Issue 307 - 22 August 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

A novel framework for Indigenous eye health care in New Zealand: Ngā Mata o te Ariki
Indigenous populations globally experience disproportionately poorer eye health outcomes than non-Indigenous peoples. Incorporating Māori perspectives of eye care and pre-existing Indigenous models of health offers potential to enhance Māori experience and engagement with eye health services. This study, published in Clinical & Experimental Optometry, seeks to develop and refine a practical framework for eye health care that incorporates nine established Indigenous health principles.

Health Equity (New Zealand)

Improving Equity of Access to a Publicly Funded Bariatric Surgery Programme by Removal of Mandatory Weight Loss Targets
Obesity disproportionately affects 50.8% of Māori and 71.3% of Pacific adults in New Zealand, and these groups also have reduced access to bariatric surgery. Mandatory preoperative weight loss targets are a requirement of many bariatric surgery programmes globally; however, the evidence supporting their efficacy is inconclusive. In 2017, mandatory preoperative weight loss targets were eliminated from the bariatric surgery programme at Auckland City Hospital in New Zealand, with the aim to improve equity of access to bariatric surgery. This study, published in Obesity Surgery, reviews postoperative patient outcomes following the elimination of preoperative weight loss targets from the programme.

Changes in indicators of well-being on moving from home to long-term care for Māori in Aotearoa New Zealand: A retrospective cohort study
The objective of this study, published in the Australasian Journal on Ageing, was to investigate changes in well-being measures for older Māori after moving from community to long-term care (LTC).

Challenges affecting migrant healthcare workers while adjusting to new healthcare environments: a scoping review
Shifting demographics, an aging population, and increased healthcare needs contribute to the global healthcare worker shortage. Migrant Health Care Workers (MHCWs) are crucial contributors to reducing this shortage. Economic factors and health workforce demand drive their migration, but they also face challenges adapting to a new country and new working environments. To effectively address these challenges, it is crucial to establish evidence-based policies. Failure to do so may result in the departure of Migrant Healthcare Workers (MHCWs) from host countries, thereby worsening the shortage of healthcare workers. The aim of this review, published in Human Resources for Health, was to synthesise the barriers experienced by MHCWs as they adjust to a new country and their new foreign working environments.

Early years wānanga report
In June 2024, 60 community innovators from 17 community organisations leading health promotion projects that support whānau wellbeing across Aotearoa came together with the Te Whatu Ora Health Promotion Early Years team to wānanga. The wānanga created an opportunity to articulate how the system might better support māmā, pēpi and whānau in the early years. This report, published by Health Promotion - Health New Zealand, captures key insights from community leaders on how we can meet the needs of whānau. This work demonstrates that when government trusts community to design their own solutions, we can address issues that the system has struggled to solve. The reports details insights about what makes community-led innovations successful, and what the enablers and barriers are.

A qualitative evaluation of rural and provincial surgery wānanga to enhance cultural safety among surgical registrars in Taranaki, New Zealand
The Royal Australasian College of Surgeons (RACS) recently instituted cultural safety and cultural competency as its 10th competency with formalized cultural safety training yet to be instituted. Wānanga are Indigenous Māori teaching institutions that can be used contemporarily for cultural safety training. In 2022, surgical registrars based at Taranaki Base Hospital (TBH) held in-hospital wānanga ranging from 1 to 3 h focussed on cultural safety, professionalism and wellbeing. This study, published in ANZ Journal of Surgery, explores the perspectives of these registrars who attended wānanga using a Kaupapa Māori aligned methodological stance and interpretive phenomenological analysis.

Racism and Health Among Aotearoa New Zealand Young People Aged 15-24 years: Analysis of Multiple National Surveys
This Aotearoa New Zealand-based study, published in the Journal of Adolescent Health, addresses a gap in literature focusing on individual experiences of racism among adolescents and young adults and its links to health.

Nutrition & Physical Activity (New Zealand)

Development of an Aotearoa New Zealand adapted Mediterranean dietary pattern and Kai/food basket for the He Rourou Whai Painga randomised controlled trial
Following a Mediterranean diet (MedDiet) is associated with a lower risk of cardiovascular disease. He Rourou Whai Painga is a dietary intervention trial with behaviour change support that seeks to determine whether a MedDiet pattern can provide equivalent benefits in Aotearoa New Zealand (NZ), a country where cardiovascular disease is a leading cause of death. This study, published in Frontiers in Nutrition, explored how the MedDiet needs to be adapted in an acceptable way for NZ, with consideration of the Māori (indigenous) population.

Street redesign, active mobility and well-being for Pacific elders
While the evidence linking attributes of urban street design to physical activity behaviour is strong, there is little research on the impact of the built environment on Pacific elders’ active mobility. The study, published in Kōtuitui, seeks to address this knowledge gap by focusing on the impacts of streetscape changes on the active travel and social connectivity of this group of residents.

Cancer Services (New Zealand)

'I was able to make a better decision about my health.' Wāhine experiences of colposcopy at a marae-based health clinic: A qualitative study
Equitable access to colposcopy services is required if we are to realise the benefit of the introduction of human papilloma virus (HPV) screening in Aotearoa New Zealand. The authors of this study, published in the Australian & New Zealand Journal of Obstetrics & Gynaecology, piloted a community colposcopy clinic, co-located at an urban marae health clinic. The study aimed describe the experiences of wāhine (women) attending the marae-based colposcopy clinic.

Indigenous access to clinical services along the lung cancer treatment pathway: a review of current evidence
Lung cancer is a deadly cancer. Early diagnosis and access to timely treatment are essential to maximizing the likelihood of survival. Indigenous peoples experience enduring disparities in lung cancer survival, and disparities in access to and through lung cancer services is one of the important drivers of these disparities. This manuscript, published in Cancer Causes & Control, aimed to examine the current evidence on disparities in Indigenous access to services along the lung cancer treatment pathway.

Cancer Services (International)

Understanding and tackling cancer inequities: What opportunities does intersectionality offer researchers, policymakers, and providers? A scoping review
This review, published in the Journal of Psychosocial Oncology, summarised the international evidence relating to the role of intersectionality in patients' lived experience of inequities along the cancer care pathway.

Increasing coverage in cervical and colorectal cancer screening by leveraging attendance at breast cancer screening: A cluster-randomised, crossover trial
Screening participation remains suboptimal in cervical cancer (CC) and colorectal cancer (CRC) screening despite their effectiveness in reducing cancer-related morbidity and mortality. This study, published in PLOS Medicine, investigated the effectiveness of an intervention by leveraging the high participation rate in breast cancer (BC) screening as an opportunity to offer self-sampling kits to nonparticipants in CC and CRC screening.

Primary Health Care (International)

Supporting people with learning disabilities to attend general practice appointments
This article, published in Learning Disability Practice, identifies some of the barriers to effective service provision for people with learning disabilities in primary care. It describes how learning disability nurses and learning disability support workers can assist staff in primary care to improve the experiences of people with learning disabilities when attending healthcare appointments such as annual health checks, blood tests, cancer screening and other routine investigations.

Educational and psychological interventions for managing atopic dermatitis (eczema)
Atopic dermatitis (eczema), can have a significant impact on well‐being and quality of life for affected people and their families. Standard treatment is avoidance of triggers or irritants and regular application of emollients and topical steroids or calcineurin inhibitors. Thorough physical and psychological assessment is central to good‐quality treatment. Overcoming barriers to provision of holistic treatment in dermatological practice is dependent on evaluation of the efficacy and economics of both psychological and educational interventions in this participant group. The objective of this Cochrane Review was to assess the clinical outcomes of educational and psychological interventions in children and adults with atopic dermatitis (eczema) and to summarise the availability and principal findings of relevant economic evaluations.

Pharmacist-led primary care interventions to promote medicines optimisation and reduce overprescribing: a systematic review of UK studies and initiatives
The objective of this systematic review, published in BMJ Open, was to synthesise evidence on the effectiveness and implementation barriers/facilitators of pharmacist-led interventions to promote medicines optimisation and reduce overprescribing in UK primary care.

Primary Mental Health (New Zealand)

Let's get real older persons' option paper - full report
This report, by Te Pou, presents findings and options for updating Let’s get real. A wide range of knowledge and skills were highlighted as important for working with older persons, many of which are not currently in the Let’s get real framework or require tailored language to be relevant to older persons.

Disability Services (New Zealand)

Low-intensity parent- and clinician-delivered support for young autistic children in Aotearoa New Zealand: a randomised controlled trial
Aotearoa New Zealand does not provide publicly-funded intensive autism support. While parent-mediated supports are promising, children and families may also benefit from direct clinician support. This study, published in The Lancet Regional Health - Western Pacific, tested the efficacy of a low-intensity programme involving parent- and clinician-delivered support for autistic children.

Key Ministry of Health Publications

Registrar (assisted dying) Annual Report – June 2024
The End of Life Choice Act 2019 (the Act) came into force on the 7 November 2021. This established the Assisted Dying – Ngā Ratonga Mate Whakaahuru service in New Zealand Aotearoa. The Ministry of Health is responsible for the administration of the Act. The Act requires the Registrar (assisted dying) to report to the Minister of Health about the operation of the service each year by the 30 June.

Ministry of Health Consultations & Events

Safe Areas - One year survey
The Ministry is conducting a survey to understand provider experiences and observations following the establishment of a Safe Area around their facility. The information gathered from this survey will contribute to a review of the effectiveness of Safe Areas surrounding abortion services in Aotearoa New Zealand. This survey closes on the 30th September 2024.

Health Sector Initiative

New Hospital in the Home service to begin at Gisborne Hospital
Select patients at Gisborne hospital, will now be able to receive treatment at home, under medical supervision, with a new service which was blessed on Tuesday 9 July. Hospital in the Home Tairawhiti Project Manager, Tori Mackle, says Āhuru Mōwai Hospital in the Home (HitH) is an acute clinical service which takes staff, equipment, technologies, medication and skills which are provided in hospital and delivers that care to selected patients in their homes.

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.