Prevalence of Micronutrient Deficiencies in Preoperative Bariatric Patients in a New Zealand Tertiary Centre.

PURPOSE: A potential complication of bariatric surgery is development of nutritional deficiencies. Study aims were to assess prevalence of micronutrient deficiencies in preoperative bariatric patients and to examine for ethnic differences. METHODS: Retrospective analysis of 573 patients that underwent bariatric surgery at Counties Manukau District Health Board was carried out. Mean preoperative levels of albumin, calcium, phosphate, folate, vitamin B12, vitamin D, magnesium, haemoglobin, haematocrit, mean cell volume, mean cell haemoglobin, ferritin, iron, and transferrin were calculated. Chi square, fisher exact test, and multiple logistic regression was used to assess for differences in prevalence of micronutrient deficiencies across ethnicities. RESULTS: The most common micronutrient deficiency was vitamin D (30.85%). There were statistically significant differences in vitamin D deficiency across ethnicities (p < 0.0001). Asians had the highest prevalence of vitamin D deficiency (60%), followed by Pacifica (44.57%), and Maori (31.68%). Asians were more likely to have vitamin D deficiency compared to NZ/Other Europeans (OR = 14.93, p < 0.001). Vitamin D deficiency was associated with higher BMI (OR = 1.05, p = 0.008). The second most common deficiency was iron (21.1%). Asians had the highest prevalence of iron deficiency (44%), followed by Maori (27.95%), and Pacifica (19.57%) (p = 0.0064). Compared to NZ/Other Europeans, Asians (OR = 4.26) and Maori (OR = 1.78) were more likely to be iron deficient (p = 0.004). Female gender was associated with iron deficiency (OR = 2.12, p = 0.007). CONCLUSION: Vitamin D and iron are the most common micronutrient deficiencies among preoperative bariatric patients in this cohort and ethnic differences were seen. There may be a role for preoperative supplementation in these at-risk ethnic groups.

The lived experience of chronic pain for Maori: how can this inform service delivery and clinical practice? A systematic review and qualitative synthesis.

AIM: To synthesise the literature describing experiences of chronic pain and pain management for Maori, and to understand how this experience could inform service delivery and clinical practice. METHOD: We systematically searched for qualitative research on Maori chronic pain experiences (Scopus, Medline, APA PsycINFO, NZ Research, Research Square). Data extracted were coded and synthesised using thematic analysis. RESULTS: Seven studies were included. Three themes encapsulated the data: 1) a multidimensional view of pain and pain management: Maori expressed a holistic and integrated understanding of the multiple factors that influence pain and its management, 2) a responsibility: respectful tikanga-informed care: the experiences of Maori participants with healthcare highlight a need for antiracist approaches, and a clinical responsibility to practice manaakitanga and tikanga, and 3) tino rangatiratanga: a desire for knowledge, choice and autonomy in pain management: Maori valued the empowering nature of knowledge about pain, and information and support to make decisions about treatment, including considerations regarding Western and traditional Maori medicine. CONCLUSION: Health services need to understand and respect the multidimensional aspects of pain, minimise racism and discrimination, use whakawhanaungatanga, manaakitanga, and tikanga-informed practices, and provide appropriate information to support tino rangatiratanga for pain management.

Tuakana-teina peer education programme to help Maori elders enhance wellbeing and social connectedness.

BACKGROUND: There are significant inequities between Maori (Indigenous people) and non-Maori in ageing outcomes. This study used a strengths-based approach based on the key cultural concept of mana motuhake (autonomy and self-actualisation) to develop a tuakana-teina (literally older sibling-younger sibling) peer education programme to assist kaumatua (elders) in addressing health and social needs. The purpose of this study was to test the impact on those receiving the programme. Three aims identify the impact on outcomes, resources received and the cost effectiveness of the programme. METHODS: Five Kaupapa Maori (research and services guided by Maori worldviews) iwi (tribe) and community providers implemented the project using a partnership approach. Tuakana (peer educators) had up to six conversations each with up to six teina (peer learners) and shared information related to social and health services. A pre- and post-test, clustered staggered design was the research design. Participants completed a baseline and post-programme assessment of health and mana motuhake measures consistent with Maori worldviews. Open-ended questions on the assessments, five focus groups, and four individual interviews were used for qualitative evaluation. FINDINGS: A total of 113 kaumatua were recruited, and 86 completed the programme. The analysis revealed improvements in health-related quality of life, needing more help with daily tasks, life satisfaction, paying bills and housing problems. Qualitative results supported impacts of the programme on mana motuhake and hauora (holistic health) through providing intangible and tangible resources. Cost-effectiveness analysis showed that the intervention is cost effective, with a cost per QALY of less than the conventional threshold of three times GDP per capita. CONCLUSIONS: A culturally-resonant, strengths-based programme developed through a participatory approach can significantly improve health and social outcomes in a cost-effective way. TRIAL REGISTRY: Clinical trial registry: Trial registration: (ACTRN12620000316909). Prospectively registered 06/03/2020, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379302&isClinicalTrial=False .

He Taonga Te Wareware: Connecting Older Maori Experiences of Wairuatanga with Mate Wareware (Dementia).

Mate wareware (dementia) is a complex disease of the brain that progressively inhibits memory and cognitive ability, affecting many Maori (the Indigenous people of Aotearoa New Zealand) kaumatua (elderly persons) in Aotearoa (New Zealand). Mate wareware care aims to protect and sustain wellbeing, yet Maori perspectives of wellbeing that consider wairuatanga (Maori spirituality) are often neglected within current treatment planning. This study investigates the presence of wairuatanga within kaumatua lives, drawing upon 61 interviews with kaumatua to glean a Maori understanding of mate wareware and to develop a diagnostic screening tool for mate wareware. Recorded responses were thematically analysed using reflexive qualitative analysis, informing four key themes that influence wairuatanga: he hononga tangata (social connection), turangawaewae (places of connection), tuakiritanga (identity) and mahi mauritau (mindful practices). These themes consider the value of creating rich and gratifying lifestyles for kaumatua that cultivate their spiritual wellbeing. This study validates diverse understandings and experiences of wairuatanga as essential to Maori wellbeing, affirming the relevance of wairuatanga to improve outcomes for Maori living with mate wareware.

A quality improvement approach to improving recognition of Maori tamariki (children) and assessing barriers to culturally responsive care in a paediatric ward setting.

BACKGROUND: Health inequity persists in Aotearoa (New Zealand) and internationally amongst most indigenous peoples. To address these health inequities, countries need to contend with the ramifications of entrenched historical, cultural and systemic failures. Within Aotearoa part of the solution to rectifying persistent health inequities lies in shifting everyday healthcare practices towards a more culturally responsive, patient-centred approach that utilises Maori knowledge and principles. Although the need for culturally responsive services in healthcare settings is clearly evident, most practitioners struggle with the challenge of creating a culturally safe environment. Further to these challenges, there are issues related to accurate recognition of ethnicity within the time constraints of an overwrought hospital environment. Within this environment, the correct identification of ethnicity is a fundamental step in the process of moving towards culturally responsive and more inclusive care. METHOD: The research was concerned with indigenous Maori patients being consistently and correctly identified so that they might receive culturally appropriate interaction and treatment. The research specifically focused on the impact of introducing a customised sticker prompt on the front cover of clinical notes of Maori tamariki (children) to assist with correct ethnicity identification. Surveys were conducted on the paediatric ward over a 3-week period, prior to and during the intervention to evaluate the effect of the customised stickers. This study sought to (1) assess the efficacy of a sticker to improve recognition of Maori tamariki (children), (2) examine key barriers to identifying ethnicity and (3) identify wider impacts of a sticker prompt on clinical practice. RESULTS: Results showed wide ranging positive impacts on clinical practice and culturally responsive care. Sixty-four per cent of participants indicated that the stickers were a useful tool to improve identification of Maori tamariki. Respondents reported increased accuracy of identifying patients by ethnicity, as well as improved awareness of existing ethnicity documentation, and increased engagement regarding cultural needs and ethnicity. CONCLUSIONS: This study identified that sticker prompts are a useful tool for healthcare workers to improve recognition and awareness of ethnicity and to increase dialogue around cultural needs. The stickers led to increased consideration of the wider elements of holistic wellbeing and therefore improved culturally responsive care for Maori tamariki.

Whakawhanaungatanga-Building trust and connections: A qualitative study indigenous Maori patients and whanau (extended family network) hospital experiences.

AIMS: Investigated the experiences of Maori (the Indigenous peoples of Aotearoa, New Zealand) patients and whanau (extended family network) engaging with acute hospital inpatient services and their priorities for a Maori-centred model of relational care. DESIGN: A qualitative Maori-centred research design using a Thought Space Wananga (learning through in-depth group discussion, deliberation and consideration) approach. METHODS: Two wananga were conducted between May 2022 and June 2022, with 13 Maori patients who had been acutely hospitalized within the past 12 months and their whanau members. The first wananga utilized storytelling and journey mapping to collect data. The second wananga refined the initial themes. Wananga were audio-recorded and then inductively coded and developed into themes. RESULTS: Thirteen patients and whanau attended the first wananga, while 10 patients and whanau participated in the second wananga). Four themes were developed: (1) Whakawhanaungatanga (establishing connections and relationships), (2) Whakamana (uplifting the status and esteem of Maori), (3) Whakawhitiwhiti korero (the importance of communicating, discussing and deliberating) and (4) Kotahitanga (working together with purpose) all provide insights into the importance of effectively engaging and connecting with Maori patients and whanau when acutely hospitalized. CONCLUSIONS: The experiences and priorities of Maori patients and whanau affirm the international literature, suggesting that Indigenous relational concepts are critical to building relationships, connections and trust. Despite existing healthcare models for working with Indigenous peoples, their poor application contributes to sub-optimal healthcare experiences at all points of their healthcare journey. A relational mode of practice focused on engagement and forming connections better meets the needs of Indigenous peoples engaging with inpatient health services. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Despite the existence of Indigenous models of care, Indigenous peoples consistently report a lack of engagement and connection when accessing inpatient health services. Without establishing relationships, applying models of care is challenging. IMPACT (ADDRESSING): What problem did the study address? Internationally, healthcare systems are consistently ill-equipped to deliver culturally safe care for Indigenous and marginalized peoples, evident in ongoing health inequities. Like other reports of Indigenous experiences of health services, Maori express dissatisfaction with care delivery in an acute inpatient setting. This study investigated Maori patients and whanau experiences engaging with acute hospital inpatient services and their priorities for a Maori-centred model of relational care. What were the main findings? Maori patients and whanau recounted negative experiences with healthcare professionals lacking effective relationships and trust. Satisfaction occurred when engagement with health care professionals resembled Indigenous cultural rituals of encounter that considered their holistic, collective and dynamic worldviews. Previous models of relational care, while helpful, are not Indigenous and so do not address their needs, such as engagement as a mode of practice (how) to achieve this. Where and on whom will the research have an impact? This research impacts Indigenous peoples' health outcomes, particularly Maori, and nurses and clinicians working and interacting within acute inpatient and other hospital settings. Indigenous research methods support co-constructing knowledge for translation into practical outcomes through transformational practices, policies and theory development. REPORTING METHOD: We used the Consolidated Criteria for Strengthening the Reporting of Health Research Involving Indigenous Peoples (CONSIDER) statement (see File S2-CONSIDER Checklist) and the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines (see File S3-COREQ Checklist). PATIENT OR PUBLIC CONTRIBUTION: Maori patients and their whanau interviewed about their experiences were involved in data interpretation.

Enhancing health outcomes for Maori elders through an intergenerational cultural exchange and physical activity programme: a cross-sectional baseline study.

Background: The study offers baseline data for a strengths-based approach emphasizing intergenerational cultural knowledge exchange and physical activity developed through a partnership with kaumatua (Maori elders) and kaumatua service providers. The study aims to identify the baseline characteristics, along with correlates of five key outcomes. Methods: The study design is a cross-sectional survey. A total of 75 kaumatua from six providers completed two physical functioning tests and a survey that included dependent variables based in a holistic model of health: health-related quality of life (HRQOL), self-rated health, spirituality, life satisfaction, and loneliness. Results: The findings indicate that there was good reliability and moderate scores on most variables. Specific correlates included the following: (a) HRQOL: emotional support (ß = 0.31), and frequent interaction with a co-participant (ß = 0.25); (b) self-rated health: frequency of moderate exercise (ß = 0.32) and sense of purpose (ß = 0.27); (c) spirituality: sense of purpose (ß = 0.46), not needing additional help with daily tasks (ß = 0.28), and level of confidence with cultural practices (ß = 0.20); (d) life satisfaction: sense of purpose (ß = 0.57), frequency of interaction with a co-participant (ß = -0.30), emotional support (ß = 0.25), and quality of relationship with a co-participant (ß = 0.16); and (e) lower loneliness: emotional support (ß = 0.27), enjoyment interacting with a co-participant (ß = 0.25), sense of purpose (ß = 0.24), not needing additional help with daily tasks (ß = 0.28), and frequency of moderate exercise (ß = 0.18). Conclusion: This study provides the baseline scores and correlates of important social and health outcomes for the He Huarahi Tautoko (Avenue of Support) programme, a strengths-based approach for enhancing cultural connection and physical activity.

Investigation and treatment after non-ST segment elevation acute coronary syndrome for patients presenting to rural or urban hospitals in Aotearoa New Zealand: ANZACS-QI 75.

AIMS: Compare the care patients with non-ST segment elevation acute coronary syndrome (NSTEACS) received in Aotearoa New Zealand depending on the rural-urban category of the hospital they are first admitted to. METHODS: Patients with NSTEACS investigated with invasive coronary angiogram between 1 January 2014 and 31 December 2019 were included. There were three hospital categories (routine access to percutaneous coronary intervention [urban interventional], other urban [urban non-interventional] and rural) and three ethnicity categories (Maori, Pacific and non-Maori/non-Pacific). Clinical performance measures included: angiography ≤3 days, assessment of left ventricular ejection fraction (LVEF) and prescription of secondary prevention medication. RESULTS: Of 26,779 patients, 66.2% presented to urban-interventional, 25.6% to urban non-interventional and 8.2% to rural hospitals. A smaller percentage of patients presenting to urban interventional than urban non-interventional and rural hospitals were Maori (8.1%, 17.0% and 13.0%). Patients presenting to urban interventional hospitals were more likely to receive timely angiography than urban non-interventional or rural hospitals (78.5%, 60.8% and 63.1%). They were also more likely to have a LVEF assessment (78.5%, 65.4% and 66.3%). In contrast, the use of secondary prevention medications at discharge was similar between hospital categories. Maori and Pacific patients presenting to urban interventional hospitals were less likely than non-Maori/non-Pacific to receive timely angiography but more likely to have LVEF assessed. However, LVEF assessment and timely angiography in urban non-interventional and rural hospitals were lower than in urban interventional hospitals for both Maori and non-Maori/non-Pacific. CONCLUSIONS: Patients presenting to urban hospitals without routine interventional access and rural hospitals were less likely to receive LVEF assessment or timely angiography. This disproportionately impacts Maori, who are more likely to live in these hospital catchments.

A tohu (sign) to open our eyes to the realities of Indigenous Maori registered nurses: A qualitative study.

AIMS: Identify the experiences of Maori nurses and priorities for a Maori model of relational care working with Maori patients and their whanau (extended family network) in acute hospital services. BACKGROUND: Maori, the Indigenous peoples of Aotearoa (New Zealand), have a relational and holistic worldview fundamental to establishing relationships with Maori patients and their whanau. Increasing the Indigenous Maori nursing workforce can improve Maori patient experiences but is challenged by ongoing recruitment and retention issues. DESIGN: A qualitative Maori-centred research methodology with 12 Maori nurses. METHODS: Data were collected using wananga (learning through discussion, deliberation and consideration) using he aha o hikoi (journey mapping) and korero mai (storytelling). Inductive thematic analysis was undertaken using a mahi a roopu (group process) approach. This study was conducted between May 2022 and June 2022. RESULTS: Three key themes: (1) Maori first, nurse second, (2) Cultural loading and (3) Compromised realities were identified. Maori nurses' praxis used their complex cultural and clinical intelligence to engage in a mana-enhancing way (strengths-based) to improve the care delivery for whanau Maori during their hospitalization journey. Cultural loading meant Maori nurses were often burdened with unrecognized workloads as they provided care for Maori patients and whanau, which often compromised their cultural integrity. CONCLUSION: Nurses' commitment to care for whanau and their assigned patient load created extra burdens and threatened their cultural integrity. Their experiences highlighted modes of practice rather than models of care required to improve healthcare delivery for Maori entering the hospital. These findings signal issues and areas nursing leaders need to heed, necessary for addressing the retention of Maori in nursing and improving workload equity. PATIENT OR PUBLIC CONTRIBUTION: Maori nurses and service users were involved in the interpretation of the data.

Interventions to prevent or manage obesity in Maori and Pacific adults: a systematic review and narrative synthesis.

OBJECTIVES: Obesity and its sequelae are an increasing problem, disproportionally affecting Maori and Pacific peoples, secondary to multifactorial systemic causes, including the effects of colonisation and the impact of globalisation. There is limited synthesised evidence on interventions to address obesity in these populations. The objective of this review is to identify evaluated interventions for prevention and management of obesity amongst Maori and Pacific adults, assess the effectiveness of these interventions, and identify enablers and barriers to their uptake. DESIGN: Systematic review of databases (Medline, PubMed, EMBASE, CINAHL, Scopus, CENTRAL), key non-indexed journals, and reference lists of included articles were searched from inception to June 2021. Eligibility criteria defined using a Population, Intervention, Control, Outcome format and study/publication characteristics. Quantitative and qualitative data were extracted and analysed using narrative syntheses. Study quality was assessed using modified GRADE approach. RESULTS: From the 8190 articles identified, 21 were included, with 18 eligible for quantitative and five for qualitative analysis. The studies were heterogenous, with most graded as low quality. Some studies reported small but statistically significant improvements in weight and body mass index. Key enablers identified were social connection, making achievable sustainable lifestyle changes, culturally-centred interventions and incentives including money and enjoyment. Barriers to intervention uptake included difficulty in maintaining adherence to a programme due to intrinsic programme factors such as lack of social support and malfunctioning or lost equipment. CONCLUSIONS: Normal weight trajectory is progressive increase over time. Modest weight loss or no weight gain after several years may have a positive outcome in lowering progression to diabetes, or improvement of glycaemic control in people with diabetes. We recommend urgent implementation of Maori and Pacific-led, culturally-tailored weight loss programmes that promote holistic, small and sustainable lifestyle changes delivered in socially appropriate contexts.