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

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In 2020, the New Zealand (NZ) Parliament voted to decriminalise abortion. Although NZ's abortion law formally opposes sex selective abortions, there is considerable complexity in the gender politics of 'choice' and 'agency' in multi-ethnic societies, and interpretations of reproductive rights for ethnic minority women and for the girl child, respectively. This paper explores these complexities through the perspectives of reproductive and maternity care practitioners who are situated at the interface of legal systems, health service provision, and delivery of culturally sensitive care. Thirteen practitioners were interviewed as part of this study. The analysis highlights strains in framings of 'reproductive choice' (underpinned by western liberal notions of rights) and 'gender equality' (abortion rights that acknowledge the complexity of cultural son-preference) for ethnic minority women. These tensions are played out in three aspects of the post-reform landscape: (a) everyday practice and accountability; (b) consumerism and choice; (c) custodianship and gender rights. The findings point to the limitations in operationalising choices for ethnic women in health systems wherein trust deficit prevails, and cultural dynamics render complex responses to abortion. They also highlight reconfigurations of client-expert relationships that may have implications for practitioners' abilities to advocate for ethnic women's rights against cultural influences. [ABSTRACT FROM AUTHOR]

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

Introduction. The 2001 Primary Health Care Strategy provided significant new government funding for primary care (general practice and related services) via capitation funding formulas. However, there remain important unanswered questions about how capitation funding formulas should be redesigned to ensure equitable and sustainable service provision to all population groups. Aim. To compare levels of chronic illness, utilisation, and unmet need in patients categorised as ‘high-need’ with those categorised as non-‘high-need’ using the definitions that are used in the current funding context, in order to inform primary care funding formula design. Methods. Respondents of the New Zealand Health Survey (2018–19) were categorised into ‘high-need’ and non-‘high-need’, as defined in current funding formulas. We analysed: (i) presence, and number, of chronic diseases; (ii) self-reported primary care utilisation (previous 12 months); and (iii) self-reported unmet need for primary care (previous 12 months). Analyses used integrated survey weights to account for survey design. Results. In total, 29% of respondents were ‘high-need’, of whom 50.2% reported one or more chronic conditions (vs 47.8% of non-‘highneed’ respondents). ‘High-need’ respondents were more likely than non-‘high-need’ respondents to: report three or more chronic conditions (14.4% vs 13.7%); visit a general practitioner more often (seven or more visits per year: 9.9% vs 6.6%); and report barriers to care. Discussion. There is an urgent need for further quantification of the funding requirements of general practices serving high proportions of ‘high-need’ patients in order to ensure their viability, sustainability and the provision of quality of care. [ABSTRACT FROM AUTHOR]

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

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

Introduction. Community-based primary care physiotherapy has developed through private practice, fee-for-service model in Aotearoa New Zealand where independent businesses operate in competition. Aim. We aimed to explore how the private practice model of physiotherapy impacts patient care, physiotherapists, and professional behaviour. Methods. Six physiotherapists managing musculoskeletal conditions in a primary care private practice in Aotearoa New Zealand were recruited using maximum variation purposive sampling. In-depth individual face-toface semi-structured interviews were audio-recorded, transcribed verbatim, and analysed using Interpretive Description. Inductive data analysis synthesised and contextualised data, creating a thematic framework that developed across interviews. Results. All physiotherapy participants discussed concerns about culture and professionalism in private practice physiotherapy despite not being asked about these. Three themes were identified. 'Competitive business model and lack of collaboration' - participants thought that competition between practices resulted in a lack of trust, collegiality, and collaboration, and pressure on clinicians to maintain income. '(Un)professional behaviour' - participants thought that physiotherapists were defensive and averse to scrutiny, resulting in reluctance to admit when they needed help, or to undertake peer review or seek second opinions. 'Lack of support and mentoring' - the professional culture in private practice was perceived to reduce support and mentoring, with negative impacts that affected physiotherapists at all stages of career. Conclusion. This exploratory qualitative study suggests that competition dominates communication and collaboration in private practice physiotherapy and may have wider implications for professionalism and the quality of patient care. Competitive business models and an aversion to scrutiny may reduce collegial interaction and professional behaviour. [ABSTRACT FROM AUTHOR]

There is growing interest in the idea of elected members on health service governing boards as a means to induce public participation in planning and decision making, yet studies of elected boards are limited. Whether elected boards are an effective mechanism for public participation remains unclear. This article discusses the experiences of New Zealand where, since 2001, there have been three sets of elections for District Health Boards. Information on candidates and election results is presented along with data gathered via post-election voter surveys. The article also considers the broader regulatory context within which the elected boards must operate. The New Zealand experience illustrates that elected health boards may not be an effective mechanism for public participation. Voter turnout has declined since the inaugural elections of 2001, and non-voters form the majority. Reasons for not voting include failure to receive voting papers, a lack of interest, or no knowledge of elections. The elections have also failed to produce minority representation, while the capacity for elected members to represent their communities is subject to constraints. On the upside, elections have enabled public involvement in various dimensions of participation, including oversight and processes of governance. New Zealand's mixed performance suggests that elected boards may need to be complemented with other participatory channels, if increased public participation is the goal. [ABSTRACT FROM AUTHOR]

Background: The increase in multimorbidity or co-occurring chronic illnesses is a leading healthcare concern. Patients with multimorbidity require ongoing care from many different professionals and agencies, and often report a lack of integrated care. Objective: To explore the daily help-seeking behaviours of patients with multimorbidity, including which health professionals they seek help from, how professionals work together, and perceptions and characteristics of effective interprofessional, interagency multimorbidity care. Design: Using a case study observational research design, multiple data sources were assembled for four patients with multimorbidity, identified by two general practitioners in New Zealand. In this paper, two case studies are presented, including the recorded instances of contact and communication between patients and professionals, and between professionals. Professional interactions were categorized as consultation, coordination, or collaboration. Results: The two case studies illustrated two female patients with likely similar educational levels, but with different profiles of multimorbidity, social circumstances, and personal capabilities, involving various professionals and agencies. Engagement between professionals showed varying levels of interaction and a lack of clarity about leadership or care coordination. The majority of interactions were one-to-one consultations and rarely involved coordination and collaboration. Patients were rarely included in communications between professionals. Conclusion: Cases constructed from multiple data sources illustrate the complexity of day-to-day, interprofessional, interagency multimorbidity care. While consultation is the most frequent mode of professional interaction, targeted coordinated and collaborative interactions (including the patient) are highly effective activities. Greater attention should be given to developing and facilitating these interactions and determining who should lead them. [ABSTRACT FROM AUTHOR]

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

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

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

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

INTRODUCTION: Gout remains a health equity issue; Māori and Pacific peoples are disproportionately afflicted, with increased burden and loss of quality of life, yet are less likely to receive appropriate management, which mainly occurs in primary care. AIM: This study aims to understand the perspectives of the mainly Māori and Pacific clinicians and staff at an urban marae practice about barriers and challenges to delivering effective care to a Māori and Pacific community with high burden of gout. METHODS: Semi-structured interviews were conducted with 10 staff members delivering health care to a mostly Indigenous community. Interviews sought to ascertain staff views of enablers and barriers to optimal gout management and analyse them thematically. RESULTS: Three themes were identified: community disadvantage; demands unique to Indigenous providers; and challenges and opportunities for optimising gout management. High prevalence and heavy impact of gout on wellbeing in the community was intertwined with socioeconomic disadvantage, precariousness of employment and entrenched inaccurate (yet pliable) patient views on gout, to the detriment of focused, effective care. Structural and funding demands on providers inhibited staff focus on the clear community need. Providers saw the culturally safe and competent approach necessary for improvement as requiring community empowerment with appropriate clinical tools and adequate resourcing. DISCUSSION: Despite provider intent to deliver culturally appropriate and safe care and equitable health outcomes for patients suffering from gout, general practice initiatives without aligned resourcing or incentives are inhibited when inequity is pervasive. Simply asking Māori providers to do more for the same amount of resource may not be effective. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Health literacy is linked to better health outcomes and underpins effective self-management, yet over one-and-a-half million New Zealanders are known to have poor health literacy skills. An ability to access and understand health information is an important component of health literacy. Little is known, however, about New Zealand consumers' health information needs. This qualitative study sought to understand the perceptions of consumers related to their needs and use of health information. METHODS: Four focus group interviews provided data for this qualitative descriptive study. Data analysis used a thematic inductive approach. Participants were from the general population, accessed through community-based health organisations. These consumers were predominantly of New Zealand European ethnicity, female, older, and most were actively engaged in managing their health. FINDINGS: Four themes were identified: issues with current information provision; preferences for content; format; and sources of health information. These themes are described in the paper, using illustrative quotes from consumer participants. CONCLUSION: This study indicates that consumers have varied health information needs. Health professionals cannot assume that consumers all have the same health literacy skills. The ideal is to provide personalised, relevant information in a manner the consumer can understand, within the current time constraints in practice. Health professionals can support consumers in their use of different strategies to ensure their health information needs are expressed and met. [ABSTRACT FROM AUTHOR]

INTRODUCTION: A number of studies have identified that gay, lesbian, bisexual, transgender, and intersex (GLBTI) people have poorer mental health than the general population. This article describes current mental health promotion and service provision for GLBTI people in New Zealand, and the views of stakeholders on current service delivery and concerns facing the sector. METHODS: An email survey of service providers gathered descriptive data about mental health promotion and services provided for GLBTI people. Data obtained from interviews with key informants and online submissions completed by GLBTI individuals were analysed thematically. FINDINGS: Five organisations provide clear, specific and utilised services and programmes to some or all of the GLBTI populations. Twelve GLBTI-focused mental health promotion resources are identified. The analysis of data from key informants and GLBTI respondents identified factors affecting mental health for these populations occurring at three levels--macro-social environment, social acceptance and connection, and services and support. CONCLUSION: While GLBTI individuals have the same basic mental health promotion and service provision needs as members of the general population, they have additional unique issues. To enhance the mental health of GLBTI New Zealanders, a number of actions are recommended, including building sector capacity, allocating sufficient funding, ensuring adequate research and information is available, and reducing stigma, enhancing young people's safety, and supporting practitioners through training and resources. An important role for government, alongside GLBTI input, for improving mental health is noted. [ABSTRACT FROM AUTHOR]

Background: Diabetes is a major health issue for individuals and for health services. There is a considerable literature on the management of diabetes and also on communication in primary care consultations. However, few studies combine these two topics and specifically in relation to nurse communication. This paper describes the nature of nurse-patient communication in diabetes management. Methods: Thirty-five primary health care consultations involving 18 patients and 10 nurses were video-recorded as part of a larger multi-site study tracking health care interactions between health professionals and patients who were newly diagnosed with Type 2 diabetes. Patients and nurses were interviewed separately at the end of the 6-month study period and asked to describe their experience of managing diabetes. The analysis used ethnography and interaction analysis. In addition to analysis of the recorded consultations and interviews, the number of consultations for each patient and total time spent with nurses and other health professionals were quantified and compared. Results: This study showed that initial consultations with nurses often incorporated completion of extensive checklists, physical examination, referral to other health professionals and distribution of written material, and were typically longer than consultations with other health professionals. The consultations were driven more by the nurses' clinical agenda than by what the patient already knew or wanted to know. Interactional analysis showed that protocols and checklists both help and hinder the communication process. This contradictory outcome was also evident at a health systems level: although organisational targets may have been met, the patient did not always feel that their priorities were attended to. Both nurses and patients reported a sense of being overwhelmed arising from the sheer volume of information exchanged along with a mismatch in expectations. Conclusions: Conscientious nursing work was evident but at times misdirected in terms of optimal use of time. The misalignment of patient expectations and clinical protocols highlights a common dilemma in clinical practice and raises questions about the best ways to balance the needs of individuals with the needs of a health system. Video- recording can be a powerful tool for reflection and peer review. [ABSTRACT FROM AUTHOR]

This paper summarizes survey and interview results from a cross-sectional study of New Zealand health care chaplaincy personnel concerning their involvement in multiple bioethical issues encountered by patients, families and clinical staff within the health care context. Some implications of this study concerning health care chaplaincy, ecclesiastical institutions, health care institutions and government responsibilities are discussed and recommendations presented. [ABSTRACT FROM AUTHOR]

ABSTRACT This paper provides part of an analysis of the use of the Maori term whakapapa in a study designed to test the compatibility and commensurability of views of members of the indigenous culture of New Zealand with other views of genetic technologies extant in the country. It is concerned with the narrow sense of whakapapa as denoting biological ancestry, leaving the wider sense of whakapapa as denoting cultural identity for discussion elsewhere. The phenomenon of genetic curiosity is employed to facilitate this comparison. Four levels of curiosity are identified, in the Maori data, which penetrate more or less deeply into the psyche of individuals, affecting their health and wellbeing. These phenomena are compared with non-Maori experiences and considerable commonalities are discovered together with a point of marked difference. The results raise important questions for the ethical application of genetic technologies. [ABSTRACT FROM AUTHOR]

This paper investigates the reasoning processes of social workers in child protection social work as they make decisions. Within this interpretive process, they assign meaning to clients' behaviours in a context containing a multitude of competing discourses relating to the nature and cause of clients' problems. The study used a qualitative approach, specifically a critical incident framework. It asked workers to describe cases they felt ‘pleased with’ and explain the reasoning processes they used in those cases. It also asked clients their views of decisions made about them. This article draws on social constructionist theorising to describe and analyse the discourses used to frame the aims of practice and the causes of clients' problems. It found that workers valued family maintenance and sought to bolster this while managing potential risk. In the cases selected by workers, they constructed the causes of clients' problems in non-blaming but individualised ways, viewed clients as being capable of change and honest in their dealings with workers. It is proposed that these ways of viewing contributed to maintaining relationships with clients despite the challenges of balancing risk, care, control and power. [ABSTRACT FROM PUBLISHER]

Introduction. Maternal vaccination against influenza and pertussis protects mothers and babies from severe disease and is recommended and funded in Aotearoa New Zealand. Despite this, maternal vaccination uptake is low, varies by region and is inequitable, with Māori and Pacific māmā (mothers) less likely to receive vaccination. Aim. To determine what interventions currently exist to support and encourage maternal vaccination against influenza and pertussis and what changes and interventions could be implemented to improve coverage, with a focus on Māori and Pacific hapū māmā (pregnant mothers). Methods. Interviews with six participants with diverse roles in the vaccination workforce were conducted. Participants were involved in education, certification and supporting vaccinators, high-level strategising, and vaccination. Interviews aimed to determine what interventions currently exist for hapū māmā, what changes need to be made to improve coverage and how Māori and Pacific people have been specifically engaged. Qualitative data analysis was used to determine themes. Results. Participants identified that interventions must focus on prioritising and emphasising the importance of maternal vaccination, promoting collaboration and innovation, making interventions accessible, and empowering Māori- and Pacific-driven avenues to vaccination. To create positive foundations, participants identified the importance of building and maintaining trust and affording mothers’ time and autonomy in vaccination. Discussion. Healthcare professionals need to proactively engage hapū māmā about vaccination and collaborate in service delivery. Interventions must be suitably accessible and allow for the autonomy of hapū māmā over vaccination decisions. Equity should be considered at the foundation of vaccine interventions to improve the accessibility of vaccines to all communities. [ABSTRACT FROM AUTHOR]

Introduction. A handful of reports detail efforts to redesign traditional hospital gowns to address common concerns related to patient comfort and privacy for big bodied patients. Results suggest that improving gown design has the potential to improve both the patient and carer experience and satisfaction of care. Aim. This study aimed to ascertain the utility of gowns purposely designed for big bodied patients (named Xcellent Gowns) from a staff perspective. Methods. Qualitative semi-structured interviews were conducted in 2022 with 14 hospice staff members. Interview transcripts were uploaded to DedooseTM. Data were analysed utilising reflexive thematic analysis according to a six-phase process including data familiarisation, iterative data coding, and theme development and refinement. Results. The qualitative analysis of the interview data identified four main themes: (1) the gown experience, (2) fit-for-purpose, (3) love and dignity, (4) design principles. Each theme is presented and discussed with illustrative quotes from participants’ interview transcripts. Discussion. The perspectives of the staff participants in this study confirm research findings from other healthcare settings, that the patient and carer experience may be improved through focused redesign of this vital item of patient clothing. [ABSTRACT FROM AUTHOR]

Artificial Intelligence (AI) is undergoing rapid development, meaning that potential risks in application are not able to be fully understood. Multiple international principles and guidance documents have been published to guide the implementation of AI tools in various industries, including healthcare practice. In Aotearoa New Zealand (NZ) we recognised that the challenge went beyond simply adapting existing risk frameworks and governance guidance to our specific health service context and population. We also deemed prioritising the voice of Māori (the indigenous people of Aotearoa NZ) a necessary aspect of honouring Te Tiriti (the Treaty of Waitangi), as well as prioritising the needs of healthcare service users and their families. Here we report on the development and establishment of comprehensive and effective governance over the development and implementation of AI tools within a health service in Aotearoa NZ. The implementation of the framework in practice includes testing with real-world proposals and ongoing iteration and refinement of our processes. [ABSTRACT FROM AUTHOR]

Introduction: Delivery of end-of-life care for severe chronic obstructive pulmonary disease (COPD) has been hampered by an unpredictable disease trajectory and poor integration of health care and social services. Objective: To critically explore the perspectives, values, and experiences of stakeholders in COPD end-of-life healthcare services in a large district in Aotearoa New Zealand. Design: Focus groups analysed utilising critical theory and Actor-Network Theory. Methods: Stakeholders in end-of-life COPD healthcare services were purposively sampled from a large healthcare network in Canterbury, Aotearoa New Zealand to participate in seven focus groups (bereaved carers, community-based health professionals, non-Māori, non-Pacific patients, and support people (two groups), Māori patients, supporters and health professionals, Pacific patients, support people and health professionals, and hospital-based health professionals). Participants discussed end-of-life care services for people with COPD. Transcripts were coded utilising descriptive and structural coding to develop themes related to provision of quality care. Participants were positioned as experts. We considered how the themes arising supported and disrupted the healthcare network for end-of-life COPD. Results: Five themes related to quality of care for end-of-life COPD were identified: compassion, competence, community, commitment, and collaboration. The absence of any of these five themes required for quality care led to power imbalances within healthcare systems. Power inequities created disconnection among stakeholders which then disrupted commitment, community, and collaboration. A dysfunctional healthcare network impeded compassion between stakeholders and did not support their competence, leading to lower quality care. All five themes were identified as essential to delivery of high-quality end-of-life care in COPD. Conclusion: Stakeholders' perspectives of end-of-life care for COPD identified of core features of a health system network that enabled or impeded the actions of stakeholders and allocation of resources to provide quality care. [ABSTRACT FROM AUTHOR]

Introduction. The New Zealand Medicinal Cannabis Scheme (NZMCS) was established in April 2020 with the aim of expanding access to quality controlled medicinal cannabis products and developing a domestic medicinal cannabis industry. Yet, two years later, many patients report challenges in utilising the NZMCS, including physicians' reluctance to provide prescriptions for products. Aim. To explore the barriers and facilitators to prescribing medicinal cannabis in New Zealand. Methods. We conducted semi-structured interviews with 31 New Zealand physicians (general practitioners, specialists, and cannabis clinicians) who had discussed medicinal cannabis with patients in the last 6 months. Results. Physicians reported the principal barrier to prescribing medicinal cannabis was the limited clinical evidence to support cannabis therapy. Further barriers included: a perceived lack of knowledge of medicinal cannabis; concerns over professional reputation; social stigma; and the price of products. Conversely, the factors that facilitated cannabis prescribing included patients' and physicians' knowledge of medicinal cannabis; some physicians' desire to avoid patients having to engage with private cannabis clinics; and the timing of prescription requests (ie considering medicinal cannabis after other treatments had been exhausted). Discussion. Further clinical research of medicinal cannabis medications, education and training, and information would support physicians to deliver more informed advice to patients and enhance professional confidence with cannabis therapies. [ABSTRACT FROM AUTHOR]

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

AIM: To identify factors that have enabled some New Zealand general practitioner obstetricians (GPOs) to continue providing maternity care and factors implicated in decisions to withdraw from maternity care. METHOD: Semi-structured interviews and one focus group (n = 3) were conducted with 23 current and former GPOs. Interviews were transcribed and analysed thematically. RESULTS: Current and former GPOs practiced maternity care because they enjoyed being involved in the birth process and delivery suite environment. Their maternity practice was framed by a philosophy of lifelong continuity of care for patients. Legislative changes in New Zealand and barriers to shared care that resulted in many GPOs withdrawing from maternity care left remaining GPOs feeling professionally isolated; another reason for ceasing maternity care. Funding was perceived to be inadequate and on-call demands were both major disincentives to providing maternity and intrapartum care. Current GPOs often have strong supportive local relationships with other maternity providers when compared with those no longer practicing. Local shared care arrangements enhance professional support and reduce professional isolation. CONCLUSION: GPOs still practicing in New Zealand do so because they find maternity care highly rewarding despite their perceptions that the current maternity care model is incompatible with general practice. They have often developed local solutions that support their practice, particularly around shared care arrangements. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The role of healthcare providers and their use of systems is one of the most important factors in vaccination uptake. AIM: To identify reasons and find patterns behind why immunisation providers code the word 'decline' in their system for childhood immunisation events. METHODS: A qualitative study involving face-to-face semi-structured interviews with staff members involved in immunisation delivery. General practices were purposively selected for having either high or low rates of registered children coded on the electronic practice management system as having declined immunisation events. Thematic analysis was undertaken using an inductive approach to link themes to the data. RESULTS: A total of 35 interviews were conducted with practice nurses; 21 were from practices with high rates of registered children recorded as having declining immunisation events, and 14 practices with low rates of declining. Common themes were: effective use of systems, early and ongoing engagement, adequate health care practitioner time and practitioner experience. Practices with low rates of coded decliners had stronger approaches for early and ongoing engagement, and were less likely to use formalised decline forms. As practice immunisation coverage rates improved over time, there was perceived to be less expressed vaccine hesitancy from families. CONCLUSIONS: The reasons for coding individuals as 'decliners' are a complex mixture of individual, community, practitioner and practice systems. Front-line providers need adequate tools, time and resourcing to support effective and ongoing engagement with families. Community factors have influence but can change over time. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Outreach Immunisation Services (OIS) enable children who have not been immunised on time at general practice to be immunised in the community, thereby improving immunisation coverage and reducing equity gaps. AIM: To identify the most effective service delivery models and make recommendations for more effective and cost-efficient OIS delivery in New Zealand. METHODS: Data collection and thematic analysis through a detailed review of OIS contracts and service specifications, an online survey and in-depth interviews with stakeholders and providers, and an analysis of cost data was conducted. RESULTS: In total, 28 OIS providers completed survey questionnaires, 28 OIS staff were interviewed, and cost effectiveness data were obtained from 11 providers. The surveys and interviews identified key themes around identifying clients with the highest needs, effective engagement strategies, staffing requirements, and service challenges. On average, each OIS referral costs NZ$361 (median NZ$257), and each vaccination event costs NZ$636, ranging from NZ$145 to NZ$2403. Characteristics for two separate models of service delivery were identified based on provider size. CONCLUSION: There is considerable range in costs and style of OIS delivery, and efficiencies can be gained. Models need to fit with locality needs and include adequate resourcing, staff with good local knowledge, close relationships with other key child health services and preferably co-location, sustainable funding, and regular service reviews. OIS are part of an effective integrated service that relies on accurate data, positive relationships and a rapid response when children fail to present for vaccination in a timely fashion. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Research supports talking about death outside the end-of-life context. Benefits include allaying death anxiety to increased engagement in health promotion interventions. Nonetheless, the focus on death conversations remains centred on the imminently dying. This qualitative study investigated New Zealanders' perspectives on the value of, opportunities for, and barriers to death conversations in primary healthcare. METHODS: Twenty-one participants were interviewed. Participants were young older adults (54-65 years) not receiving palliative care or diagnosed with a terminal illness. Most were women who identified ethnically as New Zealand European. An immersion-crystallisation approach to thematic development was used to accommodate the multidisciplinary research framework. RESULTS: Four core themes were identified: 'a need to talk about death'; 'the role of the GP'; 'broaching the topic'; and 'media'. CONCLUSION: A cultural silence on death has rendered both the medical and lay community insufficiently prepared for frank and meaningful engagement with the topic, exacerbated by restricted consultation timeframes. The ease of death conversations may be facilitated by taking a family-centred approach, using community organisations and settings, and harnessing conversation entry points provided by the media. Future research should aim to develop tailored resources and frameworks to support general practitioners' meaningful engagement with the topic of death both within and outside of the end-of-life context. [ABSTRACT FROM AUTHOR]

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

Aim: To explore nurses' experiences with, and barriers to, obesity healthcare in rural general practice. Background: Obesity is a significant health risk worldwide, which can lead to many other physical and psychosocial health issues that contribute to a poor quality of life. Primary care is considered the most suitable context to deliver obesity management healthcare across the world, including New Zealand, which reportedly has 34% of all adults (and 51% Indigenous Māori) classed as obese. Nurses in primary care have a significant role in the multidisciplinary team and deliver obesity healthcare in general practice contexts. Yet, there is little focus on the nurse perspective of weight management, specifically in rural areas where medical staff and resources are limited, and obesity rates are high. Methods: This was a qualitative research design. Semi-structured interviews with 10 rural nurses from indigenous and non-indigenous health providers were analyzed guided by Braun and Clarke (2006) approach to thematic analysis. Findings: Three themes were identified: limitations of a nurse role; patient-level barriers; and cultural barriers. Nurses reported experiencing significant barriers to delivering effective weight management in their practice due to factors outside the scope of their practice such as patient-level factors, social determinants of health, rural locality restrictions, and limitations to their role. While this study highlights that practice nurses are versatile with an invaluable skill repertoire, it also demonstrates the near impossibility for rural nurses to meet their rural patient's complex weight management needs, as there are many social determinants of health, sociocultural, and rural locality factors acting as barriers to effective weight management. Nurses experienced a lack of systemic support in the form of time, resources, funding, and effective weight management referral options. Future investigation should look to address the unique rural weight management healthcare needs that experience many barriers. [ABSTRACT FROM AUTHOR]

Introduction. Restrictions imposed to eliminate the spread of the coronavirus disease 2019 (COVID-19) virus had significant implications on peoples’ experiences of caring for family/whānau at the end of life, and on their own bereavement process. Aim. This qualitative research explored the impact of COVID-19 lockdown restrictions on experiences of loss, grief and bereavement in Aotearoa New Zealand. Methods. This qualitative narrative research used semi-structured interviews with 10 participants who experienced the loss of a loved one during Levels 3 or 4 lockdown in Aotearoa New Zealand (23 March–13 May 2020). Interviews were coded using NVivo software and inductive thematic analysis was used to evaluate the data. Results. Results were grouped into three themes: death experience; mourning in isolation; and availability of support. These themes provide insight into the challenges and difficulties participants faced when they experienced the death of a loved one during a COVID-19 lockdown, and the impact of these restrictions on their experiences of grief and bereavement. Discussion. The findings from this research suggest there is an increased risk of prolonged grief among those bereaved during lockdown. Primary care professionals need to be aware of this increased risk in order to identify need and provide access to bereavement support. [ABSTRACT FROM AUTHOR]

New Zealand (NZ) lacks nationally representative or generalisable information on the dietary intakes of pre‐schoolers. We used Growing Up in New Zealand cohort data to i) develop child feeding indexes (CFIs) based on National Food and Nutrition Guidelines for 2‐ and 4.5‐year‐olds; ii) describe the cohort adherence to the guidelines at 2 (n = 6046) and 4.5 years (n = 5889) and; iii) assess the CFIs' convergent construct validity, by exploring associations with maternal sociodemographic and health behaviours and with child body mass index for age (BMI/age) and the waist‐to‐height ratio at 4.5 years. The CFIs scores ranged from 0 to 11, with 11 representing full adherence to the guidelines. Associations were tested using multiple linear regressions and Poisson regressions with robust variance (risk ratios [RR], 95% confidence intervals, 95% CI). The CFIs mean scores (SD) at 2 and 4.5 years were, respectively, 6.13 (1.21) and 6.22 (1.26) points. Maternal characteristics explained, respectively, 27.2% and 31.9% of the variation in the CFIs scores at 2 and 4.5 years. In the adjusted model at the 4.5‐year interview, in relation to girls ranked in the 5th quintile, those in the 2nd (RR, 95% CI: 1.48; 1.03; 1.24) and 4th (1.53; 1.05; 2.23) quintiles of the CFI were more likely to have BMI/age > +2z (World Health Organization growth standards) at 4.5 years. At 2 and 4.5 years, most children fell short of meeting national guidelines. The associations between the CFIs scores at both time points with maternal characteristics and with children's body size at 4.5 years were in the expected directions, confirming the CFIs' convergent construct validity among NZ pre‐schoolers. Key messages: Data from a nationally generalisable New Zealand birth cohort was used to i) develop child feeding indexes (CFIs) for 2 and 4.5‐year‐olds based on National Food and Nutrition Guidelines (NFNG); ii) describe the cohort's adherence to the NFNG; and iii) assess the CFIs' construct validity.There was low adherence to the overall NFNG at 2 and 4.5 years and adherence was predicted by inequalities in maternal sociodemographics and health behaviours.In unadjusted regressions, children ranked in the 2nd–4th quintiles of the CFIs, in relation to those ranked in the highest quintiles (5th), were more likely to have higher body size and adiposity at 4.5 years. In adjusted model, girls with lower adherence to the NFNG at 4.5 years were more likely to have BMI/age > +2z at 4.5 years.Associations between CFIs scores with maternal characteristics and child adiposity were in the expected directions, confirming the indexes' construct validity. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Rural women face many challenges with regards to maternity services. Many rural primary birthing facilities in New Zealand have closed. The Lead Maternity Carer (LMC) model of maternity care, introduced in 1990, has moved provision of rural maternity care from doctors to independent midwifery services. Shortages of rural midwives in the Midland region led to rural maternity care being seen as a vulnerable service. AIM: To understand the views and experiences of rural women concerning maternity care, to inform the future design and provision of rural maternity services. METHODS: Participants were drawn from areas purposively selected to represent the five District Health Boards comprising the Midland health region. A demographic questionnaire, focus groups and individual interviews explored rural women's perspectives of antenatal care provision. These were analysed thematically. RESULTS: Sixty-two women were recruited. Key themes emerging from focus groups and interviews included: access to services, the importance of safety and quality of care, the need for appropriate information at different stages, and the role of partners, family and friends in the birthing journey. While most women were happy with access to services, quality of care, provision of information, and the role of family in their care, for some women, this experience could be enhanced. CONCLUSION: Midwives are the frontline service for women seeking antenatal services. Support for rural midwives and for local birthing units is needed to ensure rural women receive services equal to that of their urban counterparts. [ABSTRACT FROM AUTHOR]

Introduction. Diabetes is a leading cause of blindness in New Zealanders, yet a significant proportion of patients with diabetes are not reached by diabetes eye screening. Aim. Our study audited patients with diabetes in a large New Zealand rural general practice, to identify addressable barriers preventing patients from attending diabetes eye screening. Methods. All patients who had missed a diabetes eye screening appointment at the Dargaville Hospital Eye Screening Clinic between 2018 and 2021 were identified. Demographic information, laboratory and disease status data were recorded and analysed. Semi-structured telephone interviews were undertaken with 66 patients exploring barriers to diabetes eye screening. Descriptive statistical analysis was performed on quantitative data and a thematic analysis on qualitative results. Results. One-hundred and fifty-four (27%) of 571 patients invited to screening missed at least one appointment; of these, 66 (43%) were interviewed. Quantitative analysis suggested Māori patients were less likely to be reached, with a 20% higher number of missed appointments than European patients and a higher glycated haemoglobin (HbA1c). Māori patients reported greater barriers to attending eye screening. Common barriers identified by participants were transport, work and family commitments, financial, health and lack of appointment reminders. Discussion. Increased barriers for Māori patients could explain the reduced ability of the screening service to reach Māori patients. In order to address inequity and increase overall screening rates, diabetes eye screening and primary care services need to improve the booking system, facilitate transport to screening, engage patients and their whānau and build trust. [ABSTRACT FROM AUTHOR]

Background: Hospitalisation of a child is a unique opportunity for health staff to offer smoking cessation support; that is screening for carer smoking status, discussing cessation and providing interventions to carers who smoke. This has the potential to reduce the child's exposure to second-hand smoke, and in turn tobacco related illnesses in children. However, these interventions are not always offered in paediatric wards. The aim of this study was to explore the provision and prioritisation of smoking cessation support to patient carers in a paediatric ward with a high proportion of Aboriginal patients and carers in a regional area of Australia's Northern Territory. Methods: This is a qualitative descriptive study of data collected through semi-structured interviews with 19 health staff. The interviews were audio recorded and transcribed verbatim. Thematic analysis was performed on the transcripts. Results: We found low prioritisation of addressing carer smoking due to, a lack of systems and procedures to screen for smoking and provide quitting advice and unclear systems for providing more detailed cessation support to carers. Staff were demotivated by the lack of clear referral pathways. There were gaps in skills and knowledge, and health staff expressed a need for training opportunities in smoking cessation. Conclusion: Health staff perceived they would provide more cessation support if there was a systematic approach with evidence-based resources for smoking cessation. These resources would include guidelines and clinical record systems with screening tools, clear action plans and referral pathways to guide clinical practice. Health staff requested support to identify existing training opportunities on smoking cessation. [ABSTRACT FROM AUTHOR]

Introduction. Prediabetes is the asymptomatic precursor to type two diabetes mellitus, a significant and growing public health problem in New Zealand (NZ). Little is known about how general practitioners (GPs) and nurses view prediabetes care, and similarly little is known about how people with prediabetes view their condition and care. Aim. This study aimed to investigate the views of NZ GPs and nurses, and people with prediabetes about prediabetes and its management. Methods. This was a mixed qualitative methods study that is part of a randomised control trial of a prediabetes intervention. Results. Three key themes emerged from the health professional data (GPs and nurses) and another three themes emerged from people with prediabetes data. GPs and nurses were uncertain about the progression of prediabetes; they felt prediabetes was not a priority and they were unsure about what to advise. People with prediabetes were uncertain about the diagnosis and information given to them; they were unsure about what to do about prediabetes and they found lifestyle change hard. Discussion. GPs, nurses and people with prediabetes, expressed much uncertainty, but also some certainty about prediabetes. All were certain that prediabetes is common and increasing and that sustained lifestyle change was very difficult. But uncertainty prevailed about whether, in reality, prediabetes could be stopped, who would be most likely to benefit from lifestyle interventions and how best to achieve these. Older Māori and Pacific women were keen to promote lifestyle change and this appeared best done through Māori and Pacific peoples' organisations by means of co-designed interventions. [ABSTRACT FROM AUTHOR]

INTRODUCTION: A Continuity of Cancer Care pilot project was established in two urban general practices, with the goal of improving cancer care and patient access to services. Practice nurses were engaged as coordinators to implement a model of care and patient navigation to offer continued and consistent care, and to assist the patient to navigate their cancer experience. AIM: The aim was to evaluate the effectiveness of the Continuity of Cancer Care pilot project. METHODS: Patients enrolled in the pilot project were invited to participate. Each participant completed a Patient Satisfaction Questionnaire and SF-12 Health Survey, and was then invited to take part in an interview. The evaluation framework utilised concepts of informational, management and relational continuity. RESULTS: The SF-12 subcategories of physical functioning, role physical, bodily pain and role emotional were lower than other results from cancer patients in the literature. The Patient Satisfaction Questionnaire and interviews indicated patients were satisfied with the relational continuity components of the project, but that gaps existed within the management and informational continuity aspects of care. DISCUSSION: Overall, the participants were satisfied with the Continuity of Cancer Care programme and valued the support, clarification and listening aspects of the programme. However, when evaluated in relation to a more comprehensive definition of continuity of care, there were distinct gaps. While the relational aspects of continuity of care were mostly achieved, the management and informational aspects appeared to be limited primarily to nurses acting to interpret hospital and general practitioner comments for patients. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Obesity is disproportionately prevalent among Pacific population groups in New Zealand. Lifestyle behaviours of excessive consumption of high energy, unhealthy foods and inadequate physical activity are risk factors for obesity that can be modified. AIM: To identify and describe the risk factors for and protective factors against obesity among Pacific Is- land (PI) adolescents who attend church and compare them with PI adolescents who do not attend church. METHODS: We investigated the lifestyle behaviours of 2495 PI adolescents at six secondary schools in Auckland, New Zealand (NZ), 77% of whom attend a church or other place of worship. The cross-sectional survey was undertaken in 2005. Structured individual interviews and anthropometric measurements were undertaken. RESULTS: Church attendees had a higher mean body mass index (BMI) compared with non-attendees (BMI 27.4 vs BMI 26.6), adjusted for age, gender and PI ethnicity (p=0.01). The weight status of attendees was associated with less healthy breakfast and lunch sources, lower levels of physical activity, and limited knowledge of the risk factors for obesity (p<0.05) DISCUSSION: Culturally appropriate and ethnic-specific weight management interventions, including monitoring and policy development programmes, are needed urgently to change pro-obesity lifestyle behaviours in PI adolescents and to avoid the burgeoning future obesity-related illnesses that would otherwise result. The church may be an important venue and change agent in the prevention of obesity for this population. [ABSTRACT FROM AUTHOR]

The article focuses on the perception of New Zealand smokers on tobacco endgame as of November 2013. New Zealand has a goal of achieving a smoke-free society by year 2025. It notes that this goal reflects the country's endgame solutions to tobacco smoking. In response, tobacco companies created an endgame strategies as contrary to individual freedoms and choice. An interview which shows the strong support of the 2025 smoke-free goal is detailed.

INTRODUCTION: Internationally, non-medical practitioners are increasingly involved in tasks traditionally undertaken by general practitioners (GPs), such as medication review and prescribing. This study aims to evaluate GPs' perceptions of pharmacists' contributions to those services. METHODS: Semi-structured interviews were carried out in two localities with GPs whose patients had and had not undergone a pharmacist-led adherence support Medication Use Review (MUR). GPs were asked their opinions of pharmacists' provision of MUR, clinical medication review and prescribing. Data were analysed thematically using NVivo 8 and grouped by strengths, weaknesses, opportunities and threats (SWOT) category. FINDINGS: Eighteen GPs were interviewed. GPs mentioned their own skills, training and knowledge of clinical conditions. These were considered GPs' major strengths. GPs' perceived weaknesses were their time constraints and heavy workloads. GPs thought pharmacists' strengths were their knowledge of pharmacology and having more time for in-depth medication review than GPs. Nevertheless, GPs felt pharmacist-led medication reviews might confuse patients, and increase GP workloads. GPs were concerned that pharmacist prescribing might include pharmacists making a diagnosis. This is not the proposed model for New Zealand. In general, GPs were more accepting of pharmacists providing medication reviews than of pharmacist prescribing, unless appropriate controls, close collaboration and co-location of services took place. CONCLUSION: GPs perceived their own skills were well suited to reviewing medication and prescribing, but thought pharmacists might also have strengths and skills in these areas. In future, GPs thought that working together with pharmacists in these services might be possible in a collaborative setting. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The vision for palliative care service provision in New Zealand is for all people who are dying and their families to have timely access to culturally appropriate, quality palliative care services. An Auckland hospice's records show that the ethnically diverse population statistics were not reflected in the referrals for hospice services. The aim of this research was to gain a patient-and-their-family perspective on the hospice, including exploration of components of service care that could be improved for various cultural groups. METHODS: Patients currently under the care of the hospice and family members were recruited from hospice records. Semi-structured interviews were conducted to explore the emerging issues. The study collected data from a purposive sample of 18 palliative care patients or carer family members, ranging in age from 39 to 81 years, who reflected the ethnic diversity of the population of the region. Interviewing was carried out by an experienced research assistant and continued until data saturation was reached. FINDINGS: Four key themes emerged--hospice personnel's approach to patients, quality of service, cultural barriers, and strategies for future improvement. It was determined that the latter two were the most significant to address in this article. CONCLUSION: The study revealed the need for information-giving and education, including public profiling of the hospice to strengthen community involvement. Strategies to reduce ethnic disparities include strengthening the awareness of, and access to, services by connecting with cultural groups through churches, community and specific cultural media. [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: Multiple medications are recommended for the management of ischaemic heart disease. Unfortunately, increasing the number of medicines reduces adherence to medicines therapy. The concept of a polypill with a ixed dose combination of the common cardiovascular medicines (aspirin, statin, two blood pressure-lowering medicines) has been promoted. Patient perceptions about this con- cept have not been explored. METHODS: People taking at least three cardiovascular medicines were interviewed using a semi-struc- tured interview about their views on a polypill that could reduce the number of tablets they would need to take. FINDINGS: The participants considered that the polypill would be very convenient, especially when travelling and would reduce the pill burden. If the polypill was subsidised by the government, they would have reduced dispensing fee costs. There were concerns around the inlexibility of dosing of individual components of the polypill, and some concerns about safety and eficacy. Medical practitioners were identiied as having an important role in inluencing participants about the acceptability of the polypill. CONCLUSION: Generally the concept of the polypill was acceptable to participants, primarily because of the convenience and reduced number of tablets required daily. There were concerns about whether the polypill would be as effective and safe as the individual medicines. [ABSTRACT FROM AUTHOR]

INTRODUCTION: There is a worldwide trend for diabetes care to be undertaken in primary care. Nurses are expected to take a leading role in diabetes management, but their roles in primary care are unclear in New Zealand, as are the systems of care they work in as well as their training. AIM: To describe and compare demographic details, education and diabetes experience, practice set- ting and facilities available for the three main groups of primary health care nurses working in the largest urban area in New Zealand. METHOD: Of the total number of practice nurses, district nurses and specialist nurses working in Auckland (n=1091), 31% were randomly selected to undertake a self-administered questionnaire and telephone interview in 2006-2008. RESULTS: Overall response was 86% (n=284 self-administered questionnaires, n=287 telephone interviews). Almost half (43%) of primary care nurses were aged over 50 years. A greater proportion of specialist nurses (89%) and practice nurses (84%) had post-registration diabetes education compared with district nurses (65%, p=0.005), from a range of educational settings including workshops, workplaces, conferences and tertiary institutions. More district nurses (35%) and practice nurses (32%) had worked in their current workplace for >10 years compared with specialist nurses (14%, p=0.004). Over 20% of practice nurses and district nurses lacked access to the internet, and the latter group had the least administrative facilities and felt least valued. DISCUSSION: These findings highlight an ageing primary health care nursing workforce, lack of a national primary health care post-registration qualification and a lack of internet access. [ABSTRACT FROM AUTHOR]

Background: There appears to be considerable variation between different national jurisdictions and between different sectors of public policy in the use of evidence and particularly the use of randomised controlled trials (RCTs) to evaluate non-healthcare sector programmes. Methods: As part of a wider study attempting to identify RCTs of public policy sector programmes and the reasons for variation between countries and sectors in their use, we carried out a pilot study which interviewed 10 policy makers and researchers in six countries to elicit views on barriers to and facilitators of the use of RCTs for social programmes. Results: While in common with earlier studies, those interviewed expressed a need for unambiguous findings, timely results and significant effect sizes, users could, in fact, be ambivalent about robust methods and robust answers about what works, does not work or makes no difference, particularly where investment or a policy announcement was planned. Different national and policy sector cultures varied in their use of and support for RCTs. Conclusions: In order to maximise the use of robust evaluations of public programmes across the world it would be useful to examine, systematically, cross-national and cross-sectoral variations in the use of different methods including RCTs and barriers to and facilitators of their use. Sound research methods, whatever their scientific value, are no guarantee that findings will be useful or used. 'Stories' have been shown to influence policy; those advocating the use of RCTs may need to provide convincing narratives to avoid repetition about their value. [ABSTRACT FROM AUTHOR]

Background Tobacco companies have opposed the removal of tobacco retail displays, arguing this would compromise retailers' safety, increase retail crime, reduce retailers' income, impose additional costs and be inconvenient. These arguments have successfully delayed policy development in several jurisdictions. Methods In-depth interviews conducted with New Zealand retailers who had voluntarily removed tobacco from open display in their stores. Results Retailers who had removed tobacco displays did so primarily to reduce their security risk and found their stores had become less vulnerable to retail crime. They did not find removing displays costly or inconvenient nor had this decision significantly reduced their revenue. Conclusions Removing in-store tobacco displays may increase rather than decrease store safety. Our findings reveal that retailers' experiences differed in many ways from tobacco companies' predictions and suggest that industry arguments against display removal lack objective support and are self-serving. [ABSTRACT FROM AUTHOR]

Background Tobacco industry documents illustrate how packaging promotes smoking experimentation and reinforces existing smokersbehaviour. Plain packaging reduces the perceived attractiveness of smoking and creates an opportunity to introduce larger pictorial warnings that could promote cessation-linked behaviours. However, little is known about the effects such a combined policy measure would have on smokers' behaviour. Methods A 3 (warning size) *4 (branding level) plus control (completely plain pack) best-worst experiment was conducted via face-to-face interviews with 292 young adult smokers from a New Zealand provincial city. The Juster Scale was also used to estimate cessation-linked behaviours among participants. Results Of the 13 options tested, respondents were significantly less likely to choose those featuring fewer branding elements or larger health warnings. Options that featured more branding elements were still preferred even when they also featured a 50% health warning, but were significantly less likely to be chosen when they featured a 75% warning. Comparison of a control pack representing the status quo (branded with 30% front of pack warning) and a plain pack (with a 75% warning) revealed the latter would be significantly more likely to elicit cessation-related behaviours. Conclusions Plain packs that feature large graphic health warnings are significantly more likely to promote cessation among young adult smokers than fully or partially branded packs. The findings support the introduction of plain packaging and suggest use of unbranded package space to feature larger health warnings would further promote cessation. [ABSTRACT FROM AUTHOR]