Issue 285 - 28 September 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

Māori expert views of antimicrobial resistance using a one health approach: a qualitive study
Māori experience disproportionately worse outcomes from infectious diseases compared to non-Māori, and antimicrobial resistance (AMR) contributes to these inequities. The aim of the study, published in Mai Journal, was to gain insight into Māori experts’ perspectives on AMR using a One Health approach, which incorporates understandings of human, animal and environmental health.

Health Equity (New Zealand)

"I haven't even taken them to the doctors, because I have that fear of what to expect": a qualitative description study exploring perceptions and experiences of early childhood healthcare among ethnically diverse caregivers in Aotearoa New Zealand
Equity underpins Aotearoa New Zealand's publicly funded healthcare system; however, ethnic inequality persists. This qualitative study, published in The Lancet Regional Health - Western Pacific, explored the perceptions and experiences of ethnically diverse parents accessing health services for their children.

Pacific models for engagement
These Pacific models for engagement resources were developed for use internally within our organisation to help put Pacific methodologies, frameworks and epistemologies at the centre of our thinking when considering working with our Pacific communities. The Health Quality & Safety Commission are now making them available for the sector to use, digest, consider and implement into their engagements and co-design with Pacific communities.

A systematic review of ageing in place among Indigenous People in Canada, USA, México, Chile and New Zealand
The ageing in place (AIP) model enjoys widespread recognition in gerontology and has been strongly encouraged through social policy. However, progress remains to be made in terms of analysing AIP for minority groups and groups with diverse life pathways in old age. This systematic review, published in Health Psychology and Behavioral Medicine, aims to identify studies that address the AIP model in indigenous communities.

Ensuring equity for Indigenous peoples using a Māori model of health
Systemic inequity and homelessness among Māori in New Zealand is explored, highlighting the disproportionate impact of poverty, overcrowding and homelessness on this population. This paper, published in Mai Journal, examines the historical context of colonisation and societal changes contributing to the housing strain and homelessness faced by Māori.

Preference-based measures of health-related quality of life in Indigenous people: a systematic review
In many countries, there are calls to address health inequalities experienced by Indigenous people. Preference-based measures (PBMs) provide a measurement of health-related quality of life and can support resource allocation decisions. This review, published in Quality of Life Research, aimed to identify, summarise, and appraise the literature reporting the use and performance of PBMs with Indigenous people.

Quality Improvement (New Zealand)

A quality improvement approach to improving recognition of Māori tamariki (children) and assessing barriers to culturally responsive care in a paediatric ward setting
Health inequity persists in Aotearoa (New Zealand) and internationally amongst most indigenous peoples. To address these health inequities, countries need to contend with the ramifications of entrenched historical, cultural and systemic failures. Within Aotearoa part of the solution to rectifying persistent health inequities lies in shifting everyday healthcare practices towards a more culturally responsive, patient-centred approach that utilises Māori knowledge and principles. Although the need for culturally responsive services in healthcare settings is clearly evident, most practitioners struggle with the challenge of creating a culturally safe environment. Further to these challenges, there are issues related to accurate recognition of ethnicity within the time constraints of an overwrought hospital environment. Within this environment, the correct identification of ethnicity is a fundamental step in the process of moving towards culturally responsive and more inclusive care. The research, published in Child, was concerned with indigenous Māori patients being consistently and correctly identified so that they might receive culturally appropriate interaction and treatment.

Cancer Services (New Zealand)

Quality outcomes for end‐of‐life care among people with haematological malignancies at a New Zealand cancer centre
Little is known about the end‐of‐life (EOL) experience and specialist palliative care use patterns of patients with haematological malignancies (HMs) in New Zealand. This retrospective analysis, published in the Internal Medicine Journal, sought to examine the quality of EOL care received by people with HMs under the care of Auckland District Health Board Cancer Centre's haematology service and compare it to international data where available.

Cardiovascular Disease and Diabetes (New Zealand)

Experiences of Indigenous Patients Receiving Dialysis: Systematic Review of Qualitative Studies
Indigenous people suffer a high burden of kidney disease. Those receiving maintenance dialysis have worse outcomes compared to similarly treated non-Indigenous patients. This study, published in the American Journal of Kidney Diseases, characterised the experiences of Indigenous patients receiving dialysis in British colonised countries to gain insights into which aspects of kidney care may benefit from improvement. 

Primary Health Care (New Zealand)

Adjustment to chronic illness as informed by Māori. A qualitative synthesis of studies and best practice guidelines
Supporting equitable healthcare outcomes in Aotearoa New Zealand requires urgent attention. Several models of Māori health and wellbeing introduce elements and strategies that may be central to adjustment to chronic illness. This article, published in Mai Journal, conducts a literature review of Māori health and wellbeing models and best practice guidelines to identify what Māori see as central to illness adjustment and determine practical strategies to inform better practice in the context of chronic illness.

Financial barriers to primary health care in Aotearoa New Zealand
In Aotearoa New Zealand, co-payments to see a general practitioner (GP, family doctor) or collect a prescription are payable by virtually all adults. The objective of this study, published in Family Practice, was to examine the extent to which these user co-payments are a barrier to accessing health care, focussing on inequities for indigenous Māori.

Primary Mental Health (New Zealand)

Global Implications From the Rise and Recession of Telehealth in Aotearoa New Zealand Mental Health Services During the COVID-19 Pandemic: Mixed Methods Study
The COVID-19 pandemic accelerated the adoption of telehealth services for remote mental health care provision. Although studies indicate that telehealth can enhance the efficiency of service delivery and might be favoured or even preferred by certain clients, its use varied after the pandemic. Once the pandemic-related restrictions eased, some regions curtailed their telehealth offerings, whereas others sustained them. Understanding the factors that influenced these decisions can offer valuable insights for evidence-based decision-making concerning the future of telehealth in mental health services. This study, published in JMIR Formative Research, explored the factors associated with the uptake of and retreat from telehealth across a multiregional outpatient mental health service in Aotearoa New Zealand.

Smoking Cessation (New Zealand)

How young people in Aotearoa perceive vaping and the associated oral health risks
The use of electronic cigarettes (EC) among young people has escalated in Aotearoa and in other jurisdictions where they are available commercially. The rise in vaping among young people for lifestyle reasons rather than for smoking cessation is of concern, given the growing evidence of the harmful effects of vaping. Specifically, there is little known about how young people in Aotearoa perceive the effect of vaping on their oral health. This study, published in the New Zealand Medical Journal, aims to explore how young people in Aotearoa perceive risks of vaping on oral health.

Smoking Cessation (International)

Pharmacological and electronic cigarette interventions for smoking cessation in adults: component network meta‐analyses
Tobacco smoking is the leading preventable cause of death and disease worldwide. Stopping smoking can reduce this harm and many people would like to stop. There are a number of medicines licensed to help people quit globally, and e‐cigarettes are used for this purpose in many countries. Typically treatments work by reducing cravings to smoke, thus aiding initial abstinence and preventing relapse. More information on comparative effects of these treatments is needed to inform treatment decisions and policies. The objective of this Cochrane Review was to investigate the comparative benefits, harms and tolerability of different smoking cessation pharmacotherapies and e‐cigarettes, when used to help people stop smoking tobacco.

Weight Management (International)

The effect of breakfast on childhood obesity: a systematic review and meta-analysis
Previous cohort trials have shown that skipping breakfast increases the risk of obesity or overweight in children. However, this finding remains controversial. Through a meta-analysis, this study, published in Frontiers in Nutrition, systematically evaluated the effect of skipping breakfast on the prevalence of obesity or overweight in children.

Impact of School-Based Interventions on Pediatric Obesity: A Systematic Review
This systematic review, published in Cureus, aims to explore and evaluate the impact of school-based interventions on reducing pediatric obesity among school-aged children.

Key Ministry of Health Publications

Office of the Director of Mental Health and Addiction Services Regulatory Report 1 July 2021 to 30 June 2022
The Office of the Director of Mental Health and Addiction Services Regulatory Report 1 July 2021 to 30 June 2022 provides information and statistics relating to the use of compulsory mental health assessment and treatment legislation in Aotearoa New Zealand.

Health Sector Initiative

New mental health taonga launched to support tamariki in Te Tai Tokerau
A free, downloadable te reo Māori resource is being launched to help children and their whānau who have a parent with mental health and addiction issues.

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.