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Te Whare Pora a Hine-te-iwaiwa (Te Whare Pora), a Māori (Indigenous peoples of Aotearoa (New Zealand)) approach to the prevention of sudden infant death, posits that immersion in traditional knowledge and the weaving of the wahakura (woven flax bassinet) as a safe infant sleep space boosts the resilience of pregnant wāhine Māori (Māori women) and the post-neonatal safety of their infants. Our data are drawn from the observations, conversations and 24 months field-work of an embedded researcher, and formal interviews with 15 pregnant Māori women, their weaving tutor and six kuia (female elders). A rich description of the womens' experiences demonstrates that Te Whare Pora bolsters the capability of those involved to stand tall in mana wāhine (status as Māori women). This reclaiming of the antenatal period and decolonisation of antenatal care demonstrates that the wahakura belongs within a Māori world, where health outcomes are achieved through Māori being Māori. [ABSTRACT FROM AUTHOR]

This study explores how a purposively selected sample of mainstream primary schools in regional New Zealand incorporate mātauranga Māori (traditional Māori (Indigenous people of New Zealand) knowledge) into school life to support successful learning. Qualitative semi-structured interviews with five principals of low advantage schools with high Māori student populations identified six themes focused on creating a curriculum built around Te Ao Māori (Māori worldview). They were mainstream curriculum not fit for purpose for Māori learners, blending of mātauranga Māori and western knowledge, mātauranga Māori as learning and educational experiences, mātauranga ā-iwi (local Māori knowledge) and achievement fit for tamariki (children). Mātauranga Māori is incorporated into these schools' environment to support learning, but the mainstream curriculum can be a challenge for schools wishing to promote Māori ways of being. Some schools, however, supported a He Awa Whiria (braided rivers) approach to education, the interweaving of both western practices and mātauranga Māori. [ABSTRACT FROM AUTHOR]

In 2020, a government-funded healthy school lunch program was introduced in a quarter of New Zealand schools, selected due to high levels of socio-economic barriers. This study assesses the impact of the introduction of the school lunch program from family (whānau), student and school principal perspectives. Across four schools, we conducted five focus groups (two with secondary students and three with family members) and four school principal interviews. Participating schools represented a range of contexts: primary and secondary, schools with cooks in on-site kitchens and schools receiving meals delivered by external caterers. Thematic analysis was used to develop themes describing the health, wellbeing and nutritional impact of the program. Family participants were 82% Indigenous Māori and self-identified as having 'borderline' (73.5%) or no financial security (8.8%). Seven positive impact themes were identified: improved food security, enhanced equity, increased appreciation of healthy foods for students, enhanced mana (wellbeing) for all, reduced financial hardship/stress for families, opportunities for nutritional learning and recognition that appreciation and uptake happen over time. Four negative impact themes were identified: low uptake that created food waste, perception that healthy food is not palatable for students, lack of knowledge of the program and loss of agency for students. This is the largest intervention in nutrition and food security for children implemented in New Zealand since the 1930's. The first 2 years have offered wellbeing and financial benefits for students and families, particularly when school environments promote uptake. More involvement of students and family members in the program planning is essential. [ABSTRACT FROM AUTHOR]

Systems Thinking is increasingly applied to address complex societal and public health issues in Aotearoa, New Zealand and has been proposed as a good fit with traditional wisdom and Mātauranga Māori (Indigenous knowledge) from Aotearoa, New Zealand. In this article, we delve into the theoretical underpinnings of Systems Thinking approaches used in Community-Based System Dynamics research and find parallels with Indigenous narratives and knowledge. The synergy created by combining these two knowledge systems and practices is proposed as an effective way to approach public health issues that emerge from complex adaptive systems, particularly in communities with large numbers of Indigenous peoples. Examples are given from an initiative to engage community to improve food security and nutrition in regional Aotearoa, New Zealand. [ABSTRACT FROM AUTHOR]

Our current food system is failing to deliver on equitable health outcomes, wellbeing and food security and the Hawke's Bay region of New Zealand has high inequities and one the highest levels of childhood obesity nationally. This articlereports baseline quantitative data from 2087 students (aged 9 or 13) from 41 primary and secondary schools, including schools participating in the Ka Ora, Ka Ako Healthy School Lunch programme. Students answered an online survey covering food security, general wellbeing (WHO-5), eating behaviours and physical activity and were measured/weighed for body size. 16.8% of students experienced food insufficiency in the home and 31.3% of 13-yr-olds did not eat breakfast. Overall, only 12.9% met the national vegetable intake guidelines and 39.6% met fruit intake guidelines. Students in high advantage schools (decile 8–10) were twice as likely to meet the vegetable intake guidelines. 47.1% of 13-year old girls were at risk of reduced wellbeing. 54.6% of students had a healthy weight and 44.5% experienced overweight or obesity; in low advantage (decile 1–3) schools 64.4% experienced overweight or obesity. The data form a baseline for an evaluation of multiple public health initiatives underway in Hawke's Bay to improve food environments and nutritional wellbeing. [ABSTRACT FROM AUTHOR]

The bassinet-like wahakura is an Indigenous initiative for the prevention of Sudden Unexpected Death in Infancy (SUDI). It was developed by New Zealand Māori in 2005 when Māori were rejecting the 'stop bedsharing' SUDI prevention message and the SUDI disparity between Māori and non-Māori had become entrenched. Made of native flax, the wahakura was promoted as a culturally resonant, in-bed safe sleep device that would disrupt the SUDI risk associated with 'bedsharing where there was smoking in pregnancy' without relying on smoking cessation. A significant movement of weavers and health professionals grew around the wahakura program. A body of research, including infant care surveys, retrospective case review, qualitative enquiry and a randomised controlled trial comparing wahakura and bassinet safety demonstrated the device's public health plausibility, acceptability to Māori women and its essential safety. This facilitated the distribution, by District Health Boards, of safe sleep devices, including a related device called the Pēpi-Pod, and safe sleep education to high-risk, mainly Māori, mothers. Infant mortality in New Zealand fell by 29%, primarily among Māori infants, over the period 2009–15, suggesting that Māori cultural concepts, traditional activities and community engagement can have a significant effect on ethnic inequities in infant mortality. [ABSTRACT FROM AUTHOR]

Aim: To explore the experiences of people recently diagnosed with prediabetes and overweight or obese in making dietary changes following a six‐month primary care nurse‐delivered dietary intervention pilot. Methods: Semi‐structured interviews were conducted with 20 participants, purposefully selected to ensure a mix of ethnicity, gender and glycaemic outcome. Thematic analysis of interview data was undertaken. Results: Participants described feeling shocked when they received the diagnosis of prediabetes. Three core themes, each containing subthemes, emerged: (i) supportive factors ‐ determination not to develop diabetes, clear information and manageable strategies, and supportive relationships; (ii) barriers ‐ lack of family support, financial constraints, social expectations around food, and chronic health issues; and (iii) overcoming challenges ‐ growing and sharing food, using frozen vegetables and planning. Challenges related to cultural expectations around providing and partaking of food were more evident for indigenous Māori participants. Conclusions: A diagnosis of prediabetes provides a window of opportunity for healthcare professionals to work with those diagnosed and their families to make healthful dietary changes. Dietary guidance is likely to be most effective when individuals' life circumstances are taken into account. Clear information and supportive relationships to facilitate lifestyle change are extremely important. (Clinical Trials Registry No; ANZCTR ACTRN1261500080656) What's new?: Well presented, clear dietary information and individualised manageable strategies within the context of supportive health professional and family relationships facilitate healthful dietary change in those with prediabetes.Conversely, lack of family support, financial constraints, social expectations around food, and chronic health issues present barriers to dietary change.Adoption of dietary recommendations for prediabetes is more likely to occur when guidance is tailored to individuals' life circumstances, and advice provided around the time of diagnosis of prediabetes when the motivation to make changes appears high may be an ideal time. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to identify the potential risks and benefits of sleeping infants in a Pēpi-Pod distributed to families with high risk of sudden unexpected death in infancy compared to a bassinet.Methods: Forty-five mostly indigenous Māori mothers who were referred by local health providers to receive a Pēpi-Pod were surveyed at recruitment, 1 and 3 months. A sleep study at 1 month included infrared video, oximetry and temperature measures.Results: When compared with 89 historical bassinet controls, an intention-to-treat analysis of questionnaires showed no increase in direct bed sharing but demonstrated significantly less sharing of the maternal bedroom at both interviews, with the majority of those not sleeping in the maternal bedroom, actually sleeping in the living room. The 1 month 'as-used' analysis showed poorer maternal sleep quality. The 'as-used' analysis of video data (24 Pēpi-Pod and 113 bassinet infants) also showed no increase in direct bed sharing, head covering or prone/side sleep position. Differences in oxygen saturation were not significant, but heart rate was higher in the Pēpi-Pod infants by 8.37 bpm (95% confidence interval 4.40, 12.14). Time in the thermal comfort zone was not different between groups despite Pēpi-Pod infants being situated in significantly warmer rooms.Conclusions: Overall, we found that most differences in infant risk behaviours in a Pēpi-Pod compared to a bassinet were small, with confidence intervals excluding meaningful differences. We noted poorer maternal sleep quality at 1 month. Higher infant heart rates in the Pēpi-Pod group may be related to higher room temperatures. The Pēpi-Pod appears physiologically safe but is associated with lower reported maternal sleep quality. [ABSTRACT FROM AUTHOR]

Objective: To compare overnight oxygen saturation, heart rate and the thermal environment of infants sleeping in an indigenous sleep device (wahakura) or bassinet to identify potential risks and benefits.Design: Randomised controlled trial.Setting: Family homes in low socio-economic areas in New Zealand.Patients: 200 mainly Māori mothers and their infants.Interventions: Participants received a wahakura or bassinet from birth.Main Outcome Measures: Overnight oximetry, heart rate and temperature at 1 month.Results: Intention-to-treat analysis for 83 bassinet and 84 wahakura infants showed no significant differences between groups for the mean time oxygen saturation (SpO2) was less than 94% (0.54 min, 95% CI -1.36 to 2.45) or less than 90% (0.22 min, 95% CI -0.56 to 1.00), the mean number of SpO2 dips per hour >5% (-0.19, 95% CI -3.07 to 2.69) or >10% (-0.41, 95% CI -1.63 to 0.81), mean heart rate (1.99 beats/min, 95% CI -1.02 to 4.99), or time shin temperature >36°C (risk ratio (RR): 0.63, 95% CI 0.13 to 2.99) or <34°C (RR: 0.89, 95% CI 0.61 to 1.30). A per-protocol analysis of 45 bassinet and 26 wahakura infants and an as-used analysis of 104 infants in a bassinet and 48 in a wahakura found no significant differences between groups for all outcome measures.Conclusions: This indigenous sleep device is at least as safe as the currently recommended bassinet, which supports its use as a sleep environment that offers an alternative way of bed-sharing.Trial Registration Number: Australian New Zealand Clinical Trials Registry: ACTRN12610000993099. [ABSTRACT FROM AUTHOR]

Objectives.New Zealand has a unique tool, Te Tiriti o Waitangi, the Treaty of Waitangi, for addressing health disparities. Indigenous Māori have compromised health status compared to other groups. This paper investigates ways in which public health units (PHUs) and non-governmental organisations (NGOs) use Te Tiriti o Waitangi in service delivery to Māori. Design.A nationwide telephone survey of primary health providers (n=162) was conducted in 2014-15. Participants were asked about effectiveness and monitoring of their service delivery to Māori. Results.PHUs reported actively working with Māori, and Te Tiriti o Waitangi to reduce health disparities. Direct Māori engagement with development and delivery of programmes was viewed as essential. Strategies included designated PHU staff in positions of responsibility, formal partnerships with Māori, and providing operational and strategic guidance. Some PHUs supported development of cultural competencies. NGO responsiveness to Māori was variable. Some NGOs described prioritising service delivery and programmes for Māori. Others reported the focus of their service was European or other non-Māori ethnicities. Lack of resources or past difficulties engaging with Māori were barriers. Conclusion.Public health has an ethical commitment to reduce health disparities. Advancing Te Tiriti obligations in everyday practice has the potential to address inequalities. [ABSTRACT FROM AUTHOR]

Aim: Postneonatal mortality rates changed very little from 2000 until recently. There has been a decrease in mortality in New Zealand from 2009 to 2015. This study describes an infant Safe Sleep programme and postulates it is the cause for the recent decrease in deaths.Methods: The Safe Sleep programme involved as follows: a focus on preventing accidental suffocation, a 'blitz' approach to SUDI education, the targeted provision of portable infant Safe Sleep devices (ISSD) and the development of Safe Sleep policy across all district health boards (DHBs).Results: Participation in the education 'blitz' by health professionals exceeded one in 23 live births, distribution of Safe Sleep leaflets exceeded two for every live birth, and over 16 500 ISSDs have been distributed to vulnerable infants. Postperinatal mortality fell 29% from 2009 to 2015 (2.8 to 2.0/1000 live births). The fall has been greatest for Māori and in regions with the most intensive programmes.Conclusion: The recent fall in postperinatal mortality has not happened by chance. It is likely that the components of end-stage prevention strategy, a focus on preventing accidental suffocation, the education 'blitz', the targeted supply of ISSDs and strengthened health policy, have all contributed to varying degrees. [ABSTRACT FROM AUTHOR]

BACKGROUND AND CONTEXT: New Zealand's primary mental health initiatives (PMHIs) have successfully filled a health service gap and shown good outcomes for many presenting with mild to moderate anxiety/depression in primary health care settings. Maori have higher rates of mental health disorders and complexity of social and mental health needs not matched by access to PMHIs. ASSESSMENT OF PROBLEM: The Wairua Tangata Programme (WTP), a Hawkes Bay PMHI, aimed to provide an integrated, flexible, holistic, tikanga Maori-based therapeutic service targeting underserved Maori, Pacific and Quintile 5 populations. External evaluation of the programme provided formative and outcome feedback. RESULTS: The WTP reported high engagement of Maori (particularly women), low non-attendance rates, good improvements in mental health assessment exit scores, strong stakeholder support and service user gratitude. GPs reported willingness to explore mental health issues in this high needs population. Challenges included engaging Pacific peoples and males and recruiting from scarce Maori, Pacific and male therapist workforces. STRATEGIES FOR IMPROVEMENT: Effectively meeting the target population's complex social and therapeutic needs required considerable programme flexibility, referral back into the programme and assistance with transitioning to other therapeutic or social support services. Referral criteria required adaptation to accommodate some sectors, especially youth. A group programme was developed specifically for males. LESSONS: A holistic PMHI programme delivered with considerable flexibility and a skilled, culturally fluent team working closely with primary care providers can successfully engage and benefit underserved Maori communities with complex social and mental health needs. Successful targeted programmes are integral to reducing mental health disparities. [ABSTRACT FROM AUTHOR]

Aim: To review autopsy reports of all SUDI deaths in the Auckland region, New Zealand, from October 2000 to December 2009. Methods: Information on all SUDI cases from 2000 to 2009 was extracted from autopsy and police reports from the National Forensic Pathology Service at Auckland Hospital. Results: Of the 332 post-mortems in this period, 221 were classified as SUDI. Of these, 83% were Māaori or Pacific infants. The median age at death was 11 weeks and 11% occurred in 7- to 28-day-olds. At the time of death, 64% overall were bedsharing; this was more common in 7-28 day olds (92%). Bedsharing infants were significantly younger at death than non-bedsharing infants (p = 0.008). Where sleep position was known, 57% were placed in non-supine at the last sleep. There was no evidence of diagnostic shift and the prevalence of bedsharing did not change over the decade. Conclusions: Bedsharing was associated with a high proportion of SUDI cases, especially in the youngest infants, and non-supine sleep positions were common. There is a need to enhance SUDI prevention messages and consider innovative ways of promoting safe sleeping environment and supine sleep position in Māori and Pacific communities. [ABSTRACT FROM AUTHOR]

The loss of a baby is always hard to cope with and the grieving process is likely to be difficult. Interventions to work with Sudden Infant Death Syndrome (SIDS) families have improved grieving outcomes for many but the needs of Maori fathers are not well understood or catered to by existing services. This article presents narrative data from Maori fathers who have lost a baby to SIDS and analyzes these narratives in the context of the literature and of traditional Maori constructs about grief. The authors document a rarely discussed Maori concept, “the attainment of mauri tau,” as the desired outcome of the grieving process; and begin a discussion around the changing face of the Maori grieving process and its implications for the grieving practices of Maori men. [ABSTRACT FROM AUTHOR]

The article informs that an independent research report has been released by the Medical Council of New Zealand, in partnership with Te Ohu Rata O Aotearoa (Te ORA) on September 25, 2020 analyzing the current state of cultural safety and health equity delivered by physicians in New Zealand. The report analyzes systemic racism and lack of health equity among Maori patients and ways to prevent it.

Among Maori families, the loss of an infant to SIDS is a terrible burden that reverberates through social networks for years after the event. The statutory services that investigate the death have a huge impact on such processes. This qualitative investigation studied the experiences of whanau following a SIDS death by reporting narrative data, gathered from families, police officers, coroners, and pathologists. Thematic analyses revealed multiple domains of high significance--police actions, post-mortem, and coronial process--to bereaved whanau, and this paper considers their implications for grieving, service provision, and social justice. [ABSTRACT FROM AUTHOR]