Issue 281 - 3 August 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.

Māori Innovation

Reflections on the co-design process of a holistic assessment tool for a Kaupapa Māori antenatal wānanga (workshop)
Co-designed health initiatives are gaining popularity in Aotearoa (New Zealand). However, emerging research identifies potential pitfalls for Indigenous populations, particularly Māori (Indigenous Peoples of Aotearoa), when Kaupapa Māori principles are ignored. This paper, published in Kōtuitui , provides an autoethnographic reflective account of the co-design process that led to the development and implementation of the Whirihia holistic assessment tool for the Kaupapa Māori antenatal wānanga (workshop) Whirihia Te Korowai Aroha.

Understanding how whānau-centred initiatives can improve Māori health in Aotearoa New Zealand
This article, published in Health Promotion International, highlights the significance of prioritising Indigenous voices and knowledge systems, using whānau-centred initiatives (a concept that encompasses the broader family and community) as a foundation for health promotion within an Indigenous context.

Health Equity (New Zealand)

Walking our pepeha: The influence of whakapapa on health and well-being
Whakapapa is the essence of health and well-being. Whakapapa is a tool, created by our tūpuna to frame our existence as Māori. By identifying the names of places and people, we create a timeline of locators of who we are, where we come from and where we exist today. The opportunity to “walk our pepeha” enables us to not only identify these places but also to engage with them, making the connection stronger. It is through whakapapa that we can identify who and where we come from; this is vital to identity and therefore to health and well-being. In this article, published in MAI Journal, examined the experiences of rangatahi engaging with and learning about their whakapapa.

Ethnic variation in hospitalisation due to treatment injury and complications of healthcare in older adults residing in New Zealand
The aim of this study, published in The New Zealand Medical Journal, was to describe the incidence, characteristics, and ethnic variation of hospitalisations for treatment injury and complications of medical or surgical care in older adults in two regions of Aotearoa New Zealand.

Health Equity (International)

A systematic review of how social connectedness impacts associations between racism and discrimination on health outcomes
Racial discrimination is a well-known risk factor of racial disparities in health. While progress has been made in identifying multiple levels through which racism and racial discrimination influences health, less is known about social factors that may buffer racism's associations with health. This systematic review, published in Epidemiologic Reviews, focuses on social connectedness, racism, and health.

Quality Improvement (New Zealand)

Te Whatu Ora - Nelson Marlborough case study: Trauma at the top of the South
The transition from hospital to home can be challenging for patients who have experienced major trauma. The team at Te Whatu Ora – Nelson Marlborough identified that discharge information is often complex and confusing for patients. They are expected to understand how to manage their injuries and any associated functional restrictions, arrange and/or attend follow-up appointments and liaise with the different health and social agencies relevant to their rehabilitation journey. This is made even more difficult when patients are discharged without receiving their electronic discharge summary where some, or all, of this information is found. The team worked to ensure all major trauma patients are discharged safely from Nelson Hospital with appropriate information to support their transition to the community.

Quality Improvement (International)

Interventions for preventing and reducing the use of physical restraints for older people in all long‐term care settings
Physical restraints (PR), such as bedrails and belts in chairs or beds, are commonly used for older people receiving long‐term care, despite clear evidence for the lack of effectiveness and safety, and widespread recommendations that their use should be avoided. The objective of this Cochrane Review was to evaluate the effects of interventions to prevent and reduce the use of physical restraints for older people who require long‐term care (either at home or in residential care facilities).

Cancer Services (New Zealand)

Skin Cancer Prevention across the G7, Australia and New Zealand: A Review of Legislation and Guidelines
Incidence rates of melanoma and keratinocyte skin cancers have been on the rise globally in recent decades. While there has been a select focus on personal sun protection awareness, to our knowledge, there is a paucity of legislation in place to help support citizens' efforts to protect themselves from the harmful effects of ultraviolet radiation (UVR). Given this, this study, published in Current Oncology, conducted a comprehensive review of legislation and guidelines pertaining to a variety of sun protection-related topics in countries of the Group of Seven (G7), Australia and New Zealand.

Cancer Services (International)

From Awareness to Action: A Review of Efforts to Reduce Disparities in Breast Cancer Screening
Breast cancer is a significant public health concern, and addressing disparities in breast cancer screening is crucial for improving early detection and reducing mortality rates. This review article, published in Cureus, examines efforts to bridge the gap between awareness and action in reducing disparities in breast cancer screening.

Primary Health Care (International)

Mobile phone‐based interventions for improving contraception use
Contraception provides significant benefits for women's and children's health, yet many women have an unmet need for contraception. Rapid expansion in the use of mobile phones in recent years has had a dramatic impact on interpersonal communication. Within the health domain text messages and smartphone applications offer means of communication between clients and healthcare providers. This Cochrane Review focuses on interventions delivered by mobile phone and their effect on use of contraception.

Telemedicine in the primary care of older adults: a systematic mixed studies review
Family physicians had to deliver care remotely during the COVID-19 pandemic. Their efforts highlighted the importance of developing a primary care telemedicine (TM) model. TM has the potential to provide a high-quality option for primary care delivery. However, it poses unique challenges for older adults. The aim of this study, published in BMC Primary Care, aimed to explore the effects of telemedicine and the determinants of its use in primary care for older adults.

Characteristics of self-management support (SMS) interventions and their impact on quality of life (QoL) in adults with chronic diseases: an umbrella review of systematic reviews
The objective of this review, published in Health Policy, was to provide an overview of types and characteristics of self-management support (SMS) interventions in adults with chronic disease and to assess the impact on the patient reported outcome Quality of Life (QoL).

Smoking Cessation (New Zealand)

Support for and potential impacts of key Smokefree 2025 strategies among Māori who smoke
The recently passed Smokefree Environments and Regulated Products (Smoked Tobacco) Amendment Act has the potential to profoundly reduce smoking prevalence and related health inequities experienced among Māori. This study, published in The New Zealand Medical Journal, examined support for, and potential impacts of, key measures included within the legislation.

Weight Management (New Zealand)

Towards a Kuapapa Māori Fitness Gym. A Bourdieusian analysis
The fitness gym is an avenue where people pursue their health and well-being aspirations. In Aotearoa New Zealand, Māori have similar rates of physical activity to non-Māori; however, it is unclear how many Māori access the fitness gym. This article, published in MAI Journal, examined whether a Kaupapa Māori gym was possible.

How do Māori navigate advice about nutrition? A review that spans the mātauranga Māori, western science, and social media divides
Cardiovascular disease is one of the leading causes of death in Aotearoa (New Zealand). Life expectancy for Māori (Indigenous people of Aotearoa) is 7 years less than that for non-Māori. Maintaining a healthy nutrition lifestyle is vital to reduce cardiovascular disease risk and improve overall well-being. Though diet and nutrition campaigns are standard parts of health promotion and campaigns have been developed to target Māori, little is known about the way Māori navigate nutrition advice. This review, published in AlterNative, explored mātauranga Māori (Māori knowledge) and western science as bodies of knowledge for nutrition advice and social media as a platform to disseminate nutrition information to understand how communities get their nutrition advice.

Oral Health (New Zealand)

Facilitators and Challenges to Maintaining Oral Health for Indigenous Communities Globally: A Qualitative Systematic Review
Globally, Indigenous Peoples experience pervasive oral health inequities due to a complex interplay of social determinants of health including the sustained effects of colonisation, racism, and intergenerational disruption to Indigenous communities. This qualitative systematic review, published in the Journal of Health Care for the Poor and Underserved, aimed to synthesise evidence related to facilitators and challenges that affect the ability of global Indigenous communities to maintain oral health.

Key Ministry of Health Publications

Independent Review of the Alcohol Levy Stage 1: Rapid Review
The independent alcohol levy review is being undertaken right now and includes broad stakeholder engagement. This report is from the early stage one of the review and sets out some interim recommendations from the reviewers. Stage 2 will be completed towards the end of 2023.

Health Sector Initiative

Keeping the faith!
As the sun creeps over the horizon and the birds start to wake, Kiwi and Jordan are arriving at Middlemore Hospital to take part in a karakia with a tuuroro (patient). As Maaori chaplains, contracted through Te Whare Ruruhau o Meri Trust, they provide amorangi/chaplaincy services to mainly Maaori patients at Middlemore Hospital. The difference in this chaplaincy role is they observe the Kaupapa Maaori way of doing things and ensure tikanga is adhered to and Te Whare Tapa Whaa model also informs their work – whaanau (family), wairua (spiritual), tinana (physical), and hinengaro (mental).

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.