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Abstract Background As a key determinant of ill-health, family violence is inadequately responded to within Aotearoa New Zealand health policy and practice. Without adequate system support, health professionals can often be unsure of what to do, or how to help. Developed in response to this system gap, ‘Atawhai’ aims to make it easier for primary care professionals to respond to family violence. Methods Underpinned by indigenous Māori customs, Atawhai combines complexity theory and participatory research methodologies to be responsive to the complexity involved in family violence. We worked with 14 primary care professionals across ten whakawhitiwhiti kōrero wānanga (meetings for deliberate dialogue) to identify and develop primary care system pathways and tools for responding to family violence. This paper focuses on the development of Atawhai through wānanga and observation methods. Methods used to capture change will be reported separately. Findings Atawhai is a relational response to family violence, focused on developing a network of trusted relationships between health and social care professionals to support safe responses to those accessing care. This study identified four key health system pathways to responsiveness and developed associated tools to support health care responsiveness to family violence. We found the quality of relationships, both among professionals and with those accessing care, coupled with critical reflection on the systems and structures that shape policy and practice are essential in generating change within primary care settings. Conclusions Atawhai is a unique health care response to family violence evidenced on empirical knowledge of primary care professionals. Our theoretical lens calls attention to parts of the system often obscured by current health care responses to family violence. Atawhai presents an opportunity to develop a grassroots-informed, long-term response to family violence that evolves in response to needs.

IntroductionSleep is vital for health in older adulthood. Ethnic disparities have been noted with regards to sleep health. However, culturally appropriate approaches to sleep as a broader social experience are lacking.MethodsHere, sleep-related group interviews were conducted in the form of hui (group meetings and discussions) with eleven participants of a health service intervention for older Māori (the Indigenous people of New Zealand) and their whānau (extended family). Notes were collated and analyzed thematically.ResultsFour key themes were constructed that represent the key conversations and ideas. These concerned the conceptualizing of sleep—including appreciation for its somatic role but also the spiritual properties of sleep states; the changing obligations around sleep and wake—including individual and communal time use and changing cultural and familial obligations with advancing age; and the barriers and facilitators for supporting sleep—including the social and spiritual nature of communal sleeping, the schedules and sleep of others, as well as holistic and environmental methods for relaxation. Findings demonstrate the multifaceted nature of sleep and aging among Māori. Culturally relevant interpretations of sleep practices and disturbances were offered and are beyond typical Western models which are predominantly medicalized.DiscussionThis work aids the understanding and representation of sleep as a social and cultural perspective within the New Zealand context. This provides foundations for future participatory research to design culturally appropriate approaches to assessing and supporting sleep health in forms that are meaningful for aging well across cultures.

While critical thinking is widely regarded as a key outcome of higher education, research has shown that in practice it is only developed when certain conditions are in place, relating to the pedagogical approach, the nature of the curriculum and the level of challenge, amongst other factors. This article reports on findings from a four-year mixed methods study in Botswana, Ghana and Kenya, aiming to investigate the factors underpinning the successful development of critical thinking amongst undergraduate students. A two-stage critical thinking assessment was conducted with students in 15 sites, showing that only some of the institutions were ensuring significant gains in students' critical thinking, even when endorsing learner-centred methods. The study points to the central importance of teaching orientations amongst lecturers, involving a deep shift in approaches to knowledge, and a facilitation rather than a transmission approach.

This article stems from participation in a TLRI research study, Renewing Participatory Democracy: Walking with Young Children to Story and Read the Land. It presents an account of the growing awareness of the place-based environmental and cultural relationship between Maunganui Kindergarten and Mauao.

BackgroundCardiometabolic diseases are highly prevalent in Aotearoa New Zealand. Dietary intake is a modifiable risk factor for such diseases and certain dietary patterns, specifically the Mediterranean diet (MedDiet), are associated with improved metabolic health. This study aims to test whether an intervention including a Mediterranean dietary pattern incorporating high quality New Zealand foods (NZMedDiet pattern) and behavior change science can improve the metabolic health of participants and their household/whānau.Methods and analysisThis is a multi-center, three-stage trial with two parallel group superiority randomized controlled trials (RCTs), and a longitudinal cohort study embedded within the trial design. The first RCT (RCT 1) is a comparison of the NZMedDiet pattern compared to usual diet for 12 weeks. The Behavior Change Wheel was used to select and implement strategies to support participant adherence to the NZMedDiet, such as web-based nutrition education on healthy shopping and cooking. The second (RCT 2) compares online social support to no online social support for 12 weeks, administered to participants immediately following RCT 1. The third stage is a longitudinal cohort study where all participants are followed from the beginning of their start of the active intervention for 12 months in total. The primary outcome measure for each stage is the metabolic syndrome severity score (MetSSS). The duration of enrolment is 12–15 months. The total recruitment target is 200 index participants and their household/whānau members who participate with them, and the primary analyses will be intention to treat on index participants.DiscussionThe trial will test whether the NZMedDiet pattern and behavior change support improves the cardiometabolic health of people in Aotearoa New Zealand.Clinical trial registrationhttps://www.anzctr.org.au/Default.aspx, identifier ACTRN12622000906752 and https://www.isrctn.com/, identifier ISRCTN89011056 (Spirit 2).

Abstract Background Atrial fibrillation (AF), the most common cardiac arrhythmia in the general population, has significant healthcare burden. Little is known about AF in octogenarians. Objective To describe the prevalence and incidence rate of AF in New Zealand (NZ) octogenarians and the risk of stroke and mortality at 5-year follow-up. Design Longitudinal Cohort Study. Setting Bay of Plenty and Lakes health regions of New Zealand. Subjects Eight-hundred-seventy-seven (379 indigenous Māori, 498 non-Māori) were included in the analysis. Methods AF, stroke/TIA events and relevant co-variates were established annually using self-report and hospital records (and ECG for AF). Cox proportional-hazards regression models were used to determine the time dependent AF risk of stroke/TIA. Results AF was present in 21% at baseline (Māori 26%, non-Māori 18%), the prevalence doubled over 5-years (Māori 50%, non-Māori 33%). 5-year AF incidence was 82.6 /1000-person years and at all times AF incidence for Māori was twice that of non-Māori. Five-year stroke/TIA prevalence was 23% (22% in Māori and 24% non- Māori), higher in those with AF than without. AF was not independently associated with 5-year new stroke/TIA; baseline systolic blood pressure was. Mortality was higher for Māori, men, those with AF and CHF and statin use was protective. In summary, AF is more prevalent in indigenous octogenarians and should have an increased focus in health care management. Further research could examine treatment in more detail to facilitate ethnic specific impact and risks and benefits of treating AF in octogenarians.

Vietnam has achieved near-universal access to compulsory schooling over the past two decades. However, inequalities between ethnic majority and minority students are stark at post-compulsory levels, where progression is selective based on academic criteria and ability to pay. In this article, we adopt a mixed-methods approach to examine quality and equity for ethnic minority students in upper secondary education. Across five provinces, we find that ethnic minority students attend "less effective" upper secondary schools than ethnic majority students. However, an in-depth case study of an ethnic minority boarding school in Lao Cai province provides an example of positive deviance. Guided by a targeted affirmative action policy, the provincial government invests a relatively high level of resources to provide fee-free, high-quality schooling for gifted ethnic minority students. We consider the extent to which such policies can redress socioeconomic inequalities in Vietnam, and wider lessons for creating more equitable education systems.

This study examines the trends in mathematics learning for Grade 4 pupils in Ethiopia based on a longitudinal survey of 33 schools from 2012-13 to 2018-19. The study employs unique data collected both at the start and end of the General Education Quality Improvement Program – Phase II (GEQIP-II) reform targeting the same schools in six regions. The data included repeated measures of pupil learning outcomes plus child socio-economic background, teacher, and school characteristics. Despite the implementation of the GEQIP-II reform, we found that pupils’ mathematics learning levels declined between 2012-13 and 2018-19. Progress in mathematics within the 2018-19 academic year improved slightly compared to 2012-13, but there is difference in magnitude of learning progress for the two periods between pupils across rural-urban locations, regional states, and family economic backgrounds. There is an overall improvement in school and teacher ‘quality’ between 2012 and 2019, while there is some evidence of changes in student composition between the two periods. Consistent with the GEQIP-II reform in terms of supporting access and retention, pupils in 2018-19 were more likely to have attended pre-school, less often absent from school, and less likely to have dropped out, compared to pupils in the same grade level in 2012-13. In 2018-19, pupils’ caregivers are less likely to be literate, they have fewer assets at home, and they travel a relatively longer distance to school. Differences in mathematics learning levels and learning progress between disadvantaged pupils (i.e., pupils from rural areas, emerging regions, poorest socio-economic background) and their relatively advantaged counterparts are discussed in relation to the GEQIP-II educational reform.

Universalization of basic education in India has increased demand for access to secondary schooling, yet concerns about quality and equity remain. While evidence of poor learning attainment continues to accumulate, less is known about classroom interactions or how these relate to student outcomes. In this article, we employ a unique data set that links school effectiveness and classroom observation data to examine the relationship between these dimensions. We show that teacher classroom practices represent a potentially distinctive aspect of school quality only weakly associated with effectiveness measures in two states in India. We discuss the implications of this for understandings of equity of learning opportunities.

Abstract Background Maintaining independence is of key importance to older people. Ways to enable health strategies, strengthen and support whanāu (family) at the community level are needed. The Ageing Well through Eating, Sleeping, Socialising and Mobility (AWESSOM) programme in Aotearoa/New Zealand (NZ) delivers five integrated studies across different ethnicities and ages to optimise well-being and to reverse the trajectory of functional decline and dependence associated with ageing. Methods Well-being, independence and the trajectory of dependence are constructs viewed differently according to ethnicity, age, and socio-cultural circumstance. For each AWESSoM study these constructs are defined and guide study development through collaboration with a wide range of stakeholders, and with reference to current evidence. The Compression of Functional Decline model (CFD) underpins aspects of the programme. Interventions vary to optimise engagement and include a co-developed whānau (family) centred initiative (Ngā Pou o Rongo), the use of a novel LifeCurve™App to support behavioural change, development of health and social initiatives to support Pacific elders, and the use of a comprehensive oral health and cognitive stimulation programme for cohorts in aged residential care. Running parallel to these interventions is analysis of large data sets from primary care providers and national health databases to understand complex multi-morbidities and identify those at risk of adverse outcomes. Themes or target areas of sleep, physical activity, oral health, and social connectedness complement social capital and community integration in a balanced programme involving older people across the ability spectrum. Discussion AWESSoM delivers a programme of bespoke yet integrated studies. Outcomes and process analysis from this research will inform about novel approaches to implement relevant, socio-cultural interventions to optimise well-being and health, and to reverse the trajectory of decline experienced with age. Trial registration The At-risk cohort study was registered by the Australian New Zealand Clinical Trials registry on 08/12/2021 (Registration number ACTRN 12621001679875 ).

Aims This study explores perspectives of on-pack alcohol warning labels, and how they might influence alcohol purchase and/or consumption behavior to inform culturally appropriate label design for effective behavior change. Methods New Zealand participants ≥18 years, who reported having purchased and consumed alcoholic beverages in the last month were recruited via a market research panel and grouped into 10 focus groups (n  = 53) by ethnicity (general population, Māori, and Pacific peoples), age group, and level of alcohol consumption. Participants were shown six potential alcohol health warning labels, with design informed by relevant literature, label framework, and stakeholder feedback. Interviews were transcribed and analyzed via qualitative (directed) content analysis. Results Effective alcohol labels should be prominent, featuring large red and/or black text with a red border, combining text with visuals, and words like "WARNING" in capitals. Labels should contrast with bottle color, be easily understood, and avoid excessive text and confusing imagery. Participants preferred specific health outcomes, such as heart disease and cancer, increasing message urgency and relevance. Anticipated behavior change included reduced drinking and increased awareness of harms, but some may attempt to mitigate warnings by covering or removing labels. Contextual factors, including consistent design and targeted labels for different beverages and populations, are crucial. There was a strong emphasis on collective health impacts, particularly among Māori and Pacific participants. Conclusions Our findings indicate that implementing alcohol warning labels, combined with comprehensive strategies like retail and social marketing campaigns, could effectively inform and influence the behavior of New Zealand's varied drinkers. [ABSTRACT FROM AUTHOR]

Primary school enrolment in Ethiopia has more than doubled over the past two decades. In spite of this impressive achievement, and as in many low- and middle-income countries that have experienced rapid expansion, the Ethiopian education system is characterised by a 'learning crisis' in which many children are leaving school without basic numeracy and literacy skills. In this paper, we explore the relationship between low learning levels and the features of an education system characterised by a sudden increase in learners from disadvantaged backgrounds, including 'first generation learners', or students whose parents have never been to school. Using unique longitudinal school survey data, we examine whether first-generation learner status represents an additional layer of disadvantage in the Ethiopian education system; the relationship between first-generation learner status and learning outcomes; and the educational trajectories of first generational learners through primary school. Based on these findings, we consider the implications of a rising tide of access for Ethiopia as it seeks to provide equitable, quality education for all by 2030.

India's informal economy accounts for more than half the country's GDP but is characterised by low levels of skills, and considerable barriers to skills development for workers. The Government of India has implemented ambitious policy initiatives for upskilling, designed to catalyse 'formalisation' of the economy, and improve productivity. However, evidence on skills development remains weak. Drawing on systematic review methodologies, this article reviews and synthesises the literature on the practical barriers to upskilling. It finds that access to, and quality of, training (especially for women) are serious limitations, while skills are often under-utilised in the absence of supportive labour market and wider business environment conditions. Training is often insufficiently linked to labour market and learner needs, and the capacity of the training system is limited. Government should increase investment in training for the informal sector, and consider strengthening incentives for training providers to focus on improving training quality and relevance.

Background. Each year, approximately 5000 New Zealanders are admitted to hospital with first-time acute coronary syndrome (ACS). The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS) is a prospective longitudinal cohort study embedded within the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry in six hospitals. The objective of MENZACS is to examine the relationship between clinical, genomic, and cardiometabolic markers in relation to presentation and outcomes post-ACS. Methods. Patients with first-time ACS are enrolled and study-specific research data is collected alongside the ANZACS-QI registry. The research blood samples are stored for future genetic/biomarker assays. Dietary information is collected with a food frequency questionnaire and information about physical activity, smoking, and stress is also collected via questionnaire. Detailed family history, ancestry, and ethnicity data are recorded on all participants. Results. During the period between 2015 and 2019, there were 2015 patients enrolled. The mean age was 61 years, with 60% of patients aged Conclusion. MENZACS represents a cohort with optimal contemporary management and will be a significant epidemiological bioresource for the study of environmental and genetic factors contributing to ACS in New Zealand’s multi-ethnic environment. The study will utilise clinical, nutritional, lifestyle, genomic, and biomarker analyses to explore factors influencing the progression of coronary disease and develop risk prediction models for health outcomes.

Abstract Background Lung Cancer is the leading cause of cancer deaths in Aotearoa New Zealand. Māori communities in particular have higher incidence and mortality rates from Lung Cancer. Diagnosis of lung cancer at an early stage can allow for curative treatment. This project aimed to document the barriers to early diagnosis and treatment of lung cancer in secondary care for Māori communities. Methods This project used a kaupapa Māori approach. Nine community hui (focus groups) and nine primary healthcare provider hui were carried out in five rural localities in the Midland region. Community hui included cancer patients, whānau (families), and other community members. Healthcare provider hui comprised staff members at the local primary healthcare centre, including General Practitioners and nurses. Hui data were thematically analysed. Results Barriers and enablers to early diagnosis of lung cancer were categorised into two broad themes: Specialist services and treatment, and whānau journey. The barriers and enablers that participants experienced in specialist services and treatment related to access to care, engagement with specialists, communication with specialist services and cultural values and respect, whereas barriers and enablers relating to the whānau journey focused on agency and the impact on whānau. Conclusions The study highlighted the need to improve communication within and across healthcare services, the importance of understanding the cultural needs of patients and whānau and a health system strategy that meets these needs. Findings also demonstrated the resilience of Māori and the active efforts of whānau as carers to foster health literacy in future generations.

The concept of 'approaches to learning' (Marton, 1976) has long assumed a position of central importance in the analysis of student learning outcomes. However, constructing effective measures of students' approaches to learning is a complex task, and it is an empirical question whether such measures transfer well across contexts. In this paper, we examine the functioning of a moderately modified version of one of the most commonly used assessment of approaches to learning -- the revised two-factor Study Process Questionnaire (R-SPQ2F) -- in three African contexts (Ghana, Kenya and Botswana). We first present confirmatory factor analysis, which demonstrates that the modified R-SPQ2F functions in these contexts as intended by the developers of the instrument. We then consider the potential utility of the R-SPQ2F in these contexts by examining its relationship with student background characteristics, educational experiences at universities and learning outcomes.

Abstract 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.

The rapid global rise of COVID-19 from late 2019 caught major manufacturers of RT-qPCR reagents by surprise and threw into sharp focus the heavy reliance of molecular diagnostic providers on a handful of reagent suppliers. In addition, lockdown and transport bans, necessarily imposed to contain disease spread, put pressure on global supply lines with freight volumes severely restricted. These issues were acutely felt in New Zealand, an island nation located at the end of most supply lines. This led New Zealand scientists to pose the hypothetical question: in a doomsday scenario where access to COVID-19 RT-qPCR reagents became unavailable, would New Zealand possess the expertise and infrastructure to make its own reagents onshore? In this work we describe a review of New Zealand's COVID-19 test requirements, bring together local experts and resources to make all reagents for the RT-qPCR process, and create a COVID-19 diagnostic assay referred to as HomeBrew (HB) RT-qPCR from onshore synthesized components. This one-step RT-qPCR assay was evaluated using clinical samples and shown to be comparable to a commercial COVID-19 assay. Through this work we show New Zealand has both the expertise and, with sufficient lead time and forward planning, infrastructure capacity to meet reagent supply challenges if they were ever to emerge.

Abstract Background Prescribing for older people is complex, and many studies have highlighted that appropriate prescribing in this cohort is not always achieved. However, the long-term effect of inappropriate prescribing on outcomes such as hospitalisation and mortality has not been demonstrated. The aim of this study was to determine the level of potentially inappropriate prescribing (PIP) for participants of the Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ) study at baseline and examine the association between PIP and hospitalisation and mortality at 12-months follow-up. Methods PIP was determined using STOPP/START. STOPP identified potentially inappropriate medicines (PIMs) prescribed, START identified potential prescribing omissions (PPOs). STOPP/START were applied to all LiLACS NZ study participants, a longitudinal study of ageing, which includes 421 Māori aged 80–90 years and 516 non-Māori aged 85 years. Participants’ details (e.g. age, sex, living arrangements, socioeconomic status, physical functioning, medical conditions) were gathered by trained interviewers. Some participants completed a core questionnaire only, which did not include medications details. Medical conditions were established from a combination of self-report, review of hospital discharge and general practitioner records. Binary logistic regression, controlled for multiple potential confounders, was conducted to determine if either PIMs or PPOs were associated with hospital admissions and mortality (p 0.05; adjusted models). 590 potential prescribing omissions were identified, affecting 58.1% Māori and 49.0% non-Māori. PPOs were associated with hospitalisation (p = 0.001 for Māori), but were not associated with risk of mortality (p > 0.05) for either cohort within the 12-month follow-up (adjusted models). Conclusion PPOs were more common than PIMs and were associated with an increased risk of hospitalisation for Māori. This study highlights the importance of carefully considering all indicated medicines when deciding what to prescribe. Further follow-up is necessary to determine the long-term effects of PIP on mortality and hospitalisation.