Issue 260 - 1 September 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.

You can forward this newsletter to others who may be interested in receiving it. They can register and subscribe here. You can also access other recent issues of the digest here.

If you have any queries, please email us at library@health.govt.nz.

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

Securing cultural identity for whānau well-being: a qualitative study of a whānau-led initiative
Colonial processes have severely disrupted Māori social organisation and attachment to place through land alienation and different experiences of urban migration. As a result, many whānau (extended family) have lost connection to their whenua (land) and ancestral marae (communal and sacred meeting ground) causing intergenerational loss of knowledge and values that secure cultural identity and belonging. Finding accessible pathways to restore fragmented knowledge and reconnect whānau to te ao Māori (Māori world) is an essential part of securing cultural identity to facilitate well-being. This qualitative study, published in AlterNative, explores the social, cultural, and health benefits experienced by whānau involved in a whānau-led initiative at their ancestral marae.

Health Equity (New Zealand)

Kōrero Mai: A Kaupapa Māori study exploring the experiences of whānau Māori caring for tamariki with atopic dermatitis
Racism and colonisation have caused the systemic exclusion of Indigenous Māori populations in Aotearoa (New Zealand) and the perpetuation of health inequities. Atopic dermatitis, a chronic skin condition, is one such example where Māori tamariki (children) are disproportionately affected. International research highlights the challenges of caring for children with atopic dermatitis; however, there has been no such research in Aotearoa. This small qualitative study, published in Nursing Praxis, aimed to explore the experiences of Māori parents caring for their tamariki with atopic dermatitis.

Weaving together the many strands of Indigenous nursing leadership: Towards a Whakapapa model of nursing leadership
This article, published in Nursing Praxis, builds on current leadership theories and incorporates mātauranga Māori (Māori knowledge systems) and Kaupapa Māori methodology to inform a new model of Indigenous nursing leadership.

Māori experiences of hospital care: a qualitative systematic review
Indigenous experiences of hospitalisation may contribute to maintenance of Indigenous health inequities. This qualitative systematic review, published in AlterNative, explores Māori experiences of hospital care within New Zealand.

Pacific Health Promotion Action Plan 2022
The Pacific Health Promotion Action Plan, published by the Health Promotion Agency, presents an opportunity to direct what health promotion means for Pacific peoples through a future focused, action plan designed by Pacific, for Pacific.

Indigenous adolescent health in Aotearoa New Zealand: Trends, policy and advancing equity for rangatahi Maori, 2001-2019
Rangatahi Māori, the Indigenous adolescents of Aotearoa New Zealand (NZ), have poorer health outcomes than Pākehā (NZ European /other European/"White") adolescents. This study, published in The Lancet Regional Health Western Pacific, explored the influence of policies for Indigenous youth by presenting health trends, inequities and contrasting policy case examples: tobacco control and healthcare access.

Health Equity (International)

Self-assessment tools for assessing cultural competency: a rapid review of literature
Established tools that assess cultural competency in the health workforce could contribute to providing culturally safe care to First Nations peoples. This review, published in AlterNative, evaluated the characteristics of self-assessment tools used to assess cultural competency and ascertain the context and outcomes of their use.

Cancer Services (New Zealand)

Pasifika women's knowledge and perceptions of cervical-cancer screening and the implementation of self-testing in Aotearoa New Zealand: A qualitative study
In Aotearoa New Zealand, Pasifika women have a higher rate of cervical cancer incidence and mortality than European/Other women and a lower screening rate. Despite actions to reduce the barriers, there has been little change in screening coverage for Pasifika women since 2007. Novel strategies are therefore required. Persistent cervical infection with oncogenic human papillomavirus (HPV) causes virtually all cervical cancers and HPV testing will be implemented in Aotearoa in 2023, with women being able to choose to self-test. This study, published in The Lancet Regional Health Western Pacific, undertook a qualitative focus group (FG) study with Pasifika women to explore their perspectives on the barriers to, and facilitators of, HPV self-testing and how best to implement this in Aotearoa.

Cancer Services (International)

Delivery of cancer care via an outpatient telephone support line: a cross-sectional study of oncology nursing perspectives on quality and challenges
Patient support lines (PSLs) assist in triaging clinical problems, addressing patient queries, and navigating a complex multi-disciplinary oncology team. While providing support and training to the nursing staff who operate these lines is key, there is limited data on their experience and feedback. This study, published in Supportive Care in Cancer, was a cross-sectional study of oncology nurses' (ONs') perspectives on the provision of care via PSLs at a tertiary referral cancer centre.

Cardiovascular Disease and Diabetes (New Zealand)

What nursing interventions and healthcare practices facilitate type 1 diabetes self-management in young adults? An integrative review
This integrative review, published in Nursing Praxis, aimed to explore how current nursing and healthcare practices can be designed to facilitate effective type 1 diabetes (T1D) self-management in young adults aged 16-25 years.

Lower versus Higher Glycemic Criteria for Diagnosis of Gestational Diabetes
Treatment of gestational diabetes improves maternal and infant health, although diagnostic criteria remain unclear. This study, published in the New England Journal of Medicine, randomly assigned women at 24 to 32 weeks’ gestation in a 1:1 ratio to be evaluated for gestational diabetes with the use of lower or higher glycemic criteria for diagnosis.

Cardiovascular Disease and Diabetes (International)

Understanding strategies to improve medication adherence among persons with type 2 diabetes: A scoping review
The objectives of this scoping review, published in Diabetic Medicine, were to identify the target audience and contexts in which strategies to improve type 2 diabetes mellitus (T2DM) medication adherence have been used; provide an overview of behaviour change techniques (BCTs) used; describe the determinants of behaviour targeted by strategies; and to identify current gaps in strategies.

Primary Health Care (New Zealand)

Medical Treatment for Rheumatic Heart Disease: A Narrative Review
Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are rare in high-income countries; however, in Aotearoa New Zealand ARF and RHD disproportionately affect Indigenous Māori and Pacific Peoples. This narrative review, published in Heart, Lung & Circulation, explores the evidence regarding non-surgical management of patients with clinically significant valve disease or heart failure due to RHD.

Primary Health Care (International)

Pulmonary rehabilitation versus usual care for adults with asthma
Asthma is a respiratory disease characterised by variable airflow limitation and the presence of respiratory symptoms including wheeze, chest tightness, cough and/or dyspnoea. Exercise training is beneficial for people with asthma; however, the response to conventional models of pulmonary rehabilitation is less clear. The objective of this Cochrane Review was to evaluate, in adults with asthma, the effectiveness of pulmonary rehabilitation compared to usual care on exercise performance, asthma control, and quality of life (co‐primary outcomes), incidence of severe asthma exacerbations/hospitalisations, mental health, muscle strength, physical activity levels, inflammatory biomarkers, and adverse events.

Social Prescribing: Systematic Review of the Effectiveness of Psychosocial Community Referral Interventions in Primary Care
Social prescribing (SP) aims to provide targeted psychosocial support and close the gap between medical and non-medical services. This review, published in the International Journal of Integrated Care, assesses the effectiveness of community-based SP interventions.

Telehealth for the Longitudinal Management of Chronic Conditions: Systematic Review
Extensive literature support telehealth as a supplement or adjunct to in-person care for the management of chronic conditions such as congestive heart failure (CHF) and type 2 diabetes mellitus (T2DM). Evidence is needed to support the use of telehealth as an equivalent and equitable replacement for in-person care and to assess potential adverse effects. Objective: This systematic review, published in the Journal of Medical Internet Research, addressed the following question: among adults, what is the effect of synchronous telehealth (real-time response among individuals via phone or phone and video) compared with in-person care (or compared with phone, if synchronous video care) for chronic management of CHF, chronic obstructive pulmonary disease, and T2DM on key disease-specific clinical outcomes and health care use?

Primary Mental Health (New Zealand)

Non-Indigenous privilege in health, justice and social services preceding first episode psychosis: A population-based cohort study
There is evidence of disparities between non-Indigenous and Indigenous incidence of psychotic disorders. Despite these disparities being a clear signpost of the impact of structural racism, there remains a lack of evidence to target institutional factors. This study, published in The Australian and New Zealand Journal of Psychiatry, aimed to investigate non-Indigenous and Indigenous differences in government service use prior to first episode diagnosis as a means of identifying points of intervention to improve institutional responses.

Primary Mental Health (International)

Experiences of treatment-resistant mental health conditions in primary care: a systematic review and thematic synthesis
Most adults fail to achieve remission from common mental health conditions based on pharmacological treatment in primary care alone. There is no data synthesising the reasons. This review, published in BMC Primary Care, addresses this gap through a systematic review and thematic synthesis to understand adults' experiences using primary care for treatment-resistant mental health conditions.

Oral Health (New Zealand)

Is childhood oral health the 'canary in the coal mine' for poor adult general health? Findings from two New Zealand birth cohort studies
This study, published in Community Dentistry and Oral Epidemiology, aimed to investigate whether childhood dental caries was associated with self-reported general health in midlife.

Key Ministry of Health Publications

Position statement and working definitions for racism and anti-racism in the health system in Aotearoa New Zealand
This position statement is a declarative step for the Ministry of Health. It formally outlines the Ministry’s position on racism, and signals expectations for the broader health system to take collective action against all forms of racism and racial health inequity. The position statement also includes a set of evidence-informed working definitions for racism and anti-racism that are fit for the Aotearoa context. 

Evolution of Racism and Anti-racism Literature Review & Summary Document – Whiria Te Muka Tangata
This first literature review for Ao Mai te Rā traces how understandings of racism and anti-racism have shifted over time and explores various concepts, language and definitions that have been used to date. The Ministry has also created a summary paper to ensure the evidence, insights, and research from the literature review are accessible for the general public.

Ministry of Health Consultations & Events

Have your say on Aotearoa New Zealand’s HIV Action Plan 2022-2032
The Ministry of Health has drafted an ambitious new HIV Action Plan with support from organisations representing communities living with and affected by HIV and health sector representatives. The HIV Action Plan is an exciting opportunity to increase the momentum of our HIV response and strive for an Aotearoa New Zealand where local HIV transmission is eliminated and people living with HIV have healthy lives free from stigma and discrimination. This consultation closes on the 12th of  September 2022.

Health Sector Initiative

Support for long-COVID sufferers in Hawke’s Bay
Hundreds of Hawke’s Bay people are struggling to bounce back to normal after having COVID-19, but support is at hand. Kate Te Pou, Nurse Practitioner at Te Whatu Ora Te Matau a Māui is part of the COVID Community Outreach Service which provides support to whaiora/patients when further assessment is needed to help people manage their health at home.

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.