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Choosing Wisely seeks to prevent harm by reducing the number of unnecessary tests, treatments and procedures, and by promoting shared decision-making. This article scopes perspectives of Māori patients/consumers and Māori health practitioners around Choosing Wisely and explores shared decision-making between Māori and their medical practitioners.Eight Māori consumers and seven Māori health practitioners participated in a qualitative, semi-structured, in-depth interview study with an inductive thematic analysis.Participant feedback spanned issues from lack of Māori participation in programme governance through to practical issues like meaningful and literacy-appropriate health messaging, traversing consumer, practitioner, organisational and health-system aspects. Feedback further focused on the patient having trust in the practitioner, a sense of autonomy and the availability of advocacy and support in the consultation.Despite a late campaign collaboration with Māori, Choosing Wisely New Zealand is the first of the international programmes to acknowledge the possibility that their initiative might increase inequity for Indigenous populations. This enquiry highlights the need to consult Māori early and to infuse Treaty principles and Māori knowledge and custom at every stage of the programme.

Children’s nutrition is highly influenced by community-level deprivation and socioeconomic inequalities and the health outcomes associated, such as childhood obesity, continue to widen. Systems Thinking using community-based system dynamics (CBSD) approaches can build community capacity, develop new knowledge and increase commitments to health improvement at the community level. We applied the formal structure and resources of a Group Model Building (GMB) approach, embedded within an Indigenous worldview to engage a high deprivation, high Indigenous population regional community in New Zealand to improve children’s nutrition. Three GMB workshops were held and the youth and adult participants created two systems map of the drivers and feedback loops of poor nutrition in the community. Māori Indigenous knowledge (mātauranga) and approaches (tikanga) were prioritized to ensure cultural safety of participants and to encourage identification of interventions that take into account social and cultural environmental factors. While the adult-constructed map focused more on the influence of societal factors such as cost of housing, financial literacy in communities, and social security, the youth-constructed map placed more emphasis on individual-environment factors such as the influence of marketing by the fast-food industry and mental wellbeing. Ten prioritized community-proposed interventions such as increasing cultural connections in schools, are presented with the feasibility and likely impact for change of each intervention rated by community leaders. The combination of community-based system dynamics methods of group model building and a mātauranga Māori worldview is a novel Indigenous systems approach that engages participants and highlights cultural and family issues in the systems maps, acknowledging the ongoing impact of historical colonization in our communities.

Background Although breastfeeding duration in New Zealand’s indigenous Māori is shorter than in non-Māori, we know little about barriers or motivators of breastfeeding in this community. The aim of this analysis was to identify predictors for extended duration of breastfeeding amongst participants drawn from predominantly Māori communities in regional Hawke’s Bay. Methods Mother/baby dyads were recruited from two midwifery practices serving predominantly Māori women in mostly deprived areas, for a randomised controlled trial comparing the risks and benefits of an indigenous sleeping device (wahakura) and a bassinet. Questionnaires were administered at baseline (pregnancy) and at one, three and six months postnatal. Several questions relating to breastfeeding and factors associated with breastfeeding were included. The data from both groups were pooled to examine predictors of breastfeeding duration. Results Māori comprised 70.5% of the 197 participants recruited. The median time infants were fully breastfed was eight weeks and Māori women were more likely to breastfeed for a shorter duration than New Zealand European women with an odds-ratio (OR) of 0.45 (95% CI 0.24, 0.85). The key predictors for extended duration of breastfeeding were the strong support of the mother’s partner (OR = 3.64, 95% CI 1.76, 7.55) or her mother for breastfeeding (OR = 2.47, 95% CI 1.27, 4.82), longer intended duration of maternal breastfeeding (OR = 1.02, 95% CI 1.00, 1.03) and being an older mother (OR = 1.07, 95% CI 1.02, 1.12). The key predictors for shorter duration of breastfeeding were pacifier use (OR = 0.28, 95% CI 0.17, 0.46), daily cigarette smoking (OR = 0.51, 95% CI 0.37, 0.69), alcohol use (OR = 0.54, 95% CI 0.31, 0.93) and living in a more deprived area (OR 0.40, 95% CI 0.22, 0.72). Conclusions Breastfeeding duration in this group of mainly Māori women was shorter than the national average. Increasing the duration of breastfeeding by these mothers could be further facilitated by ante and postnatal education involving their own mothers and their partners in the support of breastfeeding and by addressing pacifier use, smoking and alcohol use.

Māori demand on New Zealand mental health services is out of proportion to the size of the Māori population, and the psychiatric service response is limited by lack of capacity. But there is also an inherent lack of capability, that is, the ability of a Western paradigm psychiatric service to meet the needs of an indigenous community. The Mahi a Atua narratives-based programme established in the primary mental healthcare services of the Tairāwhiti/Gisborne area has created a new approach to psychiatric assessment, diagnosis and therapy that is appropriate, but not confined, to the Māori community.

OBJECTIVES: To compare an indigenous sleep device (wahakura) for infants at high risk for sudden unexpected death with a bassinet, for measures of infant sleep position, head covering, breastfeeding, bed-sharing, and maternal sleep and fatigue. METHODS: A total of 200 mainly Māori pregnant women were recruited from deprived areas of New Zealand. They were randomized to receive a bassinet or wahakura and asked to sleep the infant in this device from birth. Questionnaires at 1, 3, and 6 months and an overnight infrared video in the home at 1 month were completed. RESULTS: An intention-to-treat and an “as-used” analysis of questionnaires showed no group differences at 1, 3, and 6 months in infant-adult direct bed-sharing (7% vs 12%, P = .24 at 1 month), and at the 6-month interview, the wahakura group reported twice the level of full breastfeeding (22.5% vs 10.7%, P = .04). Maternal sleep and fatigue were not significantly different between groups. Video identified no increase in head covering, prone/side sleep position, or bed-sharing in the wahakura group, either from intention-to-treat analysis, or when analyzed for actual sleep location. CONCLUSION There were no significant differences in infant risk behaviors in wahakura compared with bassinets and there were other advantages, including an increase in sustained breastfeeding. This suggests wahakura are relatively safe and can be promoted as an alternative to infant-adult bed-sharing. Policies that encourage utilization are likely to be helpful in high-risk populations.

Background: The suggestion that body mass index (BMI) cutoffs to define obesity should differ in persons of Polynesian descent compared with Europeans is based principally on the observation that persons of Polynesian descent have a relatively higher propor- tion of lean body mass for a given BMI. Objectives: The objectives were to determine whether the relation between BMI, waist circumference, and metabolic comorbidity dif- fers in the 2 major ethnic groups in New Zealand and to ascertain whether ethnicity-specific BMI and waist circumference cutoffs for obesity are justified for Maori (indigenous New Zealanders). Design: Subjects included a convenience sample of 1539 men and women aged 17-82 y (47% Maori, 53% white) with measures of BMI, waist circumference, blood pressure, fasting insulin, glucose, and lipids. The sensitivity and specificity of BMI (in kg/m 2 ; 30 and 32), waist circumference (80 and 88 cm in women, 94 and 102 cm in men), and waist-to-height ratio (WHtR 0.6) in relation to in- sulin sensitivity, insulin resistance, and the metabolic syndrome were determined. Receiver operating characteristic curves and areas under the curve (AUCs) were also calculated. Results: No ethnic or sex differences in AUCs were observed for BMI, waist circumference, or WHtR, which showed that these an- thropometric measures perform similarly in Maori and European men and women and correctly discriminate between those with and without insulin resistance or the metabolic syndrome 79-87% of the time. Any increase in specificity from a higher BMI cutoff of 32 in Maori was offset by appreciable reductions in sensitivity. Conclusion: These findings argue against having different BMI or waist circumference cutoffs for people of Polynesian descent. Am J Clin Nutr doi: 10.3945/ajcn.2010.29317.

The wahakura (flax bassinet) is presently being distributed as a safe infant sleeping device amongst New Zealand Māori, where sudden unexpected deaths in infancy (SUDI) rates are high. It is promoted as mitigating bedsharing risk by providing a separate infant sleeping surface. This study aimed to understand exactly what factors determine the apparent acceptability of the wahakura as an infant sleeping device to Māori mothers and other key Māori community stakeholders.The qualitative study used face-to-face, semi-structured interviews, following Māori cultural protocols, to explore the experiences and views of 12 Māori mothers and 10 key informants who had wahakura experience. We employed purposeful sampling of participants and thematic analysis of data.The practical appeal of the wahakura related to its portability, the enabling of bedsharing and easier breastfeeding. Considerable cultural and spiritual appeal was related to its native flax composition and traditional origin. Health professionals found it useful to engage Māori women antenatally.The study affirmed the acceptance of the wahakura as a culturally initiated endeavour, meaningfully engaging Māori mothers and families in SUDI risk mitigation. It has the potential to capitalise on the benefits of bedsharing to enhance infant wellbeing while also safeguarding them from harm.

Maori have high SIDS rates and relevant information is needed to craft appropriate prevention strategies. The aim of the study was to determine what Maori mothers know about SIDS prevention, and to determine their SIDS-related child care practices.Maori mothers who gave birth in the Counties Manukau District Health Board area were surveyed about their SIDS related knowledge, and infant care practices and their reasons for using and their concerns about these practices. Results were compared with a similar 2005 survey of a largely European sample.Knowledge of Maori mothers about SIDS prevention was much lower than for European mothers. More Maori infants slept prone and Maori mothers stopped breastfeeding significantly earlier. Although co-sleeping rates were similar, bedsharing increased to 65% for some part of the night. In addition, more than half of the Maori mothers had smoked in pregnancy and 21% of them were sharing a bed with their infant. Potentially unsafe soft objects such as rolled blankets or pillows were used by a third of mothers to help maintain the sleep position.Maori mothers have a poorer knowledge of SIDS prevention practices. The high rate of maternal smoking, the early cessation of breastfeeding, and co-sleeping where there was smoking in pregnancy were also areas of concern. Appropriate health promotion measures need to be developed for the high-risk Maori community.

To determine the prevalence of insulin resistance, impaired fasting glycaemia, impaired glucose tolerance, and diabetes mellitus in a rural Maori community, and to compare different methods for identifying individuals with insulin resistance.589 randomly selected individuals from the Ngati Porou Hauora Register aged 25 years and over and resident on New Zealand's East Coast north of Gisborne were invited to participate in the study. A questionnaire was administered, anthropometric measures made, and blood samples taken for an oral glucose tolerance test and biochemical analysis. Impaired fasting glycaemia, impaired glucose tolerance, and diabetes mellitus were defined according to World Health Organization (WHO) diagnostic criteria, and among those persons with normal glucose tolerance, insulin resistance was calculated according to the McAuley formula and three other recognised methods for calculating insulin sensitivity.The overall age-standardised prevalence of diabetes (both known and newly diagnosed) was 10.6% and the age-standardised prevalence of insulin resistance was 37.0%. Age-specific diabetes rates were high among the older age groups, peaking at 34.1% for 60-69 year olds, whereas age-specific insulin resistance rates were high among the young age groups with the highest rate (44.3%) occurring among 30-39 year olds. Persons identifying as insulin-resistant reported higher rates of gout and family history of diabetes--and were found to have a higher waist circumference, blood pressure, and lower high-density lipoprotein (HDL) cholesterol than those without a glucose metabolism disorder.Diabetes is a common disorder among this population, but insulin resistance is even more prevalent, especially among young age groups. This is considerable cause for concern given that insulin resistance is believed to be the underlying cause of most cases of type 2 diabetes mellitus, and is confirmed by these data to be associated with a high degree of cardiovascular risk.