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This article describes the origins and development of Te Mauri (the life essence), a unique Māori (Indigenous people of New Zealand) public health and well-being programme aimed at addressing critical gaps in knowledge about supportive cancer care for whānau (families) living with cancer in Aotearoa (New Zealand). Te Mauri is a kaupapa Māori (Māori philosophy) public health initiative having a whānau ora (family well-being) approach, so is based not on the individual, or patient, but within whānau and the core role of communities in relation to the provision of cancer care, the promotion of recovery from cancer, and the maintenance of well-being for current and future generations. Te Mauri makes an important contribution to expanding mātauranga Māori (Māori knowledge) and the range of Indigenous models of care so that cancer service provision is improved for the benefit of all those who are on a cancer journey. [ABSTRACT FROM AUTHOR]

For Aotearoa New Zealand Māori, sleep and wairua (spirit) are closely intertwined. During sleep the wairua awakens and journeys across multiple dimensions of time and space to attain the tools and knowledge the individual needs to navigate waking life. While this function of sleep is understood within Mātauranga Māori (bodies of knowledge regarding everything within the universe) (Hikuroa 2017), it has yet to be explored within psychological sleep research. This qualitative study contributes to addressing this gap by exploring nine Māori participants' personal experiences of wairua during sleep. A whakapapa thematic analysis identified two interconnected layers. The first layer contributed to a spiritual explanatory framework for sleep, developed to encompass participants' beliefs regarding wairua, which were utilised to interpret their sleep experiences. The second layer describes these interpretations, comprised of three central themes: (1) Tohu/Guidance; (2) Ako/Space and time for learning; and (3) Tau/Attaining a state of stability, peace, and purpose. These findings suggest that the spiritual experience of sleep supported participants in navigating their waking lives safely, purposefully, and meaningfully, contributing to Indigenous and Māori scholarship regarding the spiritual and cultural purpose of sleep, and with important implications for clinical, social, and academic approaches to understanding and supporting sleep. [ABSTRACT FROM AUTHOR]

This study aims to explore the impacts of COVID-19 on birthing for wāhine (women) and whānau (immediate and extended family) in Aotearoa (New Zealand) during the lockdowns of 2020 and 2021. This rangahau (research) provided whānau with an opportunity to share their whakawhānau (birthing process) experiences via interviews. The data were analysed through interpretative phenomenological analysis. Themes identified in the results included the importance of whānau tautoko (family support), the experiences of isolation and trauma, and the effect of birthing under COVID-19 restrictions. Indigeneity was a core identity that was crucial to maintain, during these sacred times. Whakawhānau is a pivotal transition with the potential to engage with medical services. The findings of this study contribute to the knowledge of whānau Māori (Māori [Indigenous peoples of New Zealand] families) experiences to enhance service provision. [ABSTRACT FROM AUTHOR]

Background: The incidence of early-onset colorectal cancer (EOCRC), diagnosed before age 50, has been rising in many countries in the past few decades. This study aims to evaluate this trend in Aotearoa New Zealand and assess its impact on Māori. Methods: Crude incidence and age-standardized incidence of colorectal cancer (CRC) was analyzed from all new cases from the Aotearoa New Zealand national cancer registry for the period 2000–2020. Trends were estimated by sex, ethnicity, age group and location of cancer and projections made to 2040. Results: Between 2000 and 2020, there were a total of 56,761 cases of CRC diagnosed in Aotearoa New Zealand, 3,702 of these being EOCRC, with age-standardized incidence decreasing significantly (P = 8.2 × 10− 80) from 61.0 to 47.3 cases per 100,000. EOCRC incidence increased on average by 26% per decade (incidence rate ratio (IRR) 1.26, p = < 0.0001) at all sites (proximal colon, distal colon and rectum), while the incidence in those aged 50–79 years decreased on average by 18% per decade (IRR 0.82, p = < 0.0005), again across all sites. There was no significant average change in CRC incidence in those over 80 years. In Māori, there was no significant change in age-standardized incidence. There was however a significant increase in crude incidence rates (IRR 1.28, p = < 0.0005) driven by significant increases in EOCRC (IRR1.36, p = < 0.0005). By 2040, we predict the incidence of EOCRC will have risen from 8.00 to 14.9 per 100,000 (6.33 to 10.00 per 100,000 in Māori). However, due to the aging population an estimated 43.0% of all CRC cases will be diagnosed in those over 80 years of age (45.9% over 70 years of age in Māori). Conclusion: The age-standardized incidence of CRC from 2000 to 2020 decreased in Aotearoa New Zealand, but not for Māori. The incidence of EOCRC over the same period continues to rise, and at a faster rate in Māori. However, with the ageing of the population in Aotearoa New Zealand, and for Māori, CRC in the elderly will continue to dominate case numbers. [ABSTRACT FROM AUTHOR]

Unnecessary hospitalisations for preventable or treatable conditions provides an indication of the health of a country and its systems. We present data on potentially avoidable hospitalisations of Māori and non-Māori non-Pacific (NMNP) under-25-year-olds for medical conditions during the period 2000–2019, with particular focus on the magnitude of inequity by area deprivation. Potentially avoidable hospitalisation rates of under-25 years for medical conditions were consistently higher for Māori than for NMNP over the 20-year study period. The absolute difference in potentially avoidable hospitalisation rates between the most and least deprived areas were greater for Māori than for NMNP in all years of the study. Respiratory conditions and skin infections accounted for more than 60% of potentially avoidable hospitalisations of Māori under-25-year-olds. The persistent trends in deprivation-based inequities in health outcomes for Māori, on both absolute and relative scales, suggest greater attention needs to be paid to implementing effective policy focussed on reducing these deprivation-based inequities and on improving access to and quality of care. [ABSTRACT FROM AUTHOR]

Every five years and when initially enrolling to vote, Māori have the choice between the Māori roll or the general roll. Research has explored the predictors of roll choice for older adults, but this paper presents the first exploration of roll choice for rangatahi Māori (Māori youth; aged 13–18), and the predictors of rangatahi not understanding the difference between rolls. We draw on Māori data (n = 1528) from Youth19 which surveyed students from a random sample of schools from Tai Tokerau, Tāmaki Makaurau, and Waikato. We find those Māori who also identify as Pākehā (New Zealand European) are less likely to opt for the Māori roll, but those who know their Iwi, are comfortable in Māori social surroundings, feel a spiritual connection to land and the presence of their ancestors in their lives, or feel the drive to be respected as Indigenous, are more likely to choose the Māori roll. Older rangatahi are more likely to say they understand the question, as are those with study plans post-secondary school, and who say they are comfortable in Māori social settings. These results contribute to a body of knowledge valuable for those seeking to increase voter enrolment and enrolment on the Māori roll. Glossary of Māori words: Hapū: kinship group, generally smaller than Iwi; sometimes translated to sub-tribe; hui: meeting; Iwi: broader tribal unit or grouping; nation; kaitiaki: guardian, steward, trustee; kanohi-ki-te-kanohi: face to face/in person; kapa haka: Māori performing arts; traditional performance; Kura Kaupapa Māori: Māori language/Māori medium schools; mana whenua: Māori group(s) who have authority, power, or rights over a certain area of land; marae: meeting house and the area surrounding it; mātauranga Māori: Māori ways of knowing/knowledge; Pākehā: New Zealanders of European descent; rangatahi: youth; rohe: area, region; tangata whenua: Indigenous peoples of Aotearoa New Zealand; people(s) of the land; te reo Māori: the Māori language; te Tiriti o Waitangi: the Māori language version of the Treaty of Waitangi; tīpuna/tupuna: ancestors; waka ama: canoe sport; wānanga: meetings for discussion, deliberation, forums; whanau: family, extended family, or family-like group; whanaungatanga relationship, kinship, sense of family-like connections between people. [ABSTRACT FROM AUTHOR]

Purpose: In Aotearoa me Te Waipounamu (New Zealand; NZ) there are considerable inequities in health status and outcomes for Māori, the Indigenous peoples of NZ. It is therefore important that the health status and preferences of Māori are specifically considered in healthcare policy and decision making. This paper describes the health-related quality of life of 390 Māori adults who took part in the NZ EQ-5D-5L valuation study. Methods: Responses on the five dimensions of the EQ-5D-5L were dichotomised into "no problems" and "any problems", summarised and disaggregated by age group. Mean preference weights were reported by age group and overall. Mean utility values (calculated by applying each participant's preference weights to their EQ-5D-5L profile) were summed and respective means and standard deviations reported by age, chronic disease status and disability. Results: The EQ-5D-5L dimensions with the highest proportion of participants reporting any problems were pain/discomfort (61.5%) and anxiety/depression (50%). The most commonly-reported chronic disease was mental illness/distress (24.6%). Anxiety/depression ranked as the most important dimension, with usual activities, the least important. The mean utility value was 0.83 with the lowest value (0.79) found in the 18–24 and 45–54 age groups. For participants with at least one chronic disease the mean utility value was 0.76 compared to 0.91 for those with none. Conclusion: To reduce inequities experienced by Māori it is crucial that the health status of Māori and the values Māori place on health-related quality of life are properly understood. This can only be achieved using Māori-specific data. [ABSTRACT FROM AUTHOR]

There are access, treatment and morbidity inequities for Māori (Indigenous people of New Zealand) with cancer in Aotearoa (New Zealand). This includes inequities in quality of life and experiences of the palliative care setting for Māori. This review included 20 papers that were identified through a combination of our literature review and key informant surveys. In this review, we consider the context of palliative care and cancer quality of care for Māori, draw on evidence regarding access and challenges for Māori with cancer in the palliative setting and discuss how to achieve palliative care equity for Māori with cancer. In Aotearoa, palliative care has fundamental underpinnings based on westernised understandings of health with a focus on addressing physical health aspects. Our findings highlight the misalignment of this approach with regard to Māori with cancer in the palliative care setting and to being able to fulfil their right to good health. [ABSTRACT FROM AUTHOR]

Longitudinal studies into the relationship between affect (positive or negative feelings) towards one's own ethnic group and wellbeing are rare, particularly for Indigenous peoples. In this paper, we test the longitudinal effects of in-group warmth (a measure of ethnic identity affect) and ethnic identity centrality on three wellbeing measures for New Zealand Māori: life satisfaction (LS), self-esteem (SE), and personal wellbeing (PW). Longitudinal panel data collected from Māori (N = 3803) aged 18 or over throughout seven annual assessments (2009–2015) in the New Zealand Attitudes and Values Study were analyzed using latent trajectory models with structured residuals to examine cross-lagged within-person effects. Higher in-group warmth towards Māori predicted increases in all three wellbeing measures, even more strongly than ethnic identity centrality. Bi-directionally, PW and SE predicted increased in-group warmth, and SE predicted ethnic identification. Further, in sample-level (between-person) trends, LS and PW rose, but ethnic identity centrality interestingly declined over time. This is the first large-scale longitudinal study showing a strong relationship between positive affect towards one's Indigenous ethnic group and wellbeing. Efforts at cultural recovery and restoration have been a deliberate protective response to colonization, but among Māori, enculturation and access to traditional cultural knowledge varies widely. The data reported here underline the role of ethnic identity affect as an important dimension of wellbeing and call for continued research into the role of this dimension of ethnic identity for Indigenous peoples. [ABSTRACT FROM AUTHOR]

This study investigated the experiences of pain and pain management among Māori with cancer in Aotearoa (New Zealand). Using a qualitative study design underpinned by Kaupapa Māori research principles, focus groups and interviews were held with Māori experiencing cancer and their whānau (n=24). Our research identified themes that relate to holistic experiences of pain and pain management, the importance of appropriate support and good communication, and the intertwined nature of cancer and pain journeys and their impact on Māori with cancer and their whānau. We argue that Aotearoa's health care system must expand the scope of their understanding of pain and pain management in the context of cancer, and act accordingly. The health care system must work to support Te Ao Māori-centred approaches and heed the call for culturally responsive pain management for Māori. This is especially important when caring for whānau with diseases that cause significant physical and nonphysical pain. [ABSTRACT FROM AUTHOR]

There are differences between research that is performed in an Indigenous setting using Western methodologies and research performed using Indigenous methodologies. Kaupapa Māori research provides opportunities for Māori, the Indigenous people of New Zealand, to participate in and influence research agendas and processes while providing a platform for Māori to contribute to empirical knowledge about Māori peoples. Using the central tenets of whakawhanaungatanga (Māori process of establishing relationships), this article discusses and explains why kaupapa Māori research is well suited to explore the experiences of older Māori in aged residential care in New Zealand. To do this, the theoretical and methodological framework of kaupapa Māori research is discussed. [ABSTRACT FROM AUTHOR]

This paper examines the relationship between body mass index (BMI), self-esteem and self-reported confidence and capability in expressing oneself culturally as Māori (cultural efficacy) for 5,470 Māori who participated in Te Rangahau o Te Tuakiri Māori me Ngā Waiaro ā-Pūtea | The Māori Identity and Financial Attitudes Study (MIFAS) in 2017. Adjusting for demographics, self-reported health, education and socio-economic status, we found that a higher BMI was associated with lower body satisfaction and self-esteem. However, higher scores on cultural efficacy were associated with higher levels of body satisfaction and self-esteem for respondents. Furthermore, the negative association between BMI and both body satisfaction and self-esteem was weaker for those with higher cultural efficacy. This held for BMI scores of 25, 30, and 35+. While our data suggest higher cultural efficacy may directly or interactively shield Māori from developing lowered self-esteem typically associated with higher BMI in Western populations, further research, using more comprehensive measures of body satisfaction should explore the extent to which Māori may find the Western "thin ideal" personally desirable for their own bodies. [ABSTRACT FROM AUTHOR]

This feasibility study examined innovations in kaupapa Māori (a Māori approach) research methods to explore kaumātua (older Māori men and women) understandings of ageing well. We designed a research pathway that brought together kaupapa Māori methods in the form of noho wānanga (a method of knowledge sharing) with kaumātua and researchers in Tutukaka in 2018. Kaumātua participants were invited as guests in a comfortable and congenial setting to share their experiences of growing older. Our engagement with kaumātua, and our data-gathering and analysis methods provided an effective method for understanding kaumātua well-being. We found that focusing directly on health did not resonate with participants. There was diffidence when kaumātua talked about their own personal health, when compared with their enthusiasm for other parts of their lives. They understood well-being as a holistic process connecting hinengaro (mental health), wairua (the spirit and spiritual health), tinana (physical health) and te taiao (natural environments). [ABSTRACT FROM AUTHOR]

Objective: To improve consistency in New Zealand's Mortality Review Committees' (MRCs) analysis, interpretation and recommendations, specifically related to equity and Māori (the Indigenous peoples of Aotearoa New Zealand) mortality.Design: A qualitative Plan-Do-Check-Act design informed by Māori expertise to develop a rubric and guidelines. The rubric and guidelines aimed to improve MRCs' capability to analyse mortality data, its interpretation and the recommendations for preventing deaths.Setting: New Zealand's MRCs make recommendations to address preventable deaths. Variation existed between the MRCs' understanding of equity, and its application to reduce avoidable mortality for Māori, which subsequently influenced their analysis, reporting and the recommendations generated. Improving the quality and robustness of MRCs' recommendations and reporting are crucial for improving equity.Participants: Māori Caucus (comprising MRC members with Māori health and wellbeing expertise) designed the rubric and guidelines with input from the secretariat and other MRC Chairs and members.Intervention(s): None.Main Outcome Measure(s): None.Results: The rubric comprises four key 'pou' (metaphorical posts or domains) 'Tika' (doing things right); 'Manaakitanga' (caring compassionately); 'Mana' (status, authority); and 'Mahi tahi' (working collaboratively); and criteria for three levels of practice. Evaluation of the efficacy of the use of the rubric and its implementation showed further education and support was required.Conclusions: A shared understanding of equity about mortality is required. Effective implementation of a quality-based rubric into practice requires careful planning and ongoing education and support for staff and committee members at multiple levels. Follow-up support is needed to support its implementation into practice. [ABSTRACT FROM AUTHOR]

Māori in Aotearoa have higher incidence, prevalence and mortality from chronic disease. The dominant narrative in Aotearoa about the reasons for Māori ill health neglects to acknowledge the history of colonisation and failures of the health system, alongside the holistic view of health taken by Māori focusing on collective, whānau-based outcomes. In this article, we review health interventions for chronic disease that have a kaupapa Māori philosophical basis. Our findings demonstrate that there is no clear process in health service design, delivery, research and funding that values and understands mātauranga Māori. Western knowledge systems are inadequate for collecting and presenting Māori knowledge. Overall, we highlight that the tension between acknowledging that a "by Māori, for Māori" approach is best, and the difficulty in defining appropriate evidence collection methodology and outcome measures when funders and policy makers continue to require Western-centric interventions is an obstacle to improving Māori health outcomes. [ABSTRACT FROM AUTHOR]

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

This paper draws on Te Rangahau o Te Tuakiri Māori me Ngā Waiaro ā-Pūtea | The Māori Identity and Financial Attitudes Study (MIFAS). The MIFAS is a nationwide study that examines the relationship between Māori identity and economic attitudes and values. The MIFAS embeds the Multidimensional Model of Māori Identity and Cultural Engagement (MMM-ICE), which assesses Māori identity in relation to eight domains. We report data regarding three aspects of economic activity: risking iwi (tribal) assets for profit; individualism at work; and preferences for workplaces that promote Māori culture and identity. We find Māori who are more strongly oriented towards a traditional Māori belief system are less likely to be individualistic at work, more likely to prefer workplaces that respect Māori development and less likely to support commercialising iwi assets. We also find marked heterogeneity and suggest 'Māori success as Māori' may not solely reflect 'traditional' Māori values. [ABSTRACT FROM AUTHOR]

Objectives: Ethnic inequities in health outcomes have been well documented with Indigenous peoples experiencing a high level of healthcare need, yet low access to, and through, high‐quality healthcare services. Despite Māori having a high ED use, few studies have explored the potential for ethnic inequities in emergency care within New Zealand (NZ). Healthcare delivery within an ED context is characterised by time‐pressured, relatively brief, complex and demanding environments. When clinical decision‐making occurs in this context, provider prejudice, stereotyping and bias are more likely. The examining emergency department inequities (EEDI) research project aims to investigate whether clinically important ethnic inequities between Māori and non‐Māori exist. Methods: EEDI is a retrospective observational study examining ED admissions in NZ between 2006 and 2012 (5 976 126 ED events). EEDI has been designed from a Kaupapa Māori Research position. Results: The primary data source is the existing Shorter Stays in Emergency Department National Research Project (SSED) dataset that will be combined with clinical information extracted from NZ's National Minimum Dataset. The key predictor variable is patient ethnicity with other covariates including: sex, age‐group, area deprivation, mode of presentation, referral method, Australasian Triage Scale and the Multimorbidity Measure (M3 Index) for co‐morbidities. Generalised linear regression models will be used to investigate the associations between pre‐admission variables and the measures of ED care, and to examine the contribution of each measure of ED care on ethnic inequities in mortality. Conclusion: The present study will provide the largest, most comprehensive investigation of ED outcomes by ethnicity to date in NZ. [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]

This paper draws on Te Rangahau o Te Tuakiri Māori me Ngā Waiaro ā-Pūtea | The Māori Identity and Financial Attitudes Study (MIFAS). The MIFAS is a nationwide study that examines the relationship between Māori identity and economic attitudes and values. The MIFAS embeds the Multidimensional Model of Māori Identity and Cultural Engagement (MMM-ICE), which assesses Māori identity in relation to eight domains. We report data regarding three aspects of economic activity: risking iwi (tribal) assets for profit; individualism at work; and preferences for workplaces that promote Māori culture and identity. We find Māori who are more strongly oriented towards a traditional Māori belief system are less likely to be individualistic at work, more likely to prefer workplaces that respect Māori development and less likely to support commercialising iwi assets. We also find marked heterogeneity and suggest 'Māori success as Māori' may not solely reflect 'traditional' Māori values. [ABSTRACT FROM AUTHOR]

Purpose: Cancer survivor numbers are on the rise but little is known about New Zealand (NZ) survivors' experiences with management of cancer-related impacts and vulnerability. This study explored the experiences and resilience of NZ cancer survivors and the experiences of healthcare practitioners who work with cancer survivors. There is a focus on indigenous Māori survivors.Methods: This study used qualitative methods to explore survivors and healthcare practitioners' views on cancer-related impact and management strategies. Two focus groups were conducted with mainly colorectal cancer survivors residing in the central regions of NZ. There was one Māori-only group (n = 6 participants) and one multicultural group (n = 18 participants). The Māori-only focus group was purposefully organised to provide a culturally safe setting for the research. In addition, 12 in-depth interviews were conducted with healthcare practitioners between October 2011 and March 2012.Results: Wide-ranging survivorship impacts were described by survivors across physical, emotional, spiritual and social domains. Shame resilience and relationships, particularly with healthcare practitioners, were indicated as useful supports. Healthcare practitioners' time constraints and role priorities were identified as barriers to their ability to provide survivorship support.Conclusions: This study generated qualitative data on survivorship impacts and components of survivor resilience in NZ. It also provided insights into the need for better strategies and pathways to help the NZ health system be more responsive to both Māori and non-Māori survivors.Implications For Cancer Survivors: Survivor impacts create vulnerabilities that are experienced and described differently by individuals and groups in NZ. Tailored survivor support that can enhance resilience and support relationships is needed in NZ. [ABSTRACT FROM AUTHOR]

It is increasingly recognised that palliative care research needs to pay more attention to culture if the diverse needs of service users are to be appropriately met. However, in most countries research, practice and policy in palliative care remains predicated upon a specific cultural understanding of the ‘good death’, firmly rooted in a Western world view. In this paper we present the formation of a new multi-disciplinary palliative care research group, explicitly set up along bi-cultural lines – The Te Ārai Palliative Care and End of Life Research Group to face challenges of traditional paradigms of palliative care in the specific context of Aotearoa New Zealand (NZ). We outline the rationale for establishing a research group which meets both Māori (indigenous people of NZ) and conventional Western standards for conducting academic research, describe our bi-cultural framework, and provide examples of how it shaped the design of three recently completed projects. We also situate our experience within the wider international literature, identifying transferable lessons for researchers wanting to do palliative care research with indigenous and minority ethnic and cultural groups. [ABSTRACT FROM AUTHOR]

Understanding how to undertake Kaupapa Māori research can be a challenge for emerging health researchers. Unless emerging researchers have exposure to Kaupapa Māori theory or senior Māori health research expertise, the challenge of undertaking Kaupapa Māori research within health research contexts can seem daunting, and for some, too difficult to attempt. This article summarizes what an Indigenous positioning means to me as a health researcher, medical practitioner, academic and Māori community member, and why it is more than just a methodological approach. The theoretical basis of Kaupapa Māori--what it is, how it emerged and what it means for my own research practice--is explored. How Kaupapa Māori interacts with Pacific research methodologies, particularly when health research involves both Māori and Pacific participants, is discussed. It is hoped that this article will assist emerging researchers (both Indigenous and non-Indigenous) to embrace Indigenous-appropriate research approaches within their own work. [ABSTRACT FROM AUTHOR]

Background: A growing number of studies document the association between maternal experiences of racial discrimination and adverse children's outcomes, but our understanding of how experiences of racial discrimination are associated with pre- and post-natal maternal mental health, is limited. In addition, existent literature rarely takes into consideration racial discrimination experienced by the partner. Methods: We analysed data from the Growing Up in New Zealand study to examine the burden of lifetime and past year experiences of racial discrimination on prenatal and postnatal mental health among Māori, Pacific, and Asian women in New Zealand (NZ), and to study the individual and joint contribution of mother's and partner's experiences of lifetime and past year racial discrimination to women's prenatal and postnatal mental health. Results: Our findings show strong associations between lifetime and past year experiences of ethnically-motivated interpersonal attacks and unfair treatment on mother's mental health. Māori, Pacific, and Asian women who had experienced unfair treatment by a health professional in their lifetime were 66 % more likely to suffer from postnatal depression, compared to women who did not report these experiences. We found a cumulative effect of lifetime experiences of ethnically-motivated personal attacks on poor maternal mental health if both the mother and the partner had experienced a racist attack. Conclusions: Experiences of racial discrimination have severe direct consequences for the mother's mental health. Given the importance of mother's mental health for the basic human needs of a healthy child, racism and racial discrimination should be addressed. [ABSTRACT FROM AUTHOR]

Māori women have one of the highest incidences of breast cancer in the world. This high incidence is generally unexplained although higher rates of obesity and alcohol intake are modifiable risk factors that may be important. Māori women are less likely to attend mammographic breast screening and are likely to be diagnosed with more advanced disease. This is one of the reasons for the excess mortality. Another factor is differences in the treatment pathway. Māori women are more likely to experience delay in receiving treatment, are less likely to receive radiotherapy, are more likely to be treated with a mastectomy and are less likely to adhere to long-term adjuvant endocrine therapy. However, genetic factors in Māori women do not seem to impact significantly on mortality. This review looks at the inequity between Māori and non-Māori women and addresses the causes. It proposes ways of reducing inequity through primary prevention, increased participation in breast screening and greater standardisation of the treatment pathway for women newly diagnosed with breast cancer. We believe that health system improvements will decrease barriers to health care participation for Māori women and suggest that further research into identifying and modifying obstacles within health systems is required. [ABSTRACT FROM AUTHOR]

This paper explores the birthing experiences of 16 pregnant Māori women under 20 years of age who were involved in E Hine, a Kaupapa Māori (by Māori, for Māori) longitudinal qualitative research study of young Māori women's journeys through pregnancy and into motherhood that ran from 2010 to 2013. This study provided these young women with an opportunity to share their birthing experiences during kanohi- ki- te- kanohi (face- to- face) interviews. Interpretive phenomenological analysis guided the analysis of these interviews. Following analysis, four themes emerged: some tikanga Māori (Māori practices) are being practised today; whānau (family) support is critical for these young Māori mothers; current system issues impact negatively on birth experiences; and adaptation to motherhood varies. From these themes, positive practices were drawn out that can be applied to clinical practice to improve the birthing experiences of young Māori women. These practices include promoting positive communication between patient and providers, facilitating supportive whānau environments, and enhancing support services accessibility. [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]

Background: Māori in New Zealand have markedly higher incidence and poorer survival from stomach cancer than non-Māori. We investigated the presentation, management and survival of stomach cancer in a cohort of newly diagnosed Māori and non-Māori patients. Methods: A clinical notes review of all Māori from the North Island diagnosed between 2006 and 2008, and a random equivalent sample of non-Māori, was conducted (final cohort n = 335). Patient characteristics, tumour characteristics, receipt and timing of treatment and cancer-specific survival were compared. Results: Compared to non-Māori, Māori patients had a younger average age at diagnosis, higher prevalence of congestive heart failure and renal disease, and were more likely to be diagnosed with distal disease (43 % Māori, 26 % non-Māori, p = 0.004). Stage and grade distributions were similar between ethnic groups. Two-thirds (66 %) of stage I-III patients had definitive surgery, with similar rates for Māori (71 %) and non-Māori (68 %). Māori were less likely to have surgery performed by a specialist upper gastrointestinal surgeon (38 % Māori, 79 % non-Māori, p < 0.01) and less likely to be treated in a main centre (44 % Māori, 87 % non-Māori, p < 0.01). After adjusting for age, sex, stage, tumour site and comorbidity, Māori had nonsignificant 27 % poorer survival (hazard ratio 1.27, 95 % CI 0.96-1.68). Conclusions: There was evidence of differential presentation and access to specialised surgical services, as well as differential survival, for Māori stomach cancer patients compared to non-Māori. These findings support the development of the national stomach cancer treatment standards and highlight the need for an equity focus within these guidelines. [ABSTRACT FROM AUTHOR]

AimTo describe the role, contribution and value of research nurses in New Zealand community-based or primary health care research.BackgroundResearch nurses are increasingly recognised as having a key role in undertaking successful research in hospitals and clinical trial units however only limited work has been undertaken to examine their role in community-based research. Undertaking health research in the community has unique challenges particularly in relation to research design and recruitment and retention of participants.MethodsWe describe four community-based research projects involving research nurses, each with particular recruitment, retention and logistical problems. Vignettes are used to illustrate the role, contribution and value of research nurses in a diverse range of community research projects.FindingsThe knowledge and skills used by research nurses in these projects included familiarity with communities, cultural competence, health care systems and practice philosophies and in particular with vulnerable populations. Their research actions and activities include competence with a broad range of research methodologies, organisational efficiency, family-centred approach, along with advocacy and flexibility. These are underpinned by nursing knowledge and clinical expertise contributing to an ability to work autonomously. These four projects demonstrate that research nurses in community-based research possess specific attributes which facilitate successful study development, implementation and outcome. [ABSTRACT FROM AUTHOR]

Objective To examine temporal trends and current survival differences between Māori and non-Māori men with prostate cancer in New Zealand (NZ). Patients and Methods A cohort of 37 529 men aged ≥40 years diagnosed with prostate cancer between 1996 and 2010 was identified from the New Zealand Cancer Registry and followed until 25 May 2011. Cause of death was obtained from the Mortality Collection by data linkage. Survival for Māori compared with non-Māori men was estimated using the Kaplan-Meier method, and Cox proportional hazard regression models, adjusted for age, year of diagnosis, socioeconomic deprivation and rural/urban residence. Results The probability of surviving was significantly lower for Māori compared with non-Māori men at 1, 5 and 10 years after diagnosis. Māori men were more likely to die from any cause [adjusted hazard ratio (aHR) 1.84, 95% confidence interval (CI) 1.72-1.97] and from prostate cancer (aHR 1.94, 95% CI 1.76- 2.14). The aHR of prostate cancer death for Māori men diagnosed with regional extent was 2.62-fold (95% CI 1.60-4.31) compared with non-Māori men. The survival gap between Māori and non-Māori men has not changed throughout the study period. Conclusion Māori men had significantly poorer survival than non-Māori, particularly when diagnosed with regional prostate cancer. Despite improvements in survival for all men diagnosed after 2000, the survival gap between Māori and non-Māori men has not been reduced with time. Differences in prostate cancer detection and management, partly driven by higher socioeconomic deprivation in Māori men, were identified as the most likely contributors to ethnic survival disparities in NZ. [ABSTRACT FROM AUTHOR]

This study examined differences in rates of home ownership among Māori (the indigenous peoples of New Zealand). We identified systematic factors that predicted why some Māori were more likely to own their own home (partially or fully) relative to other Māori. Data were drawn from a large national postal sample of 561 self-identified Māori collected as part of the New Zealand Attitudes and Values Study. As predicted, our analyses indicated that self-reported appearance as Māori, or the extent to which people thought they personally displayed features which visibly identified them as Māori to others, significantly predicted decreased rates of home ownership. This association held when adjusting for numerous demographic covariates, such as education, level of deprivation of the immediate area, household income, age, relationship status, region of residence, and so forth. Our analyses suggest there is, or at least has been in the recent past, institutional racism against Māori in New Zealand’s home lending industry based on merely appearing more Māori. [ABSTRACT FROM AUTHOR]

Background Māori are the indigenous peoples of New Zealand and experience higher rates of uterine cancer and poorer survival rates. Postmenopausal bleeding ( PMB) is the most common presenting symptom for uterine cancer. Prompt investigation is essential with 28 days being viewed as an appropriate time from first medical contact ( FMC) to first specialist appointment ( FSA). Aims To compare access to services for the investigation of PMB between Māori and non-Māori women. Materials and Methods The time interval between FMC to FSA was obtained from medical records for women presenting to gynaecology clinics for PMB. Dates of first bleeding symptoms, knowledge and access issues were collected in a nurse-administered questionnaire. Results A total of 154 women ( n = 27 Māori and 127 non-Māori) participated in the study. 23% of women had their FSA from FMC within 28 days and 67% waited more than six weeks. The 75th percentile was approximately two weeks longer for Māori women. 25% ( n = 37) of women were not aware that they needed to see a doctor about PMB, and this was significantly more common for Māori women (44%; 95% CI 25-65) than non-Māori women (20%; 95% CI 13-28; P = 0.011). Conclusions The majority of women were not seen for FSA within 28 days of their FMC. Māori women were more likely to experience lengthy delays and to report that they did not know they should see a doctor about PMB. Further investigation into reasons for delays and initiatives to improve access to services and health information appears warranted. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Continuous positive airway pressure (CPAP) is an effective treatment of obstructive sleep apnoea (OSA), but can be limited by poor adherence. In New Zealand (NZ), ethnicity has been shown to be a predictor of CPAP adherence. This study aimed to explore Maori, Pacific and NZ European patients' experience of CPAP treatment. METHODS: Patients identifying as Maori, Pacific, or NZ European ethnicity referred for CPAP treatment for OSA attended separate, 1.5-hour group discussions facilitated by a health care worker of the same ethnic group, using an interview template. Thematic analysis was applied to the discussion transcripts independently by two investigators, following published guidelines. FINDINGS: Five Maori, five Pacific, and eight NZ Europeans participated (mean age 47, range 30-71 years, mean ± standard deviation CPAP adherence 6.32 ±1.25 hours/night). Patients in all three groups reported that they had little knowledge of OSA or CPAP prior to treatment initiation. All groups identified barriers to treatment (both at the CPAP initiation phase and long term), reported feelings of being 'overwhelmed' with information during the initial CPAP education session, and discussed the importance of successful role models. Family and friends were generally reported as being supportive of CPAP therapy. CONCLUSION: The three groups all reported similar initial CPAP experiences, highlighting access barriers to publicly funded assessment and treatment pathways, and sleep health knowledge as key issues. Educational resources to improve access, enable self-management, and increase community awareness of OSA would help overcome some of the issues identified in this study. [ABSTRACT FROM AUTHOR]

Background: Maori men in New Zealand have higher mortality from prostate cancer, despite having lower incidence rates. The objective of this study was to examine patterns of screening for prostate cancer in primary care and follow-up investigations after an elevated prostate-specific antigen (PSA) result in Maori and non-Maori men in order to help explain the observed differences in incidence and mortality. Methods: Men aged 40+ years were identified from 31 general practices across the Midland Cancer Network region. Computerised practice records were cross-referenced with laboratory data to determine the number and value of PSA tests undertaken between January 2007 and December 2010. Screening rates were calculated for the year 2010 by age, ethnicity, and practice. For men with an elevated PSA result information on specialist referrals and biopsy was extracted from practice records. Practice characteristics were assessed with respect to screening rates for Maori and non-Maori men. Results: The final study population included 34,960 men aged 40+ years; 14% were Maori. Maori men were less likely to be screened in 2010 compared with non-Maori men (Mantel Haenszel (M-H) age-adjusted risk ratio (RR), 0.52 [95% CI, 0.48, 0.56]). When screened, Maori men were more than twice as likely to have an elevated PSA result compared with non-Maori men (M-H age-adjusted RR, 2.16 [95% CI, 1.42, 3.31]). There were no significant differences between Maori and non-Maori men in the rate of follow-up investigations and cancer detection. Maori provider practices showed equal screening rates for Maori and non-Maori men, but they were also the practices with the lowest overall screening rates. Conclusions: Maori men were half as likely to be screened compared to non-Maori men. This probably explains the lower reported incidence of prostate cancer for Maori men. Practice characteristics had a major influence on screening rates. Large variation in screening behaviour among practices and differences in follow-up investigations for men with an elevated PSA result seems to reflect the uncertainty among GPs regarding PSA screening and management. [ABSTRACT FROM AUTHOR]

Māori, the indigenous people of Aotearoa New Zealand, experience poorer health than non-Māori across a range of health measures. Interventions focused at an individual level have proved largely ineffective; ‘bottom-up’ approaches where communities determine their own priorities may be more sustainable than ‘top-down’ approaches where goals are determined by health authorities. The purpose of this paper is to illustrate an innovative health promotion programme aimed at improving Māori health and to discuss the importance of ownership and control of health initiatives by Māori. Evaluators conducted a comprehensive evaluation of a Healthy Eating Healthy Action programme in six small Māori health agencies, gathering information from programme managers and co-ordinators, participants and wider community members about what changes were occurring at individual, family and community levels. Effective interventions built on cultural values and practices and were delivered by Māori with close connections to the community. Changes in nutrition and physical activity made by participants also benefitted their wider families and community. The changes demonstrated subtle but important shifts in thinking about healthy eating and healthy activity that in the longer term could lead to more measurable change towards improved quality of life for people within communities. [ABSTRACT FROM AUTHOR]

INTRODUCTION: International research consistently shows that sole mothers experience poorer health and suboptimal health care access. New Zealand studies on sole mothers' health report similar findings. The aim of this exploratory research was to better understand the experiences of Maori sole mothers' access to health services, particularly primary health care, for personal health needs. METHODS: This qualitative study employed a general inductive design informed by a Kaupapa Maori approach, providing guidance on appropriate cultural protocols for recruiting and engaging Maori participants. Distributing written information and snowballing techniques were used to purposively recruit seven Maori sole mothers. Data collection involved semi-structured interviews which were digitally-recorded and transcribed verbatim. Data were analysed using general inductive thematic analysis to identify commonalities and patterns in participants' experiences. FINDINGS: The dominant themes that emerged captured and described participants' experiences in accessing health care. The major barrier to access reported was cost. Compounding cost, transport difficulties and location or scheduling of services were additional barriers to health service accessibility. Child-related issues also posed a barrier, including prioritising children's needs and childcare over personal health needs. CONCLUSION: The findings illuminate Maori sole mothers' experiences of accessing health care and the complex socioeconomic inequalities affecting access options and uptake of services. Further investigation of barriers to access is needed. The study has implications for addressing barriers to access at policy, funding and practice levels to improve health outcomes and equitable health care access for Maori sole mothers. [ABSTRACT FROM AUTHOR]

INTRODUCTION: There are unacceptable ethnic differences in cancer survival in Aotearoa/New Zealand. For people with cancer, quality of life and survival are shaped by access to care, but research on Maori access to, and through, cancer care is limited. Internationally, research has shown that primary care plays an important role in providing patient-centred, holistic care and information throughout the cancer care journey. Additionally, Maori health providers provide practical support and facilitate access to all levels of health care. Here we describe the cancer journeys of Maori patients and whanau and identify factors that may facilitate or inhibit access to and through cancer care services. METHODS: Twelve Maori patients affected by cancer and their whanau (family) in the lower North Island took part in face-to-face semi-structured interviews exploring their experiences of cancer screening, diagnosis, treatment, survival and palliative care. FINDINGS: Three key areas were identified that impacted upon the cancer care journey: the experience of support; continuity of care; and the impact of financial and geographic determinants. CONCLUSION: Primary care plays a key role in support and continuity of care across the cancer journey. Alongside interpersonal rapport, a long-term relationship with a primary health provider facilitated a more positive experience of the cancer care journey, suggesting that patients with a 'medical home' are happier with their care and report less problems with coordination between services. Positive, longstanding relationships with general practitioners and Maori health providers assisted patients and whanau with the provision and understanding of information, alongside practical support. [ABSTRACT FROM AUTHOR]

The Oranga Tāne Māori research project explored the views of tāne Māori (Māori men) with a chronic disease or cancer, and their whānau (families), to discover how they experienced their health care in relation to whānau ora (healthy families). The first phase of developing this research involved developing a local whānau ora framework called Te Korowai. Interviews were undertaken with 47 tāne Māori with chronic disease or cancer and 15 support people. The men had received or were currently receiving care for one or more chronic diseases. Data were analysed using Te Korowai as a conceptual framework. Findings included the foundational importance of "being Māori" as an enabler for health decision-making and service engagement, and whakamā (shyness, embarrassment) as a barrier to effective service provision. Health professionals are urged to look to how they can re-engage individuals and whānau, and to prioritize relationship building and respectful engagement. [ABSTRACT FROM AUTHOR]

Evidence from health surveys have identified that Māori, the indigenous people of Aotearoa New Zealand, experience a high incidence of obesity with physical and social implications. In 2000, the New Zealand Government introduced a strategy aimed, among other objectives, at improving nutrition, increasing physical activity and reducing obesity through a 'Healthy Eating Health Action' (HEHA) strategy. As part of the HEHA strategy, a Māori primary health organisation (PHO) in a regional centre of Aotearoa, New Zealand, developed a program aimed at improving the health of the local Māori communities. The program, called Project REPLACE, invited participants to gradually change their behaviour by replacing behaviours potentially detrimental to health with a healthier alternative. Between 2009 and 2010 a team of researchers evaluated the program, taking care to use Māori approaches when conducting the research. The findings from the evaluation were that each community was innovative in their approaches to implementing Project REPLACE, drawing on their culture to combine healthy eating with increased exercise activities as well as measurements of achievement. The relationship that each coordinator had with the community was pivotal to the success of the program. Project REPLACE highlighted the importance of Māori ownership and control of health initiatives. [ABSTRACT FROM AUTHOR]

Persisting ethnic disparities in cancer incidence and outcomes exist between Māori and non- Māori in Aotearoa/ New Zealand. It is difficult to disentangle the complex interplay of environmental and genetic factors that contribute to the variation in cancer statistics between these two groups. In Māori, the sites of highest cancer incidence are the prostate in men, breast in women and lung in both - the next most common cancers in Māori are colorectal and stomach cancer. This paper discusses colorectal, prostate and stomach cancer in Māori to illustrate selected issues that impact on cancer care. Colorectal cancer is discussed to illustrate the importance of accurate cancer statistics to focus management strategies. Prostate cancer in Māori is reviewed - an area where cultural factors impact on care delivery. Sporadic stomach cancer in New Zealand is used to show how sub-classification of different types of cancer can be important and illustrate the breadth of putative causal factors. Then follows an overview of developments in hereditary gastric cancer in New Zealand in the last 15 years, showing how successful clinical and research partnerships can improve patient outcomes. One example is the Kimi Hauora Clinic, which provides support to cancer patients, mutation carriers and their families, helping them navigate the interface with the many health-care professionals involved in the multidisciplinary care of cancer patients in the 21st century. [ABSTRACT FROM AUTHOR]

Introduction Poorer cancer survival in Indigenous populations contributes to health inequalities in both New Zealand and Australia. Methods We reviewed recent evidence of cancer treatment and outcomes among Māori and non- Māori New Zealanders and examined the range of factors that may contribute to poorer survival in Māori. Results There is clear evidence that Māori have poorer cancer survival compared with other ethnic groups, particularly European New Zealanders. Two recent studies show that Māori patients receive poorer quality treatment for cancers of the lung and colon, even after adjusting for patient factors. These findings suggest the need to consider how the health-care system as a whole may disadvantage Indigenous patients. Discussion We present a framework for considering how inequalities may arise in the delivery of cancer care, taking account of the health system as a whole - including the structure and organization of cancer services - as well as treatment processes and patient factors. A key feature of this framework is that it directs attention towards system-level factors affecting cancer care, including the location, resourcing and cultural focus of services. Our analysis suggests a need to look beyond individual patient factors in order to improve the quality and equity of cancer services and to optimize cancer survival in Indigenous populations. [ABSTRACT FROM AUTHOR]

Aims and objectives. To explore Māori (Indigenous people of New Zealand) experiences of hospitalisation in surgical or medical settings and how these might influence length of stay. Background. Globally Indigenous peoples with histories of colonisation suffer health disparities compared with other groups. They experience higher levels of morbidity, premature mortality, lower life expectancies and differential access, use and quality of health services. In Indigenous communities' negative anecdotal accounts of hospital experiences indicate more research is needed about their hospital experiences. Design. A Māori (Indigenous) centered approach using case study methodology and three data sources: medical-surgical discharge data, interviews with Māori and a literature review. Method. Using statistical data from the New Zealand Health Information Service from 1989-2006, a retrospective interrupted time series design was used to examine length of stay for Māori patients in medical and surgical hospital settings. Semi-structured interviews with 11 participants identifying as Māori who had experienced hospitalisation in a medical or surgical setting were transcribed and thematically analysed. A structured review of the research literature on Indigenous hospital experiences was also analysed. These data were analysed individually, triangulated and interpreted. Results. Māori consistently have a shorter average length of stay than non-Māori using public hospitals in New Zealand. Marginalisation of Indigenous peoples in public hospitals was evident in both the interviews undertaken and the literature reviewed. Participants believed hospitals were not conducive to healing and negative experiences contributed to decisions to seek an early discharge. Conclusions. Given the disparities in Indigenous health status, health professionals can address negative hospitalisation experiences by attending to the quality of care delivered and nature of the hospital environment. Relevance to cinical practice. Nurses can play an important role improving health outcome disparities for Indigenous peoples linked to health service delivery, especially the delivery of culturally responsive and quality nursing care. [ABSTRACT FROM AUTHOR]

The aim of this paper is to challenge the hypothesis that genetic differences play a significant role in the disparities in health status between Māori and non-Māori. To do so I considered the patterns of these disparities to see if they are consistent with the manifestations of genetic variation. I compared disparities in health between Māori and non-Māori with patterns of disparity across most social sectors (reason one), patterns of disparity across most health indicators (reasons two, three and four) with international experience (reasons five and six) over time (reason seven) and by spatial or kin based clusters (reason eight) over intermarriage (reason nine) and by considering the consensus of modern population genetics (reason ten) and concluded that there appears to be little evidence to suggest genetics to be a major cause of those disparities. [ABSTRACT FROM AUTHOR]

Objective. This study investigated the role that demographic and tumour factors play in explaining ethnic inequalities in breast cancer survival. Design. Breast cancer cases notified to the New Zealand Cancer Registry (NZCR) from April 2005 to April 2007 were followed up to April 2009. Māori, Pacific and non-Māori/non-Pacific women were categorised according to ethnicity on the NZCR. Deprivation was analysed as quintiles of the New Zealand area-based index of socio-economic position. Relative survival rates were estimated using ethnic-specific life tables. Missing values were imputed and excess mortality modelling was used to estimate the contribution of demographic and tumour factors to ethnic inequalities in survival. Results. There were 2968 breast cancer cases (76.5% non-Māori/non-Pacific, 17% Māori, and 6.5% Pacific) included and 433 recorded deaths. Relative survival rates at 4 years were 91.5% (95% confidence interval (CI) 89.7 to 92.9) for non-Māori/non-Pacific, 86.2% (CI 80.3 to 90.4) for Māori, and 79.6% (CI 68.2 to 87.2) for Pacific women. Using non-Māori/non-Pacific as the reference group, the age-adjusted hazard ratio (HR) dropped for Māori from 1.76 (CI 1.22 to 2.48) to 1.43 (CI 0.97 to 2.10) when further adjusted by deprivation. For Pacific the HR dropped from 2.49 (CI 1.57 to 3.94) to 1.94 (CI 1.20 to 3.13). Inequalities persisted after adjustment for subtype variables (ER/PR/HER2), but adjusting for access to care variables (extent/size) eliminated the ethnic inequalities in excess mortality. Conclusion. Ethnic disparities in breast cancer survival in New Zealand can be attributed to deprivation and differential access to health care rather than differences in breast cancer subtypes. [ABSTRACT FROM PUBLISHER]

Many countries across the globe experience disparities in health between their indigenous and non-indigenous people. The indigenous Māori of New Zealand are the most marginalized and deprived ethnic group with the poorest health status overall. Factors including the historical British colonization, institutional discrimination, healthcare workforce bias and the personal attitudes and beliefs of Māori significantly contribute to disparities, differential access and receipt of quality health services. Māori experience more barriers towards accessing health services and as a result achieve poorer health outcomes. Contradicting translations of Te Tiriti o Waitangi have created much debate regarding social rights as interpreted by Oritetanga (equal British citizenship rights) and whether or not Māori are entitled to equal opportunities or equal outcomes. Inconsistent consideration of Māori culture in the New Zealand health system and social policy greatly contributes to the current health disparities. Nurses and healthcare professionals alike have the gifted opportunity to truly change attitudes toward Māori health and move forward in adopting culturally appropriate care practices. More specifically the nursing workforce provides 80% of direct patient care, thus are in a unique position to be the forefront of change in reducing health disparities experienced by Māori. Incorporating cultural safety, patient advocacy, and Māori-centred models of care will support nurses in adopting a new approach toward improving Māori health outcomes overall. [ABSTRACT FROM AUTHOR]

Chronic illnesses are a feature of many Māori homescapes. These illnesses are often managed at home through the use of health technologies, particularly medications. This article explores the meanings given to medications and the use of this health technology in four Māori households. We use a range of qualitative methods to engage with householders and to document how medications are acculturated into Māori homescapes and noa (permitted); 2) reminder strategies, or ngā pūrere whakamāharahara; 3) the enactment of the value of manaakitanga (kindness) in care relationships; 4) pōharatanga, or attitudes towards medication procurement and administration in households textured by low socio-economic status; and 5) rangatiratanga, the right of people to manage and make decisions about their own lives and health status. This study presents a view of how medications are acculturated into Māori homescapes, relationships and daily routines. The use of health technologies by health professionals to interrupt illness and improve quality of life must be cognisant of the cultural contexts into which medications are prescribed. [ABSTRACT FROM AUTHOR]

The increased use of information technology in health care allows researchers to generate data on rates of medication use among population groups, raising questions as to whether these rates are too high or too low. This paper presents findings from a study of records of all prescription medication dispensed in one New Zealand region (Te Tāirawhiti) over a one year period. The study examined patterns of psychotropic medication use amongst older people, by age, gender, ethnicity and socio-economic position. It concludes that the chances of being defined as needing psychotropic medication, that is, of being 'medicalised', are not evenly spread through the elderly population. Gender, age and ethnicity impacted significantly on whether prescriptions were received. Our results suggest the need for a nuanced understanding of the medicalisation of unhappiness and deviant behaviour amongst the elderly which takes into account barriers to treatment for some social groups. [ABSTRACT FROM AUTHOR]

Background There is an ethnic variation in outcomes for colonic cancer in New Zealand. Whether this disparity is caused by cancer biology or inequitable provision of treatment services after diagnosis has not been elucidated. Method National cancer registry data from 1996 to 2003 were obtained. Incidence and mortality rates for the four major ethnic groups were age-adjusted to the new WHO world population. The impact of age, sex, AJCC stage and site of cancer at diagnosis was compared between ethnic groups using a Cox regression analysis. Results A total of 11 987 colonic cancer registrations were identified. The overall raw 5-year mortality was 53.7%. The age-adjusted incidence in Europeans was more than double that of the Maori, Asian and Pacific populations at 33.0 per 100 000 population / year. Europeans presented at a greater age, with more right sided cancers, and at an earlier stage of disease. The opposite was true for the Maori population. Pacific Islanders and Asians presented at a younger age, but with a similar site, stage and sex distribution to the rest of the population. There were no significant differences in 5 year mortality after diagnosis when age, sex, stage, and site at presentation were controlled for by cox regression analysis. Conclusion These results suggest that age, sex, stage and site at presentation may be more important than inequality in treatment provision after diagnosis in explaining differences in outcomes between the ethnicities. Efforts need to be focused on identifying reasons for the increased risk of colonic neoplasia in Europeans and the later stage disease presentation in the Maori population. [ABSTRACT FROM AUTHOR]

The article focuses on a study which compared the cancer treatment approaches applied to a nationally representative cohort of Maori (indigenous) and non-Maori New Zealanders with colon cancer. The study included 301 Maori patients and 329 randomly selected non-Maori patients who were diagnosed with colon cancer between 1996 and 2003. It examined the medical notes and surgical and oncology treatments received by the patients. It found that Maori New Zealenders with colon cancer were less likely to receive adjuvant chemotherapy.

Background: New Zealand Maori have a poorer outcome from breast cancer than non-Maori, yet prognostic data are sparse. The objective of this study was to quantify levels of prognostic factors in a cohort of self-declared Maori and European breast cancer patients from Christchurch, New Zealand. Methods and Results: Clinicopathological and survival data from 337 consecutive breast cancer patients (27 Maori, 310 European) were evaluated. Fewer tumours were high grade in Maori women than European women (p = 0.027). No significant ethnic differences were detected for node status, tumour type, tumour size, human epidermal growth factor receptor, oestrogen and progesterone receptor (ER/PR) status, or survival. In addition, tumour and serum samples from a sub-cohort of 14 Maori matched to 14 NZ European patients were analyzed by immunohistochemistry and enzyme linked immunosorbent assay for molecular prognostic factors. Significant correlations were detected between increased grade and increased levels of hypoxia inducible factor-1 (HIF-1α), glucose transporter-1 (GLUT-1), microvessel density (MVD) and cytokeratins CK5/6 (p < 0.05). High nodal status correlated with reduced carbonic anhydrase IX (CA-IX). Negative ER/PR status correlated with increased GLUT-1, CA-IX and MVD. Within the molecular factors, increased HIF-1α correlated with raised GLUT-1, MVD and CK5/6, and CK5/6 with GLUT-1 and MVD (p < 0.05). The small number of patients in this sub-cohort limited discrimination of ethnic differences. Conclusions: In this Christchurch cohort of breast cancer patients, Maori women were no more likely than European women to have pathological or molecular factors predictive of poor prognosis. These data contrast with data from the North Island NZ, and suggest potential regional differences. [ABSTRACT FROM AUTHOR]