Issue 305 - 25 July 2024

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 Health NZ district 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

Te Ruru: Co-creating an Indigenous Systems Change Framework
Indigenous cultures have long-held perspectives that emphasise the interdependence of all living things as holistic systems. Our worldview is thus shaped by deeply embedded relationality, which is in constant response to our interconnected experiences and knowledges. Systems thinking is a way of looking at the world that recognises the interconnectedness of both natural and human-made systems. The systems change approach, which takes into account the interconnected nature of the world's economic, social, and ecological systems, finds common ground with an inclusive, connected Indigenous holistic world view. This article, published in the Journal of Awareness-Based Systems Change, explores the congruence and compatibility between systems change thinking and Indigenous frameworks, emphasizing their common ground. The article introduces an example from Aotearoa New Zealand, which has integrated the tenets of systems change methodology within tribally based principles and aspirations to create ‘Te Ruru”.

The TOHU framework: Sensing and interpreting tohu to heal from trauma
This hypotheses article, published in Explore, presents understandings and practices of tohu (signs) in the personal, eco-environmental, and spiritual wellbeing of Māori.

Māori nurse practitioners: The intersection of patient safety and culturally safe care from an Indigenous lens
Dynamic and complex health systems require innovative and adaptive solutions to support patient safety and achieve equitable health outcomes for Indigenous populations. Understanding the ways by which Indigenous (and specifically Māori) nurse practitioners (NPs) practice patient safety is key to enhancing Indigenous health outcomes in predominantly westernized healthcare systems. The aim of this study, published in the Journal of Advanced Nursing, was to describe Māori NPs perspectives on patient safety when caring for Māori and understand how Māori NPs deliver safe health care.

Theorising Māori Health and Wellbeing in a Whakapapa Paradigm: Voices from the Margins
Whakapapa is an Indigenous metatheoretical framework; a phenomenon of metaphysical and social connections embedded in Indigenous epistemology unique to Aotearoa New Zealand (Aotearoa NZ). This research, published in Health Communication, foregrounds the innate connection between Māori, land, health, and wellbeing as an expression of Whakapapa, nuanced through the layering of lived experience and sensemaking of 30 Māori participants, situated in dialogue with the culture-centred approach.

Health Equity (New Zealand)

Māori experiences of physical rehabilitation in Aotearoa New Zealand: a scoping review
The purpose of this review, published in Disability and Rehabilitation, was to explore what is currently known about Māori experiences of physical rehabilitation services in Aotearoa New Zealand.

An integrative review of racism in nursing to inform anti-racist nursing praxis in Aotearoa New Zealand
The aim of this study, published in the Journal of Clinical Nursing, was to synthesise international literature to identify mechanisms that maintain racism in nursing and understand the factors that contribute to designing and implementing anti-racist praxis to inform nursing in Aotearoa New Zealand.

Nutrition & Physical Activity (New Zealand)

Development and implementation of a novel approach to dietary education for people with inadequate health literacy and advanced kidney disease
The objective of this article, published in the Journal of Renal Nutrition, was to describe the process of developing and implementing a novel approach to renal diet education by changing from a nutrient-based food list to a pictorial meal compilation approach through the skill steps: Plan, Select, Cook, Eat.

Nutrition & Physical Activity (International)

Interventions for High Body Mass Index in Children and Adolescents: US Preventive Services Task Force Recommendation Statement
Approximately 19.7% of children and adolescents aged 2 to 19 years in the US have a body mass index (BMI) at or above the 95th percentile for age and sex, based on Centers for Disease Control and Prevention growth charts from 2000. The prevalence of high BMI increases with age and is higher among Hispanic/Latino, Native American/Alaska Native, and non-Hispanic Black children and adolescents and children from lower-income families. This statement published in, JAMA, discusses the recommendations surrounding the evidence on interventions (behavioural counselling and pharmacotherapy) for weight loss or weight management in children and adolescents that can be provided in or referred from a primary care setting.

Quality Improvement (International)

Components of pharmacist-led medication reviews and their relationship to outcomes: a systematic review and narrative synthesis
Pharmacist-led medication reviews are an established intervention to support patients prescribed multiple medicines or with complex medication regimes. The aim of this systematic review, published in BMJ Quality & Safety, was to explore the common themes associated with positive outcomes from pharmacist-led medication reviews.

Emergency Department Services (International)

Non-emergency department (ED) interventions to reduce ED utilization: a scoping review
Emergency department (ED) crowding is a global burden. Interventions to reduce ED utilisation have been widely discussed in the literature, but previous reviews have mainly focused on specific interventions or patient groups within the EDs. The purpose of this scoping review, published in BMC Emergency Medicine, was to identify, summarise, and categorise the various types of non-ED-based interventions designed to reduce unnecessary visits to EDs.

Primary Health Care (New Zealand)

Addressing closed and limited enrolments in general practices in Aotearoa New Zealand: a mixed-methods study
The aim of this study, published in the New Zealand Medical Journal was to ascertain the reasons for and impacts of closed books in general practices in Aotearoa New Zealand and report recommendations for mitigation.

Primary Mental Health (New Zealand)

An evaluation of digital intervention for perinatal depression and anxiety: A systematic review
Digital intervention has been shown to be helpful in improving perinatal mental health. However, the design characteristics of such interventions have not been systematically reviewed. Considering that a lack of support-especially from a partner-is one of the major contributing factors to perinatal depression and anxiety, it is crucial to determine whether digital interventions have included partner participation. In this review, published in AIMS Public Health, the authors systematically examined the design characteristics of digital interventions related to perinatal depression and anxiety and aimed to determine whether partner participation was incorporated as part of the interventions.

Asian Rainbow Youth in New Zealand: Protective Factors 
This aim article, published in the Journal of Adolescent Health, was to explore the impacts of double minority status (ethnic and sexual/gender minority) and protective factors associated with the emotional wellbeing and mental health of Asian Rainbow (sexual/gender minority) youth in New Zealand.

Primary Mental Health (International)

Cognitive behavioural therapy and third‐wave approaches for anxiety and related disorders in older people
Cognitive behavioural therapy (CBT) is the most researched psychological therapy for anxiety disorders in adults and known to be effective in this population. However, it remains unclear whether these results apply to older adults, as most studies include participants between 18 and 55 years of age. This Cochrane Review aims to provide a comprehensive and up‐to‐date synthesis of the available evidence on CBT and third wave approaches for older adults with anxiety and related disorders.

Key Ministry of Health Publications

The New Zealand Illicit Drug Harm Index 2023: Research Report
The 2023 Illicit Drug Harm Index, prepared by the National Drug Intelligence Bureau (a joint operation of New Zealand Customs Service, Ministry of Health, and New Zealand Police), uses the same methodology as the 2020 Illicit Drug Harm Index to calculate estimates of total harm and harm per kilogram of drug consumed.

Evidence synthesis of the research on Suicide Prevention and Postvention; Aotearoa New Zealand and International Perspectives
There have been some encouraging signs of a reduction in lives lost to suicide in the past few years, after a decade of relatively static rates. Evidence-based interventions are required to build on this momentum and ensure that as a country we continue to see reductions in the suicide rate. This publication summarises the most up-to-date and relevant local and international literature on suicide prevention and postvention. It highlights what the most impactful interventions are for the New Zealand context and where the gaps in the research are.

New Zealand Pandemic Plan: A framework for action
This version of the New Zealand Pandemic Plan updates the New Zealand Influenza Pandemic Plan: A framework for action (Ministry of Health 2017). The interim update was completed at pace, is limited in scope, and reflects changes to how the health system is run since the 2022 reforms and some of the early lessons from the COVID-19 response.

Measuring public health behaviours and intentions
In June 2023, the Public Health Agency, within the Ministry of Health, commissioned research agency Verian to undertake a series of research projects and population surveys into attitudes and behaviours related to public health measures following the COVID-19 pandemic. The purpose of this research was to examine the impact of COVID-19 on New Zealanders’ attitudes and behaviours towards public health measures and use this knowledge to better prepare the Ministry, and other decision makers, for future pandemics and other major health threats.

Ministry of Health Consultations & Events

Code of Practice for Radiation Therapy: ORS C3 - New Zealand Ministry of Health - Citizen Space
The Radiation Safety Act 2016 (the Act) is administered by the Ministry of Health –Manatū Hauora (the Ministry). Section 86(1) of the Act allows the Director to issue codes of practice. This is for the purpose of specifying technical requirements. Code of Practice for Radiation Therapy: ORS C3 (C3) first became effective as of 9 August 2019. Section 90(a) of the Act requires the Director to review a code of practice at least once every five years. Section 89(2) of the Act requires that the Director consult with any person who the Director reasonably considers is likely to be affected by a proposed amendment or revocation to a code of practice. This consultation will be open until 7th August 2024.

Health Sector Initiative

Marae-based mate wareware, dementia clinic extended
A trial of a Te Tai Tokerau, Northland marae-based clinic set up to support care for people with mate wareware, dementia has been deemed a success and extended.

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.