Issue 317 - 6 March 2025

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

Ngā Māuiui Kai: creating Indigenous Māori terms for eating disorders in Aotearoa New Zealand
Māori (the Indigenous people of Aotearoa New Zealand) report higher rates of eating disorders than non-Māori, but access treatment at lower rates. Diagnostic terms lacking in cultural relevance likely contribute to Māori exclusion in eating disorder spaces. This article, published in the Journal of Eating Disorders, discusses developing terms in te reo Māori (the Māori language) and presents an opportunity to challenge eating disorder stereotypes and increase cultural safety in the eating disorder workforce.

"When you're in pain you do go into your shell" A community-based pain management programme co-designed with Māori whānau to address inequities to pain management - A qualitative case study
Chronic or persistent non-cancer pain disproportionately affects Māori - the Indigenous population of Aotearoa New Zealand (NZ) and their whānau (family and significant others). The main aim of this study, published in The Journal of Pain, was to describe the implementation of a community-based, whānau-focused pain management programme.

Health Equity (New Zealand)

Community organizing and public health: a rapid review
Advancing health equity is a global priority within public health, requiring a focus on structural determinants of health and power imbalances. Community organizing is one strategy to cultivate community power and advance health equity by challenging oppressive systems. While examples of public health partnering with community-organizing groups and utilizing organizing methods can be found in the literature, these strategies remain an underdeveloped area for practice. This rapid review, published in BMC Public Health, aims to uncover the benefits, challenges, and outcomes of governmental, non-profit, and academic public health partnering with community organizers and/or applying community-organizing methods.

A scoping review of visual communication of written patient health information preferences including a Māori perspective
This scoping review, published in Health Education Research, examines the visual design elements of written patient information (WPI), specifically focusing on imagery, colour, layout and content presentation, and their impact on health information communication, understanding, behaviour and preferences among patients. Understanding patient preferences allows for patient-informed WPI design, which is important for Māori (Indigenous peoples of Aotearoa New Zealand) living in a colonial society.

Is No difference a good outcome? Equity evaluation of the general surgery prioritization tool
The general surgery prioritization tool (GSPT) was implemented in 2018 to equitably prioritize non-cancer elective general surgery waitlists. It combines patient-reported Impact On Life (IOL) scores and clinician-reported values for a total score which determines access to the waitlist. In New Zealand there are inequities in surgical access and outcomes, particularly for Māori, and this study, published in ANZ Journal of Surgery, evaluates whether the GSPT may contribute.

Health Equity (International)

Understanding the circle of care: Indigenous service providers’ perspectives on health and well-being
There is a need for broadening understandings of health and well-being to fill the critical and persistent gap in culturally safe health and social service provision for Indigenous populations. While the importance of Indigenous cultural interventions in healthcare is increasingly recognized and the perspective of Indigenous patients increasingly sought, there has been little research on the views of Indigenous service providers themselves. This study, published in AlterNative, explores the views of Indigenous service providers and how they conceptualise and deliver health and social services, including how these services link to the principles of harm reduction.

Cancer Services (International)

Integrated access to cancer screening: expanding access for cervical and colorectal cancer screening in rural and remote Northern Alberta, Canada using a mobile service to bring cancer screening closer to home
The goal of the Integrated Access to Cancer Screening (IACS) initiative was to help reduce the disparity in cancer screening participation across Alberta by implementing an integrated mobile service delivery model for breast, cervical, and colorectal cancer screening in rural and remote communities in Northern Alberta, performed by Nurse Practitioners (NPs) that addressed barriers to access. The aim of this study, published in BMC Health Services Research, was to evaluate the outcomes and impact the IACS initiative had on the communities and residents of Northern Alberta. This article describes the initiative design, implementation, outcomes, and impact of the initiative.

Scoping review identifying interventions that have been tested to optimise the experience of people from ethnic minority groups receiving systemic anticancer therapy (SACT)
Disparities have been identified in many aspects of the cancer care pathway for people from minority ethnic groups (MEGs). Adherence to systemic anticancer therapies (SACTs) has been shown to impact morbidity and mortality, and therefore, inequitable experiences can have a detrimental effect on outcomes. The objective of this review, published in BMJ Quality & Safety, was to identify interventions that focused on improving the experiences and clinical outcomes in people from MEG receiving SACT treatments.

Emergency Department Services (New Zealand)

Nurse Practitioner-Led Community Urgent Care Services: Actions to Support Growth
The aim of this study, published in the Journal of Clinical Nursing, was to explore the role of nurse practitioners (NPs) in delivering models of acute and urgent care in local communities informing the development of NPs as a solution to providing sustainable and effective healthcare in these settings.

Emergency Department Services (International)

Effective strategies for reducing patient length of stay in the emergency department: a systematic review and meta-analysis
Overcrowding is a common issue in emergency departments worldwide. One condition associated with overcrowding is the Emergency Department Length of Stay(EDLOS). Prolonged EDLOS is linked to increased hospitalization costs, worsening clinical outcomes, and deterioration in patient-reported outcomes. Consequently, there is a need to reduce EDLOS, and the scientific literature reports multiple strategies aimed at this goal. Therefore, the objective of this study, published in BMC Emergency Medicine, was to determine strategies statistically significant in reducing the EDLOS.

Cardiovascular Disease and Diabetes (International)

Improving type 2 diabetes care and self‐management at the individual level by incorporating social determinants of health
Suboptimal social determinants of health impede type 2 diabetes self-management. They are usually considered at population and community levels, not individually. The objective of this study, published in the Australian and New Zealand Journal of Public Health, was to draw on perspectives of people who have type 2 diabetes to identify and explore the impact of social determinants on self-management and ways to incorporate them into individual care.

The involvement of specialists in primary healthcare teams for managing diabetes: a systematic review and meta-analysis
Diabetes mellitus requires ongoing management and care coordination. The majority of patients with diabetes were managed in primary healthcare settings. Several quality improvement programs have introduced specialist involvement in primary healthcare teams. However, synthesised evidence is needed to support policy improvements regarding the impact of specialist-primary healthcare coordination on glycemic control in diabetes care. This systematic review and meta-analysis, published in BMC Primary Care, aimed to assess the effectiveness of specialist involvement in primary healthcare teams on glycemic control of patients with diabetes.

Primary Health Care (New Zealand)

Te Aorerekura : towards eliminating family violence – reflections from the Atawhai project
Family violence is an under-recognised contributor to ill-health. This report, published in Policy Quarterly, focuses on the Atawhai project, which is a sustainable responses to family violence in primary healthcare services, suggests that relationships and networks among locality-based service providers and local communities will help in making New Zealand’s strategy to eliminate family violence a reality.

Smoking Cessation (International)

Effectiveness of culturally tailoring smoking cessation interventions for reducing or quitting combustible tobacco: A systematic review and meta-analyses
Standard approaches to smoking cessation may not be as effective for certain populations, and tailoring on cultural factors could improve their effectiveness. This systematic review, published in Addiction, measured the effectiveness of culturally tailoring smoking cessation interventions on quitting or reducing smoking combustible tobacco.

Tobacco control interventions for populations living in subsidised, low-income housing: a scoping review
People living in subsidised low-income housing are more likely to smoke and experience secondhand smoke exposure compared to the general population. While tobacco control interventions have yielded substantial population health benefits, people living in subsidised housing experience a greater burden of tobacco-related harms. This scoping review, published in Public Health Research & Practice, synthesised existing peer-reviewed and grey literature to determine tobacco control interventions that have been implemented in subsidised housing globally, and to understand their impact on smoking and secondhand smoke exposure.

Electronic cigarettes for smoking cessation
Electronic cigarettes (ECs) are handheld electronic vaping devices that produce an aerosol by heating an e‐liquid. People who smoke, healthcare providers, and regulators want to know if ECs can help people quit smoking, and if they are safe to use for this purpose. This is a Cochrane Review update conducted as part of a living systematic review. It aims to examine the safety, tolerability, and effectiveness of using EC to help people who smoke tobacco achieve long‐term smoking abstinence, in comparison to non‐nicotine EC, other smoking cessation treatments, and no treatment.

Key Ministry of Health Publications

Te Awa Tārai – A career development guide for Allied Health - Hauora Haumi
Career development is often conceptualised as a linear progression. In reality, career progression often takes a winding path, which both shapes and is shaped by its environment. Te Awa Tārai acts as a guide through which individual professionals, educators, industries and organisations can recognise, value and invest in necessary skills for current and emerging hauora haumi – allied health career opportunities. This purposefully includes acknowledgement of cultural intelligence and expertise, lived experiences and mātauranga Māori, to safeguard the delivery of equitable, effective, safe and sustainable health services in Aotearoa.

Government Response to the Report from the Prime Minister’s Chief Science Advisor
Antimicrobial resistance (AMR) is a significant and growing public health threat which affects patients and communities, and threatens to undermine the modern health system. AMR can also have serious negative impacts on animal health, welfare and production, and the environment. The New Zealand Antimicrobial Resistance Action Plan was published in 2017 to enable coordinated, cross-agency national action to minimise the impacts of AMR on New Zealand. In March 2022, the Office of the Prime Minister’s Chief Science Advisor released Kotahitanga: Uniting Aotearoa against infectious disease and antimicrobial resistancenorth_east. Many of the themes and recommendations in the Kotahitanga report align with, and build on, the Action Plan. This publication notes that progress has been made on a number of the recommendations in the Kotahitanga report, as well as acknowledging that there is more work to do. The Ministries of Health and Primary Industries are working together on a new cross-agency AMR strategy to update and drive ongoing action.

Health Sector Initiative

Putting emergency preparedness into practice
Health New Zealand and Hato Hone St John (HHSJ) are teaming up to carry out an exercise simulating a large-scale emergency at Hawke’s Bay Fallen Soldiers’ Memorial Hospital. As part of the exercise, a large tent will be put up in the ambulance bay at the Emergency Department (ED) to simulate a patient overflow area. “Predicting a large-scale emergency is almost impossible, but what we can control is how we react and respond,” says Hawke’s Bay Group Director Operations David Warrington. “This training exercise is a critical part of our emergency preparedness, ensuring that we are well-equipped to respond effectively should a major incident occur that requires additional treatment space.” The practice run is crucial for teams to familiarise themselves with the tent’s setup and operational requirements, to ensure HHSJ and Health NZ clinicians work together cohesively and efficiently, while also identifying any logistical challenges before a real emergency arises.

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.