Values, perspectives, and experiences of indigenous Māori regarding kidney transplantation
Māori are highly motivated to seek kidney transplantation but face barriers including social determinants, racism, and lack of information, according to a qualitative study. In-depth interviews were conducted with 40 Māori across New Zealand, including 8 who had received a kidney transplant, 20 with chronic kidney disease, 4 live-kidney donors and 8 family members. Major themes identified were actively seeking a kidney transplant, evolving attitudes toward traditional values and practices, being confronted by interpersonal and systemic racism, poor information and communication, and being challenged by social determinants of health. Barriers faced by Māori impacted both direct experiences of transplantation and access to transplantation services.
As we all know, kidney transplants are life-changing. So it’s good to see some movement in this space. For too long the narrative focused on low Māori participation in kidney donor programmes when it appears that wider factors, including opportunities for live donation, play a role.
Reference: Am J Kidney Dis. 2022;80(1):20-29.e1.
Effects of ethnic classification on substantive findings in adolescent mental health outcomes
A New Zealand study has shown that the ethnic classification method used in research has a substantial impact on reported outcomes in adolescent mental health. The study used a nationally representative sample of 8275 adolescents aged 12-18 years, of whom 55% were female and 32% multi-ethnic. The impact of 5 ethnic classification methods on 3 mental health outcomes were investigated: overall psychosocial difficulties, deliberate self-harm, and suicide attempts. Reported outcomes within the same nominal ethnic group varied by an effect size of up to 0.12, and the reported magnitude of difference between nominal ethnic groups varied by an effect size of up to 0.25. The authors concluded that their study highlighted the importance of criticality and transparency in research involving ethnicity data.
Worth a read! As the authors note, being upfront about how researchers use ethnicity when analysing data – the who, how and importantly why – is to be encouraged.
Reference: J Youth Adolesc. 2022;51(8):1581-1596.
Participation in paid and unpaid work one year after injury and the impact of subsequent injuries for Māori
Reduced participation in paid work is prevalent for Māori after an Accident Compensation Corporation (ACC) entitlement claim injury, and particular characteristics of subsequent injuries impact on participation in paid work 12 months after the sentinel injury. These were the findings of the Subsequent Injury Study, which utilised data from an earlier study of New Zealanders with an ACC entitlement claim injury. Eligible participants for the current study were identified from the 405 Māori participants interviewed at 12 months, of whom 32% sustained at least one ACC subsequent injury, and 16% reported reduced participation in unpaid work. Of the eligible participants working for pay at the time of their sentinel injury, 35% reported reduced participation in paid work. Types of subsequent injury independently predictive of reduced participation in paid work were injury resulting from an assault (adjusted relative risk [RR] 2.4; 95% confidence interval [CI] 1.2-4.9), injury involving an entitlement claim (adjusted RR 2.0; 95% CI 1.1-3.4), >1 subsequent injury (adjusted RR 2.0; 95% CI 1.1-3.6), and a non-work-related subsequent injury (adjusted RR 1.6; 95% CI 1.0-2.7). These findings are important for future injury prevention strategies and supporting return to work rehabilitation programmes for Māori, the study authors noted.
Many of us see this first-hand in our mahi or with whānau. And although we could focus on ‘returning to work’ as the primary outcome, patients tell me it’s just as important to feel heard and valued in the process.
Reference: Injury. 2022;53(6):1927-1934.
Stakeholder perspectives of the sociotechnical requirements of a telehealth wheelchair assessment service in Aotearoa/ New Zealand
A qualitative study has revealed that training in telehealth wheelchair assessment is essential for incorporating culturally safe communication practices and user autonomy, while identifying solutions that achieve wheelchair user goals. The study used focus group and interview data from 23 assessors (19 occupational therapists and 4 physiotherapist assessors, 1 of whom was Māori) and 19 wheelchair users (3 of whom were Māori). A total of 8 themes were identified, with the final 3 themes of particular concern to Māori: (1) At the mercy of the system; (2) The hurdle of technology; (3) More efficient for all; (4) Lost information and connection; (5) Rights and the right way forward; (6) Cultural safety; (7) Whanaungatanga (relationship building); and (8) Summative disadvantage for Tāngata whaikaha (Māori with disabilities). Themes reflected a recognition of both risks and advantages associated with tele-delivered assessment.
In a similar vein to the health reforms, current practice isn’t working for Māori and so we need a new way of doing things. As noted here, there are both advantages and disadvantages to any new system, but understanding what will work for Māori is a great start.
Reference: Aust Occup Ther J. 2022;69(3): 279-289.
A kia ora, a wave and a smile: an urban marae-led response to COVID-19, a case study in manaakitanga
Māori health providers are well placed to respond effectively in a public health crisis when resourced appropriately and trusted to deliver, according to a case study of Kōkiri Marae Hauora (Kōkiri) in the Hutt Valley, New Zealand. Between June and October 2020, shortly after the first COVID-19 lockdown ended, interviews were conducted with 26 Kōkiri whānau (clients) and focus groups held with 15 Kōkiri kaimahi (workers). Findings were interpreted using a Māori worldview. The study found that kaitiakitanga (protecting) and manaakitanga (with kindness) – with whānau at the centre of all decisions and service delivery – worked as a protective mechanism to provide much needed support within the community served by Kōkiri. The study authors recommended that Māori be included in pandemic planning and decision-making, that Māori-led initiatives and organisations be valued and adequately resourced, and that strong communities with strong networks be built during non-crisis times.
One of the many Māori providers that stepped up during the COVID-19 pandemic and associated lockdowns. It was wonderful to see this paper reflecting on their experience, and to see the General Manager of Kōkiri Marae Hauora, Teresea Olsen, recognised as Wellingtonian of the year (see https://www. scoop.co.nz/stories/AK2205/S00295/tereseaolsens-a-greater-wellingtonian-of-the-yeartoo.htm).
Reference: Int J Equity Health. 2022;21(1):70.
Associations between changes in caregiver’s and child’s weight status in a community-based obesity intervention programme
In a family-centred obesity intervention programme, reductions in caregivers’ body mass index (BMI) were key to BMI standard deviation score (SDS) reductions among Māori participants. New Zealand children and adolescents aged 4.8-16.8 years with a BMI ≥98th percentile (or >91st percentile with weightrelated comorbidities) were enrolled in a randomised controlled trial. Both participants and their caregivers were assessed at baseline, 12, and 24 months. Reductions in caregivers’ BMI at 12 months were associated with reductions in their children’s BMI SDS at 12 months (r = 0.30; p = 0.038) and 24 months (r = 0.39; p = 0.009) among Māori participants. In addition, Māori participants whose caregivers’ BMI decreased at 12 months had greater BMI SDS reductions at 12 months (-0.30; 95% CI -0.49, -0.10; p = 0.004) and 24 months (-0.39; 95% CI -0.61, -0.16; p = 0.001) compared with participants whose caregivers had increased or unchanged BMI. The study authors noted the importance of culturally relevant, family-focused programmes to achieve clinically meaningful improvements in weight status across the family.
Proof here that a whānau/intergenerational approach to preventing and managing health issues, including weight, is needed.
Reference: Int J Obes. 2022;46(7):1406-1409.
Knowledge and decisions about maternal immunisation by pregnant women in Aotearoa New Zealand
There is a lack of understanding about the benefits and risks of maternal immunisation among pregnant Māori and Pacific women, according to a study conducted in Dunedin and Gisborne. Māori and Pacific women from those areas were purposively sampled and interviewed between May and August 2021. A semi-structured interview guide was used, focusing on knowledge of pertussis and influenza vaccination during pregnancy and decision-making. Not all women had knowledge of maternal vaccine recommendations or the diseases they protected against. Many women did not realise how dangerous influenza and pertussis could be, and some were more concerned about potential harms of the vaccine. Women who decided to vaccinate felt well-informed, had vaccination recommended by their healthcare provider, and vaccinated to protect their own health and that of their infant. Reasons for deciding against vaccination included vaccine safety, lack of information, not being offered the vaccine, and not considering vaccination a priority.
An important study as it does feel as though we’ve taken our eye off immunisations, including maternal, with everything else going on. One thing really stood out for me here though, which is the fact that many hapu wahine were still not even offered vaccines!
Reference: BMC Health Serv Res. 2022;22(1):779.
Māori experiences and beliefs about antibiotics and antimicrobial resistance for acute upper respiratory tract symptoms
A qualitative study has revealed factors influencing antibiotic use and perceptions of antimicrobial resistance among Māori, as well as strategies for improving antibiotic use. In-depth, semi-structured interviews were conducted with 30 Māori aged 20-77 years enrolled in primary care, of whom 23% were male. Identified factors included general practitioner times and ratios, effect of colonisation, lack of knowledge and information, access and poverty barriers, relationship with health professionals, illness perceptions, treatment beliefs and Whaakaro (thoughts), and beliefs pertaining to natural (rongoā) and Western medicine. Potential strategies for improving antibiotic use included cultural support and involving Te Ao Māori
This study had two wonderful outcomes – it has added to our knowledge on Māori views regarding antimicrobial resistance but importantly it was led by a Māori medical student with support from other experts. Well done Kayla, your first publication of many!
Reference: Antibiotics. 2022;11(6):714.
Acute respiratory infection risk associated with exposure to outdoor PM10 emissions from domestic heating
A time-stratified case crossover analysis has determined that wood smoke pollution may negatively affect the respiratory health of residents in mid-size towns in New Zealand. A total of 1870 general practitioner visits for acute respiratory infections were assessed over 5 consecutive winters (May-August 2014-2018), and daily air concentrations of particulate matter less than 10 μm (PM10) were obtained from a fixed-site monitoring station. A 10 µg/m3 increase in PM10 concentration increased the odds of a general practitioner visit for an acute respiratory infection within 24 hours in females (odds ratio 1.08; 95% CI 1.01-1.15) and in Māori of both sexes (odds ratio 1.20; 95% CI 1.04-1.38). The study authors commented that those most affected by wood smoke are also likely to be most affected by woodburner phase-out policies, and that air quality and housing policies must be integrated to achieve improved health.
An excellent example of research demonstrating both the benefits and impacts of policy changes for Māori.
Reference: N Z Med J. 2022;135(1556):53-61.
The role of the Indigenous Patient Navigator
A scoping review has mapped the current state of the Indigenous Patient Navigator (IPN) role within Canada, the US, Australia and New Zealand. The review used established methodological framework outlined by Arskey and O’Malley, with the addition of the PRISMA extension for scoping reviews. A total of 16 articles were eligible for the review, mostly originating from the US, with 1 article originating from New Zealand. No articles were identified from Australia. The term navigator was used most often in articles and was typically used when describing lay/peer roles. Professional roles were described using specific role descriptions, including social service navigation, holistic support of indigenous people, advocacy/building capacity, health assessment, administrative navigation, and outreach. Barriers and enablers addressed by IPNs were identified. The authors noted that the absence of published literature surrounding the IPN role in Australia and New Zealand was surprising, considering their similar histories of colonisation.
With the health reforms, and current health workforce crisis, it is timely to think about the potential of new ‘types’ of workers. However, as highlighted here, clarity around the job descriptions, roles and responsibilities is needed.
Reference: Can J Nurs Res. 2022;54(2):199-210.
