobile apps, multimedia messaging or a mixture of intervention tools. Most sources reported moderate uptake and improved health outcomes for Indigenous people. Suggestions to improve uptake included as follows: tailoring content and presentation formats to be culturally relevant and appropriate, customisable and easy to use. Conclusions: Culturally appropriate, evidence-based WBTI have the potential to improve health, overcome treatment barriers and reduce inequalities for Indigenous communities. Access to WBTI, alongside appropriate training, allows health care workers to better support their Indigenous clients. Developing WBTI in partnership with Indigenous communities ensures that these interventions are accepted and promoted by the communities. [ABSTRACT FROM AUTHOR]

Background: Potentially inappropriate prescribing (PIP) is associated with negative health outcomes, including hospitalisation and mortality. Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ) is a longitudinal study of Māori (the indigenous population of New Zealand) and non-Māori octogenarians. Health disparities between indigenous and non-indigenous populations are prevalent internationally and engagement of indigenous populations in health research is necessary to understand and address these disparities. Using LiLACS NZ data, this study reports the association of PIP with hospitalisations and mortality prospectively over 36-months follow-up.Methods: PIP, from pharmacist applied criteria, was reported as potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs). The association between PIP and hospitalisations (all-cause, cardiovascular disease-specific and ambulatory-sensitive) and mortality was determined throughout a series of 12-month follow-ups using binary logistic (hospitalisations) and Cox (mortality) regression analysis, reported as odds ratios (ORs) and hazard ratios (HRs), respectively, and the corresponding confidence intervals (CIs).Results: Full demographic data were obtained for 267 Māori and 404 non-Māori at baseline, 178 Māori and 332 non-Māori at 12-months, and 122 Māori and 281 non-Māori at 24-months. The prevalence of any PIP (i.e. ≥1 PIM and/or PPO) was 66, 75 and 72% for Māori at baseline, 12-months and 24-months, respectively. In non-Māori, the prevalence of any PIP was 62, 71 and 73% at baseline, 12-months and 24-months, respectively. At each time-point, there were more PPOs than PIMs; at baseline Māori were exposed to a significantly greater proportion of PPOs compared to non-Māori (p = 0.02). In Māori: PPOs were associated with a 1.5-fold increase in hospitalisations and mortality. In non-Māori, PIMs were associated with a double risk of mortality.Conclusions: PIP was associated with an increased risk of hospitalisation and mortality in this cohort. Omissions appear more important for Māori in predicting hospitalisations, and PIMs were more important in non-Māori in predicting mortality. These results suggest understanding prescribing outcomes across and between population groups is needed and emphasises prescribing quality assessment is useful. [ABSTRACT FROM AUTHOR]

Indigenous peoples' roles in conservation are important because they offer alternate perspectives and knowledge centred on the quality of the human–environment relationship. Here, we present examples of Māori cultural constructs, mechanisms, legislative warrants and customary (traditional and contemporary) interventions fundamental to the development and delivery of biocultural approaches within NZ's future conservation system. Biocultural approaches emphasise greater decision-making for the environment at the local institutional level, and contribute towards rebuilding a 'tuakana–teina' relationship (a reciprocal learning relationship and responsibility shared between older and younger persons) between societies and their environments. We further posit that the matching of social scales with ecological scales within local management is necessary for the effective implementation of biocultural approaches. Failure to do so could undermine motivation, action, energies and confidence of local communities. [ABSTRACT FROM AUTHOR]