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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]

Background: Prevalence of Type 2 diabetes mellitus (T2DM) is high among Māori and other Pacific Island peoples in New Zealand. Current health services to address T2DM largely take place in primary healthcare settings and have, overall, failed to address the significant health inequities among Māori and Pacific people with T2DM. Culturally comprehensive T2DM management programmes, aimed at addressing inequities in Māori or Pacific diabetes management and workforce development, are not extensively available in New Zealand. Deliberate strategies to improve cultural safety, such as educating health professionals and fostering culturally safe practices must be priority when funding health services that deliver T2DM prevention programmes. There is a significant workforce of community-based, non-clinical workers in South Auckland delivering diabetes self-management education to Māori and Pacific peoples. There is little information on the perspectives, challenges, effectiveness, and success of dietitians, community health workers and kai manaaki (KM) in delivering these services. This study aimed to understand perspectives and characteristics of KM and other community-based, non-clinical health workers, with a focus on how they supported Māori and Pacific Peoples living with T2DM to achieve better outcomes. Methods: This qualitative study undertaken was underpinned by the Tangata Hourua research framework. Focus groups with dietitians, community health workers (CHWs) and KM took place in South Auckland, New Zealand. Thematic analysis of the transcripts was used to identify important key themes. Results: Analysis of focus group meetings identified three main themes common across the groups: whakawhanaungatanga (actively building relationships), cultural safety (mana enhancing) and cultural alignment to role, with a further two themes identified only by the KM and CHWs, who both strongly associated a multidisciplinary approach to experiences of feeling un/valued in their roles, when compared with dietitians. Generally, all three groups agreed that their roles required good relationships with the people they were working with and an understanding of the contexts in which Māori and Pacific Peoples with T2DM lived. Conclusions: Supporting community based, non-clinical workers to build meaningful and culturally safe relationships with Māori and Pacific people has potential to improve diabetes outcomes. [ABSTRACT FROM AUTHOR]

Background: Prevalence of Type 2 diabetes mellitus (T2DM) is high among Māori and other Pacific Island peoples in New Zealand. Current health services to address T2DM largely take place in primary healthcare settings and have, overall, failed to address the significant health inequities among Māori and Pacific people with T2DM. Culturally comprehensive T2DM management programmes, aimed at addressing inequities in Māori or Pacific diabetes management and workforce development, are not extensively available in New Zealand. Deliberate strategies to improve cultural safety, such as educating health professionals and fostering culturally safe practices must be priority when funding health services that deliver T2DM prevention programmes. There is a significant workforce of community-based, non-clinical workers in South Auckland delivering diabetes self-management education to Māori and Pacific peoples. There is little information on the perspectives, challenges, effectiveness, and success of dietitians, community health workers and kai manaaki (KM) in delivering these services. This study aimed to understand perspectives and characteristics of KM and other community-based, non-clinical health workers, with a focus on how they supported Māori and Pacific Peoples living with T2DM to achieve better outcomes.Methods: This qualitative study undertaken was underpinned by the Tangata Hourua research framework. Focus groups with dietitians, community health workers (CHWs) and KM took place in South Auckland, New Zealand. Thematic analysis of the transcripts was used to identify important key themes.Results: Analysis of focus group meetings identified three main themes common across the groups: whakawhanaungatanga (actively building relationships), cultural safety (mana enhancing) and cultural alignment to role, with a further two themes identified only by the KM and CHWs, who both strongly associated a multidisciplinary approach to experiences of feeling un/valued in their roles, when compared with dietitians. Generally, all three groups agreed that their roles required good relationships with the people they were working with and an understanding of the contexts in which Māori and Pacific Peoples with T2DM lived.Conclusions: Supporting community based, non-clinical workers to build meaningful and culturally safe relationships with Māori and Pacific people has potential to improve diabetes outcomes. [ABSTRACT FROM AUTHOR]

Objective: To undertake an economic analysis of the Take Charge intervention as part of the Taking Charge after Stroke (TaCAS) study. Design: An open, parallel-group, randomised trial comparing active and control interventions with blinded outcome assessment Setting: Community. Participants: Adults (n = 400) discharged to community, non-institutional living following acute stroke. Interventions: The Take Charge intervention, a strengths based, self-directed rehabilitation intervention, in two doses (one or two sessions), and a control intervention (no Take Charge sessions). Measures: The cost per quality-adjusted life year (QALY) saved for the period between randomisation (always post hospital discharge) and 12 months following acute stroke. QALYs were calculated from the EuroQol-5D-5L. Costs of stroke-related and non-health care were obtained by questionnaire, hospital records and the New Zealand Ministry of Health. Results: One-year post hospital discharge cost of care was mean (95% CI) $US4706 (3758–6014) for the Take Charge intervention group and $6118 (4350–8005) for control, mean (95% CI) difference $ −1412 (−3553 to +729). Health utility scores were mean (95% CI) 0.75 (0.73–0.77) for Take Charge and 0.71 (0.67–0.75) for control, mean (95% CI) difference 0.04 (0.0–0.08). Cost per QALY gained for the Take Charge intervention was $US −35,296 (=£ −25,524, € −30,019). Sensitivity analyses confirm Take Charge is cost-effective, even at a very low willingness-to-pay threshold. With a threshold of $US5000 per QALY, the probability that Take Charge is cost-effective is 99%. Conclusion: Take Charge is cost-effective and probably cost saving. [ABSTRACT FROM AUTHOR]

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]

Objective: The present research sought to better understand the barriers, facilitators, attitudes and beliefs that influence the way Ma-ori and Samoan grandparents feed their grandchildren in a deprived urban neighbourhood in New Zealand. Design: The research adopted a qualitative methodology that was consistent with a Kaupapa Ma-ori research approach. Seven semi-structured interviews were conducted with grandparents to collect narrative data. Setting: Sampling occurred in one Auckland suburb. The suburb was selected because of its high level of socio-economic deprivation and ethnic diversity. Subjects: Seven grandparents participated in the study (five Ma-ori and two Samoan). Each participant met the inclusion criteria (i.e. they had provided at least five meals per week over the previous three months to grandchildren aged less than 24 months). Marae (i.e. meeting houses and areas used by local Ma-ori tribes/sub-tribes) and community organisations were used to recruit participants. Results: A general inductive thematic analysis identified four key themes: (i) grandparents' understanding of optimal feeding practices; (ii) economic and material factors; (iii) previous experiences and customary norms; and (iv) social support and societal pressure. Conclusions: The study showed that grandparents' complementary feeding practices in caring for infant grandchildren were influenced by upstream structural elements such as government policies related to welfare and pensions, employment, income and cultural knowledge. Frameworks that seek to achieve social justice and support cultural practices should be employed and promoted in the development of future policy and research in this area. [ABSTRACT FROM AUTHOR]

Objective: The present research sought to better understand the barriers, facilitators, attitudes and beliefs that influence the way Māori and Samoan grandparents feed their grandchildren in a deprived urban neighbourhood in New Zealand.Design: The research adopted a qualitative methodology that was consistent with a Kaupapa Māori research approach. Seven semi-structured interviews were conducted with grandparents to collect narrative data.Setting: Sampling occurred in one Auckland suburb. The suburb was selected because of its high level of socio-economic deprivation and ethnic diversity.Subjects: Seven grandparents participated in the study (five Māori and two Samoan). Each participant met the inclusion criteria (i.e. they had provided at least five meals per week over the previous three months to grandchildren aged less than 24 months). Marae (i.e. meeting houses and areas used by local Māori tribes/sub-tribes) and community organisations were used to recruit participants.Results: A general inductive thematic analysis identified four key themes: (i) grandparents' understanding of optimal feeding practices; (ii) economic and material factors; (iii) previous experiences and customary norms; and (iv) social support and societal pressure.Conclusions: The study showed that grandparents' complementary feeding practices in caring for infant grandchildren were influenced by upstream structural elements such as government policies related to welfare and pensions, employment, income and cultural knowledge. Frameworks that seek to achieve social justice and support cultural practices should be employed and promoted in the development of future policy and research in this area. [ABSTRACT FROM AUTHOR]

Kaupapa Māori research (KMR) is an Indigenous research approach that is decolonizing and transformative. Interpretive description (ID) is a qualitative methodology used to generate knowledge relevant to the applied health disciplines. In this article, we discuss how we combined KMR and ID to investigate the experiences of Māori (the Indigenous peoples of New Zealand) with aphasia and their whānau (extended family). This is novel because it is the first time these two approaches have been combined. In the context of aphasia research, we discuss how they work together in theory, and the synergies that became apparent in practice. We conclude that the combination of KMR and ID enables clinicians and Māori with aphasia to learn from each other and work together, thereby generating knowledge that makes a difference for Māori with aphasia and their whānau. [ABSTRACT FROM PUBLISHER]

Analysis of a Māori-led diabetes support programme, Mana Tū, has identified barriers, facilitators and motivators for Māori and Pacific peoples with type 2 diabetes. The study used a Kaupapa Māori approach to conduct 22 semi-structured interviews with participants of Mana Tū and their whanau living in Auckland and Northland. Key themes identified were: (1) whānau experience of type 2 diabetes, (2) cultural safety in healthcare interactions, (3) whānau ora (collective family wellbeing) and (4) Kaupapa Māori approaches to health interventions. Themes were consistent across Māori and Pacific participants. The study authors concluded that Māori-led health interventions are needed to ensure that Māori and Pacific peoples with type 2 diabetes receive appropriate, responsive and equitable healthcare. [ABSTRACT FROM AUTHOR]

Objective: Few community interventions following stroke enhance activity, participation or quality of life. We tested two novel community interventions designed to promote self-directed rehabilitation following stroke.Design: This was a randomized, controlled parallel group 2×2 trial.Setting: Community.Participants: Maori and Pacific New Zealanders, >15 years old, randomized within three months of a new stroke.Interventions: A DVD of four inspirational stories by Maori and Pacific people with stroke and a ‘Take Charge Session’ – a single structured risk factor and activities of daily living assessment, designed to facilitate self-directed rehabilitation.Main measures: Primary outcomes were Health-related Quality of Life (Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the Short Form 36 (SF-36)) 12 months from randomization. Secondary outcomes were Barthel Index, Frenchay Activities Index, Carer Strain Index and modified Rankin score.Results: One hundred and seventy-two people were randomized with 139 (80.8%) followed up at 12 months post randomization. The effect of the Take Charge Session on SF-36 PCS at 12 months was 6.0 (95% confidence interval (CI) 2.0 to 10.0) and of the DVD was 0.9 (95% CI −3.1 to 4.9). Participants allocated to the Take Charge Session were less likely to have a modified Rankin score of >2 (odds ratio (OR) 0.42, 95% CI 0.2 to 0.89) and their carers had lower (better) Carer Strain Index scores (−1.5, 95% CI −2.8 to −0.1).Conclusion: A simple, low-cost intervention in the community phase of stroke recovery aiming to promote self-directed rehabilitation improved outcomes. [ABSTRACT FROM PUBLISHER]

Background: Ischaemic Heart Disease (IHD) is a leading cause of death in New Zealand and the burden falls disproportionately on Māori, the indigenous population of Aotearoa New Zealand. Methods: Data for Māori:non-Māori disparities in risk factors, hospitalisation, procedure receipt and mortality for IHD are analysed. Age-adjusted rates of IHD mortality (2000–2004) and publicly funded hospitalisations and procedures (2003–2005) for Māori and non-Māori are reported and compared. Results: Significant inequalities between Māori and non-Māori in IHD risk factors, hospitalisations, mortality and the receipt of related procedures exist. IHD hospitalisation rates for Māori are 1.4 times that of non-Māori, however mortality rates are more than twice that of non-Māori. In recent years Māori revascularisation rates have increased (as have non-Māori rates) but are still considerably less than might be expected given the much higher mortality rates. Conclusion: Despite high need, Māori receive relatively low access to appropriate care for IHD. The role of society, policy, and the clinician are three key factors to be considered in reducing inequalities for IHD between Māori and non-Māori. [Copyright &y& Elsevier]

Lack of access remains a crucial barrier to improved health outcomes for children with obesity in New Zealand, according to an interview-based study. A total of 64 semi-structured interviews were conducted for 71 participants of a family-based multidisciplinary healthy lifestyle programme for children and adolescents. Half the interviews were with Māori families. Five health system factors affecting engagement were identified via thematic analysis: the national policy environment, funding constraints, lack of coordination between services, difficulty navigating the health system, and the cost of primary health care. The authors concluded that comprehensive approaches, accompanied by a clear implementation strategy and coordinated across sectors, are needed to improve engagement. [ABSTRACT FROM AUTHOR]

An interview-based study has highlighted the multifaceted benefits of participating in waka ama. As well as the health benefits for paddlers, waka ama also has a strong tikanga, encouraging use of te reo Māori through karakia, waiata, and terms associated with waka. Opportunities are created for participants to experience and connect with the natural environment. The researchers concluded that their study shows effective ways of improving health and well-being within communities with a particular focus on waiora, the spiritual connection between hauora and the environment. [ABSTRACT FROM AUTHOR]

Māori are significantly less likely to receive colonoscopy than NZ Europeans, according to a retrospective comparative study conducted at Whanganui Hospital. The study analysed 2962 colonoscopies (385 from Māori; 2577 from NZ Europeans) between September 2016 and March 2020. The rate of colonoscopy provision in participants aged ≥40 years was 6.1% among Māori versus 9.1% among NZ Europeans (p < 0.0001). However, colonoscopy completion rates, colonoscope withdrawal times and polyp detection rates were similar between Māori and NZ Europeans. While the adenoma detection rate was significantly lower in Māori than NZ Europeans (32.7% vs 40.0%; p = 0.028), this was not observed when participants were stratified by 10-year age cohorts. The authors concluded that improving equity requires the addition of colonoscopy provision rates, across ethnic groups, to other key performance indicators. [ABSTRACT FROM AUTHOR]

In a web-based survey of 1824 New Zealanders conducted before the COVID-19 vaccine rollout, 70% of respondents indicated they would likely take the vaccine once available. Survey respondents were part of a large, diverse, pre-existing social research sampling frame. Respondents who were unsure about or unlikely to get the vaccine were more likely to be young, female, and less educated, and were primarily concerned about unknown future side effects. There was no statistical association between ethnicity and vaccine hesitancy. The researchers suggested that public health efforts aimed at increasing vaccine acceptance among Māori and Pacific peoples should focus on inequities in health care access to increase uptake. [ABSTRACT FROM AUTHOR]

Public health researchers have proposed an expansion of the national COVID-19 alert level system. They note that several aspects of the current system have not worked adequately for Māori. The revised alert levels range from 0 through 6, with Levels 0-1 representing prepare (green), Levels 2-4 representing stop the spread (amber) and Levels 5-6 representing stay-at-home (red). Benefits of the revised system include: upholding Te Tiriti and implementing a more equitable response, better calibrating controls to the level of risk, responding to new knowledge, signalling improvements and innovation, supporting harmonisation with Australia (and the wider world), and establishing protective measures for a safer future. [ABSTRACT FROM AUTHOR]

A Kaupapa Māori meta-synthesis has evaluated the epidemiology of chronic kidney disease (CKD) in indigenous peoples. Quantitative studies involving Māori, Aboriginal and Torres Strait Islander, Métis, First Nations Peoples of Canada, First Nations Peoples of the United States of America, Native Hawaiian and Indigenous Peoples of Taiwan were screened, and 180 studies published up to 31 December 2019 were included. The David R Williams framework was used to categorise findings. Biological processes, particularly type 2 diabetes and cardiovascular disease, were frequently reported as the principal cause of health inequities in indigenous peoples with CKD. Social and basic causes of disparities, including racism, economic and political/legal structures and socioeconomic status, were infrequently reported or absent in the reviewed literature. [ABSTRACT FROM AUTHOR]