Issue 244 - 16 December 2021

Welcome to the fortnightly Health Improvement and Innovation Digest. The Digest has links to key evidence of interest, with access to new content arranged by topic.

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Thank you for reading the Health Improvement and Innovation Digest this year. Our next issue will be sent on the 3rd of February 2022. Wishing you all the best over the holidays!

Article Access

For articles that aren't open access, contact your DHB library, or organisational or local library for assistance in accessing the full text. If your organisation has a subscription, you may be able to use the icon under full text links in PubMed to access the full article.

Māori Innovation

Enhancing Well-Being and Social Connectedness for Māori Elders Through a Peer Education (Tuakana-Teina) Programme: A Cross-Sectional Baseline Study
Māori kaumātua (elders) face stark health and social inequities compared to non-Māori New Zealanders. The tuakana-teina (older sibling-younger sibling) peer education programme is a strengths-based approach to enhance well-being and social connectedness. The purpose of this study, published in Frontiers in Public Health, is to present the baseline data from this programme and identify correlates of well-being outcomes.

‘Why would you give your children to something you don’t trust?’: Rangatahi health and social services and the pursuit of tino rangatiratanga
Persistent health inequities between rangatahi Māori (Indigenous young people) and other young people within Aotearoa New Zealand are incurred by a colonial machinery of institutions, service systems and sociocultural contexts that facilitates the marginalisation of Māori. Despite a skilled and dedicated Māori workforce, current service contexts severely limit the innovation of Māori practitioners working from a basis of mātauranga Māori (Māori ways of knowing and being), and curtail their ability to support rangatahi Māori and their whānau (community of related families). This article, published in Kōtuitui, reports on an interview study with 13 Māori practitioners in youth development, exploring their struggles, strengths and strategies, as part of a larger project exploring rangatahi wellbeing and whanaungatanga (connectedness and relationality).

Health Equity (New Zealand)

Indigenous Māori experiences of fundamental care delivery in an acute inpatient setting: A qualitative analysis of feedback survey data
This study, published in the Journal of Clinical Nursing, aimed to explore inpatient healthcare delivery experiences of Māori (New Zealand's Indigenous people) patients and their whānau (extended family network) at a large tertiary hospital in New Zealand to determine why Māori are less satisfied with the relational and psychosocial aspects of fundamental care delivery compared to other ethnic groups; identify what aspects of care delivery are most important to them; and contribute to the refinement of the Fundamentals of Care framework to have a deeper application of Indigenous concepts that support health and well-being.

Quality Improvement (New Zealand)

Older Māori and aged residential care in Aotearoa | Ngā kaumātua me te mahi tauwhiro i Aotearoa
This report by Joanna Hikaka and Ngaire Kerse was commissioned by the Health Quality & Safety Commission as a ‘thought-piece on Māori and aged residential care (ARC)’.

Hospital Productivity (International)

Redesigning the Process for Scheduling Elective Orthopaedic Surgery: A Combined Lean Six Sigma and Person-Centred Approach
The Health Service Executive Ireland model of care for elective surgery supports the delivery of elective surgical care in achieving both process and clinical outcomes. This project, published in the International Journal of Environmental Research and Public Health, was conducted in the Orthopaedic Department. Following an outpatient consultation with an orthopaedic surgeon, patients who required surgical intervention were scheduled for their intervention by the administrative team.

Cancer Services (International)

Undertaking general practice quality improvement to improve cancer screening - a thematic analysis of provider experiences
Cancer is a major cause of illness and death, and its incidence and mortality can be reduced through effective screening. In order to improve below target screening rates in one region of Australia, the local Primary Health Network supported local general practices to implement a range of quality improvement initiatives. This article, published in BMC Family Practice, is an analysis of provider experiences.

Emergency Department Services (International)

Effectiveness of Telehealth in Rural and Remote Emergency Departments: Systematic Review
Emergency telehealth has been used to improve access of patients residing in rural and remote areas to specialist care in the hope of mitigating the significant health disparities that they experience. Patient disposition decisions in rural and remote emergency departments (EDs) can be complex and largely dependent on the expertise and experience available at local (receiving-end) hospitals. Although there has been some synthesis of evidence of the effectiveness of emergency telehealth in clinical practice in rural and remote EDs for nonacute presentations, there has been limited evaluation of the influence of contextual factors such as clinical area and acuity of presentation on these findings. The aims of this systematic review, published in the Journal of Medical Internet Research, are to examine the outcome measures used in studying the effectiveness of telehealth in rural and remote EDs and to analyse the clinical context in which these outcome measures were used and interpreted.

Improving outcomes for older people in the emergency department: a review of reviews
There has been a recognised trend of increasing use of emergency and urgent care and emergency departments (EDs) by older people, which is marked by a substantial evidence base reporting interventions for this population and guidance from key organisations. Despite this, outcomes for this population remain suboptimal. A plethora of reviews in this area provides challenges for clinicians and commissioners in determining which interventions and models of care best meet people’s needs. The aim of this review, published in the Emergency Medicine Journal, was to identify effective ED interventions which have been reported for older people, and to provide a clear summary of the myriad reviews and numerous intervention types in this area.

Cardiovascular Disease and Diabetes (New Zealand)

Assessing youth empowerment and co-design to advance Pasifika health: a qualitative research study in New Zealand
The Pasifika Prediabetes Youth Empowerment Programme (PPYEP) was a community-based research project that aimed to investigate empowerment and co-design modules to build the capacity of Pasifika youth to develop community interventions for preventing prediabetes. This paper, published in the Australian and New Zealand Journal of Public Health, reports findings from a formative evaluation process of the programme using thematic analysis. It emphasises the adoption, perceptions and application of empowerment and co-design based on the youth and community providers’ experiences.

Cardiovascular Disease and Diabetes (International)

Delivering the Diabetes Remission Clinical Trial (DiRECT) in primary care: A mixed-methods study of experiences of health care professionals
The Diabetes Remission Clinical Trial (DiRECT) used a formula total diet replacement programme followed by structured weight loss maintenance to induce and sustain weight loss and remission of type 2 diabetes in 36% of participants after two years. Nurses and dietitians delivering DiRECT in 22 primary care practices in Tyneside and Scotland provided behavioural support to participants. Participant experiences with DiRECT highlighted the key role of support by healthcare professionals (HCPs). This study, published in Diabetic Medicine, evaluated HCPs’ experiences with DiRECT.

Communication strategies in the prevention of type 2 diabetes and gestational diabetes in vulnerable groups: a scoping review
The global prevalence of diabetes is nearly 9%, with an upward trend in type 2 diabetes mellitus (T2DM) and gestational diabetes (GDM). Although evidence shows that vulnerable groups are affected disproportionally, these groups are difficult to reach in terms of preventive measures. This review, published in Systematic Reviews, explores the evidence around communication strategies and/or public awareness campaigns in the prevention of type 2 diabetes and gestational diabetes in vulnerable groups.

Primary Health Care (International)

Relational continuity of care in community pharmacy: A systematic review
Relational continuity of care (COC) is becoming an important concept related to improving healthcare quality, reducing medical costs and increasing patient satisfaction with primary care. While community pharmacy (CP) has a considerable role in primary care, there are few reports dedicated to the role of relational COC in CP. This study, published in Health & Social Care in the Community, reviewed the existing evidence of relational COC in CP and its effect on patients.

Primary Mental Health (International)

Implementing the Routine Use of Electronic Mental Health Screening for Youth in Primary Care: Systematic Review
Adolescents often present at primary care clinics with nonspecific physical symptoms when, in fact, they have at least 1 mental health or risk behaviour (psychosocial) issue with which they would like help but do not disclose to their care provider. Despite global recommendations, over 50% of youths are not screened for mental health and risk behaviour issues in primary care. This review, published in JMIR mental health, aimed to examine the implementation, acceptability, feasibility, benefits, and barriers of e-screening tools for mental health and risk behaviours among youth in primary care settings.

Smoking Cessation (International)

How can hospitals change practice to better implement smoking cessation interventions? A systematic review
Smoking cessation reduces the risk of death, improves recovery, and reduces the risk of hospital readmission. Evidence and policy support hospital admission as an ideal time to deliver smoking-cessation interventions. However, this is not well implemented in practice. In this systematic review, published in CA: a cancer journal for clinicians, the authors summarise the literature on smoking-cessation implementation strategies and evaluate their success to guide the implementation of best-practice smoking interventions into hospital settings.

Weight Management (New Zealand)

Māori first foods: a Māori centred approach to understanding infant complementary feeding practices within Māori whānau
This study, published in Kōtuitui, sought to explore infant complementary feeding practices among Māori whānau and the extent to which they may be informed by traditional and culturally specific practices, knowledge, personal beliefs and values. This study also endeavoured to explore how these practices, values and beliefs may have changed across time and between generations.

Weight Management (International)

Mediterranean diet and adiposity in children and adolescents: A systematic review
The aim of this study, published in Obesity Reviews, was to summarise, through a systematic review, the current evidence from dietary intervention and observational studies on the impact of adherence to the Mediterranean diet on adiposity markers and obesity in children and adolescents.

Cultural adaptations of obesity-related behavioral prevention interventions in early childhood: A systematic review
Interventions for obesity prevention can effectively reduce obesity-related behaviours in young children. Understanding how to leverage and adapt evidence-based interventions is needed to improve reach among culturally and linguistically diverse families. This systematic review, published in Obesity Reviews, aimed to synthesise the approaches and outcomes of culturally adapted early childhood obesity-related behavioural prevention interventions.

Oral Health (International)

Screening and Interventions to Prevent Dental Caries in Children Younger Than 5 Years: US Preventive Services Task Force Recommendation Statement
Dental caries is the most common chronic disease in children in the US. Dental caries in early childhood is associated with pain, loss of teeth, impaired growth, decreased weight gain, negative effects on quality of life, poor school performance, and future dental caries. The Screening and Interventions to Prevent Dental Caries in Children Younger Than 5 Years: US Preventive Services Task Force Recommendation Statement, published in JAMA, updates the 2014 recommendation.

Disability Services (International)

An overview of systematic reviews to determine the impact of socio-environmental factors on health outcomes of people with disabilities
People with disabilities are often subject to intersecting layers of social and economic disadvantage and other barriers that drive health inequity. As a result, they frequently experience worse health than people without disabilities, beyond the direct effects of their health condition or impairment. The aim of this overview of systematic reviews, published in Health & Social Care in the Community, was to summarise the evidence on the impact of socio-environmental factors (i.e. social, physical or attitudinal) on the health outcomes of disabled people.

Key Ministry of Health Publications

Smokefree Aotearoa 2025 Action Plan - Auahi Kore Aotearoa Mahere Rautaki 2025
This plan sets out the actions the Ministry will take over the next four years and beyond to achieve Smokefree Aotearoa 2025 and ultimately end the harm smoking causes.

Strategic Intentions 2021-25
This publication showcases the strategic intentions of the Ministry over the next four years. 

Data and Information Strategy for Health and Disability: He Rautaki Raraunga, He Rautaki Pārongo mō te Pūnaha Hauora, Whaikaha hoki
The Ministry of Health has developed a Data and Information Strategy for Health and Disability to set clear priorities for the sector on how to improve the ways we manage, use and share health and disability data and information. 

Ministry of Health Annual Report for the year ended 30 June 2021
The 2020/21 Annual Report summarises the Ministry’s major work programmes and achievements, and demonstrates our progress towards our Strategic Intentions 2017/21, and the strategic objectives set out in Ta Tatou Rautaki | Our Strategy and Pae Ora | Healthy Futures. 

District Health Board Initiative

Paul Sayers: Youth champion
Sayers is Capital & Coast DHB's Celebrating Success' 2021 Outstanding Leadership award winner. Through boxing and implementing strong foundational values on life such as 'respect', he has led many youth from the wider Porirua community suffering from depression, loneliness, and even suicidal thinking, to confident, thriving, healthier mind-sets.

The information available on or through this newsletter does not represent Ministry of Health policy. It is intended to provide general information to the health sector and the public, and is not intended to address specific circumstances of any particular individual or entity.