Zealand Health Professionals Research Articles

Genetic discrimination by insurance companies in Aotearoa New Zealand: experiences and views of health professionals.

Genetic discrimination in insurance is a significant clinical, research and consumer issue. Recently, the Australian life insurance industry introduced a partial moratorium on the use of genetic test results. However, in Aotearoa New Zealand, both life and health insurers can still use genetic results legally to discriminate against applicants. We aimed to document experiences and concerns of New Zealand-based health professionals (HPs) around the potential misuse of genetic test results for insurance purposes. We administered an online survey to New Zealand HPs who discuss genetic testing with patients, their experiences regarding the use of genetic test results in insurance and views on regulation. Twenty-three New Zealand HPs responded, 15 of whom worked in genetics clinics, representing >60% of the total New Zealand clinical genetics workforce. Eleven respondents reported having patients who experienced adverse outcomes related to insurance based on genetic results. Respondents reported patients sometimes/often delayed (n=11) or refused (n=4) genetic testing due to insurance concerns. Over 80% of those who answered (n=17/21) believe insurers' use of genetic results should be legally regulated. New Zealand HPs have concerns about insurance companies using genetic test results in underwriting, including the effect on patients, and strongly believe government legislation is required.

“The most important thing when we arrive in New Zealand": Experiences of refugee women of reproductive age with interpreters

This study provides insight into the experiences of refugee women of reproductive age, who use interpreters while resettling in New Zealand. Understanding their experiences of using interpreters allows a deeper understanding for interpreting services and health professionals. It also enables more mindful and comprehensive language assistance approaches to migrant communities. Finally, refugee women will have the opportunity to voice their experiences. This research is the first of its kind in New Zealand. Women refugees are shown to be the most vulnerable refugee group, as they face many risks during their resettlement to their host country (UN Women Organisation, 2020). Refugee women often face family separation, psychosocial stress, trauma, violence, reproductive and sexual health complications while migrating (UN Women, 2020). Due to low literacy rates, they are less likely to understand or speak English, and therefore more likely to rely on interpreters to assist them with communication during the process of resettling in New Zealand. When women refugees arrive in New Zealand, they stay at the Mangere Refugee Resettlement Centre (MRRC). During their stay in the Centre, and after their resettlement to their new home, interpreters are hired to facilitate communication between refugees with numerous New Zealand services and health professionals (Ministry of Health, 2012). As this study focuses on human lived experience, it will use a qualitative approach and a methodology based on Heidegger’s hermeneutic phenomenology, to explore the lived experiences of refugee women and uncover their meaning through an interpretive analysis (Van Manen, 2016). 15-20 participants will be recruited during the first one to five years of resettlement in New Zealand and interviewed face to face or via Zoom when Covid-19 restrictions apply. Ultimately the intention of this study is to improve the experiences of refugee women as they settle into New Zealand life and into their new homes.

Health professionals' views and experiences around the dietary and lifestyle management of gestational diabetes in New Zealand.

This study aimed to investigate New Zealand health professionals' views and experiences around the dietary and lifestyle management of gestational diabetes. Semi-structured interviews were conducted remotely with health professionals; sessions were recorded and transcribed. Core themes were extracted using inductive thematic analysis using a framework method. Twenty-seven health professionals were interviewed (13 diabetes dietitians, 8 specialist diabetes midwives, 2 community midwives, 1 antenatal clinic midwife, 1 obstetrician and 2 endocrinologists). Themes were organised into three central domains: (a) Social and cultural barriers, (b) Service provision and (c) Nutrition advice. Enabling themes included professional collaboration, innovation and creating trusting and supportive environments. Key barriers identified included accessibility, cultural barriers, overwhelmed service, fragmentation and conflicting information and nutrition resource gaps. Findings highlight foremost a deficit in primary antenatal nutrition advice that may play a significant role in the fragmentation identified. Investment in community-inclusive services providing antenatal nutrition and diabetes education appears critical to overcome barriers associated with misinformation and poor outcomes. Pathways to include nutrition education from various primary care health providers should be investigated to ease the burden from specialist gestational diabetes clinicians and allow effective delegation of dietetic resources. Revision of current nutrition guidelines for the management of gestational diabetes in New Zealand is needed to facilitate consistent messaging and standards of care.

Implementation effectiveness of health interventions with Māori communities: a cross‐sectional survey of health professional perspectives

ObjectiveTo identify factors that New Zealand health professionals rate as important for implementation effectiveness for health interventions with Māori communities. MethodsHealth professionals (N=200) participated in an online cross‐sectional survey. The survey was organised in three sections: a) participants’ general perceptions of key features for implementation effectiveness; b) participants’ direct experience of implementing health interventions with Māori communities, and c) general demographic information. ResultsPaired sample t‐tests revealed four levels of importance for implementation effectiveness with teamwork and community autonomy as being most important. Only 24% of participants had experience with a previous health intervention in Māori communities. A multiple regression model identified two key overall factors that were associated with participants’ rating of implementation effectiveness in these previous interventions: process (B=0.29 p<0.01), and community (B=0.14, p<0.05). ConclusionsKey areas of implementation effectiveness were community engagement and participatory process; this contributes to the body of literature that challenges traditional top‐down approaches of implementation. Implications for public healthThis study provides the perspectives of health professionals on implementation effectiveness when working with Māori/Indigenous communities. These professionals often lead the implementation of health interventions to address health equity. The study supports the inclusion of community voice in implementing community health interventions.

The clinical considerations for early cancer detection using ctDNA within the Pacific setting

Abstract Pacific Peoples living in Aotearoa/New Zealand and in the Pacific Region, remain disproportionately affected by some cancers. In addition to ensuring effective treatments and therapies are available and continue to improve, continued early cancer diagnostic efforts are also critical for supporting better health outcomes for Pacific Peoples within the cancer setting. A novel and promising early cancer detection method known as circulating tumour DNA (ctDNA) analyses small fragments of tumour DNA found in the blood circulation to provide information about a tumour. This approach is more commonly associated with and utilised for monitoring patients being treated for their cancers and is being adapted to support early cancer detection efforts. To support the possible acceptability of this approach for early cancer diagnosis for Pacific Peoples, it is imperative to better understand the clinical considerations relevant to the Pacific setting. To identify the clinical considerations needed for early cancer detection with ctDNA approaches within the Pacific setting for Pacific Peoples living in Aotearoa/New Zealand, researchers and Pacific Health Professionals were consulted. Relevant considerations included the immediate need to support early cancer diagnostic efforts to avoid late presentations, better understanding of the cultural context for Pacific Peoples within the healthcare setting more broadly, with strong support expressed for a simple approach for early cancer detection such as that being proposed with ctDNA technology. These findings highlight the critical need to consider the clinical context within the cancer setting for Pacific Peoples. Health Research Council of New Zealand

'I think there is nothing . . . that is really comprehensive': healthcare professionals' views on recommending online resources for pain self-management.

To explore healthcare professionals' views on, and attitudes, towards recommending online resources for persistent pain self-management. This study was the qualitative phase of a two-phase mixed method study. Thirty-one New Zealand health professionals involved in the management of persistent pain were interviewed via focus groups and individual interviews. Data were analysed using the general inductive approach. The major themes were as follows: (1) risks and limits of online information outweigh benefits, (2) a blended model, of online resources with healthcare professional support, could work, (3) only trustworthy resources can be recommended, (4) need for personalisation and (5) perceived barriers to adoption. Online resources were perceived as a useful adjunct to support pain self-management; however, due to potential risks of misinterpretation and misinformation, healthcare professionals proposed a 'blended model' where curated online resources introduced during face-to-face consultations could be used to support self-management. Participants needed 'trustworthy online resources' that provide evidence-based, updated information that is personalised to clients' health literacy and cultural beliefs. Training for healthcare professionals on critical appraisal of online resources or curation of evidence-based online resources could increase recommendation of online resources to support pain self-management as an adjunct to in-person care.

The context and influences of safety: An exploration of social networks, actions, and behaviour.

Safety systems are socio-cultural in nature, characterized by people, their relationships to one another and to the whole. This study aimed to (i) map the social networks of New Zealand's quality improvement and safety leaders, (ii) illuminate influential characteristics and behaviours of key network players and (iii) make recommendations regarding how networks might be optimized. Instrumental case study was done using mixed methods. Purposeful sampling was applied to collect survey data from delegates at two national safety and quality forums (n = 85). Social network questions asked respondents who influenced their safety work. Key network players were identified and invited to participate in a semi-structured interview (n = 7). Key players described safety systems in humanistic terms. Safety influence was determined to be a responsive relational process. Adaptive leaders broker relationships between multiple perspectives and contexts, which is essential for safe healthcare. Influential safety approaches appreciate the human contribution to safety. Designing the health system to adapt and respond to the needs of people, teams and communities, rather than the unilateral needs of the system, is essential. Adaptive leadership will assist in achieving these aims and will likely be embraced by New Zealand health professionals.

Doctors and pharmacists provision and opinions of medicines information leaflets in New Zealand

Background Providing verbal medicines information to patients may be insufficient. Providing medicine information leaflets could support verbal information, however New Zealand health professionals' opinions or use of leaflets is unknown. Objective To examine self-reported provision and health professionals' views about medicine information leaflets and to determine their support for tailoring patient leaflets. Setting A cross sectional survey of general practitioners (GPs) and community pharmacists in New Zealand primary care. Method GPs and pharmacists completed validated questionnaires. Data was collected using SurveyMonkey® and where applicable, Chi squared analysis was carried out. Main outcome measures Frequency of leaflet provision, how leaflets are used in practice and why, likes and dislikes of available leaflets, and opinions on providing tailored information. Results 143 GPs and 126 pharmacists responded. For new medicines, significantly more pharmacists than GPs reported providing leaflets all or most of the time. For repeat medicines, leaflets were more likely to be given only on request. Leaflets were given to ensure patients are well-informed. Most GPs and pharmacists report discussing sections of leaflets with patients. The likes and dislikes of leaflets were mostly about design and content. Both professions support tailoring leaflets to meet individual's requirements. Conclusions Provision of medicines information needs to be re-evaluated. Relying on verbal communication is inadequate and leaflet provision appears to be suboptimal. Making leaflets more patient-centred and accessible could improve health professionals' perceptions and use of them. Automated creation and provision of tailored summary leaflets would be beneficial. Further advantage could be gained by digital patient access.

A Rural Scope of Practice for Pharmacists

Introduction : Too few medical graduates opt to become general practitioners or family physicians, particularly in rural areas. Predicted to worsen in the next decade as current practitioners retire, to meet health needs it will be essential to make the best use of all available health professionals. Building on existing collaboration and with better use of technology, community pharmacists have the skills and knowledge to provide expanded services. A ‘rural’ scope of practice for pharmacists, allowing more autonomous practice, could improve health provision and pharmacist retention in rural areas. Objective : To show how pharmacists could better meet the health needs of rural New Zealanders by providing accessible, safe and affordable care in line with New Zealand’s health strategies. Targeted population : Policy makers, health providers or funders, pharmacists and other health professionals practising in rural or provincial areas. Exemplified by the author’s experience as a community pharmacist in Greymouth, a provincial town on the West Coast of New Zealand’s South Island. Highlights : There is a high reliance on locums due to the shortage of medical practitioners in rural areas. A lack of continuity of care has been associated with increased hospital admissions. Community pharmacists are highly accessible with a quarter of New Zealand’s population visiting a pharmacy every month. Comparisons are drawn with changes in scopes of practice for New Zealand health professionals and developments in expanded pharmacist services in other jurisdictions; the United Kingdom and Canada. There is potential for pharmacists to work more collaboratively with better integration, using technology to build on existing collegial relationships. A role between the current ‘pharmacist’ and ‘pharmacist prescriber’ scopes of practice would allow more autonomous practice by pharmacists in rural or hard to staff areas. Using existing linkages with university rural outposts could give pharmacists additional training and a transferable qualification while improving health care provision. Various solutions are offered, to improve services available from rural pharmacists, including creating a vocational scope in rural pharmacy. A ‘rural’ scope of practice, not available to urban pharmacists, fits with New Zealand’s current health policy framework which encourages team work and top of scope practice. Transferability : Rural scopes of practice apply in some medical and nursing fields. Expanded scopes of practice for pharmacists have been successful in other jurisdictions. Rural scopes of practice could be applied to pharmacists and other allied health professionals practising in rural or high needs areas. Conclusions : Experience elsewhere shows pharmacists can use their skills to do more for patient care. Where offered, these services are safe, effective and well received by patients while improving pharmacist job satisfaction. They reduce presentations to medical practices or emergency departments, leading to better use of resources. By providing a richer professional environment, a rural scope of practice for pharmacists could incentivise relocation to areas difficult to staff.

The health professionals' perspectives of support needs of adult head and neck cancer survivors and their families: a Delphi study.

The aim was to identify the views of Australian and New Zealand health professionals regarding the support needs of people with head and neck cancer (HNC) and their families and current gaps in service delivery. A modified Delphi process assessed support needs of people with HNC following acute medical management. A systematic review of the literature was used to develop items relevant to seven key concepts underpinning the psychological experience of living with HNC. A panel of 105 health professionals was invited to participate in two questionnaire rounds. Of the potential panellists, 50 (48%) completed round 1, and of these, 39 (78%) completed round 2. Following two rounds, there was consensus agreement on the concepts uncertainty and waiting, disruption to daily life and fear of recurrence. The concepts the diminished self, making sense of and managing the experience, sharing the burden and finding a path did not achieve consensus. There were no differences in responses according to gender, organization type or location. Medical professionals had significantly higher agreement for the concept uncertainty and waiting compared to allied health professionals, and professionals with five years' or more experience had significantly higher agreement than those with less experience. Health professionals agreed that many psychosocial support needs of HNC survivors and families are not being met and that they experience difficulties in meeting these needs. Findings may inform evidence-based treatment programs for HNC survivors and their families to promote psychological resilience and quality of life in this vulnerable population.

Breast cancer and breast screening: perceptions of Chinese migrant women living in New Zealand

Migrant Chinese constitute a significant and increasing proportion of New Zealand women. They have lower rates of participation in breast cancer screening than other New Zealanders, but reasons for this are unknown. The aim of this study was to investigate factors affecting Chinese women's understanding of, and access to, breast health services, to better understand reasons for low participation in screening and their experiences of breast cancer clinic care. The participants were 26 Chinese migrant women-19 recruited in the community and seven recruited from 17 eligible women attending a breast clinic between 2008 and 2010 in Wellington, New Zealand. The design was that of a qualitative study, using semi-structured interviews and thematic content analysis. There were low levels of awareness about the national breast screening programme and limited engagement with preventive primary care services. Concerns about privacy and a range of communication difficulties were identified that related to oral language, lack of written information in Chinese, and limited understanding about Chinese perceptions of ill health and traditional Chinese medicine by New Zealand health professionals. Addressing communication barriers for Chinese migrant women has the potential to raise awareness about breast cancer and breast health, and to increase successful participation in breast cancer screening. Greater efforts are needed to ensure this group has an understanding of, and is engaged with a primary care provider. Such efforts are key to improving health for this growing sector of the New Zealand population.

Healthcare professional perspectives on quality and safety in New Zealand public hospitals: findings from a national survey

Few studies have sought to measure health professional perceptions of quality and safety across an entire system of public hospitals. Therefore, three questions that gauge different aspects of quality and safety were included in a national New Zealand survey of clinical governance. Three previously used questions were adapted. A total of 41040 registered health professionals employed in District Health Boards were invited to participate in an online survey. Analyses were performed using the R statistical environment. Proportional odds mixed models were used to quantify associations between demographic variables and responses on five-point scales. Relationships between other questions in the survey and the three quality and safety questions were quantified with the Pearson correlation coefficient. A 25% response rate delivered 10303 surveys. Fifty-seven percent of respondents (95% CI: 56-58%) agreed that health professionals in their District Health Board worked together as a team; 70% respondents (95% CI: 69-70%) agreed that health professionals involved patients and families in efforts to improve patient care; and 69% (95% CI: 68-70%) agreed that it was easy to speak up in their clinical area if they perceived a problem with patient care. Correlations showed links between perceptions of stronger clinical leadership and performances on the three questions, as well as with other survey items. The proportional mixed model also revealed response differences by respondent characteristics. The findings suggest positive commitment to quality and safety among New Zealand health professionals and their employers, albeit with variations by district, profession, gender and age, but also scope for improvement. The study also contributes to the literature indicating that clinical leadership is an important contributor to quality improvement. WHAT IS KNOWN ABOUT THE TOPIC? Various studies have explored aspects of healthcare quality and safety, generally within a hospital or group of hospitals, using a lengthy tool such as the 'safety climate survey'. WHAT DOES THIS PAPER ADD? We used a simple three-question survey approach (derived from existing measures) to measuring healthcare professionals' perceptions of quality and safety in New Zealand's public hospitals. In doing so, we also collected the first such information on this. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? New Zealand policy makers and health professionals can take some comfort in our findings, but also note that there is considerable scope for improvement. Our finding that more positive perceptions of quality and safety were related to perceptions of stronger clinical leadership adds to the international literature indicating the importance of this. Policy makers and hospital managers should support strong clinical leadership.

New Zealand health professionals’ assessment and management practices of children/young people who are overweight/obese: Findings from a summer studentship project 2011

New Zealand health professionals’ assessment and management practices of children/young people who are overweight/obese: Findings from a summer studentship project 2011

The anatomical placement of body organs by Australian and New Zealand patients and health professionals in general practice

Understanding patients' awareness of the anatomical placement of their body organs is important for doctor-patient communication. To measure the correct anatomical placement of body organs by people from Australian and New Zealand general practices A questionnaire survey containing drawings of 11 organs placed in different locations within each drawing. Among 1156 participants, there was no difference in the proportion of correct placement of 11 organs between Australian (51.7%) and New Zealand (49.6%) general practices. There was a positive correlation between the proportion of correctly placed organs and the age participants left school (p=0.012) and a negative correlation with the number of GP visits in the previous year (p=0.040). Participants from rural Australia were more likely to correctly place organs than urban participants (p=0.018). The mean proportion of organs correctly placed for doctors was 80.5%, nurses 66.5%, allied health 61.5%, health administrators 50.6% and the remaining consulting patients 51.3%. Patients from Australian and New Zealand general practice were poorly aware of the correct placement of organs. Health professionals were moderately better than patients at correct placement.

Erratum: The anatomical placement of body organs by Australian and New Zealand patients and health professionals in general practice

Erratum: The anatomical placement of body organs by Australian and New Zealand patients and health professionals in general practice

Occupational Overuse Syndrome

In this article we examine the moral ambiguities expressed by New Zealand health professionals regarding their clients and patients who have occupational overuse syndrome (OOS). Workers with OOS were described as being hard working and dedicated, but also undisciplined in their work and personal lives. The goal of rehabilitation in such cases is a return to full work duties and to this end, health professionals represent the disciplinary and normalizing technologies of the neoliberal state which, in New Zealand, provides financial support and treatment for injured workers. According to the health professionals in this study, the disciplinary technologies exercised through rehabilitation require that clients and patients internalize key values associated with the rhetoric of healthism; primarily self-discipline, self-control, self-denial, and willpower. These underpin successful rehabilitation and ongoing management of OOS, and at the same time represent the central values of the neoliberal capitalist workplace.

Better Hospital Care for Aboriginal and Torres Strait Islander People Experiencing Heart Attack

practitioners when working with indigenous people and Aotearoa/NZ’s culturally diverse population. Other registration authorities have developed their own standards de novo or based on the Medical Council resources. Developing online training for a broad interprofessional audience has multiple challenges – in terms of content, style, interactivity, assessment activities, aswell as the time, expertise and cost of developing online training for health professionals. Mauri Ora Associates has developed online training for health professionals based on the Treaty ofWaitangi, Tikanga in Practice and a Foundation Course in Cultural Competence. In 2011 online training will be provided to nearly 80,000 New Zealand health professionals and health workers. The presentation will report on the development and delivery of cultural competency training programmes. DOI of original abstract: http://dx.doi.org/10.1016/j.hlc.2011.04.012 DOI of this abstract: http://dx.doi.org/10.1016/j.hlc.2012.07.025

Genetics and tragady

The sudden death of a young person is a devastating event for both the family and community. Over the last decade, significant advances have been made in understanding both the clinical and genetic basis of sudden cardiac death (SCD) in the young. Many of the causes of SCD in the young are due to genetic heart disorders, which can lead to both structural (e.g., hypertrophic cardiomyopathy) and arrhythmogenic (e.g. familial long QT syndrome) abnormalities. Most commonly, SCD in the young can be the first presentation of an underlying heart problem, leaving the family at a loss as to why an otherwise healthy young person has died. Not only is the tragic event for those involved, but it also presents a medical challenge to the clinician involved in the management of the surviving family members. Given the complex problem of SCD in the young, a co-ordinated multidisciplinary team approach to the investigation of such deaths is required, including expert pathology, cardiology, clinical and molecular genetic assessment, grief and genetic counselling, and involvement of patient support groups. The TRAGADY Network (Trans-Tasman Response AGAinst Sudden Death in the Young) was established in 2005, and comprises a group of highly motivated Australian and New Zealand health professionals, scientists and patient advocates who share the aim of reducing SCD in the young, principally by understanding the molecular, genetic and pathological basis of genetic heart diseases. The sudden death of a young person is a devastating event for both the family and community. Over the last decade, significant advances have been made in understanding both the clinical and genetic basis of sudden cardiac death (SCD) in the young. Many of the causes of SCD in the young are due to genetic heart disorders, which can lead to both structural (e.g., hypertrophic cardiomyopathy) and arrhythmogenic (e.g. familial long QT syndrome) abnormalities. Most commonly, SCD in the young can be the first presentation of an underlying heart problem, leaving the family at a loss as to why an otherwise healthy young person has died. Not only is the tragic event for those involved, but it also presents a medical challenge to the clinician involved in the management of the surviving family members. Given the complex problem of SCD in the young, a co-ordinated multidisciplinary team approach to the investigation of such deaths is required, including expert pathology, cardiology, clinical and molecular genetic assessment, grief and genetic counselling, and involvement of patient support groups. The TRAGADY Network (Trans-Tasman Response AGAinst Sudden Death in the Young) was established in 2005, and comprises a group of highly motivated Australian and New Zealand health professionals, scientists and patient advocates who share the aim of reducing SCD in the young, principally by understanding the molecular, genetic and pathological basis of genetic heart diseases.

Irreconcilable differences: Health professionals’ constructions of adolescence and motherhood

Adolescent motherhood has been associated with negative health outcomes for both adolescent mothers and their children in many studies. Although the link between early motherhood and disadvantage has more recently been questioned, professional understandings continue to focus on hardship and social exclusion. Social constructionism provides a critical approach to the professional constructions of adolescent motherhood. Using discourse analysis, transcripts of individual interviews with 17 New Zealand health professionals working in a variety of settings were analysed to examine the discourses used to construct adolescent motherhood. During the interviews, doctors, midwives, and nurses drew upon ‘Developmental’ and ‘Motherhood’ discourses to position adolescent mothers as problematic. The ‘Developmental’ discourse positions young mothers as ‘adolescents’ who are naive, distracted, and self-centred, and hence unable to mother correctly. The health professionals also employed a ‘Motherhood’ discourse that attributes certain behaviours to ‘good’ mothers. These discourses were drawn upon to illustrate how the characteristics of an ‘adolescent’ cannot be reconciled with the attributes of a ‘good’ mother. These constructions have implications for health care provision for adolescent mothers in New Zealand.

Rural New Zealand health professionals' perceived barriers to greater use of the internet for learning

The purpose of this research was to investigate rural North Island (New Zealand) health professionals' attitudes and perceived barriers to using the internet for ongoing professional learning. A cross-sectional postal survey of all rural North Island GPs, practice nurses and pharmacists was conducted in mid-2003. The questionnaire contained both quantitative and qualitative questions. The transcripts from two open questions requiring written answers were analysed for emergent themes, which are reported here. The first open question asked: 'Do you have any comments on the questionnaire, learning, computers or the Internet?' The second open question asked those who had taken a distance-learning course using the internet to list positive and negative aspects of their course, and suggest improvements. Out of 735 rural North Island health professionals surveyed, 430 returned useable questionnaires (a response rate of 59%). Of these, 137 answered the question asking for comments on learning, computers and the internet. Twenty-eight individuals who had completed a distance-learning course using the internet, provided written responses to the second question. Multiple barriers to greater use of the internet were identified. They included lack of access to computers, poor availability of broadband (fast) internet access, lack of IT skills/knowledge, lack of time, concerns about IT costs and database security, difficulty finding quality information, lack of time, energy or motivation to learn new skills, competing priorities (eg family), and a preference for learning modalities which include more social interaction. Individuals also stated that rural health professionals needed to engage the technology, because it provided rapid, flexible access from home or work to a significant health information resource, and would save money and travelling time to urban-based education. In mid-2003, there were multiple barriers to rural North Island health professionals making greater use of the internet for learning. Now that access to broadband internet is available in all rural towns in New Zealand, there is a clear need to address the other identified barriers, especially the self-reported lack of IT skills, which are preventing many in the rural health workforce from gaining maximum advantage from both computers and the internet.