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

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

Aims: The first aim of this study was to measure the extent of care planning and support for health goals within a sample of Māori/non-Māori people with long-term conditions (LTCs). The second aim was to compare those with and without care plans, and those with and without support for health goals, with respect to health and experiences with general practice. Background: Collaborative care planning, resulting in a written care plan, and providing support for patient-identified goals are important aspects of LTC management. In the MidCentral District Health Board region, primary care practitioners have had help to achieve this through the introduction of comprehensive assessment and care-planning tools. Methods: 569 people with at least one LTC, who had recently enrolled in a local EnhancedCare+ programme or were receiving care from an LTC community clinical nurse, were recruited into the region's "Talking about Health" study, designed to explore LTC care from patient and provider perspectives. Consenting participants chose to complete a paper (by post) or electronic (email link) questionnaire, which included measures of health, healthy behaviours, experiences with doctors and nurses in general practice, patient activation, care planning/goal support and demographics. Results: People with written care plans were more active self-managers, reported better interactions with primary-care doctors and nurses, and perceived receiving more support from the general practice team than those without. Results were similar for people receiving support for their health goals, but differences in mental and physical health were also evident. More Māori than non-Māori reported having a written care plan, and support for health goals in the absence of a written care plan. A slightly broader range of benefits was evident for non-Māori than Māori, but the different sample sizes need to be taken into account when drawing conclusions. Conclusions: Written care plans and practitioner support for health goals appear to benefit people with LTCs. Support for health goals is important as, even without a written care plan, it was associated with better health and more positive ratings of practitioner interactions. Challenges for the region are to involve more people/whanau in collaborative care planning and to address system-wide barriers to embedding care-planning practices into routine care. [ABSTRACT FROM AUTHOR]

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

INTRODUCTION: Literature suggests that good quality health care access can have a positive impact on the health of people with serious mental illness (SMI), but literature relating to patterns of access by this group is equivocal. AIM: This study was designed to explore health care access patterns in a group of people with SMI and to compare them with a general New Zealand population group, in order for health providers to understand how they might contribute to positive health outcomes for this group. METHODS: The study surveyed 404 mental health consumers aged 18-65 years receiving care from one district health board in Auckland about their patterns of health care access. Results were compared with those from the New Zealand Health Survey of the general population. RESULTS: Findings suggest that the SMI consumer respondents had poorer physical health than the general population respondents, accessed health care services in more complex ways and were more particular about who they accessed for their care than the general population respondents. There was some concern from SMI consumers around discrimination from health care providers. The study also suggested that some proactive management with SMI consumers for conditions such as metabolic syndrome was occurring within the health care community. DISCUSSION: The first point of access for SMI consumers with general health problems is not always the family general practitioner and so other health professionals may sometimes need to consider the mental and physical health of such consumers in a wider context than their own specialism. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Adolescents are known to have high risk factors for sleep disorders, yet the youth rates of sleep disturbances are unknown. AIM: This study aimed to determine the prevalence of sleep disorders among New Zealand high school students. METHODS: The Auckland Sleep Questionnaire (ASQ) was administered to high school students at six schools in the North Island. Schools were chosen to reflect a range of ethnicities and school deciles, which identify the socioeconomic status of households in the school catchment area. RESULTS: A total of 1388 students completed the ASQ. The median age was 17 years (range 14-23) and females represented 43.5% (n=604) of the total group. A total of 37.2% of the students surveyed reported having significant sleep symptoms lasting longer than one month. Depression and anxiety were present in 51.7% and 44.8% of students reporting a sleep problem, respectively. A moderate correlation was observed between sleep problems and depression (r=0.34, p<0.01), and sleep problems and anxiety (r=0.31, p<0.01). Problem alcohol use and other substance use were more common in students with sleep symptoms (12.2% and 5.5% respectively). No difference was found in the rate of sleep problems reported by different ethnic groups. DISCUSSION: A considerable proportion of students surveyed reported significant sleep symptoms. This study has the potential to aid physicians within New Zealand in better appreciating the burden of sleep disorders faced by young people and in effectively assessing and managing different causes of sleep symptoms in this demographic. [ABSTRACT FROM AUTHOR]

Understanding employability for Māori, the Indigenous peoples of Aotearoa New Zealand (NZ), is an under researched area. The dominant Western culture, structures and practices in university and industries within NZ have obscured Māori presence and limited Māori student's expression of their own cultural identity. The current employment environment in NZ is starting to appreciate and recognize the contribution of Māori values and principles in the workplace. The demand for Maori employees competent in tikanga (Māori protocols) and Te Reo (Māori language, one of three official languages of NZ) is on the rise. We highlight the need to explore ways to change Higher Education and work-integrated learning (WIL) to better enable and encourage students to explore their cultural identity and add value into the workplace by bringing their 'whole selves' and their 'superpower'. This study adopted a case study methodology to examine employability from a Māori perspective. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Effective communication is fundamental to successful health care service delivery, and has a positive impact on access, quality of care, health outcomes, and patient satisfaction. Although there are a growing number of New Zealanders who do not speak English proficiently, underutilisation of trained interpreter services appears to be common in primary health care settings. AIMS: To describe the pattern of interpreter service need and utilisation by general practice services, and to identify key barriers and enabling factors to the use of trained interpreters. METHODS: A mixed methods study was employed. Census and Partnership Health Canterbury Te Kei o Te Waka (PHC) databases were combined, and quantitative analysis used to derive interpreter service need and utilisation patterns. Transcripts of focus groups and interviews from general practitioners, practice nurses and practice administration staff within the PHC were analysed, using qualitative methods to identify barriers and enablers to interpreter service use. RESULTS: For the years 2008-2010, approximately 10 742 consultations per year involved a non-English- speaking patient, yet in only approximately 74.8 (0.7%) consultations per year were interpreter services utilised. Analysis of focus groups and interviews identified four global themes that represented barriers for interpreter service utilisation; namely, practicalities, expectations, knowledge of service, and systems. DISCUSSION: The current use of interpreter services in PHC general practice appears to be significantly less than the need. In order to maximise health outcomes and reduce risk, strategies must be initiated to counter the barriers currently inhibiting interpreter service use, including adopting best practice policies. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Despite more than 10 years of the diabetes annual review (DAR) programme, ensuring the annual return of diabetic patients for review remains a challenge for primary care. Regardless of future arrangements for diabetes review programmes, regular review of patients remains clinically important. AIM: To investigate the effect of patient and practice characteristics on the retention of patients continuously enrolled with the same practice in the DAR programme. METHODS: We undertook a retrospective, observational study of a cohort of enrolled diabetic patients who had a DAR in the July 2006 - June 2007 reporting year and remained enrolled with the same practice for the following three years. Controlling for death and migration, retention rates were calculated for age, gender, ethnicity, rurality, practice fundingtype and practice nurse (PN) to general practitioner (GP) ratio. RESULTS: The study included data from 78 practices and 6610 patients with Type 2 diabetes. Non-Maori and those aged 60 years and over were more likely to be retained in the programme. For practice factors, those with a higher PN to GP ratio had a significant retention advantage. Rurality and funding type was not shown to have a significant role in retention. DISCUSSION: Results support the view that both patient and practice factors influence a patient's retention within the DAR programme. The PN to GP ratio may be an important factor in the retention of patients in a DAR programme and warrants further research and consideration when planning future primary care models. [ABSTRACT FROM AUTHOR]

Māori (Indigenous people of New Zealand [NZ]) experience inequitable health outcomes compared to non‐Māori, across the spectrum of clinical care, including those relating to medicines. Internationally, pharmacist‐facilitated medicines review services have been shown to benefit older adults. Despite national policies calling for the increased implementation of these services, NZ data relating to them remain limited, and these services may increase disparities between Māori and non‐Māori. There are currently no medicines review services developed specifically for Māori older adults. The current study aims to elicit stakeholder views of current and potential pharmacist services to help inform the development of a pharmacist‐facilitated medicines review service for community‐dwelling Māori older adults. Kaupapa Māori theory was applied within this qualitative research. Purposive sampling was used to recruit participants who were involved in providing, planning, funding developing or culturally supporting health services in Waitematā District Health Board, Auckland, NZ. Data were collected in semi‐structured interviews and in a focus group and analysed using reflexive thematic analysis. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative research. Eleven participants took part in the research in one focus group (n = 4) and seven semi‐structured interviews, conducted between November 2018 and March 2019. Three main themes were generated: (a) moving out of the shadows – claiming pharmacists' unique role within a healthcare whānau (family); (b) 'give them the power to be able to ask' – upholding the mana (self‐esteem, pride, standing) and autonomy of kaumātua (Māori older adults) and (c) rights versus realities – reimagining pro‐equity Māori health services within the constraints of the colonial health system. The right of Māori to experience equitable health outcomes needs to be included in policy and also operationalised in relation to medicines review services through improved utilisation of pharmacist skills and improving Māori older adults' autonomy and control. [ABSTRACT FROM AUTHOR]

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

Little population-based work has been published about the mental health of adolescents with both sexual/gender (SG) and ethnic minority (i.e. double minority) status. This study aimed to provide an overview on their mental health. Analysis of data from a total of 17,607 high school students from New Zealand's 2007 and 2012 cross-sectional nationally representative Adolescent Health Surveys, including a total of 1306 (7.4%) SG minority participants, of whom 581 (3.3%) were also an ethnic minority. SG minority status, minority ethnicity, and female sex were associated with higher mental distress and poorer well-being. Generally speaking, double minority students reported poorer mental health than SG majority students of the same ethnicity, but reported better mental health than SG minority New Zealand European students. Explanations and future directions for research were suggested to further explore how double minority students negotiate mental health in the context of their communities/cultures in New Zealand. [ABSTRACT FROM AUTHOR]

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

We interrogated historical continuity and change in discourses of enlightenment and racism through the analysis of 160 years of New Zealand Speeches from the Throne (1854-2014, 163 speeches). Enlightenment discourses of benevolence and perfectibility were prevalent in all periods, much more so than racism. 'Old-fashioned' racism took the form of an assumed civilizational superiority (including accusations of 'barbarism') during colonization, with 'modern' racism taking forms like blaming Māori for not 'productively' using the land. Both declined to almost zero by the 20th century, undermining the idea of 'old-fashioned' versus 'modern' racism. Utilitarian discourses peaked in the late 19th to early 20th centuries as justification for Māori land alienation. 'Master discourses of enlightenment' consisted of a central core of social representations that changed at the periphery, with a gradual expansion of symbolic inclusion of Māori in discourses of national identity to the point where biculturalism is the dominant discourse for elites today. [ABSTRACT FROM AUTHOR]

This study examined the perceived availability and helpfulness of supports used by caregivers of children with Autism Spectrum Disorder in New Zealand, particularly for caregivers who are Māori, and who live rurally. Caregivers ( N = 92) completed the Family Support Scale with comparisons analysed using t tests. Free text comments were invited and analysed using a general inductive approach. More support was perceived as available by Non-Māori than Māori p = 0.03, 95 % CI (0.21, 3.88). Spouses were rated as the most helpful support. Professional helpers were rated as 'somewhat helpful'. Helpful support emphasised caring, knowledge and accessibility. Ethnic differences in perceptions of support endorse calls for culturally tailored supports. Informal supports are highly valued however professional supports require development to better meet caregiver needs. [ABSTRACT FROM AUTHOR]

Background: Obesity is prevalent in health care workers, but it is unknown whether a lack of nutritional knowledge contributes to this. This study measured the nutrition knowledge of undergraduate nursing students to identify knowledge gaps that could be addressed through nutrition teaching in an updated undergraduate nursing curriculum. Method: Undergraduate nursing students (N = 197) completed a nutrition knowledge survey with questions on demographics, body composition, nutrition labels, food packaging claims, and healthy food-purchasing choices. Results: Mean overall nutritional knowledge scores were low, but overall scores were higher for students who had received nutrition teaching (60.5% versus 52.5%; F[1,187] = 7.2, p < 0.001). Improvements in nutrition knowledge were consistent across all ethnic groups, and no effects of age were observed. Conclusion: To sufficiently prepare nurses for their public health role in obesity prevention, more nutrition education is needed in undergraduate nursing education programs, with emphasis on ethnic-specific educational requirements. [ABSTRACT FROM AUTHOR]

Aims To investigate relationships between caregiving and subjective sleep reports among older New Zealanders. Methods Participants were 434 carers (177 home-based) and 1747 non-carers (aged 55-72 years) who completed the 2008 Health Work and Retirement survey. Sleep outcomes (feeling worn out, tired, or dissatisfied with sleep or having a diagnosed sleep disorder) were explored by caregiving status. Logistic regression was used to investigate caregiving as an independent predictor of poor sleep health after controlling for other demographic variables. Results Home-based carers were more likely to report feeling tired some/all of the time than non-carers (odds ratio 1.6, 95% confidence interval 1.1-2.2). Being Māori, a woman, younger or more socioeconomically deprived ( New Zealand Deprivation Index 2006) were also significant independent predictors of poor sleep outcomes. Conclusions Carers are at increased risk of feeling tired in the daytime. Early recognition and management of underlying sleep problems are particularly important for older people providing care at home. [ABSTRACT FROM AUTHOR]

Background In New Zealand, the burden of childhood obesity is greatest in M_aori and Pacific children. Methods In 687 infants from an internet-based birth cohort in New Zealand, we investigated ethnic differences in early life risk factors for later obesity, the degree to which these were explained by sociodemographic factors, and the extent to which ethnic differences in weight at age 3 months were explained by measured risk factors. Results The risk of having an obese mother was double in M_aori and Pacific infants compared with NZ European infants (prevalence 24% and 14%, respectively; OR 2.23, 95% CI 1.23 to 4.04). M_aori and Pacific infants had higher weights in the first week of life and at 3 months (mean difference 0.19 kg, 95% CI 0.01 to 0.38), and their mothers had higher scores on a ‘snacks' dietary pattern and lower scores on ‘healthy' and ‘sweet' dietary patterns. These inequalities were not explained by maternal education, maternal age or areabased deprivation. No ethnic differences were observed for maternal pre-pregnancy physical activity, hypertension or diabetes in pregnancy, exclusive breastfeeding or early introduction of solid foods. Ethnic inequalities in infant weight at 3 months were not explained by sociodemographic variables, maternal pre-pregnancy body mass index or dietary pattern scores or by other measured risk factors. Conclusions This study shows excess prevalence of early life risk factors for obesity in M_aori and Pacific infants in New Zealand and suggests an urgent need for early interventions for these groups. [ABSTRACT FROM AUTHOR]

We apply latent class analysis (LCA) to build typologies of response profiles underlying variation in attitudes. LCA is directly suited for identifying categories of people who have distinct representational profiles, that is, discretely measureable patterns of attitudes that are bound together by a common system of interpretation used by the group to make sense of and communicate about a social object within a social context. This novel application extends social representations theory and provides a way to simultaneously examine the relevant content of important representations and their prevalence across a priori social categories and demographics within a given society. We identify four distinct representational profiles underlying bicultural policy attitudes in a nationally representative New Zealand sample (N = 6150). We map the prevalence of these four profiles across the population, show how they vary demographically across indicators of social class, immigration status, and ethnicity, and predict distinct patterns of voting behavior, political party support, social identification, and in-group and out-group attitudes. Guidelines for the use of LCA in the study of social representations are discussed, including a three-step model of the following: (i) profile prediction and derivation; (ii) profile validation; and (iii) prevalence mapping of profile distributions across strata within the population. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

We sought to identify what services indigenous (Maori) and immigrant populations use pharmacies for, and how long pharmacy staff spend interacting with them, as longer interactions are associated with better quality care. We review literature on counseling in pharmacy, and interaction length as an indicator of counseling quality. 1,086 interactions were discretely observed in 36 pharmacies in 5 cities around New Zealand. Maori or Pacific people, along with men, were more likely to treat pharmacies as prescription 'depots', being less likely to buy over-the-counter or pharmacist only medicines (ORs: 0.25-0.72). However, the influence of demographic factors on interaction length was small (| B|s < 7.7 s). The weak effect of ethnicity on interaction length suggests that pharmacies are providing advice of relatively consistent quality to different population groups. Possible barriers to use of pharmacies for primary healthcare, including over-the-counter medicines in Maori and Pacific people are discussed. [ABSTRACT FROM AUTHOR]

We experimentally evaluate inexpensive interventions to increase response fractions in two alcohol surveys. Residents on the New Zealand General and Maori electoral rolls were randomized to receive a survey pack with or without an offer of entry to a $500 prize draw. Subsequent randomization of sample members who did not initially respond allowed estimation of effects of offering a $5 donation to charity as an incentive to respond. Offering prize draw entry did not significantly increase responses in either population. Contrary to expectation, promising a $5 donation to non-respondents reduced subsequent responding in the group previously offered the prize draw incentive. [ABSTRACT FROM AUTHOR]