Issue 318 - 20 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

A Bi-Cultural Multidisciplinary Approach to Achieving Excellence in Care for Indigenous Māori: Report From the Wānanga, Auckland, 2023
The aim of this report, published in the Journal of Advanced Nursing, was to explore the alignment of nursing and healthcare practice illustrated in the Fundamentals of Care framework with Māori (Indigenous person of Aotearoa, New Zealand) worldviews using Indigenous methods.

Health Equity (New Zealand)

Vision impairment and differential access to eye health services in Aotearoa New Zealand: a scoping review
In Aotearoa New Zealand, Māori and Pacific People experience worse health outcomes compared with other New Zealanders. No population-based eye health survey has been conducted, and eye health services do not generate routine monitoring reports, so the extent of eye health inequality is unknown. This information is required to plan equitable eye health services. This scoping review, published in BMJ Public Health, aimed to summarise the nature and extent of the evidence reporting vision impairment, its main causes and access to eye health services by ethnicity in New Zealand.

Towards Regional Food Security and Food System Sustainability: Findings From a Stakeholder Cognitive Mapping Study
Food system sustainability is a broad goal, contributing to resilience, positive health, equity, cultural, environmental and economic outcomes. This study, published in the Health Promotion Journal of Australia, aims to understand the essential components on the journey towards "sustainable food systems" in New Zealand's, Hawke's Bay (HB) region.

Does access to medicines differ from access to healthcare? Experiences of barriers to medicines access by people facing social disadvantage
Levesque et al.'s widely-cited five dimensional model of access to healthcare has been used in a variety of contexts, including access to medicines. However the model is based on healthcare, i.e., facilities where health professionals work. This study, published in Research in Social & Administrative Pharmacy, examined whether there were other important features of access to medicines, not captured by this model.

Quality Improvement (International)

Equity in action: a scoping review and meta-framework for embedding equity in quality improvement
There are increasing efforts to include equity in all quality improvement (QI) initiatives. A comprehensive framework to embed equity in QI has been lacking, which acts as a barrier to the QI community from taking action to reduce healthcare inequities. The objectives of this scoping review, published in BMJ Quality & Safety, were to map and summarise available equity frameworks for QI and create a 'meta-framework' for QI leaders and practitioners, with engagement of people with lived experience of health inequities.

Emergency Department Services (New Zealand)

Accessing care in an unfamiliar environment: experiences of tūroro Māori and their whānau when transported outside their local area after a cardiac emergency
After an acute cardiac event tūroro (patients) are often transported to a hospital with specialist cardiac services, sometimes far from home. While such hospitals offer specialist care, it is unknown how transport out-of-area affects tūroro and whānau (family) holistically. This study, published in The New Zealand Medical Journal, explored tūroro Māori and whānau experiences and perceptions of transport away from their community after an acute cardiac event. Methods Using a Kaupapa Māori research approach, five semi-structured interviews and two focus groups were undertaken with tūroro Māori and/or whānau.

A falls early response service in Aotearoa New Zealand: a scoping review
The aim of this review, published in The New Zealand Medical Journal, was to understand the extent and type of evidence available on a joint service between occupational therapy and paramedics in a community falls early response service (FERS).

Cardiovascular Disease and Diabetes (International)

Dietary interventions for the management of type 2 diabetes mellitus in childhood and adolescence: A systematic review
Despite the alarming increasing incidence of type 2 diabetes mellitus (T2DM) in children and young People (CYP), and its associated morbidities and poor long‐term prognosis, there remains uncertainty in its management. Dietary interventions have been shown to be effective in adults with T2DM, but little is known about their effectiveness in CYP. The aim of this systematic review, published in Diabetic Medicine, is to provide up‐to‐date evidence regarding dietary interventions for T2DM in childhood and adolescence.

Diabetes self‐management education and support delivered by mobile health (mHealth) interventions for adults with type 2 diabetes—A systematic review and meta‐analysis
Diabetes self‐management education (DSME) and support (DSME/S) delivered via mobile health (mHealth) is potentially cost‐effective, if proven effective. The objective of this review, published in Diabetic Medicine, was to assess the effectiveness of DSME, DSMS or DSME/S delivered by mHealth interventions compared to usual care (UC) or attention placebo control (APC) in adults with type 2 diabetes.

Primary Health Care (New Zealand)

The Clinical Nurse Specialist as the Manager of the Family Medicine Clinic: A Hybrid Solution Between Four Major Commonwealth Realms
There exist several interconnected issues that hinder the development of family medicine in Commonwealth realms such as the United Kingdom, Canada, New Zealand, and Australia. These issues affect both the medical and nursing professions. Family physicians, in most countries including the United Kingdom, are not considered "specialists" and are called "general practitioners" instead. The term GP is an outdated and potentially demeaning term relegated to the early 20th century when they did not receive any more than a few rotations as staff grades before being allowed to run their own community clinic. Registered nurses often cover a minor and subaltern role when working as practice nurses in the UK. They are often replaced by cost-effective, licensed practical nurses in most other English-speaking countries. Nurse practitioners in the UK, though being de facto entirely equal to family physicians in countries like Canada, Australia, New Zealand, and most US states, do not hold a special registration status. Their training is not defined in specific legislation, and they do not function as alternatives to general practitioners in the sense that patient may register with them alone which is often the case in Canada or the USA. Family medicine is, therefore, generally left lacking leadership with members of the medical and nursing professions often struggling for "power" in a way that undermines the foundation of family medicine which is to serve the health needs of a large population ranging from children to seniors. Methods: The purpose of this paper, published in Healthcare, is to describe a solution to management in a Family Medicine Clinic in Calgary, Alberta, Canada.

Primary Mental Health (New Zealand)

Twelve steps and talanoa: An exploratory study of the experiences of pacific peoples in New Zealand Twelve Step Programmes
Fewer Pacific peoples in New Zealand with substance use disorder access addictions services than the general population. This study, published in the Journal of Ethnicity in Substance Abuse, explored the experiences of six Pacific peoples in Twelve Step Programmes via face-to-face semi-structured talanoa-style interviews.

Primary Mental Health (International)

Mental health consumers and primary care providers co-designing improvements and innovations: a scoping review
Co-design and co-production are increasingly used to improve and innovate healthcare practices and services to better address people’s healthcare needs. Mental health consumers, especially people diagnosed with serious mental illness, experience considerable health disparities and barriers to primary care, while primary care providers experience barriers to addressing the healthcare needs of people diagnosed with serious mental illness. Both mental health consumers and primary care providers bring knowledge and expertise to improving mental health consumers’ health care. This scoping review, published in the Australian Journal of Primary Health, was undertaken to determine the extent and scope of co-design and co-production involving mental health consumers and primary care providers to address mental health consumers’ healthcare needs. The review also sought to determine factors that enable or limit co-design and co-production involving mental health consumers and primary care providers.

Codesign of Mental Health Interventions With Young People From Racially Minoritised Populations: A Systematic Review of Methods and Outcomes
Codesign of mental health interventions entails the active involvement of end users and other stakeholders in various stages of the developmental process. This has emerged as a promising approach for developing evidence‐based mental health interventions aligned with minoritised populations' needs and preferences. However, key questions remain about the methods and outcomes of codesign studies focused on young people from racially minoritised groups. The current review, published in Health Expectations, aimed to explore the codesign approaches and phases used in developing mental health interventions with young people from racially minoritised populations, analyse the codesign outcomes for participants and examine the contextual enablers and barriers impacting the codesign process.

Increased Immunisation (New Zealand)

The role of narratives in promoting vaccine confidence among Indigenous peoples in Canada, the United States, Australia, and New Zealand: a scoping review
Many Indigenous youth and young adults in Canada, the United States, Australia, and New Zealand have reported low vaccine confidence, which has been linked to lower vaccination rates for COVID-19, MMR, HPV, DTaP-IPV-Hib, and pneumococcal conjugate vaccines. Narrative-based health promotion approaches, including those focused on strengthening vaccine confidence, have been used in public health interventions. Scoping reviews have become increasingly valued for their rigorous and reproducible exploration of evidence in public health research. The aim of this scoping review, published in the International Journal for Equity in Health, was to understand the extent and types of evidence related to the facilitators, challenges, and benefits of narrative-based health promotion approaches in vaccine confidence interventions within Indigenous populations.

Increased Immunisation (International)

Influenza vaccination for healthcare workers who care for people aged 60 or older living in long‐term care institutions
People who work in long‐term care institutions (LTCIs), such as doctors, nurses, other health professionals, cleaners and porters (and also family visitors), may have substantial rates of influenza during influenza seasons. They often continue to work when infected with influenza, increasing the likelihood of transmitting influenza to those in their care. The objective of this Cochrane Review was to assess the effects of vaccinating healthcare workers in long‐term care institutions against influenza on influenza‐related outcomes in residents aged 60 years or older.

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.

Strategic Approach to Immunisation in New Zealand 2025–2030
Immunisation is a highly successful public health intervention. It safeguards individuals, whānau and communities against a range of potentially devastating diseases, and is a critical way of preventing and controlling infectious disease outbreaks. An accessible and effective immunisation system maximises immunisation uptake and coverage, improving the health of the population and enabling pae ora – healthy futures. The Strategic Approach to Immunisation in New Zealand 2025–2030 (the strategic approach) provides a renewed vision and strategic direction for the immunisation system for the next five years.

Briefing to the Incoming Minister of Health January 2025
Following a change of Minister, the Ministry of Health | Manatū Hauora, produces a Briefing to the Incoming Minister of Health, as is usual practice. This briefing provided the incoming Minister of Health, Hon Simeon Brown, with an overview of the context of recent Government reforms and priorities and identified key issues and upcoming milestones and decisions for the Health Minister.

Health Sector Initiative

Southern junior doctors’ tikanga initiative a first for Aotearoa
A new tikanga initiative to ensure medical staff can access a kit of dedicated equipment for confirming deaths has been rolled out across hospitals in Otago and Southland by the Southern Māori House Officers’ Working Group.

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.