Issue 278- 8 June 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.

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.

Health Equity (New Zealand)

Culturally Safe Neonatal Care: Talking With Health Practitioners Identified as Champions by Indigenous Families
The burden of health inequities borne by Indigenous peoples can be overwhelming, especially when mothers and newborns' lives are at stake and health services seem slow to invest in responsiveness. In Aotearoa (New Zealand), urgent action is required to eliminate persistent systemic inequities for Māori (Indigenous) whānau (family collectives that extend beyond the household). This Kaupapa Māori (by Māori, for Māori) qualitative study, published in Qualitative Health Research, aimed to explore the views of health practitioners identified as champions by whānau of preterm Māori infants.

From Kaimahi to Enrolled Nurse: A Successful Workforce Initiative to Increase Māori Nurses in Primary Health Care
A culturally competent health workforce is critical to achieving equitable health outcomes for Māori people in Aotearoa New Zealand. Fundamental to this goal is the urgent need to not only increase numbers of Māori nurses but to enable them to deliver innovative models of care that are responsive to the unmet need of whānau (family) and hapori (community). This article, published in Nursing Praxis, describes a national initiative to increase the capacity and capability of the Indigenous workforce by supporting kaimahi (unregulated health workers) to become enrolled nurses delivering holistic care within their own communities.

The Māori Student Nurse Experience of Cohorting: Enhancing Retention and Professional Identity as a Māori Nurse
Despite decades of work by tertiary providers to increase the Māori nursing workforce, there has been little change in the numbers of Māori nurses graduating from schools of nursing. The call for more culturally responsive teaching and learning strategies saw one tertiary provider implement Māori student cohorts for labs and tutorials in year one and two of the Bachelor of Health Science Nursing programme. This research, published in Nursing Praxis, explored the student experience of the cohorts using a hermeneutic methodology within a Māori-centred approach.

Quality Improvement (New Zealand)

He maungarongo ki ngā iwi: Envisioning a restorative health system in Aotearoa New Zealand
This framework, published by the Health Quality & Safety Commission, supports the health and disability sector to mitigate and respond to health care harm in Aotearoa New Zealand.

The case for investment in: A quality improvement programme to reduce pressure injuries in New Zealand
This report from KPMG and published by the Health Quality & Safety Commission, presents the findings of a qualitative study into reducing pressure injuries in New Zealand.

A window on quality 2022 (Part 2)
In this report, the Health Quality & Safety Commission, use perspectives from respondents in the health and disability sector and hard data to continue important lines of enquiry that began in A window on quality 2021: COVID-19 and its impacts on our broader health system (Part 1). 

Quality Improvement (International)

Clinical nurse competence and its effect on patient safety culture: a systematic review
Unsafe health practices are one of the leading causes of disability and even death. Competent nurses are crucial to ensure safe and high-quality healthcare services. The patient safety culture is concerned with internalizing safety beliefs, values, and attitudes, translating them into healthcare practices, and committing to maintaining an error-free health environment. A high level of competence ensures the achievement and compliance with the safety culture goal. This systematic review, published in BMC Nursing, aims to identify the relationship between the level of nursing competence and the safety culture score and perception among nurses at their workplace.

Cancer Services (New Zealand)

Aotearoa New Zealand Deaf women's perspectives on breast and cervical cancer screening
Since the introduction of both cervical and breast screening programmes in Aotearoa New Zealand, mortality rates have dropped. Both screening programmes track women's engagement, but neither capture the level of engagement of Deaf women who are New Zealand Sign Language users or their experiences in these screening programmes. This paper, published in The New Zealand Medical Journal, addresses this knowledge deficit and provides insights that will benefit health practitioners when providing screening services to Deaf women.

Cardiovascular Disease and Diabetes (New Zealand)

Interviews with Indigenous Māori with type 1 diabetes using open-source automated insulin delivery in the CREATE randomised trial
Open-source automated insulin delivery (AID) is used by thousands of people with type 1 diabetes (T1D), but has unknown generalisability to marginalised ethnic groups. This study, published in the Journal of Diabetes and Metabolic Disorders, explored experiences of Indigenous Māori participants in the CREATE trial with use of an open-source AID system to identify enablers/barriers to health equity.

Younger Women’s Experiences of Stroke: A Qualitative Study
The incidence of stroke in younger adults is rising, especially among women. This study, published in Nursing Praxis, aims to explore the experiences of younger women who have had a stroke to understand their experience and support needs.

Cardiovascular Disease and Diabetes (International)

Lower-Intensity Interventions for Prediabetes: A Systematic Review
Systematic reviews of interventions for diabetes prevention have focused on lifestyle interventions, including the Diabetes Prevention Program (DPP) and translations of the DPP. However, nationally, few people with prediabetes have joined or completed a DPP, with one cited barrier being committing to a yearlong program. This study, published in the American Journal of Preventative Medicine,  was a systematic review to evaluate the effectiveness of lower-intensity lifestyle interventions for prediabetes on weight change, glycemia, and health behaviours.

Quality improvement strategies for diabetes care: Effects on outcomes for adults living with diabetes
There is a large body of evidence evaluating quality improvement (QI) programmes to improve care for adults living with diabetes. These programmes are often comprised of multiple QI strategies, which may be implemented in various combinations. Decision‐makers planning to implement or evaluate a new QI programme, or both, need reliable evidence on the relative effectiveness of different QI strategies (individually and in combination) for different patient populations. The objective of this Cochrane Review was to update existing systematic reviews of diabetes QI programmes and apply novel meta‐analytical techniques to estimate the effectiveness of QI strategies (individually and in combination) on diabetes quality of care.

Primary Health Care (New Zealand)

Chronic health conditions and mortality among older adults with complex care needs in Aotearoa New Zealand
Older people have more comorbidities than younger groups and multimorbidity will increase. Often chronic conditions affect quality of life, functional ability and social participation. This study, published in BMC Geriatrics, aimed to quantify the prevalence of chronic conditions over a three-year period and their association with mortality after accounting for demographics.

Primary Health Care (International)

Case management for integrated care of older people with frailty in community settings
Ageing populations globally have contributed to increasing numbers of people living with frailty, which has significant implications for use of health and care services and costs. Case management is one model of integrated care that has gained traction with policymakers to improve outcomes for populations at high risk of decline in health and well‐being. These populations include older people living with frailty, who commonly have complex healthcare and social care needs but can experience poorly co‐ordinated care due to fragmented care systems. The objective of this Cochrane Review was to assess the effects of case management for integrated care of older people living with frailty compared with usual care.

Primary Mental Health (New Zealand)

Understanding youth drinking decline: Similarity and change in the function and social meaning of alcohol use (and non‐use) in adolescent cohorts 20 years apart
Qualitative research aimed at understanding the decline in youth drinking has so far been hampered by a lack of baseline data for comparison. This New Zealand study, published in Drug and Alcohol Review, overcomes this limitation by comparing archival qualitative data collected at the height of youth drinking (1999–2001) with contemporary data collected for this study (June–October 2022). The aim is to explore changes in the function and social meaning of alcohol use (and non-use) for two cohorts about 20 years apart.

Smoking Cessation (International)

Antidepressants for smoking cessation
The pharmacological profiles and mechanisms of antidepressants are varied. However, there are common reasons why they might help people to stop smoking tobacco: nicotine withdrawal can produce short‐term low mood that antidepressants may relieve; and some antidepressants may have a specific effect on neural pathways or receptors that underlie nicotine addiction. The objective of this Cochrane Review was to assess the evidence for the efficacy, harms, and tolerability of medications with antidepressant properties in assisting long‐term tobacco smoking cessation in people who smoke cigarettes.

Effectiveness of smoking cessation interventions among persons with cancer: A systematic review
Continued smoking after cancer diagnosis is associated with worse outcomes, however, many persons diagnosed with cancer who smoke are unable to quit successfully. Effective interventions are needed to promote quitting in this population. The purpose of this systematic review, published in Psycho-Oncology, is to understand the most effective interventions for smoking cessation among persons with cancer.

Weight Management (New Zealand)

Not Just a Free Lunch a logic model and evidence review for the Ka Ora, Ka Ako | Healthy School Lunch programme
Ka Ora, Ka Ako provides free, healthy lunches for 220,000 learners in low-equity New Zealand schools. Costing over $260 million annually, it represents the largest government investment in child nutrition in generations. Early evaluations indicate success in achieving programme aims of delivering nutritious food, improving learners’ wellbeing, and easing financial stress for families. However, international evidence and emerging local data indicate the programme can achieve the above and more. This article, published in Policy Quarterly, presents a programme logic model drawing on local data and a review of relevant international literature on universal school food provision with the aim of identifying potential long-term outcomes and impacts at multiple levels.

Relationship between perceived and measured body size among Pacific 14-year-olds in Aotearoa|New Zealand: Findings from the Pacific Islands Families Study
Pacific people carry a disproportionate burden of socio-cultural and economic determinants of health in Aotearoa | New Zealand (NZ), and 61.7% of Pacific children aged 0-14 years are overweight or obese. Yet Pacific children's self-perception of their body size is unknown. This population-based study, published in the Journal of Paediatrics and Child Health, aimed to investigate the concordance between measured and perceived body size in a cohort of Pacific 14-year-olds in NZ, and to assess how this relationship is influenced by their cultural orientation, socio-economic deprivation and degree of recreational internet use.

Key Ministry of Health Publications

Victims’ Rights in the Health System
The guidelines are intended to assist Directors of Area Mental Health Services, compulsory care coordinators or victims’ coordinators in undertaking their registered victim notification obligations under the Victims Rights Act 2002. They replace previous guidelines issued in 2018.

Ministry of Health Consultations & Events

Precision health: Exploring opportunities and challenges to predict, prevent, diagnose, and treat disease more precisely in Aotearoa New Zealand
Manatū Hauora (the Ministry of Health) is seeking written feedback on this draft of its Long-term Insights Briefing (the briefing) by 5pm on 19 June 2023.  This briefing represents the start of a conversation about how we use current and emerging technologies toward precision health specifically.

Health Sector Initiative

Planned new whānau rooms welcomed by advocate Dame Rangimārie Naida Glavish
A new state-of-the-art hospital building due to open on Auckland’s North Shore in 2024 will include modern whānau rooms that enable families to be in close-proximity to loved ones requiring medical care. 

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.