Issue 268 - 19 January 2023

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.

Health Equity (New Zealand)

Connecting hapū māmā (pregnant women) early to a lead maternity carer: striving for equity using the Best Start-Pregnancy Tool
In Aotearoa New Zealand, lead maternity carers (LMCs) provide maternity care through pregnancy and birth, until 6weeks’ postpartum. An early LMC connection in pregnancy is associated with better maternal and perinatal health outcomes. However, hapū māmā (pregnant women) may experience barriers to engaging with LMC, delaying screening, risk assessments, and education. These barriers contribute to inequitable health outcomes for Māori māmā and pēpi (Māori mothers and babies). A pro-equity approach to maternity care is warranted. The aim of this study, published in the Journal of Primary Health Care, was to investigate the LMC plan at the first point of contact with a primary care provider once pregnancy is confirmed, as well as selected risk factors to maternal and perinatal health for Māori and non-Māori hapū māmā.

Designing for health equity: A mixed method study exploring community experiences and perceptions of pharmacists' role in minor ailment care
Minor ailments are self-limiting, easily diagnosable and treatable conditions. Funded pharmacist minor ailments services (PMAS) have been posited to improve medicines access equity and, despite ethnic minorities across the globe experiencing reduced access to medicines and health care, PMAS internationally have not explicitly centered ethnic equity in service design or outcome measurement. The objective of this study, published in Research in Social & Administrative Pharmacy, was to explore Māori experiences of minor ailments care and perceptions of the pharmacists' role.

Cultural safety involves new professional roles: a rapid review of interventions in Australia, the United States, Canada and New Zealand
Cultural safety is a decolonizing and transformative approach to health care aimed at achieving health care that recognizes, respects and nurtures the needs, rights and identities of Indigenous peoples. Such a transformation requires new or radically reimagined professional roles. Based on a rapid review design, this synthesis, published in AlterNative, aimed to identify fundamental characteristics of cultural safety interventions that involved the creation or transformation of professional roles.

Cancer Services (New Zealand)

People with early-onset colorectal cancer describe primary care barriers to timely diagnosis: a mixed-methods study of web-based patient reports in the United Kingdom, Australia and New Zealand
People with early-onset colorectal cancer, under the age of 50, are more likely to experience diagnostic delay and to be diagnosed at later stages of the disease than older people. Advanced stage diagnosis potentially requires invasive therapeutic management at a time of life when these patients are establishing intimate relationships, raising families, building careers and laying foundations for financial stability. This study, published in BMC Primary Care, discusses barriers to timely diagnosis at primary care level.

Cardiovascular Disease and Diabetes (New Zealand)

It is time for a more targeted approach to prediabetes in primary care in Aotearoa New Zealand
Type 2 diabetes (T2DM), its related morbidities and entrenched diabetes‐related inequities pose significant challenges for health care delivery systems in Aotearoa New Zealand (NZ). Primary care services undertake the majority of diabetes prevention work by initially detecting and managing those with prediabetes. This viewpoint, published in the Journal of Primary Health Care, presents available NZ data to highlight NZ trends in prediabetes and consider the current NZ clinical guidelines and the prediabetes care pathway. Multiple areas for improvement are identified to optimise diabetes prevention, potentially reduce T2DM inequities, and sustain more effective prediabetes management in primary care in NZ.

Cardiovascular Disease and Diabetes (International)

Comparison of an online versus conventional multidisciplinary collaborative weight loss programme in type 2 diabetes mellitus: A randomized controlled trial
The aim of this study, published in the International Journal of Nursing Practice, was to examine the effect of an online multidisciplinary weight loss management programme.

Redesigning Rural Acute Stroke Care: A Person-Centered Approach
Stroke service delivery in rural areas in Australia lacks evidence-based, best practice care protocols as a result of limited resources and opportunity. Healthcare redesign is an approach to improving health services by understanding barriers and enablers to service provision and work with users to develop solutions for improvement. This research, published in the International Journal of Environmental Research and Public Health, aimed to qualitatively evaluate stroke care in rural Tasmania using a person-centered approach, as part of a larger healthcare redesign initiative to improve acute stroke care.

Developments in the design and delivery of self‐management support for children and young people with diabetes: A narrative synthesis of systematic reviews
Facilitated self-management support programmes have become central to the treatment of chronic diseases including diabetes. For many children and young people with diabetes (CYPD), the impact on glycated haemoglobin (HbA1c) and a range of self-management behaviours promised by these programmes remain unrealised. This narrative synthesis, published in Diabetic Medicine, creates an appraisal of current thinking and the existing evidence to guide the development of programmes better targeted at this age group.

Primary Health Care (New Zealand)

Family‐centred interventions for Indigenous early childhood well‐being by primary healthcare services
Primary healthcare, particularly Indigenous‐led services, are well placed to deliver services that reflect the needs of Indigenous children and their families. Important characteristics identified by families for primary health care include services that support families, accommodate sociocultural needs, recognise extended family child‐rearing practices, and Indigenous ways of knowing and doing business. The objective of this Cochrane Review was to evaluate the benefits and harms of family‐centred interventions delivered by primary healthcare services in Canada, Australia, New Zealand, and the USA on a range of physical, psychosocial, and behavioural outcomes of Indigenous children (aged from conception to less than five years), parents, and families.

Primary Mental Health (New Zealand)

Centering Indigenous knowledge in suicide prevention: a critical scoping review
Indigenous peoples of Canada, United States, Australia, and New Zealand experience disproportionately high rates of suicide as a result of the collective and shared trauma experienced with colonization and ongoing marginalization. Dominant, Western approaches to suicide prevention-typically involving individual-level efforts for behavioural change via mental health professional intervention-by themselves have largely failed at addressing suicide in Indigenous populations, possibly due to cultural misalignment with Indigenous paradigms. Consequently, many Indigenous communities, organizations and governments have been undertaking more cultural and community-based approaches to suicide prevention. To provide a foundation for future research and inform prevention efforts in this context, this critical scoping review, published in BMC Public Health, summarizes how Indigenous approaches have been integrated in suicide prevention initiatives targeting Indigenous populations.

Impacts of religious faith on the mental wellbeing of young, multi-ethnic Pacific women in Aotearoa
This study, published in Pacific Health Dialog, employed a multi-faceted approach in the disciplines of Theology and Pacific Studies; three key areas of investigation were examined and included: how young Pacific women perceived images of God and faith; how it impacted upon their mental resilience and their responses to mundane and significant life events; and their personal constructs of mental wellbeing.

Nōku te Ao: Sovereignty of the Māori Mind
The purpose of this report, published by the Health Promotion Agency, is to present a Māori world view of factors that contribute to discrimination of people who have experienced — or continue to experience — mental distress. The focus in this research is on Māori and recognises that discrimination associated with mental distress has many causative factors including colonisation, racism, socioeconomic deprivation, different perspectives on ‘mental distress’, historic separation of mental health from other health problems, and the longstanding societal disregard for people who experience mental distress.

Increased Immunisation (New Zealand)

Mapping the maternal vaccination journey and influencing factors for Māori women in Aotearoa New Zealand: a qualitative study
Uptake of maternal vaccinations (MVs) is suboptimal in Aotearoa New Zealand, particularly for Māori. The aim of this study, published in the Journal of Primary Health Care, was to describe Māori women’s journeys regarding maternal pertussis and influenza vaccinations and explore influences on uptake.

Increased Immunisation (International)

A systematic review of communication interventions for countering vaccine misinformation
Misinformation and disinformation around vaccines has grown in recent years, exacerbated during the Covid-19 pandemic. Effective strategies for countering vaccine misinformation and disinformation are crucial for tackling vaccine hesitancy. This systematic review, published in Vaccine, aimed to identify and describe communications-based strategies used to prevent and ameliorate the effect of mis- and dis-information on people’s attitudes and behaviours surrounding vaccination.

Key Ministry of Health Publications

He Arotake ngā Tūraru Reviewing risk: A discussion paper
To support a national conversation to reconsider beliefs, evidence and attitudes about mental health and risk, Manatū Hauora has commissioned an external document which can be used as a discussion prompt by anyone interested in supporting the wider conversation.

Victims’ rights in the health system
This guide is to help victims of offenders in the mental health system understand their rights.

Ministry of Health Consultations & Events

Proposals for the Smoked Tobacco Regulatory Regime
This consultation document outlines proposals for the Smoked Tobacco Regulatory Regime including the smoked tobacco retail scheme, low nicotine requirements, fees, notification requirements and youth vaping. The closing date for submissions is 5.00 pm, Wednesday 15 March 2023.

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.