Zealand Health Research Articles

Implementing healthy food policies in health sector settings: New Zealand stakeholder perspectives

BackgroundIn 2016, a voluntary National Healthy Food and Drink Policy was released to improve the healthiness of food and drinks for sale in New Zealand health sector organisations. The Policy aims to role model healthy eating and demonstrate commitment to health and well-being of hospital staff and visitors and the general public. This study aimed to understand the experiences of hospital food providers and public health dietitians/staff in implementing the Policy, and identify tools and resources needed to assist with the implementation.MethodsA maximum variation purposive sampling strategy (based on a health district’s population size and food outlet type) was used to recruit participants by email. Video conference or email semi-structured interviews included 15 open-ended questions that focused on awareness, understanding of, and attitudes towards the Policy; level of support received; perceived customer response; tools and resources needed to support implementation; and unintended or unforeseen consequences. Data was analysed using a reflexive thematic analysis approach.ResultsTwelve participants (eight food providers and four public health dietitians/staff) were interviewed; three from small (< 100,000 people), four from medium (100,000-300,000 people) and five from large (> 300,000 people) health districts. There was agreement that hospitals should role model healthy eating for the wider community. Three themes were identified relating to the implementation of the Policy: (1) Complexities of operating food outlets under a healthy food and drink policy in public health sector settings; (2) Adoption, implementation, and monitoring of the Policy as a series of incoherent ad-hoc actions; and (3) Policy is (currently) not achieving the desired impact. Concerns about increased food waste, loss of profits and an uneven playing field between food providers were related to the voluntary nature of the unsupported Policy. Three tools could enable implementation: a digital monitoring tool, a web-based database of compliant products, and customer communication materials.ConclusionsAdopting a single, mandatory Policy, provision of funding for implementation actions and supportive tools, and good communication with customers could facilitate implementation. Despite the relatively small sample size and views from only two stakeholder groups, strategies identified are relevant to policy makers, healthcare providers and public health professionals.

Development of a Nutrient Profiling Model for Processed Foods in Japan.

Numerous nutrient profiling models (NPMs) exist worldwide, but Japan lacks an official NPM. Using the Australian and New Zealand Health Star Rating (HSR) as a reference, "Processed Foods in Japan version 1.0" (NPM-PFJ (1.0)) was developed to fit Japanese food culture and policies. In total, 668 processed foods from the Standard Tables of Food Composition in Japan were analyzed, excluding seasonings/spices, fats/oils, alcoholic beverages, and infant food. The NPM-PFJ (1.0) scoring algorithm was adapted from HSR, with revised reference values for energy, saturated fat, total sugars, sodium, protein, and dietary fiber in alignment with Japanese standards. Reference values for fruits, vegetables, nuts, and legumes (fvnl) remained unchanged. Median scores were 4.5 for HSR and 5.0 for NPM-PFJ (1.0), showing high correlation (r = 0.939, p < 0.01). Thereafter, food categories familiar and meaningful in Japan were defined based on a hierarchical cluster analysis of scoring patterns, creating six categories with distinct characteristics. Finally, the rating algorithm for NPM-PFJ (1.0) was created using each group's score distribution (10th percentile). The NPM-PFJ (1.0) was developed through a fully transparent and evidence-based process and is expected to facilitate the reformulation of food products by food industries and help consumers easily access healthier processed foods. This model marks a significant step forward in developing an NPM tailored to Japanese food culture and health policies, with the potential to enhance public health.

Mental health training for physicians supervising resident physicians: a cluster randomised controlled trial.

To evaluate an online training program for physician supervisors with the aim of promoting a mentally healthy workplace by improving their use of both responsive and preventive mental health support strategies. Cluster randomised, waitlist-controlled trial. Royal Australasian College of Physicians fellows who were supervising at least one resident physician in any of the 31 primary health networks in Australia and 20 district health boards in New Zealand (health network clusters). A brief online skills-based mental health training program, comprising twelve modules grouped into three topics: common mental illnesses; helping trainees you are concerned about (responsive strategies); and minimising mental health risks at work (preventive strategies). Change between baseline and the 3-month assessment in self-reported recommended supervisor behaviours; differences between intervention and control groups in recommended behaviour scores three weeks, three months, and six months after the program. Ninety physicians from 20 health network clusters were allocated to the intervention group, 88 physicians from 22 clusters to the control group. Intervention group participants reported greater positive change in behaviour across the study period than those in the control group (mixed model repeated measures analysis, group × time interaction: P < 0.001). The mean change in self-reported supervisory behaviour score was higher for the intervention than the control group at the 3-week (mean difference in score, 1.6; 95% confidence interval [CI], 0.8-2.4), 3-month (0.9; 95% CI, 0.2-1.6), and 6-month assessments (1.9; 95% CI, 1.1-2.7). The mean change in self-reported responsive behaviour score was also greater for the intervention group at the 3-week (mean difference, 2.3; 95% CI, 1.5-3.1), 3-month (1.0; 95% CI, 0.2-1.9), and 6-month assessments (2.0; 95% CI, 1.1-2.9); differences in the mean change in preventive behaviour scores were statistically significant at the 3-week (mean difference, 1.1; 95% CI, 0.1-2.2) and 6-month assessments (1.8; 95% CI, 0.8-2.8), but not the 3-month assessment (0.8; 95% CI, -0.1 to 1.7). Brief online mental health training for senior physicians can lead to changes in their self-reported behaviour for supporting the mental health needs of resident physicians. Whether this leads to better mental health for resident physicians should be investigated. Australian New Zealand Clinical Trials Registry, ACTRN12619001496101 (prospective).

New Zealand Health and Safety System in 2024

New Zealand Health and Safety System in 2024

Health and Safety Law from the Industrial Revolution to the New Zealand Health and Safety at Work Act 2015

Health and Safety Law from the Industrial Revolution to the New Zealand Health and Safety at Work Act 2015

A trade union perspective on the New Zealand health and safety system

A trade union perspective on the New Zealand health and safety system

What Matters to You? A Qualitative Investigation of Factors That Influence Aotearoa New Zealand Early-Career Nurses to Thrive in the Workplace

Globally, there is a nursing shortage which is expected to worsen in the next two decades. To increase nursing workforce numbers, retention of early-career nurses is vital. One such method stipulated to improve workforce retention is increasing thriving in the workplace. This study aimed to investigate the factors that influence the thriving of early-career nurses in Aotearoa New Zealand. Guided by a qualitative descriptive design, this study used semi-structured interviews to explore factors influencing the thriving of New Zealand nurses from an urban hospital. Data analysis was completed using reflexive thematic analysis. Participants included nine early-career nurses. We identified four themes affecting thriving in the workplace: interpersonal relationships, work environment, finding positive meaning, and ongoing learning and development. Early-career nurses experience multiple factors that increase and decrease thriving. Early-career nurses commonly reported high workloads, which affected multiple dimensions of their ability to thrive in the workplace. Interpersonal relationships can increase or decrease elements of thriving at work depending on the nature of the relationship. Early-career nurses also experienced a large amount of job satisfaction from the act of caring. Roles that promoted ongoing learning similarly increased thriving. Early-career nurses play an important role in the future of the Aotearoa New Zealand health workforce. Results from this study can help inform organisations on the experience of thriving for early-career nurses in order to improve retention and wellbeing of early-career nurses. Te reo Māori translation He Aha ngā Mea Nunui ki a Koe? He tūhura kounga i ngā āhuatanga whakaawe i ngā tapuhi tau tuatahi o Aotearoa kia toiora i te wāhi mahi. Ngā Ariā Matua Tērā tētahi korenga tapuhi puta noa i te ao i ēnei rā, ā, e matapaetia ana ka hē kē atu hei ngā ngahuru tau e rua e tū mai mai. He mea taketake te whakapiki i te maha o ngā kaimahi i te ohu mahi, he mea nui te puritanga o ngā tapuhi tau tuatahi. Tētahi tikanga e pēnei ai te pupuru i te kāhui kaimahi ko te whakapiki i te noho taurikura i te wāhi mahi. I whai tēnei tirohanga kia tūhuratia ngā āhuatanga āki i te noho taurikura o ngā tapuhi tau tuatahi i Aotearoa. I aratakina tēnei tirohanga e tētahi hoahoa whakamārama kounga, ā, i whakamahia ētahi uiuinga i āta whakatāhuhutia i roto, hei tūhura i ngā āhuatanga e āki ana i te noho taurikura o ētahi tapuhi tau tuatahi tokoiwa i tētahi hōhipera tāone nui kotahi. I tātaritia ngā raraunga mā te whakamahi i te tātari tāhuhu huritao. I tautohutia e mātou e whā ngā tāhuhu ka pā ki te noho taurikura i roto i te wāhi mahi: ko ngā hononga tangata, te taiao mahi, te kite i ētahi tikanga whai hua mō te tangata, me te akoranga me te whanaketanga tonutanga. Ka hōkai ēnei tāhuhu i ngā āhuatanga mahi i tautohutia hei mea e piki ai, e heke ai rānei ngā wheako taurikura o ngā tapuhi tau tuatahi. E ai ki ngā tapuhi tau tuatahi, mā ngā hononga i te wāhi mahi ka piki, ka heke rānei ētahi āhuatanga o te noho taurikura i te wāhi mahi, kei te āhua tonu o te hononga. I kōrero rātou mō te taumaha o ngā kawenga i te mahi, i pā ki tō rātou āhei kia noho taurikura i te wāhi mahi. He nui hoki tō rātou koa, nā te mahi taurima i te tangata. Waihoki, nā ngā tūranga whakatairanga i te akoranga mutunga kore i piki ai te toiora. He tino nui te wāhi ki ngā tapuhi tau tuatahi mō ngā tau kei mua o te kāhui kaimahi hauora o Aotearoa. Mā ngā kitenga mai i tēnei rangahau ka te taea ētahi atu whakahaere te whakamōhio mō te wheako nei, o te noho taurikura o ngā tapuhi tau tuatahi, hei whakapiki i te puritanga me te toiora o ngā tapuhi tau tuatahi. Ngā kupu matua te whati o te tuarā, ngā tapuhi tau tuatahi, te harikoa mō te tūranga mahi, te noho taurikura, te rangahau kounga, nga puritanga kāhui kaimahi, te taiao mahi

A self-assessment maturity matrix to support large-scale change using collaborative networks in the New Zealand health system

BackgroundA maturity matrix can be a useful tool for organisations implementing large-system transformation (LST) initiatives in complex systems. Insights from implementation of a local LST initiative using collaborative networks, known as Alliances, highlighted a tool was needed to help health system leaders prompt discussions on how and where to focus their change efforts. In the New Zealand (NZ) health system, Alliances were introduced to integrate the planning and delivery of health care between primary and hospital care.MethodsThe aim of this research was to use insights from Alliance members to develop a learning tool that collaborative networks could use to assess and improve their readiness for change. We constructed a maturity matrix using the knowledge of senior NZ health system leaders, in a workshop setting. The maturity matrix was empirically tested and refined with three Alliances and with feedback from the NZ Ministry of Health Māori Health Strategy and Policy team.ResultsThe maturity matrix described the 10 key elements that had been found to support successful implementation of LST initiatives in the NZ health system, along with success indicators and different stages of maturity from beginning to excellence. Testing of the maturity matrix with three Alliances suggested that it functioned as a learning tool and stimulated collective thinking and reflection. The Māori Health Strategy and Policy team commented on the importance of such a tool to increase health system leaders’ responsiveness to improving Māori health outcomes. Comparisons with similar international matrices revealed common elements with ours. A strength of our maturity matrix is that it is specific to the NZ context and is the first practical tool to implement large-scale change in the health system that incorporates principles of the Government’s treaty with Māori, the indigenous people of NZ.ConclusionsThrough a regular self-assessment process, use of the maturity matrix may create feedback loops to support deliberate learning and knowledge sharing for senior health system leaders and collaborative networks. The maturity matrix fills an important gap in the NZ health system and contributes to implementation science literature internationally.OtherThis study was approved by the Victoria University of Wellington Human Ethics Committee (Ethics Approval Number 27,356). The research was supported by the Victoria University of Wellington research grant (222,809) and from the University of Auckland Department of Medicine research fund (H10779).

Modifying the Health Star Rating nutrient profiling algorithm to account for ultra-processing.

To modifythe Australian and New Zealand Health Star Rating to account for ultra-processing and compare the alignment of the modified ratings with NOVA classifications and the current Australian Dietary Guidelines classifications of core (recommended foods) and discretionary (foods to limit). Data was cross-sectionally analysed for 25 486 products. Four approaches were compared to the original Health Star Rating: (1) five 'negative' points added to ultra-processed products (modification 1; inclusion approach); (2) ultra-processed products restricted to a maximum of 3.0 Health Stars (modification 2; capping approach); (3 and 4) same approach used for modifications 1 and 2 but only applied to products that already exceeded 10 'negative' points from existing Health Star Rating attributes (modifications 3 and 4, respectively; hybrid approaches). Alignment occurred when products (i) received <3.5 Health Stars and were NOVA group 4 (for NOVA comparison) or discretionary (for Dietary Guidelines comparison), or (ii) received ≥3.5 Health Stars and were NOVA groups 1-3 or core. All Health Star Rating modifications resulted in greater alignment with NOVA (ranging from 69% to 88%) compared to the original Health Star Rating (66%). None of the modifications resulted in greater alignment to the Dietary Guidelines classifications overall (69% to 76%, compared with 77% for the original Health Star Rating), but alignment varied considerably by food category. If ultra-processing were incorporated into the Australian and New Zealand Health Star Rating, consideration of ultra-processing within the broader dietary guidance framework would be essential to ensure coherent dietary messaging to Australians.

Racism and Health Among Aotearoa New Zealand Young People Aged 15–24 years: Analysis of Multiple National Surveys

PurposeThis Aotearoa New Zealand–based study addresses a gap in literature focusing on individual experiences of racism among adolescents and young adults and its links to health. MethodsThis cross-sectional study uses data from multiple instances of the New Zealand Health Survey (2002/03, 2006/07, 2011/12, 2016/17) and General Social Survey (2008–2016) restricted to participants aged 15–24 years. Prevalence of reported experiences of racism are estimated. Meta-analytic techniques to pool data and multiple regression analyses are used to examine associations between experiences of racism and outcomes measures (mental and physical health, general health and well-being, life satisfaction, inability to access health care, and identity). The study used an ethical co-design process between university researchers and a rangatahi Māori (Māori young people) partnership group. ResultsRacism was higher among Māori, Pacific, and Asian young people compared to European young people. Racism was associated with all negative health and well-being measures examined for young people, including negative mental and physical health measures (12-Item Short Form Survey, Kessler Psychological Distress Scale), lower self-rated health, negative life satisfaction, higher unmet need for primary care, and identity measures (feelings of not belonging in New Zealand, less able to express their identity). DiscussionThe results of this study are concerning. Non-European young people disproportionately bear the burden of racism in Aotearoa New Zealand with a potentially substantial impact on their health and well-being. This is a breach of Indigenous (for Māori) and other international human rights and should be motivation to act to eliminate racism in all its forms.

Prevalence of urinary incontinence in New Zealand women from the cross-sectional Sexual and Reproductive Health module of the New Zealand Health Survey 2014/2015.

To describe urinary incontinence prevalence for New Zealand women. The New Zealand Health Survey Adult Sexual and Reproductive Health module 2014/2015 was used to estimate urinary incontinence prevalence. Associations between urinary incontinence and age, body mass index (BMI), parity and ethnicity were estimated by logistic regression adjusted for sampling weights. There were 2,472/5,685 (43.5%) of women aged between and 16 and 74 who responded to the urinary incontinence question and reported at least some incontinence. The sample survey weight-adjusted prevalence (95% confidence interval) was 41.7% (40.0-43.4). An increased prevalence of incontinence was seen with older age, increased BMI and greater parity. The association between BMI and parity was complex, with the lower prevalence with lower BMI attenuated with increasing parity. After adjustment for these variables there was no association with incontinence prevalence for Māori versus non-Māori or European versus non-European. Urinary incontinence is highly prevalent in New Zealand women. There was no association with ethnicity after adjusting for older age, increased BMI and parity. The prevalence identified in the New Zealand Health Survey is higher than that reported in older surveys based on the electoral roll.

Producing the well and skilled body: a critical discourse analysis of health and physical education curriculum policy in Aotearoa New Zealand

ABSTRACT Background Aotearoa New Zealand is about to embark on a re-write of the official, national, health and physical education curriculum for all primary and secondary schools. This is a significant moment in policy history as the previous most recent curriculum updates occurred in 1999 [Ministry of Education. 1999. Health and Physical Education in the New Zealand Curriculum] and 2007 [Ministry of Education. 2007. The New Zealand Curriculum]. In the latter rewrite, health and physical education was combined with all other learning areas into one policy document called The New Zealand Curriculum (NZC). In light of this imminent shift, we have undertaken a discourse analysis of the current 2007 health and physical education curriculum in order to gain insight into what driving concerns, discourses and pedagogical imperatives were privileged in that document, how we might understand those within their related social and political contexts, and what insights such an analysis might offer this moment of curriculum review. Purpose The purpose of this article is to examine how the dominant discourses of health and physical education curriculum policy in Aotearoa New Zealand construct particular ‘problems’ of the body and young people related to health, physical ability and schooling. To date, no one has undertaken such an analysis of current Aotearoa New Zealand policy in health and physical education. Methodology and analyses Based on Foucauldian concepts of discourse, knowledge/power, and problematisation, we combined Norman Fairclough’s textually oriented discourse analysis and Carol Bacchi’s ‘What’s the Problem Represented to Be?’ approach to analyse the health and physical education sections of The New Zealand Curriculum. Our analyses involved both a focus on lexical choice – in order to analyse the curriculum policy as text – and critical discourse analysis – to analyse the curriculum policy as discourse. While many commentators (including some of the authors of this article) have lauded the curriculum policy for its socio-cultural orientation, the results of this analysis suggest that Aotearoa New Zealand health and physical education curriculum policy is actually dominated by an orientation to enhance young people’s wellbeing, and surprisingly, this is communicated in the text as directly connected to the production of skilled body. We seek to understand this finding in the context of the positioning of the curriculum policy, as outcomes-focused curriculum policy, and neoliberal discourse. Conclusions The health and physical education sections of The New Zealand Curriculum (MOE 2007) problematises the non-skilled bodies of students and position the development of ‘skilled body’ as a key technique to enhance individual wellbeing. In this context, the emphasis on skills reinforces the notions of success and failure, worthiness and unworthiness. We argued that the writers of the next iteration of the health and physical education curriculum will need to be cognisant of how skills and bodies may be positioned through text, what students should understand, know and do, as well as the dominant ideologies and discourses that shape key concepts. Researchers and policymakers will need to critically examine the complex social, cultural and political contexts that work in this particular policyscape.

Supporting whānau during COVID-19 pandemic in Aotearoa New Zealand: a systems thinking case study

BackgroundThe Aotearoa New Zealand COVID-19 pandemic response has been hailed as a success story, however, there are concerns about how equitable it has been. This study explored the experience of a collective of Māori health and social service providers in the greater Wellington region of Aotearoa New Zeland delivering COVID-19 responses.MethodsThe study was a collaboration between a large urban Māori health and social service provider, Tākiri Mai Te Ata whānau ora collective, and public health researchers in Aotearoa New Zealand. Two online workshops were held with staff of the Māori service provider, collectively developing a qualitative causal loop diagram and generating systemic insights. The causal loop diagram showed interactions of various factors affecting COVID-19 response for supporting whānau (Māori family/households) at a community level. The iceberg model of systems thinking offered insights for action in understanding causal loop diagrams, emphasizing impactful changes at less visible levels.ResultsSix interacting subsystems were identified within the causal loop diagram that highlighted the systemic barriers and opportunities for effective COVID-19 response to Māori whānau. The medical model of health service produces difficulties for delivering kaupapa Māori services. Along with pre-existing vulnerability and health system gaps, these difficulties increased the risk of negative impacts on Māori whānau as COVID-19 cases increased. The study highlighted a critical need to create equal power in health perspectives, reducing dominance of the individual-focused medical model for better support of whānau during future pandemics.ConclusionsThe study provided insights on systemic traps, their interactions and delays contributing to a relatively less effective COVID-19 response for Māori whānau and offered insights for improvement. In the light of recent changes in the Aotearoa New Zealand health system, the findings emphasize the urgent need for structural reform to address power imbalances and establish kaupapa Māori approach and equity as a norm in service planning and delivery.

Realist process evaluation of occupational performance coaching: protocol

IntroductionA cluster randomised controlled trial, the Meaning, Agency and Nurturing Autonomy (MANA) study, is underway comparing the effects of occupational performance coaching (OPC) and usual care on the social participation,...

Understanding ethnic inequities associated with tobacco use in Aotearoa New Zealand: a quantitative analysis.

Despite the inclusion of both individual interventions and population-based measures in the Aotearoa New Zealand (Aotearoa NZ) Tobacco Control Programme, the gap between Māori, Pacific peoples and European/Asian/Other (EAO) populations in tobacco use has not decreased significantly. Tobacco control interventions that focus on individual behaviour change have produced little impact towards reducing tobacco smoking inequities for Māori and Pacific peoples in Aotearoa NZ. Using data from the New Zealand Health Survey (NZHS), this research investigates the impact of the wider determinants of health and individual-level factors on inequities in tobacco use between Māori, Pacific peoples and EAO. A conceptual framework was developed to support the theoretical positioning of this research and to inform data categorization, framing, discourse, analyses and interpretation. We conducted hierarchical regression to examine the effect of factors from each domain on ethnic inequities in tobacco use. We found that socioeconomic factors accounted for a significant amount of the disparity in adults currently smoking between Māori and Pacific peoples and EAO. Our results suggest that socioeconomic factors may be a more effective target of intervention than individual behaviours for reducing tobacco-related inequities. Addressing the broader determinants of health through comprehensive cross-agency cooperation to reduce ethnic inequities in tobacco use in Aotearoa NZ is likely to be more effective than individual behaviour change approaches.

Te Ruru

Indigenous cultures have long-held perspectives that emphasise the interdependence of all living things as holistic systems. Our worldview is thus shaped by deeply embedded relationality, which is in constant response to our interconnected experiences and knowledges. Systems thinking is a way of looking at the world that recognises the interconnectedness of both natural and human-made systems. The systems change approach, which takes into account the interconnected nature of the world's economic, social, and ecological systems, finds common ground with an inclusive, connected Indigenous holistic world view. This article explores the congruence and compatibility between systems change thinking and Indigenous frameworks, emphasizing their common ground. The article introduces an example from Aotearoa New Zealand, which has integrated the tenets of systems change methodology within tribally based principles and aspirations to create ‘Te Ruru”. Te Ruru, an Indigenous framework of systems change, has been designed by a tribally owned Māori (Indigenous peoples of New Zealand) health research centre to investigate the overarching system(s) that perpetuate inequity of Māori health outcomes. Te Ruru is depicted in three parts: the first part, or micro lens; the second part, the macro lens; and part three, the meso lens. The first part of the framework prioritizes Indigenous identities and values. In part two, Te Ruru's beak, eyes, and wings symbolize the translation of research findings, strategic oversight, and the ability to navigate systems change. The third part of the framework illustrates the goal of new mātauranga and the need to address internal barriers and traumas, emphasizing the necessity for healing and restoration to sustain long-term systems change. A case study of how Te Ruru has been used in conjunction with a research methodology (TUI) is also included. Te Ruru has been purposefully adapted from a specific tribe’s knowledge and iterated to represent not just the visible system(s) that Māori communities occupy, but also the ‘unseen’ within Indigenous and colonial histories. Using systems change from an intentional Indigenous paradigm is thereby an act of decolonisation— a direct act against the systems currently blocking Indigenous flourishing. Te Ruru's transformational power lies in its ability to bring to the surface the seen and unseen, and thereby support Māori to take the helm to lead systemic change via the Indigenous translation of inclusive health research.

‘Atawhai’: a primary care provider-led response to family violence in Aotearoa New Zealand

BackgroundAs a key determinant of ill-health, family violence is inadequately responded to within Aotearoa New Zealand health policy and practice. Without adequate system support, health professionals can often be unsure of what to do, or how to help. Developed in response to this system gap, ‘Atawhai’ aims to make it easier for primary care professionals to respond to family violence.MethodsUnderpinned by indigenous Māori customs, Atawhai combines complexity theory and participatory research methodologies to be responsive to the complexity involved in family violence. We worked with 14 primary care professionals across ten whakawhitiwhiti kōrero wānanga (meetings for deliberate dialogue) to identify and develop primary care system pathways and tools for responding to family violence. This paper focuses on the development of Atawhai through wānanga and observation methods. Methods used to capture change will be reported separately.FindingsAtawhai is a relational response to family violence, focused on developing a network of trusted relationships between health and social care professionals to support safe responses to those accessing care. This study identified four key health system pathways to responsiveness and developed associated tools to support health care responsiveness to family violence. We found the quality of relationships, both among professionals and with those accessing care, coupled with critical reflection on the systems and structures that shape policy and practice are essential in generating change within primary care settings.ConclusionsAtawhai is a unique health care response to family violence evidenced on empirical knowledge of primary care professionals. Our theoretical lens calls attention to parts of the system often obscured by current health care responses to family violence. Atawhai presents an opportunity to develop a grassroots-informed, long-term response to family violence that evolves in response to needs.

Consequences of cost barriers to prescriptions: cohort study in Aotearoa New Zealand.

A NZ$5 co-payment prescription charge was removed in July 2023 but may be reinstated. Here we quantify the health impact and cost of not being able to afford this charge. We linked New Zealand Health Surveys (2013/2014-2018/2019) to hospitalisation data using data available in Integrated Data Infrastructure (IDI). Cox proportional-hazards models compared time to hospitalisation between those who had faced a cost barrier to collecting a prescription and those who had not. Of the 81,626 total survey respondents, 72,243 were available for analysis in IDI. A further 516 were excluded to give an analysis dataset of 71,502. Of these, 5,889 (8.2%) reported not collecting a prescription due to cost in the previous year. Among people who faced a cost barrier, 60.0% (95% confidence interval [CI] 58.7-61.2%) were admitted to hospital during the study period, compared to 43.9% (95% CI 43.6-44.3%) of those who did not. Having adjusted for socio-demographic variables, people who faced a cost barrier were 34% (hazard ratio 1.34; 95% CI 1.29-1.39) more likely to be admitted to hospital than those who did not. Annual avoidable hospitalisation costs-were prescription co-payments to remain free-are estimated at $32.4 million per year based on the assumption of a causal relationship between unmet need for prescription medicines and subsequent hospitalisation. The revenue to the health system from co-payments may be offset by the costs associated with avoidable hospitalisations.

Preliminary feasibility assessment of a targeted, pharmacist-led intervention for older adults with polypharmacy: a mixed-methods study

BackgroundPolypharmacy is associated with the prescription of inappropriate medications and avoidable medication-related harm. A novel pharmacist-led intervention aims to identify and resolve inappropriate medication prescriptions in older adults with polypharmacy.AimTo conduct a preliminary feasibility assessment of the intervention in primary care, testing whether specific components of the intervention procedures and processes can be executed as intended.MethodThe mixed-methods study was approved by the New Zealand Health and Disability Ethics Committees and public health agency. Patients from a New Zealand general practice clinic were recruited over 4 weeks to receive the intervention. The preliminary feasibility assessment included measures of intervention delivery, patient-reported outcome measures, and perspectives from ten patients and six clinicians. Data were analysed quantitatively and qualitatively to determine if a full-scale intervention trial is warranted. The study's progression criteria were based on established research and guided the decision-making process.ResultsThe intervention met the study's progression criteria, including patient recruitment, retention, and adherence to the intervention procedures. However, several modifications were identified, including: (1) enhancing patient recruitment, (2) conducting a preliminary meeting between the patient and pharmacist, (3) supporting pharmacists in maintaining a patient-centred approach, (4) reviewing the choice of patient-reported outcome measure, (5) extending the 8-week follow-up period, (6) allocating more time for pharmacists to conduct the intervention.ConclusionThe study found the intervention feasible; however, additional development is required before progressing to a full-scale trial. This intervention has the potential to effectively reduce medication-related harm and improve outcomes for older adults with polypharmacy.Trial registration number ACTRN12621000268842 Date registered: 11/03/2021

DIGIPREDICT: physiological, behavioural and environmental predictors of asthma attacks—a prospective observational study using digital markers and artificial intelligence—study protocol

IntroductionAsthma attacks are a leading cause of morbidity and mortality but are preventable in most if detected and treated promptly. However, the changes that occur physiologically and behaviourally in the...