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

Objectives Smoking during pregnancy is harmful for the woman and the unborn child, and the harms raise risks for the child going forward. Indigenous women often have higher rates of smoking prevalence than non-indigenous. Exercise has been proposed as a strategy to help pregnant smokers to quit. Māori (New Zealand Indigenous) women have high rates of physical activity suggesting that an exercise programme to aid quitting could be an attractive initiative. This study explored attitudes towards an exercise programme to aid smoking cessation for Māori pregnant women. Methods Focus groups with Māori pregnant women, and key stakeholder interviews were conducted. Results Overall, participants were supportive of the idea of a physical activity programme for pregnant Māori smokers to aid smoking cessation. The principal, over-arching finding, consistent across all participants, was the critical need for a Kaupapa Māori approach (designed and run by Māori, for Māori people) for successful programme delivery, whereby Māori cultural values are respected and infused throughout all aspects of the programme. A number of practical and environmental barriers to attendance were raised including: cost, the timing of the programme, accessibility, transport, and childcare considerations. Conclusions A feasibility study is needed to design an intervention following the suggestions presented in this paper with effort given to minimising the negative impact of barriers to attendance. [ABSTRACT FROM AUTHOR]

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

Background: Human papillomavirus (HPV), the causative agent of cervical cancer, can be screened for using self‐collected vaginal samples (self‐testing). This may overcome barriers to screening for Māori women who suffer a greater burden of cervical disease than New Zealand European women. Aims: This study aimed to explore the potential acceptability of HPV self‐testing for never/under‐screened (self‐reported no cervical screen in 4+ years, aged 25+) Māori women by Kaupapa Māori (by, with and for Māori) mixed methods, involving hui (focus groups/interviews) and survey. Materials and Methods: Community‐based researchers ran hui with women in four regions (N = 106) and supported hui participants to collect survey data (N = 397). Healthcare providers (HCPs) were also interviewed (N = 17). Hui data were thematically analysed. Survey data were analysed by age group, rural/urban, primary health organisation (PHO) enrolment, and time since last cervical screen. Results: Most survey participants were PHO‐enrolled (87.15%) and attended regularly (71.79%), but did not attend regular cervical screening. A desire for bodily autonomy, including whakamā (embarrassment/shyness/reticence), was the most frequently cited barrier. Three in four women reported being likely/very likely to do an HPV self‐test. Nine in ten women reported being likely/very likely to attend follow up if they receive a positive HPV test result. Women and HCPs in the hui emphasised the importance of health literacy, cultural competence and empathetic support. Conclusion: The findings indicate that with a culturally competent introduction of HPV self‐testing, many currently never/under‐screened Māori women would be willing to be screened and followed up if necessary. HPV self‐testing has the potential to save lives. [ABSTRACT FROM AUTHOR]

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

Background: Despite poor cancer survival statistics, Māori do not readily access hospice services. This study aims to explore how hospice services respond to Māori by investigating the different influences and interactions between three perspectives of hospice care. Method: The authors conducted a Māori-centred, cross-sectional qualitative study by undertaking semi-structured interviews with hospice patients and whānau (families) (n=8), hospice representatives (n=4), and representatives from three Māori health provider organisations (n=5). Conclusions: The study found that negative perceptions of hospice are being changed by hospices' relationships with other organisations and positive stories from whānau. Involvement from whānau, continuity of care and after-hours care with a greater Māori workforce and a further emphasis on culturally safe care are critical for this work to gain momentum. Findings can be of use to further develop quality of care indicators that reflect the perspectives of patients and whānau, and those who provide their care. [ABSTRACT FROM AUTHOR]