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This article provides a summary of available data on Māori ocular health, highlighting significant disparities between Māori and non‐Māori populations. Māori are more likely to develop diabetes, sight‐threatening retinopathy and keratoconus, and present for cataract surgery earlier with more advanced disease. Limited data exists for macular degeneration and glaucoma, but there is some suggestion that Māori may have lower prevalence rates. The article emphasises the urgent need for robust national data on Māori ocular health to enable targeted interventions and funding allocation. Achieving equity for Māori in all aspects of health, including ocular health, requires concerted efforts from all stakeholders. [ABSTRACT FROM AUTHOR]

Background: Primary care in Aotearoa New Zealand is largely delivered by general practices, heavily subsidised by government. Te Tiriti o Waitangi (1840) guarantees equal health outcomes for Māori and non-Māori, but differences are stark and longstanding. Seven models of primary care have evolved. We hypothesised that patient health outcomes would differ between models of care; and that Māori, Pacific peoples and those living in material deprivation would have poorer outcomes from primary care. Methods: We conducted a cross-sectional study of patient-level data from national datasets and practices, at 30 September 2018, using multilevel mixed effects regression analyses (patients clustered within practices). Primary outcomes, considered to be measures of unmet need for primary care, were polypharmacy (≥ 65 years), HbA1c testing in adults with diabetes, childhood immunisations (6 months), ambulatory sensitive hospitalisations (0–14, 45–64 years) and emergency department attendances. Explanatory variables adjusted for patient and practice characteristics. Equity, by model of care, ethnicity and deprivation, was assumed if they showed no significant association with patient outcomes. Patient characteristics included: age, ethnicity, deprivation, multi-morbidity, first specialist assessments and practice continuity. Practice characteristics included: size, funding and doctor continuity. Clinical input (consultations and time with nurses and doctors) was considered a measure of practice response. Results: The study included 924 general practices with 4,491,964 enrolled patients. Traditional practices enrolled 73% of the population, but, on average, the proportion of Māori, Pacific and people living with material deprivation was low in any one Traditional practice. Patients with high health needs disproportionately enrolled in Māori, Pacific and Trust/NGO practices. There were multiple associations between models of care and patient health outcomes in fully adjusted regressions. No one model of care out-performed others across all outcomes. Patients with higher health need received more clinical input but this was insufficient to achieve equity in all outcomes. Being a Māori or Pacific patient, or living in material deprivation, across models of care, remained associated with poorer outcomes. Conclusions: Model-level associations with poor patient outcomes suggest inequity in measures that might be used to target investment in primary care. [ABSTRACT FROM AUTHOR]

The establishment of a culturally diverse surgical workforce, largely on the basis of gender, has been highly promoted in Australasia in the last decade. Despite this, discussions of gender diversity in surgery have largely excluded Indigenous women. This study presents the experiences of wāhine Māori and Pasifika doctors in Aotearoa, who formed a surgical sisterhood to support them towards applying for advanced surgical training. Utilising mana wāhine and Masi methodologies, semi-structured interpersonal interviews were undertaken with five wāhine who formed the surgical sisterhood. Following transcription and analysis of all interviews, four key themes were identified. These were mana wāhine, unity, our why and change on the horizon. These themes illustrate the complex and varied experiences of wāhine Māori and Pasifika and how they have navigated their surgical pathways amidst multiple layers of discrimination towards being in a position to apply for advanced surgical training. [ABSTRACT FROM AUTHOR]

Despite a growing amount of research with Māori and Pacific people in Aotearoa New Zealand, frameworks that support robust research methodologies with these peoples are limited. This is particularly so for research involving both Māori and Pacific people, which acknowledges the connections between the two and the uniqueness of all Pacific people. Tangata Hourua (Strength in Combining) is a research framework developed in response to this gap, drawing from Kaupapa Māori (Māori principles) and Pacific methodologies, that seeks to uphold the rights of Māori as Indigenous people of Aotearoa, whilst giving voice to Pacific peoples living here with shared or connected whakapapa (family connections). This article describes the framework's origins, its relationship to Kaupapa Māori and Pacific research methodologies, key principles in its application, and its strengths and limitations. The framework has the potential to be utilised in research that positively contributes to both Māori and Pacific knowledge and well-being. [ABSTRACT FROM AUTHOR]

Indigenous experiences of hospitalisation may contribute to maintenance of Indigenous health inequities. We undertook a qualitative systematic review of Māori experiences of hospital care within New Zealand. We performed electronic database searches and used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to assist study selection. We were guided by Kaupapa Māori (Māori centred) research methodology and used the CONSolIDated critERtia statement to evaluate completeness of reporting against recommended Indigenous ethical guidelines. The Betancourt framework for addressing ethnic disparities in health care was utilised to synthesise findings. Seven studies were included. Studies enlisting Indigenous research expertise and Kaupapa Māori research methodology demonstrated clearer links between participant voices and critique of hospital experiences. Multiple barriers were identified within clinical, organisational and structural loci of practice. Proposed interventions focused on building cultural safety against these barriers. Strategies promoting access to care for Māori and cultural safety training for the workforce are needed. [ABSTRACT FROM AUTHOR]

Māori health providers emerged in Aotearoa/New Zealand in the 1980s as a mechanism to achieve self‐determination for Māori communities. However, the contracts funding Māori health providers limit expressions of self‐determination and fail to reflect Te Tiriti O Waitangi, the founding treaty of Aotearoa/New Zealand. Significant health reforms are proposed in Aotearoa/New Zealand, including the creation of a Māori Health Authority that will commission services from Māori health providers. This paper aims to critique the government contracts provided to Māori health providers in the light of the health reforms. A discourse analysis was undertaken on contracts held by a Māori health provider. The study was informed by a Kaupapa Māori congruent methodology that centralised Māori knowledge. The contractural language utilised a variety of discursive techniques that ultimately limit the power of Māori health providers. These discursive techniques included the redefinition of Māori concepts of self‐determination, the use of rhetoric that was not matched by action, reshaping Māori health priorities to reflect the funders' priorities and the application of a deficit lens to Māori health issues. The discursive techniques present in these contracts is consistent with previous work demonstrating a failure of funders to centralise Māori knowledge and ways of being. Success of the proposed health reforms and the Māori Health Authority should require dismantling of non‐Māori ways of commissioning and contracting, otherwise there is the continued risk of discriminatory contracting practices limiting the expression of self‐determination for Māori health providers. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) is a threat to public health. Addressing unnecessary antibiotic use provides an opportunity to reduce antibiotic consumption and to slow AMR. Understanding people's beliefs is important for informing antimicrobial stewardship (AMS) initiatives. Within New Zealand, health inequities exist between Māori and non-Māori; however, no research has examined Māori beliefs about antibiotics and AMR. The aim of this study was to explore the experiences related to antibiotic use of Māori in New Zealand. In-depth, semi-structured interviews were conducted with 30 Māori adults recruited from primary care to explore the experiences, perceptions and beliefs that Māori have about antibiotics, and about AMR. Overall, 30 Māori adults (23% male; age range from 20 to 77 years) participated. Three themes emerged: systemic-, social-, and individual-related factors. From these themes, seven subthemes explained the factors that influenced antibiotic use and their perceptions of AMR in Māori: general practitioner (GP) times and ratios, effect of colonisation, lack of knowledge and information, access and poverty barriers, relationship with health professionals, illness perceptions, treatment beliefs and Whaakaro (thoughts), and beliefs pertaining to natural (rongoā) and Western medicine. Participants identified potential solutions to improve antibiotic use such as cultural support and involving Te Ao Māori; recognising these can inform future AMS initiatives. [ABSTRACT FROM AUTHOR]

To investigate the rehabilitation experiences of Māori who were still reporting disability 24 months after an injury resulting in hospitalisation. Participants had been hospitalised for an Accident Compensation Corporation (New Zealand's no-fault injury compensation insurer) entitlement claim injury between 2007 and 2009, and were experiencing disability 24 months post-injury. In-depth kanohi ki te kanohi (face-to-face) qualitative interviews with 12 participants aged between 37 and 71 years at the time of interviews were conducted. Interpretive analyses of interview transcripts, focused on the impacts of injury was conducted with the aid of NVivo software. The overarching theme identified during the analysis was "Impact" with four sub-themes of: Impact on daily life; Impact on relationships, Impact on employment; and, long-term or ongoing impacts. For Māori living with disability 24 months after hospitalisation for injury, adjusting to life after the injury and the rehabilitation process was challenging. Participants discussed frustration with feeling dependent on others, being bored and feeling unfulfilled after their injury, and that many aspects of their lives were impacted on and not always in the expected directions. Many reported longer lasting impacts even after rehabilitation was completed. Implications for rehabilitation programmes e.g., strengthening programmes by taking into account issues discussed by participants, recognising the long-term impacts on both those injured and their whānau (family), and further investigations required are also discussed. Disability after injury can have long term impacts for injured Māori and their relationships. Social impacts can be perceived as more debilitating than the physical impacts after injury. Experiences of employment changes and future prospects are often difficult to navigate for Māori returning to work after an injury. [ABSTRACT FROM AUTHOR]

This article reports an effective strategy for recruiting patients with asthma to a qualitative study using an animated comic advertised on social media. An ad spend of NZ$432 on Facebook resulted in 101 study enquiries, and 27 participants taking part in the focus groups, of which 16 (56%) were Māori, the Indigenous Peoples of New Zealand. Representation of Māori amongst participants was over five times higher than their proportion in the local population (9.7%), resulting in data fulfilling the principle of equal explanatory power, an approach to research which can help advance Māori health development and address inequity. The success of this campaign is of particular interest for health researchers in New Zealand where Māori continue to be disproportionately affected by poorer health outcomes compared with non-Māori, particularly those with asthma. Approaches that better engage and support participation of under-represented communities in clinical research are of wider global interest. We reflect on the recruitment strategy and outcomes within a Kaupapa Māori framework, explore how this can be applied more widely in healthcare, and suggest direction for future study and implementation. Lay summary We designed an animated comic to advertise a study for patients with asthma. This was shared locally with a Facebook ad. The approach was highly engaging with the public, and resulted in rapid recruitment. Interestingly, participation of Māori (the Indigenous People of New Zealand) was over five times higher than their proportion in the local population. Māori have poorer health outcomes and increased barriers to healthcare access compared with non-Māori, particularly those with asthma. Approaches which can engage and support under-represented communities to participate in clinical research are of wider global interest. In this article, we reflect on the recruitment strategy and outcomes, and suggest direction for future study and implementation. [ABSTRACT FROM AUTHOR]

We describe trends in acute rheumatic fever (ARF), rheumatic heart disease (RHD), and RHD deaths among population groups in New Zealand. We analyzed initial primary ARF and RHD hospitalizations during 2000-2018 and RHD mortality rates during 2000-2016. We found elevated rates of initial ARF hospitalizations for persons of Māori (adjusted rate ratio [aRR] 11.8, 95% CI 10.0-14.0) and Pacific Islander (aRR 23.6, 95% CI 19.9-27.9) ethnicity compared with persons of European/other ethnicity. We also noted higher rates of initial RHD hospitalization for Māori (aRR 3.2, 95% CI 2.9-3.5) and Pacific Islander (aRR 4.6, 95% CI 4.2-5.1) groups and RHD deaths among these groups (Māori aRR 12.3, 95% CI 10.3-14.6, and Pacific Islanders aRR 11.2, 95% CI 9.1-13.8). Rates also were higher in socioeconomically disadvantaged neighborhoods. To curb high rates of ARF and RHD, New Zealand must address increasing social and ethnic inequalities. [ABSTRACT FROM AUTHOR]

Background: This paper presents the pilot testing of an online professional development (PD) course for New Zealand (NZ) speech-language therapists (SLTs) working with Māori with stroke-related communication disorders (predominantly aphasia). Taking a public health approach and focusing on the context of Māori as Indigenous peoples in a colonised society, the course lays the foundation for aphasia management for Māori. It consists of two modules. Module One addresses health inequities, social determinants of health, racism, the Treaty of Waitangi, cultural safety and power inherent in the role of the SLT. Module Two includes specific information about providing therapy for Māori stroke patients (particularly those with aphasia) and family members and working with Māori health colleagues. Aim: The primary aim was to ascertain the impact of the course on participants' clinical practice with Māori with aphasia. A secondary aim was to examine participants' assessment of the content and delivery of the course. Methods & Procedures: This was a qualitative longitudinal pilot study. Eleven SLTs completed the online course, immediately followed by a survey in which they gave feedback on the course and named three activities they would do to apply their learning in the following six months. Eight participants were available for interview six months later. Interviews aimed to ascertain what participants learned from the course, how they applied their learning and how the course could be improved. Interview data were analysed using a "general inductive approach", in conjunction with responses to the survey. Outcomes & Results: Interview findings were divided into two main themes – "putting it into practice" which revealed what participants learned and how they applied their learning and "keeping it at the forefront" which focused on maintaining that learning and practice, including reflection on the course content and delivery. All participants were positive about the course and all would recommend it to colleagues. Conclusions: The pilot testing revealed that participants made positive changes to their practice as a result of their learning. Challenges inherent in completing the course and applying learning and suggestions for improvement were also identified. Although the course content is NZ-specific, many of the ideas in the course are relevant to numerous multiethnic contexts across the world in which the speech-language therapy culture in service delivery could be impacted by issues such as power, racism, and inequity. [ABSTRACT FROM AUTHOR]

Objectives: Type 2 diabetes mellitus (T2DM) and periodontal disease are two highly prevalent, directly and independently associated long‐term conditions that disproportionately impact Indigenous Māori in New Zealand (NZ). Although poorly understood, a number of social and biological mechanisms connect these conditions. This qualitative study explored experiences of T2DM and oral and dental (hereafter oral/dental) health; access to oral/dental health care; whether participants' experiences supported or challenged existing evidence; and sought suggestions for improving oral/dental health in a high‐deprivation rural area of Northland, NZ. Methods: Participants (n = 33) meeting the study criteria: self‐identified Māori ethnicity, aged ≥ 18‐years with glycated haemoglobin (HBA1c) >65 mmol/L were recruited via the local primary care clinic in September‐December 2015; two left the study prior to data collection. During face‐to‐face semi‐structured interviews, participants (n = 31) were asked How does diabetes affect your teeth? and When did you last access dental care? Kaupapa Māori (KM) theory and methodology provided an important decolonizing lens to critically analyse the fundamental causes of Indigenous health inequities. Results: Independent analysis of qualitative data by three KM researchers identified four themes: access barriers to quality care; pathways to edentulism; the 'cost' of edentulism; and, unmet need. Results contributed towards informing Mana Tū—an evidence‐based KM programme for diabetes in primary care—to be introduced in this and other communities from 2018. Conclusions: Oral health is integral to diabetes management, and vice versa. Subsidized specialist referrals for oral‐dental health care for Māori with T2DM could improve glycaemic control and diabetes outcomes and reduce diabetes‐related complications among this population. [ABSTRACT FROM AUTHOR]

Background: Health equity is a fundamental right afforded to all regardless of ethnicity. However, in New Zealand (NZ), health inequities are most compelling for Indigenous Māori who experience inadequate access to services, poorer quality of care and poor health outcomes as a result. Bariatric surgery is the most effective intervention for weight loss and remission of obesity‐related disease where all other interventions have been exhausted. This Kaupapa Māori qualitative study presents Māori perspectives of bariatric surgery from the largest public bariatric centre in NZ and offers solutions for enhancing bariatric service responsiveness to Māori. Methods: This qualitative study was informed by Kaupapa Māori methodology and involved a general inductive thematic analysis of 31 semi‐structured interviews with Māori patients who had bariatric surgery at Counties Manukau Health in South Auckland, NZ. Results: Four key themes were identified following analysis: (i) Kaupapa Māori standards of health; (ii) bariatric mentors; (iii) bariatric psychologists; and (iv) community‐integrated support. These themes offer four tangible solutions for optimizing bariatric pathways for Māori from the perspectives of Māori bariatric patients. Conclusion: Kaupapa Māori, community‐centred and greater non‐surgeon aspects of bariatric supportive mechanisms comprise key areas of opportunity for public bariatric pathways in NZ. Surgical leadership is required to advance health equity and service responsiveness to Māori. [ABSTRACT FROM AUTHOR]

Bariatric surgery is the most effective intervention for alleviating obesity and its complications. Indigenous people worldwide experience higher rates of obesity and obesity disease burden. However, few studies exploring bariatric surgery among Indigenous peoples are published. In this study we aimed to explore the motivation of Māori women in coming forward for bariatric surgery. Māori women who had bariatric surgery prior to December 31, 2014, were invited to participate in semi-structured interpersonal interviews. Kaupapa Māori research, an Indigenous Māori research methodology, informed this study. Interviews were recorded, transcribed and subject to inductive thematic analysis. Twenty-nine Māori women participated in semi-structured interpersonal interviews. The majority of women reported that the presence of obesity-related disease alongside the desire for a better quality of life served as the greatest sources of motivation for having bariatric surgery. Whānau (family) were key for participants achieving the preoperative milestones needed to be accepted for bariatric surgery. Interpersonal experiences of fat-shaming and yo-yo dieting also impacted their choice to have surgery. This study is one of the first to describe the motivations of Indigenous Māori women to have bariatric surgery. Our study conveys the importance of health, a desire to have a better quality of life and whānau in motivating Māori women to come forward for bariatric surgery. [ABSTRACT FROM AUTHOR]

Background: Health equity for Indigenous peoples in the context of surgery has recently become topical amongst surgeons in Australasia. Health inequities are amongst the most consistent and compelling disparities between Māori and New Zealand Europeans (NZE) in New Zealand (NZ). We aimed to investigate where ethnic disparities in surgical care may occur and highlight some of the potential contributing factors, over all surgical specialties, between Māori and NZE adults in NZ. Methods: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement. A series of electronic searches were performed in Medline, Embase, PubMed and CINAHL. Results: Ten studies met the inclusion criteria. All studies employed a range of indicators for surgical care including receipt of surgery following diagnosis, delays to treatment and post‐operative morbidity and mortality. Disparities in the receipt of surgical treatment for several cancers were observed for Māori and remained after adjustment for socioeconomic variables and extent of disease. Māori were more likely to experience delays in treatment and referral to other medical specialties involved in their care. Conclusion: Despite the significant variation in the types of diseases, procedures and indicators of surgical care of the included studies, consistent findings are that disparities in different aspects of surgical care exist between Māori and NZE in NZ. This review highlights the need to better quantify the important issue of health equity for Māori in surgery given the lack of studies over the majority of surgical specialties. [ABSTRACT FROM AUTHOR]

Background and objective There are significant health disparities between Māori and non-Māori with asthma, a pattern seen between other ethnic populations. This study investigates outcomes for Māori in a randomized controlled trial ( RCT) of combination budesonide/formoterol inhaler therapy in asthma. Methods This 24-week multicentre RCT recruited 303 adult asthma patients, 44 of whom were Māori. Participants were randomized to the single combination budesonide/formoterol inhaler as maintenance and reliever therapy (' SMART') regimen or 'standard' regimen (combination budesonide/formoterol inhaler for maintenance and salbutamol as reliever). Outcomes included patterns of beta-agonist inhaler use including 'high use' of reliever therapy (>8 actuations of budesonide/formoterol in excess of four maintenance doses per day for SMART and >16 actuations per day of salbutamol for standard). Differences in outcomes for Māori versus non-Māori were assessed using an interaction term between ethnicity and treatment. Results With adjustment for ethnicity, the SMART group had fewer days of high use (relative rate ( RR) 0.57 (95% confidence interval (CI): 0.38-0.85)), days of high use without medical review within 48 h ( RR 0.49 (95% CI: 0.32-0.75)) and severe exacerbations (RR 0.54 (95% CI: 0.36-0.81)) compared with standard. The magnitude of the benefit from the SMART regimen was similar in Māori and non- Māori. Regardless of treatment regimen, Māori demonstrated more days of high use, high use without medical review and underuse of maintenance therapy. Conclusions The SMART regimen has a favourable risk/benefit profile in Māori. Days of high use, days of high use without medical review and underuse of maintenance treatment were greater in Māori, regardless of treatment regimen. [ABSTRACT FROM AUTHOR]

Background:Experiences of aphasia are shaped by culture. Therefore, to provide appropriate services for people with aphasia (PWA), speech-language therapists (SLTs) must understand aphasia from their potential clients’ cultural perspective. Aims:This study aimed to describe and interpret the experiences of Māori with aphasia and their whānau (extended family), to inform service delivery for this population. Methods & Procedures:This study is kaupapa Māori research (KMR), an Indigenous research approach that privileges Māori culture and knowledge. A qualitative methodology, interpretive description (ID), was incorporated to produce clinically relevant findings that will benefit SLTs and Māori. In-depth interviews were undertaken with 11 Māori with aphasia and their nominated whānau members. Participants spoke about aphasia-related changes in relationships, health, spirituality, activities and family and community roles. Analysis was informed by interpretive description (ID) and kaupapa Māori. Outcomes & Results:Participants described a range of positive and negative experiences of aphasia. These developed into two pairs of themes: (1) “Grieving for what is lost” and “Recognising what we have got” (2) “It is hard” and “Choosing how to respond”. Conclusions:Aphasia can have a profound effect on Māori families and bring many changes in family roles and relationships. Despite difficulties, whānau can actively manage their situation, and enable the person with aphasia to participate in the whānau and community. The findings of this study will inform clinical practice and provide the basis for the development of resources for use in speech-language therapy services for Māori with aphasia and their whānau. [ABSTRACT FROM PUBLISHER]