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RATIONALE & OBJECTIVE: In Aotearoa/New Zealand, Indigenous Maori experience inequitable delivery of kidney transplantation despite disproportionately higher rates of kidney failure. This study describes Maori patients' and families' values, perspectives, and experiences related to kidney transplantation. STUDY DESIGN: Qualitative interview study. SETTING & PARTICIPANTS: We conducted 40 in-depth interviews of 40 Maori: 8 who had received a transplant, 20 with chronic kidney disease (which included 10 on the deceased donor transplant list, 9 who were interested in transplantation and not currently waitlisted or who were ineligible for waitlisting, and 1 who was not interested in transplantation), 4 live-kidney donors, and 8 family members including 6 who had experiences with donor assessment. ANALYTICAL APPROACH: Data were analyzed inductively to generate themes and a conceptual framework. RESULTS: We identified 5 major themes: actively seeking a kidney transplant; evolving attitudes toward traditional values and practices; being confronted by interpersonal and systemic racism; poor information and communication; and challenged by social determinants of health. LIMITATIONS: Participants were recruited nationally through patient advocacy organizations and 1 regional kidney service. Potential participants unrelated to these groups or region could not be included. CONCLUSIONS: Maori participants were highly motivated to seek kidney transplantation and were inspired by positive experiences through donating and receiving a kidney. However, they faced barriers including social determinants, racism, and lack of information that impacted both direct experiences of transplantation and access to transplantation services.
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Trasplante de Riñón , Racismo , Humanos , Nativos de Hawái y Otras Islas del Pacífico , Nueva Zelanda , Investigación CualitativaRESUMEN
OBJECTIVE: To understand motivators, facilitators and challenges to dietary change amongst a diverse sample of New Zealanders with prediabetes participating in a primary care nurse-led individualised dietary intervention. DESIGN: A qualitative study involving semi-structured, face-to-face interviews with a stratified sample of adults with prediabetes and BMI ≥ 25 kg/m2, purposefully selected from a larger 2-year primary care-based prediabetes dietary intervention study. Thematic analysis was undertaken. A socio-ecological model guided interpretation. SETTING: Hawke's Bay, Aotearoa/New Zealand, April 2018-March 2020. PARTICIPANTS: Fifty-eight people aged 28-69 years, with similar numbers of men and women, indigenous Maori and non-Maori, and those who had and had not regressed to normoglycaemia at 6 months. RESULTS: Motivators for wanting to make dietary changes were determination not to progress to diabetes; wanting to be healthy and contribute to others and encouragement by others. Facilitators for adopting and maintaining changes were a strong desire to be healthy; personal determination and feeling supported. Challenges were compromised control over life and environmental factors; feeling unsupported by others; social occasions; financial constraints and living with other health conditions. Developing their own strategies to overcome challenges was empowering, enabling a sense of control. These factors were similar across demographic and glycaemic outcome groups. CONCLUSIONS: Influences on dietary change involved personal, interpersonal, organisational, environmental and policy factors. Although findings appeared similar across groups, dietary interventions need to address the specific ways motivators, facilitators and challenges manifest for individuals and social groups and be tailored accordingly within the context of the wider obesogenic and socio-economic environment.
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Diabetes Mellitus , Estado Prediabético , Enfermería de Atención Primaria , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda , Investigación CualitativaRESUMEN
BACKGROUND: The management of prediabetes in the community setting is a global priority. We evaluated the feasibility of a 6-month multilevel practice nurse-led prediabetes dietary intervention which involved goal setting. The aim of this paper is to explore the weight loss goals and strategies reported by participants to achieve their weight loss goals as recorded by practice nurses, and report on factors that influenced dietary behaviours. METHODS: This study used a convergent mixed-methods design. A six-month pragmatic non-randomised pilot study with a qualitative process evaluation was conducted in two neighbouring provincial cities in New Zealand. A structured dietary intervention delivered by practice nurses was implemented in four practices in 2014-2016. Content analysis of the text and descriptive statistics were used to analyse the data. RESULTS: One hundred and fifty seven people with prediabetes were enrolled (85 intervention, 72 control). The intervention group lost a mean 1.3 kg more than the control group (p < .0.001). The majority of the intervention group indicated either a high level of readiness (n = 42, 53%) or some readiness (n = 31, 39%) to make food changes. The majority of weight loss goals aligned with clinical guidelines (between 5 and 10% of body weight). While just over half (n = 47, 55%) demonstrated weight loss at the end of the six month period, the majority of participants did not achieve their predetermined weight loss goal (n = 78, 83%). Gender, ethnicity and budget were not related to weight loss at six months. Readiness to change and reported challenges to making dietary changes were related to weight loss at six months. Negative factors or set-backs included sporadic adherence to diet due to other health problems, change in context or environment and coping with ill health, most notably stress and low mood. CONCLUSIONS: The data relating to weight loss and dietary goals provided insight into the challenges that people faced in making dietary changes for weight loss across a six month period. Simplifying goal setting to those goals with the greatest potential clinical impact or the greatest significance to the person, in a socially supportive environment, may increase the success of goal achievement. TRIAL REGISTRATION: ANZCTR ACTRN1261500080656. Registered 3 August 2015 (Retrospectively registered). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366560&isReview=true.
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BACKGROUND: Kidney transplantation is considered best practice treatment for end stage kidney disease (ESKD), however Indigenous patients are substantially less likely to receive either a deceased or live donor kidney transplant than non-Indigenous patients. We describe Indigenous peoples' experiences and perspectives including traditional values around kidney transplantation to inform international transplant programs. METHODS: We conducted a systematic review of qualitative studies involving Indigenous adults who have experience with or perceptions of kidney transplantation. We searched MEDLINE, Embase, PsychINFO, and CINAHL, in conjunction with analysis of Google Scholar and reference lists of related studies till July 2019. We utilised thematic synthesis to analyse data. Completeness of reporting in studies was evaluated using the Consolidated Criteria for Reporting Qualitative Studies (COREQ) framework. RESULTS: Eight studies involving 225 Indigenous participants were included. Five themes were identified: strong desire for transplantation (seeking normality and freedom from dialysis, wanting to reduce burden of disease within community); lack of partnership in shared decision-making (receiving inadequate information, ineffective communication); barriers to live kidney donation (difficulty asking, apprehension about impact on donor, avoiding additional financial burden and fear of complications); cultural considerations (influence of traditional values and beliefs, reconciling traditional values with pragmatic need); and experiencing lack of cultural competence in clinical care (struggling with prejudice and ignorance, mistrust of clinicians and health system). CONCLUSION: Indigenous participants had a strong desire for a kidney transplant and recognised the need for more readily available kidney transplants for others in their communities with ESKD. However, they faced prejudice and a lack of cultural competence by health workers as well as wider barriers to transplantation in systems that did not support effective and culturally appropriate delivery of information and care. Traditional cultural values also influenced decisions regarding kidney transplantation but such values were moderated when considering transplantation. Transplantation programs need to identify and mitigate barriers, such as the financial burden, promote cultural safety and incorporate traditional values into the promotion of transplantation in order to address inequitable transplantation rates. REGISTRATION: Not applicable.
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Actitud Frente a la Salud/etnología , Pueblos Indígenas/psicología , Fallo Renal Crónico/etnología , Trasplante de Riñón/psicología , Competencia Cultural , Humanos , Fallo Renal Crónico/terapia , Prejuicio , Investigación Cualitativa , Valores SocialesRESUMEN
BACKGROUND: Although breastfeeding duration in New Zealand's indigenous Maori is shorter than in non-Maori, we know little about barriers or motivators of breastfeeding in this community. The aim of this analysis was to identify predictors for extended duration of breastfeeding amongst participants drawn from predominantly Maori communities in regional Hawke's Bay. METHODS: Mother/baby dyads were recruited from two midwifery practices serving predominantly Maori women in mostly deprived areas, for a randomised controlled trial comparing the risks and benefits of an indigenous sleeping device (wahakura) and a bassinet. Questionnaires were administered at baseline (pregnancy) and at one, three and six months postnatal. Several questions relating to breastfeeding and factors associated with breastfeeding were included. The data from both groups were pooled to examine predictors of breastfeeding duration. RESULTS: Maori comprised 70.5% of the 197 participants recruited. The median time infants were fully breastfed was eight weeks and Maori women were more likely to breastfeed for a shorter duration than New Zealand European women with an odds-ratio (OR) of 0.45 (95% CI 0.24, 0.85). The key predictors for extended duration of breastfeeding were the strong support of the mother's partner (OR = 3.64, 95% CI 1.76, 7.55) or her mother for breastfeeding (OR = 2.47, 95% CI 1.27, 4.82), longer intended duration of maternal breastfeeding (OR = 1.02, 95% CI 1.00, 1.03) and being an older mother (OR = 1.07, 95% CI 1.02, 1.12). The key predictors for shorter duration of breastfeeding were pacifier use (OR = 0.28, 95% CI 0.17, 0.46), daily cigarette smoking (OR = 0.51, 95% CI 0.37, 0.69), alcohol use (OR = 0.54, 95% CI 0.31, 0.93) and living in a more deprived area (OR 0.40, 95% CI 0.22, 0.72). CONCLUSIONS: Breastfeeding duration in this group of mainly Maori women was shorter than the national average. Increasing the duration of breastfeeding by these mothers could be further facilitated by ante and postnatal education involving their own mothers and their partners in the support of breastfeeding and by addressing pacifier use, smoking and alcohol use.
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Lactancia Materna/estadística & datos numéricos , Etnicidad , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Lactante , Recién Nacido , Masculino , Edad Materna , Nativos de Hawái y Otras Islas del Pacífico , Nueva Zelanda/epidemiología , Chupetes/estadística & datos numéricos , Áreas de Pobreza , Fumar/epidemiología , Factores de TiempoRESUMEN
BACKGROUND: Primary care nurse-led prediabetes interventions are seldom reported. We examined the implementation and feasibility of a 6-month multilevel primary care nurse-led prediabetes lifestyle intervention compared with current practice in patients with prediabetes, with weight and glycated haemoglobin (HbA1c) as outcomes. METHODS: This study used a convergent mixed methods design involving a 6-month pragmatic non-randomised pilot study with a qualitative process evaluation, and was conducted in two neighbouring provincial cities in New Zealand, with indigenous Maori populations comprising 18.2% and 23.0%, respectively. Participants were non-pregnant adults aged ≤ 70 years with newly diagnosed prediabetes (HbA1c 41-49 mmol/mol), body mass index (BMI) ≥ 25 kg/m2 and not prescribed Metformin. A structured dietary intervention tool delivered by primary care nurses with visits at baseline, 2-3 weeks, 3 months and 6 months was implemented in four intervention practices. Four control practices continued to provide usual care. Primary quantitative outcome measures were weight and HbA1c. Linear and quantile regression models were used to compare each outcome between the two groups at follow-up. Qualitative data included: observations of nurse training sessions and steering group meetings; document review; semi-structured interviews with a purposive sample of key informants (n = 17) and intervention patients (n = 20). Thematic analysis was used. RESULTS: One hundred fifty-seven patients with prediabetes enrolled (85 intervention, 72 control), 47.8% female and 31.2% Maori. Co-morbidities were common, particularly hypertension (49.7%), dyslipidaemia (40.1%) and gout (15.9%). Baseline and 6 month measures were available for 91% control and 79% intervention participants. After adjustment, the intervention group lost a mean 1.3 kg more than the control group (p < 0.001). Mean HbA1c, BMI and waist circumference decreased in the intervention group and increased in the control group, but differences were not statistically significant. Implementation fidelity was high, and it was feasible to implement the intervention in busy general practice settings. The intervention was highly acceptable to both patients and key stakeholders, especially primary care nurses. CONCLUSIONS: Study findings confirm the feasibility and acceptability of primary care nurses providing structured dietary advice to patients with prediabetes in busy general practice settings. The small but potentially beneficial mean weight loss among the intervention group supports further investigation. TRIAL REGISTRATION: ANZCTR ACTRN12615000806561 . Registered 3 August 2015 (Retrospectively registered).
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Dieta , Estilo de Vida , Educación del Paciente como Asunto , Pautas de la Práctica en Enfermería , Estado Prediabético/terapia , Atención Primaria de Salud , Anciano , Índice de Masa Corporal , Peso Corporal , Competencia Cultural , Ejercicio Físico , Estudios de Factibilidad , Femenino , Hemoglobina Glucada/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Nativos de Hawái y Otras Islas del Pacífico , Nueva Zelanda , Relaciones Enfermero-Paciente , Aceptación de la Atención de Salud , Proyectos Piloto , Estado Prediabético/sangre , Estado Prediabético/etnología , Evaluación de Procesos, Atención de Salud , Evaluación de Programas y Proyectos de Salud , Circunferencia de la Cintura , Población BlancaRESUMEN
BACKGROUND: Sudden Unexpected Death in Infancy (SUDI) has persistent high rates in deprived indigenous communities and much of this mortality is attributable to unsafe sleep environments. Whilst health promotion worldwide has concentrated on avoidance of bedsharing, the indigenous Maori community in New Zealand has reproduced a traditional flax bassinet (wahakura) designed to be used in ways that include bedsharing. To date there has been no assessment of the safety of this traditional sleeping device. METHODS/DESIGN: This two arm randomised controlled trial is being conducted with 200 mother-baby dyads recruited from Maori communities in areas of high deprivation in the Hawkes Bay, New Zealand. They are randomised to wahakura or bassinet use and investigation includes questionnaires at baseline (pregnancy), when baby is 1, 3, and 6 months, and an overnight video sleep study at 1 month with monitoring of baby temperature and oxygen saturation, and measurement of baby urinary cotinine and maternal salivary oxytocin. Outcome measures are amount of time head covered, amount of time in thermal comfort zone, number of hypoxic events, amount of time in the assigned sleep device, amount of time breastfeeding, number of parental (non-feed related) touching infant events, amount of time in the prone sleep position, the number of behavioural arousals and the amount of time infant is awake overnight. Survey data will compare breastfeeding patterns at 1, 3, and 6 months as well as data on maternal mind-mindedness, maternal wellbeing, attachment to baby, and maternal sleep patterns. DISCUSSION: Indigenous communities require creative SUDI interventions that fit within their prevailing world view. This trial, and its assessment of the safety of a wahakura relative to a standard bassinet, is an important contribution to the range of SUDI prevention research being undertaken worldwide. TRIALS REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12610000993099 Registered 16th November 2010.
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Lechos , Etnicidad , Equipo Infantil , Sueño , Muerte Súbita del Lactante/prevención & control , Temperatura Corporal , Lactancia Materna , Cotinina/orina , Cultura , Humanos , Lactante , Recién Nacido , Monitoreo Ambulatorio , Relaciones Madre-Hijo , Madres , Nueva Zelanda , Oxígeno/sangre , Oxitocina/análisis , Posición Prona , Saliva/química , VigiliaRESUMEN
OBJECTIVES: Indigenous people experience higher rates of kidney failure than do non-Indigenous Peoples. However, compared to Indigenous patients, health care systems deliver kidney transplantation to non-Indigenous patients at a substantially higher rate and more frequently as the first treatment of kidney failure. Indigenous Maori patients in Aotearoa New Zealand report numerous barriers to kidney transplantation. We explore the perspectives of clinicians as stakeholders in the delivery of kidney transplantation. METHODS: In 2021/2022 we conducted in-depth qualitative interviews with key stakeholder clinicians within kidney transplantation services in Aotearoa New Zealand, asking them about the issues for Maori patients. We used thematic analysis informed by critical theory to identify key findings and used structural coding to categorize the themes at the level of society, health system, and health services. RESULTS: We interviewed 18 clinicians (nine nephrologists, including two transplant nephrologists, and nine nurses, including six transplant coordinators). We identified nine themes from stakeholders related to delivery of kidney transplantation services to Maori patients and whanau (family), categorized according to three main levels: Firstly, at the level of society (the impact of colonization and distrust). Secondly, the health care system (failure to prevent and manage kidney disease, health care model delivers inequitable outcomes, and inadequate Maori health professional workforce). Thirdly, health care services (transplantation reliant on patient and family resources, complex assessment causes untimely delays, clinical criteria for transplantation, and lack of clinician ability to effect change). CONCLUSIONS: Delivery of kidney transplantation to Indigenous Peoples is impacted at the level of society, health care system, and health care service. To address inequities, a broad approach that addresses each of these levels is required.
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Entrevistas como Asunto , Trasplante de Riñón , Nativos de Hawái y Otras Islas del Pacífico , Investigación Cualitativa , Humanos , Nueva Zelanda , Masculino , Femenino , Atención a la Salud/organización & administración , Persona de Mediana Edad , Adulto , Participación de los Interesados , Servicios de Salud del Indígena/organización & administración , Pueblos Indígenas , Accesibilidad a los Servicios de Salud , Pueblo MaoríRESUMEN
INTRODUCTION: Type 2 diabetes mellitus (T2DM) is a major health issue in New Zealand Maori. Clinical trials have demonstrated potential for the prevention of T2DM, but whether community public health programmes aiming to prevent diabetes are effective is untested. OBJECTIVE: To describe the planning and design of an intervention aiming to translate T2DM prevention clinical trial evidence into a community-wide population health intervention in a high risk predominantly Maori community. APPROACH: Community concerns about the diabetes burden were heard by the local diabetes nurse, herself a tribal member, and discussed with a locally raised academic. Project planning ensued. The intervention and its evaluation were designed using a participatory community development model. The planned intervention had three components: community-wide health promotion initiatives conveying healthy lifestyle messages, community education and monitoring for identified high-risk individuals and their extended families, and a structural strategy aimed at adapting local environments to support lifestyle changes. The evaluation plan involved interrupted time series surveys coupled with formative and process evaluations rather than a randomised control trial design. DISCUSSION: Consulting communities, validating community concerns and prioritising cultural and ethical issues were key steps. Time spent developing good relationships amongst the health provider and academic research team members at the outset proved invaluable, as the team were united in addressing the project planning and implementation challenges, such as funding obstacles that arose because of our ethically and culturally appropriate non-randomised control trial evaluation design. The pre-intervention survey demonstrated high rates of diabetes (13%), insulin resistance (33%) and risk factors, and provided evidence for positive, as opposed to negative, lifestyle intervention messages. CONCLUSION: Community-wide lifestyle interventions have the potential to reduce rates of type 2 diabetes and other chronic diseases in high-risk communities, but require a high level of commitment from the health sector and buy-in from the community. Adequate commitment, leadership, planning and resources are essential.
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Diabetes Mellitus Tipo 2 , Conductas Relacionadas con la Salud/etnología , Servicios de Salud del Indígena , Grupos de Población/educación , Servicios Preventivos de Salud , Investigación Participativa Basada en la Comunidad , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/prevención & control , Diabetes Mellitus Tipo 2/psicología , Educación en Salud/métodos , Promoción de la Salud/organización & administración , Servicios de Salud del Indígena/organización & administración , Humanos , Estilo de Vida , Nueva Zelanda/etnología , Servicios Preventivos de Salud/métodos , Servicios Preventivos de Salud/organización & administración , Desarrollo de Programa , Investigación Biomédica TraslacionalRESUMEN
BACKGROUND: Reported experiences of racism in Aotearoa New Zealand are consistently associated with negative measures of health, self-rated health, life satisfaction, and reduced access to high-quality healthcare with subsequent poor health outcomes. In this paper, we report on perceptions and experiences of prejudice and racism by Indigenous Maori with kidney disease and their family members and donors who took part in a wider study about experiences of kidney transplantation. METHODS: We conducted semi-structured interviews with 40 Maori between September and December 2020. Participants included those with kidney disease who had considered, were being worked up for, or who had already received a kidney transplant as well as family members and potential or previous donors. We examined the data for experiences of racism using a theoretical framework for racism on three levels: institutionalised racism, personally mediated racism, and internalised racism. RESULTS: We identified subthemes at each level of racism: institutional (excluded and devalued by health system; disease stigmatization; discriminatory body weight criteria, lack of power), personally mediated (experiencing racial profiling; explicit racism), and internalized racism (shame and unworthiness to receive a transplant). CONCLUSIONS: The wide-reaching experiences and perceptions of racism described by participants with kidney disease and their families in this research point to an unfair health system and suggest that racism may be contributing to kidney transplantation inequity in Aotearoa New Zealand. Addressing racism at all levels is imperative if we are to address inequitable outcomes for Maori requiring kidney transplantation.
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Trasplante de Riñón , Racismo , Humanos , Nueva Zelanda , Pueblo Maorí , FamiliaRESUMEN
With the increasing burden of chronic kidney disease (CKD) in New Zealand (NZ) the number of people requiring pre-dialysis care is increasing. Pre-dialysis nurses play a central role in the delivery of this care. This paper describes and discusses what pre-dialysis nurses perceive to be key influences on effective pre-dialysis nursing care in NZ. It is based on findings from a wider qualitative study that interviewed the majority of NZ pre-dialysis nurses. Following inductive data analysis four main influences were identified. They were: having time from referral to commencement of renal replacement therapy (RRT) to provide adequate education and support; having good access to cultural and other supports and an understanding of differing cultural views of health; the importance of good inter-professional relationships; and support from nursing management and doctors to advance professionally. With the knowledge of the projected increase in patients with CKD, we argue that it is important to ensure the positive aspects of these influences are enhanced in order to ensure effective pre-dialysis nursing care, nurse satisfaction and professional advancement.
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Competencia Cultural , Evaluación de Necesidades , Calidad de la Atención de Salud , Diálisis Renal/enfermería , Insuficiencia Renal Crónica/enfermería , Enfermería de Práctica Avanzada , Actitud del Personal de Salud , Humanos , Relaciones Interprofesionales , Nativos de Hawái y Otras Islas del Pacífico , Nueva Zelanda , Autonomía Profesional , Investigación Cualitativa , Insuficiencia Renal Crónica/etnología , Carga de TrabajoRESUMEN
Introduction: Post covid-19 syndrome or Long Covid has been estimated to impact 1.3 million individuals in the UK. This study evaluates the outcomes of delivering a complementary Long Covid support service using psycho-educational and mind-body approaches within a community setting. Methods: This study utilised quantitative methods to evaluate the outcomes of implementing a complementary approach to providing Long Covid support. The service offered a package of care including group sessions combining psychoeducation and mind-body complementary approaches and optional 1:2:1 sessions (physiotherapy and craniosacral therapy (CST)). Screening for the service and health information was obtained using the Covid-19-Yorkshire Rehabilitation Screening tool (C-19 YRS). The impact of the service was assessed using the patient reported outcome measure: Warwick Holistic Health Questionnaire (WHHQ-18), and a survey was designed for general evaluation and feedback about the service from participants. Results: 25 participants engaged with the service. The C-19YRS proved to be a useful tool to screen service users. The WHHQ-18 highlighted a positive group change (n = 16) in participants' mental, physical, emotional, and spiritual wellbeing: mean group score at the start = 33.7 (SD=12.5), mean group score at the follow up = 39.5 (SD=10.8). In the feedback from the service evaluation, participants reported that the service was useful in supporting them with their health challenges resulting from Long Covid and was delivered to the standard expected. Conclusion: In conclusion the psycho-educational and mind-body complementary approaches used within this service were well received and the measures used to evaluate were suitable for a service delivered within a community setting.
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AIMS: The aim of this study was to explore the experience and perceptions of a diagnosis of prediabetes among a demographically diverse sample of New Zealanders who had, and had not, regressed to normoglycaemia following participation in a primary care nurse-delivered intervention for 6 months. The sample included Indigenous Maori who have high rates of diabetes and associated co-morbidities. METHODS: A purposefully selected sample of 58 people with prediabetes and BMI >25 kg/m2, stratified by male/female, Maori/non-Maori, and those who had/had not regressed to normoglycaemia, after completing 6-months of a prediabetes intervention were interviewed. Interviews were audio-recorded and transcribed. Data were analysed by thematic analysis. RESULTS: Most participants recalled being shocked when told they had prediabetes, but they did not perceive the diagnosis to be a label in a negative sense, and some, described the diagnosis as helpful. Participants appreciated knowing that prediabetes could be reversed, and the opportunity to be able to take supported action and make lifestyle changes through the nurse-delivered prediabetes lifestyle intervention. Participants' clear preference was to take control and make dietary changes, not to take Metformin. CONCLUSIONS: Prediabetes was not considered a negative label, but an opportunity, when coupled with a primary care nurse-delivered dietary intervention.
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Diabetes Mellitus , Metformina , Estado Prediabético , Femenino , Humanos , Estilo de Vida , Masculino , Estado Prediabético/diagnóstico , Estado Prediabético/terapia , Investigación CualitativaRESUMEN
AIMS: Choosing Wisely seeks to prevent harm by reducing the number of unnecessary tests, treatments and procedures, and by promoting shared decision-making. This article scopes perspectives of Maori patients/consumers and Maori health practitioners around Choosing Wisely and explores shared decision-making between Maori and their medical practitioners. METHODS: Eight Maori consumers and seven Maori health practitioners participated in a qualitative, semi-structured, in-depth interview study with an inductive thematic analysis. RESULTS: Participant feedback spanned issues from lack of Maori participation in programme governance through to practical issues like meaningful and literacy-appropriate health messaging, traversing consumer, practitioner, organisational and health-system aspects. Feedback further focused on the patient having trust in the practitioner, a sense of autonomy and the availability of advocacy and support in the consultation. CONCLUSIONS: Despite a late campaign collaboration with Maori, Choosing Wisely New Zealand is the first of the international programmes to acknowledge the possibility that their initiative might increase inequity for Indigenous populations. This enquiry highlights the need to consult Maori early and to infuse Treaty principles and Maori knowledge and custom at every stage of the programme.
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Toma de Decisiones Conjunta , Nativos de Hawái y Otras Islas del Pacífico , Cultura , Humanos , Nueva Zelanda , Investigación CualitativaRESUMEN
BACKGROUND: Unintentional injuries are the leading cause of death and hospitalisation among New Zealand children, with indigenous Maori and ethnic minority Pacific children significantly over represented in these statistics. International research has shown that many children hospitalised for injury, as well as their families experience high levels of stress, and ethnic disparities in the quality of trauma care are not uncommon. The research on which this paper is based sought to identify key issues and concerns for New Zealand's multi-ethnic community following hospitalisation for childhood injury in order to inform efforts to improve the quality of trauma services. This paper reports on service providers' perspectives complementing previously published research on the experiences of families of injured children. METHODS: A qualitative research design involving eleven in-depth individual interviews and three focus groups was used to elicit the views of 21 purposefully selected service provider key informants from a range of professional backgrounds involved in the care and support of injured children and their families in Auckland, New Zealand. Interviews were transcribed and data were analysed using thematic analysis. RESULTS: Key issues identified by service providers included limited ability to meet the needs of children with mild injuries, particularly their emotional needs; lack of psychological support for families; some issues related to Maori and Pacific family support services; lack of accessible and comprehensive information for children and families; poor staff continuity and coordination; and poor coordination of hospital and community services, including inadequacies in follow-up plans. There was considerable agreement between these issues and those identified by the participant families. CONCLUSIONS: The identified issues and barriers indicate the need for interventions for service improvement at systemic, provider and patient levels. Of particular relevance are strategies that enable families to have better access to information, including culturally appropriate oral and written sources; improve communication amongst staff and between staff and families; and carefully developed discharge plans that provide care continuity across boundaries between hospital and community settings. Maori and Pacific family support services are important and need better resourcing and support from an organisational culture responsive to the needs of these populations.
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Servicios de Salud del Niño/normas , Cuerpo Médico de Hospitales/psicología , Relaciones Profesional-Familia , Servicio Social , Heridas y Lesiones/terapia , Adaptación Psicológica , Adulto , Niño , Servicios de Salud del Niño/provisión & distribución , Femenino , Grupos Focales , Necesidades y Demandas de Servicios de Salud , Hospitalización , Hospitales Pediátricos/normas , Humanos , Entrevistas como Asunto , Masculino , Cuerpo Médico de Hospitales/estadística & datos numéricos , Nueva Zelanda , Recursos Humanos , Heridas y Lesiones/etnologíaRESUMEN
In New Zealand, and globally, the incidence of patients developing chronic kidney disease and entering the pre-dialysis phase is increasing at approximately 6% per year. The specialist pre-dialysis nurse plays a key role in providing care to this complex group of chronically ill people, but as yet no literature indicates what constitutes effective pre-dialysis nursing care. This paper reports on qualitative research that asked a group of New Zealand specialist renal nurses what they believed comprised effective pre-dialysis nursing care. Semi-structured phone interviews were undertaken with eleven pre-dialysis nurses from throughout the country. Through inductive analysis a number of key themes were identified. These were; a strong nurse patient relationship, a comprehensive holistic nursing assessment and timely and appropriate patient education. Commonly used measurable indicators, timely initiation of dialysis and formation of dialysis access prior to treatment, were also considered important but essentially seen as out of the nurse's control. We argue that to ensure pre-dialysis care is effective it is important to not only measure quantifiable parameters but also consider the qualitative elements identified as being at the heart of effective pre-dialysis nursing practice.
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Conocimientos, Actitudes y Práctica en Salud , Planificación de Atención al Paciente , Diálisis Renal/enfermería , Insuficiencia Renal Crónica/enfermería , Indicadores de Salud , Humanos , Nueva Zelanda , Relaciones Enfermero-Paciente , Evaluación en Enfermería , Educación del Paciente como Asunto , Investigación CualitativaRESUMEN
OBJECTIVES: Several quantitative studies in the international literature have described disparities in the provision of and access to health services for a variety of health conditions among 'minority' populations. This New Zealand qualitative study aimed to explore and describe the experiences of indigenous Maori and Pacific families (both minority populations) and Pakeha (New Zealand European) families when their children were admitted to hospital for an unintended injury. DESIGN: Twenty-three children (eight Máori, eight Pacific and seven Pákeha) who were admitted to hospital following an injury were selected using maximum variation sampling from a trauma database and snowball sampling. In-depth individual and group interviews undertaken with the child's whanau/family explored the issues they encountered in the hospital setting. The data were analysed by key ideas and coded into main themes. Each strand was analysed separately by lead researchers of the same ethnic group prior to a comparative synthesis of the overall findings. RESULTS: While many families praised the dedication of the staff, the interviews revealed important concerns regarding their encounters with hospitals and related health and support services. These could be broadly characterised as (a) inadequate communication and information; (b) difficulties negotiating an environment perceived as foreign; (c) the stress of conflicting demands placed on families; and (d) issues relating to ethnicity and cultural miscommunication. Of note, many Maori and Pacific whanau/families felt particularly alienated within the hospital setting and did not appear to see themselves as being entitled to high-quality information or services. CONCLUSION: The findings have important implications for the structure, professional and institutional practices in the delivery of health services. The research also indicates the need for wider societal policies that increase Maori and Pacific whanau/families' sense of entitlement to the full range of available support services, and reduce alienation within public institutions such as hospitals.
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Atención a la Salud , Hospitalización/estadística & datos numéricos , Aceptación de la Atención de Salud/etnología , Heridas y Lesiones/etnología , Heridas y Lesiones/terapia , Niño , Preescolar , Estudios de Cohortes , Comunicación , Diversidad Cultural , Etnicidad , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Nueva Zelanda , Admisión del Paciente/estadística & datos numéricos , Relaciones Profesional-Familia , Investigación Cualitativa , Medición de Riesgo , Factores Socioeconómicos , Heridas y Lesiones/diagnósticoRESUMEN
The bassinet-like wahakura is an Indigenous initiative for the prevention of Sudden Unexpected Death in Infancy (SUDI). It was developed by New Zealand Maori in 2005 when Maori were rejecting the 'stop bedsharing' SUDI prevention message and the SUDI disparity between Maori and non-Maori had become entrenched. Made of native flax, the wahakura was promoted as a culturally resonant, in-bed safe sleep device that would disrupt the SUDI risk associated with 'bedsharing where there was smoking in pregnancy' without relying on smoking cessation. A significant movement of weavers and health professionals grew around the wahakura program. A body of research, including infant care surveys, retrospective case review, qualitative enquiry and a randomised controlled trial comparing wahakura and bassinet safety demonstrated the device's public health plausibility, acceptability to Maori women and its essential safety. This facilitated the distribution, by District Health Boards, of safe sleep devices, including a related device called the Pepi-Pod, and safe sleep education to high-risk, mainly Maori, mothers. Infant mortality in New Zealand fell by 29%, primarily among Maori infants, over the period 2009-15, suggesting that Maori cultural concepts, traditional activities and community engagement can have a significant effect on ethnic inequities in infant mortality.
Asunto(s)
Nativos de Hawái y Otras Islas del Pacífico , Muerte Súbita del Lactante/etnología , Cultura , Promoción de la Salud/métodos , Humanos , Lactante , Nativos de Hawái y Otras Islas del Pacífico/etnología , Nueva Zelanda , Seguridad , Higiene del Sueño , Muerte Súbita del Lactante/prevención & controlRESUMEN
INTRODUCTION: Pre-diabetes is a high-risk state for the development of type 2 diabetes mellitus (T2DM) and cardiovascular disease. Regression to normoglycaemia, even if transient, significantly reduces the risk of developing T2DM. The primary aim of this mixed-methods study is to determine if there are clinically relevant differences among those with pre-diabetes and excess weight who regress to normoglycaemia, those who have persistent pre-diabetes and those who progress to T2DM following participation in a 6-month primary care nurse-delivered pre-diabetes dietary intervention. Incidence of T2DM at 2 years will be examined. METHODS AND ANALYSIS: Four hundred participants with pre-diabetes (New Zealand definition glycated haemoglobin 41-49 mmol/mol) and a body mass index >25 kg/m2 will be recruited through eight primary care practices in Hawke's Bay, New Zealand. Trained primary care nurses will deliver a 6-month structured dietary intervention, followed by quarterly reviews for 18 months post-intervention. Clinical data, data on lifestyle factors and health-related quality of life (HR-QoL) and blood samples will be collected at baseline, 6 months, 12 months and 24 months. Sixty participants purposefully selected will complete a semi-structured interview following the 6-month intervention. Poisson regression with robust standard errors and clustered by practice will be used to identify predictors of regression or progression at 6 months, and risk factors for developing T2DM at 2 years. Qualitative data will be analysed thematically. Changes in HR-QoL will be described and potential cost savings will be estimated from a funder's perspective at 2 years. ETHICS AND DISSEMINATION: This study was approved by the Northern A Health and Disability Ethics Committee, New Zealand (Ethics Reference: 17/NTA/24). Study results will be presented to participants, published in peer-reviewed journals and presented at relevant conferences. TRIAL REGISTRATION NUMBER: ACTRN12617000591358; Pre-results.
Asunto(s)
Diabetes Mellitus/prevención & control , Enfermedades del Recién Nacido/prevención & control , Obesidad/dietoterapia , Estado Prediabético/dietoterapia , Enfermería de Atención Primaria/métodos , Dieta Saludable/enfermería , Humanos , Nueva Zelanda , Obesidad/complicaciones , Obesidad/enfermería , Proyectos Piloto , Ensayos Clínicos Pragmáticos como Asunto , Estado Prediabético/complicaciones , Estado Prediabético/enfermería , Estudios Prospectivos , Investigación CualitativaRESUMEN
We sought to identify lifestyle behaviours which influence risk of impaired glucose metabolism, IGM (newly diagnosed type 2 diabetes, impaired glucose tolerance [IGT] or impaired fasting glycemia [IFG]) or insulin resistance (IR) in a predominantly Maori community, and applied the McAuley formula to determine whether it predicts high risk individuals amongst this community. Three hundred and seventy one participants completed a lifestyle and dietary behaviour questionnaire and oral glucose tolerance test. Clinical variables, microalbuminuria, fasting glucose, insulin and lipids were measured. Diabetes, IFG and IGT were defined according to WHO criteria. IR was defined using the McAuley formula. Those with IGM and those with IR showed similar risk factor attributes. Odds ratios (95% CI) for development of IGM and IR were 0.43 (0.21-0.88) and 0.51 (0.33-0.80), respectively, for regular physical activity, and 0.55 (0.26-1.15) and 0.59 (0.37-0.96), respectively, for two or more dietary behaviours characterized by a high intake of fibre. Regular physical activity and a diet characterized by a high intake of dietary fibre were found to reduce risk of newly diagnosed IGM or IR. The McAuley formula appears to predict high-risk individuals in a predominantly Maori population as it does in European populations.