Issue 246 - 17 February 2022

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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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

Tu mai te oriori, nau mai te hauora! A Kaupapa Māori Approach to Infant Mental Health: Adapting Mellow Parenting for Māori Mothers in Aotearoa, New Zealand
Parenting programs have been shown to improve children’s relationships with their parents/caregivers, and reduce problem behaviours, but little research has focused on outcomes for Indigenous families. The aim of this pilot study, published in the Journal of Indigenous Wellbeing, was to evaluate the acceptability and effectiveness of Hoki ki te Rito (HKTR)/Mellow Parenting program, for Māori mothers in South Auckland, New Zealand.

Health Equity (New Zealand)

Inequities and perspectives from the COVID-Delta outbreak: The imperative for strengthening the Pacific nursing workforce in Aotearoa New Zealand
The COVID-19 Delta August 2021 outbreak in Aotearoa New Zealand initially affected Pacific communities more than any other group, spreading later and rapidly to Māori. From the outset of the global pandemic, historical knowledge of health inequities and the adverse effect of previous epidemics and pandemics, signaled that Pacific peoples, and Māori, would be disproportionately affected by COVID-19. The purpose of this article, published in Nursing Praxis, is to provide an overview of the COVID-19 pandemic in relation to Pacific communities and to begin to capture the learnings for the health system and the Pacific nursing workforce.

COVID-19 among Indigenous communities: Case studies on Indigenous nursing responses in Australia, Canada, New Zealand, and the United States
Globally, Indigenous Peoples experience disparate COVID-19 outcomes. This paper, published in Nursing Praxis, presents case studies from Aotearoa New Zealand, Australia, Canada, and the United States of America and explores aspects of government policies, public health actions, and Indigenous nursing leadership for Indigenous communities during a pandemic.

Health Equity (International)

How effects on health equity are assessed in systematic reviews of interventions
Enhancing health equity is endorsed in the Sustainable Development Goals. The failure of systematic reviews to consider potential differences in effects across equity factors is cited by decision-makers as a limitation to their ability to inform policy and program decisions. The objective of this Cochrane Review was to explore what methods systematic reviewers use to consider health equity in systematic reviews of effectiveness.

Quality Improvement (New Zealand)

What makes an effective Quality Improvement Manager? A qualitative study in the New Zealand Health System
Quality improvement is an international priority, and health organisations invest heavily in this endeavour. Little, however, is known of the role and perspectives of Quality Improvement Managers who are responsible for quality improvement implementation. This study, published in BMC Health Services Research, explored the quality improvement managers' accounts of what competencies and qualities they require to achieve day-to-day and long-term quality improvement objectives.

Hospital Productivity (International)

The deployment of balanced scorecard in health care organizations: is it beneficial? A systematic review
Balanced Scorecard (BSC) has been implemented for three decades to evaluate and improve the performance of organizations. This systematic review, published in BMC Health Services Research, performed a comprehensive and rigorous methodological approach to figure out the impact of Balanced Scorecard implementation in Health Care Organizations.

Cancer Services (New Zealand)

The Role of the Indigenous Patient Navigator: A Scoping Review
Healthcare systems are complex and as a result patients may experience fragmentation of services. Indigenous populations experience increasingly disproportionate health disparities compared to non-Indigenous populations. Patient navigation is known as a patient-centered approach to empower individuals to connect with appropriate services. Literature surrounding the Indigenous Patient Navigator (IPN) remains sparse necessitating this scoping review. The purpose of this review, published in The Canadian Journal of Nursing Research, was to map the current state of the role of the IPN internationally within Canada, United States, Australia and New Zealand.

Nutrition support in oncology care in Aotearoa New Zealand: current practice, and where to from here?
This research, published in the New Zealand Medical Journal, sought to identify and understand what nutrition-related information and support is available to people undergoing cancer treatment.

Cardiovascular Disease and Diabetes (New Zealand)

Exploring rural and remote patients' experiences of health services for kidney disease in Aotearoa New Zealand: An in-depth interview study
People with chronic kidney disease (CKD) living in rural communities have increased risks of death, morbidity, hospitalisation and poorer quality of life compared with people with CKD living in urban areas. This study, published in Nephrology, explores the experiences and perceptions of rural and remote patients and families in relation to accessing health services for kidney disease in Aotearoa New Zealand.

Cardiovascular Disease and Diabetes (International)

High versus low‐added sugar consumption for the primary prevention of cardiovascular disease
High intake of added sugar have been suggested to impact the risk for cardiovascular disease (CVD). Knowledge on the subject can contribute to preventing CVD. The objective of this Cochrane Review was to assess the effects of a high versus low‐added sugar consumption for primary prevention of CVD in the general population.

Primary Health Care (New Zealand)

Clinical and cost-effectiveness of telehealth for Indigenous and culturally and linguistically diverse (CALD) people: a scoping review
The objective of this review, published in Ethnicity & Health, was to examine the modalities and clinical and non-clinical effectiveness of telehealth services available to people from Indigenous and culturally and linguistically diverse backgrounds (CALD).

Steadfast is the rock: Primary health care Māori nurse leaders discuss tensions, resistance, and their contributions to prioritise communities and whānau during COVID-19
Historical experience from previous pandemics, together with knowledge of significant and perpetuating health inequities, led to predictions that Māori and Pacific peoples would experience greater morbidity and be hardest hit economically. Steadfast is the rock describes the mahi (work and actions) of three Māori nurse leaders through the first COVID-19 lockdown in Aotearoa New Zealand in 2020. Through kōrero (discussion and dialogue), this article, published in Nursing Praxis, draws on their experiences of working in a large mainstream primary health entity working across the Northland region of Aotearoa as they navigated their way within and across health sector providers and organisations to protect the health and wellbeing of whānau (families).

Primary Health Care (International)

Self‐management for people with chronic obstructive pulmonary disease
Self‐management interventions help people with chronic obstructive pulmonary disease (COPD) to acquire and practise the skills they need to carry out disease‐specific medical regimens, guide changes in health behaviour and provide emotional support to enable them to control their disease. The objective of this Cochrane Review was to evaluate the effectiveness of COPD self‐management interventions compared to usual care in terms of health‐related quality of life (HRQoL) and respiratory‐related hospital admissions.

Primary Mental Health (New Zealand)

Digital tools for mental health and wellbeing
There is a huge amount of mental health information available on apps and the internet. Research suggests that some people like using these online tools as they can help remove barriers to other help options (such as the time and cost it takes to access appointments). However, there is still a lot to learn about what digital mental health options work, who uses them, and what opportunities there are to improve them. Te Hiringa Hauora/Health Promotion Agency commissioned Victoria University of Wellington’s Digital Mental Health Lab to help them answer these questions.

Prenatal determinants of depressive symptoms in childhood: Evidence from Growing Up in New Zealand
Young people who experience depression are at an increased risk of adverse psychosocial and developmental outcomes that can persist over the lifecourse. Identifying maternal prenatal risk factors that may contribute to childhood depressive symptoms can be useful when considering mental health intervention. The current study, published in the Journal of Affective Disorders, included 3,925 children from the Growing Up in New Zealand (GUiNZ) study who had complete data for self-reported depressive symptoms and mothers' antenatal information.

Primary Mental Health (International)

Improving Depression Screening in Primary Care: A Quality Improvement Initiative
The increase in depression during the COVID-19 pandemic underscores the importance of systematic approaches to identify individuals with mental health concerns. Primary care is often underutilized for depression screening, and it is not clear how practices can successfully increase screening rates. This study, published in the Journal of Community Health, describes a quality improvement initiative to increase depression screening in five Family Medicine clinics.

Smoking Cessation (International)

Heated tobacco products for smoking cessation and reducing smoking prevalence
Heated tobacco products (HTPs) are designed to heat tobacco to a high enough temperature to release aerosol, without burning it or producing smoke. They differ from e‐cigarettes because they heat tobacco leaf/sheet rather than a liquid. Companies who make HTPs claim they produce fewer harmful chemicals than conventional cigarettes. Some people report stopping smoking cigarettes entirely by switching to using HTPs, so clinicians need to know whether they are effective for this purpose and relatively safe. Also, to regulate HTPs appropriately, policymakers should understand their impact on health and on cigarette smoking prevalence. The objective of this Cochrane Review was to evaluate the effectiveness and safety of HTPs for smoking cessation and the impact of HTPs on smoking prevalence.

Behavioural programmes for cigarette smoking cessation: investigating interactions between behavioural, motivational, and delivery components in a systematic review and component network meta-analysis
The aim of this review, published in Addiction, was to investigate the comparative and combined effectiveness of four types of components of behavioural interventions for cigarette smoking cessation: behavioural (e.g. counselling), motivational (e.g. focus on reasons to quit), delivery mode (e.g. phone), and provider (e.g. nurse). 

Weight Management (International)

Low‐carbohydrate versus balanced‐carbohydrate diets for reducing weight and cardiovascular risk
Debates on effective and safe diets for managing obesity in adults are ongoing. Low‐carbohydrate weight‐reducing diets (also known as 'low‐carb diets') continue to be widely promoted, marketed and commercialised as being more effective for weight loss, and healthier, than 'balanced'‐carbohydrate weight‐reducing diets. The objective of this Cochrane Review was to compare the effects of low‐carbohydrate weight‐reducing diets to weight‐reducing diets with balanced ranges of carbohydrates, in relation to changes in weight and cardiovascular risk, in overweight and obese adults without and with type 2 diabetes mellitus (T2DM).

Disability Services (New Zealand)

Disability Toolkit for Policy
The Office for Disability Issues has published a disability analysis tool to help policy practitioners explore the disability implications of their policies.

Key Ministry of Health Publications

Review of the Ministry of Health-funded Rongoā Sector
This publication reviews the Ministry of Health funded rongoā Māori sector and provides insights and evidence into the matters and issues faced by the sector.

District Health Board Initiative

New sensory garden will support good mental health
A Dargaville clinic is building a new sensory garden to help relieve distress in people who battle mental illness and addictions. The 13m by 12m garden will be built at Dargaville Hospital, outside its Mental Health & Addictions clinic. The idea for the garden came from clinic staff and is supported by people who attend there for treatment.

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.