Examines, describes and quantifies the extent of discrepancy in the National Immunisation Register (NIR) compared to Well Child Tamariki Ora parent-held health record books (Health Books). Source: ...National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.
Indigenous children and young people (hereafter youth) across CANZUS nations embody a rich diversity of cultures and traditions. Despite the immense challenges facing these youth, many harness ...cultural and personal strengths to protect and promote their wellbeing. To support this for all youth, it is critical to understand what contributes to their wellbeing. This review aims to identify components contributing to wellbeing for Indigenous youth in CANZUS nations. Five databases were searched from inception to August 2022. Papers were eligible if they: focused on Indigenous youth in CANZUS nations; included views of youth or proxies; and focused on at least one aspect of wellbeing. We identified 105 articles for inclusion (Canada
= 42, Australia
= 27, Aotearoa New Zealand
= 8, USA
= 28) and our analysis revealed a range of thematic areas within each nation that impact wellbeing for Indigenous youth. Findings highlight the unique challenges facing Indigenous youth, as well as their immense capacity to harness cultural and personal strengths to navigate into an uncertain future. The commonalities of Indigenous youth wellbeing across these nations provide valuable insights into how information and approaches can be shared across borders to the benefit of all Indigenous youth and future generations.
Purpose
Over the last decade there has been considerable debate about the merits of targets as a policy instrument. The purpose of this paper is to examine the implementation of two health targets ...that were cornerstones of New Zealand health policy between 2009 and 2012: immunisation rates for two-year-olds, and time to treatment, discharge or admission in hospital emergency departments.
Design/methodology/approach
For each policy target, the authors selected four case-study districts and conducted two waves of key-informant interviews (113 in total) with clinical and management staff involved in target implementation.
Findings
Despite almost identical levels of target achievement, the research reveals quite different mixes of positive and negative implementation consequences. The authors argue that the differences in implementation consequences are due to the characteristics of the performance measure; and the dynamics of the intra-organisational and inter-organisational implementation context.
Research limitations/implications
The research is based on interviews with clinical and management staff involved in target implementation, and this approach does not address the issue of effort substitution.
Practical implications
While literature on health targets pays attention to the attributes of target measures, the paper suggests that policymakers considering the use of targets pay more attention to broader implementation contexts, including the possible impact of, and effects on related services, organisations and staff.
Originality/value
The research focuses specifically on implementation consequences, as distinct from target success and/or changes in clinical and health outcomes. The paper also adopts a comparative approach to the study of target implementation.
Maternal immunisation coverage is suboptimal in Aotearoa New Zealand. Our objective was to highlight discrepancies resulting from how maternal immunisation coverage for pertussis and influenza is ...measured in Aotearoa New Zealand.
A retrospective cohort study of pregnant people was undertaken using administrative datasets. Maternity and immunisation data from three sources (National Immunisation Register NIR, general practice GP, and pharmaceutical claims) were linked to determine the proportion of immunisation records not recorded in the NIR but captured in claims data, and to compare this with coverage data available from Te Whatu Ora - Health New Zealand.
We found that while increasing numbers of maternal immunisations are being captured in the NIR, around 10% remain unrecorded on the NIR, but within claims datasets.
Accurate maternal immunisation coverage data is important for public health action. Implementation of the whole-of-life Aotearoa Immunisation Register (AIR) is an important opportunity to improve completeness and consistency of maternal immunisation coverage reporting.
Background: Vaccination in pregnancy against influenza and pertussis protects the pregnant woman/person and their infant against severe disease. Aotearoa New Zealand has a lower uptake of vaccination ...in pregnancy than some other countries, despite this immunisation being publicly funded. Coverage is also inequitable, with Maori, Pacific people, and people from high deprivation areas less likely to be vaccinated. Many barriers exist to vaccinations in pregnancy, e.g., access barriers and lack of knowledge about vaccination. Discussions about recommended vaccines with healthcare professionals, particularly midwives, may have a positive impact on vaccine decision-making. Aim: This study aimed to investigate midwives' perceptions of enablers and barriers with discussions about vaccinations in pregnancy, barriers to vaccination in pregnancy, and influences on vaccine decision-making in pregnancy. The study also aimed to gather midwives' insights into what might improve vaccination uptake. Method: A structured questionnaire was developed containing a mix of closed and open-ended questions. The questionnaire was sent out to 3002 midwives registered in Aotearoa New Zealand in October 2021, using REDCap electronic data capture tools. Simple descriptive statistics were undertaken on the quantitative data. The answers to the open-ended questions were analysed using a direct, qualitative content analysis approach. Findings: Fifty-one midwives' responses were included in the analysis (1.8% response rate). Almost all reported sufficient knowledge of vaccinations in pregnancy but had varying levels of confidence when discussing them. The most common enablers to conversations were good relationships, easy communication, and having the time and resources available. Respondents perceived that barriers to conversations were negative preconceptions, communication difficulties and lack of time. Lack of awareness, cost to access services and competing priorities for time were also thought to reduce the likelihood of vaccination in pregnancy. To improve vaccine uptake, respondents identified the need for accessible and suitable vaccination venues, appropriate information and the support of all healthcare professionals involved in maternal healthcare. Conclusion: Midwives surveyed understand the importance of vaccination in pregnancy but there may be lack of confidence, time or resources to effectively engage in discussions. A trusting relationship is important but this can be affected by disengagement or late presentation to healthcare services. Resources to counter pre-existing negative ideas and support communication would help midwives to provide useful information about vaccination. Furthermore, respect and cultural understanding of hapu Maori and their needs will positively support their ability to make informed decisions. Keywords: midwives, vaccination in pregnancy, immunisation, communication, barriers, decision-making
Purpose
Over the last decade there has been considerable debate about the merits of targets as a policy instrument. The purpose of this paper is to examine the implementation of two health targets ...that were cornerstones of New Zealand health policy between 2009 and 2012: immunisation rates for two-year-olds, and time to treatment, discharge or admission in hospital emergency departments.
Design/methodology/approach
For each policy target, the authors selected four case-study districts and conducted two waves of key-informant interviews (113 in total) with clinical and management staff involved in target implementation.
Findings
Despite almost identical levels of target achievement, the research reveals quite different mixes of positive and negative implementation consequences. The authors argue that the differences in implementation consequences are due to the characteristics of the performance measure; and the dynamics of the intra-organisational and inter-organisational implementation context.
Research limitations/implications
The research is based on interviews with clinical and management staff involved in target implementation, and this approach does not address the issue of effort substitution.
Practical implications
While literature on health targets pays attention to the attributes of target measures, the paper suggests that policymakers considering the use of targets pay more attention to broader implementation contexts, including the possible impact of, and effects on related services, organisations and staff.
Originality/value
The research focuses specifically on implementation consequences, as distinct from target success and/or changes in clinical and health outcomes. The paper also adopts a comparative approach to the study of target implementation.
•Transport professionals (N = 175) in Aotearoa/NZ completed a web survey.•Analyses suggest that inclusive access is a complex issue for transport professionals.•There was a range of perspectives on ...why it is not more prominent in transport policy, or why outcomes are not better for older and disabled people using transport.•We argue that these findings are reflective of inclusive access being vaguely defined and poorly measured in transport.•It is recommended that inclusive access in transport policy is improved with measures that link policy and design choices to outcomes.
Inclusive access to transport is an important determinant of health for older and disabled people. Despite transport policy increasingly focusing on wellbeing and equity outcomes, transport professionals’ understanding of and approaches to delivering accessible transport remain poorly understood. Transport professionals (N = 175) from a range of government and private sector organisations in Aotearoa/New Zealand completed a web survey. Questions covered respondents’ views on what might make inclusive access a more prominent transport policy objective; their approach to accessibility for older and disabled people in their work; and the extent to which they engage with older and disabled people in transport practice and design. Analyses suggest that inclusive access is a complex issue for transport professionals. There was a range of perspectives on why it is not more prominent in transport policy, or why outcomes are not better for older and disabled people using transport. In-person engagement between transport professionals and older and disabled people is infrequent. We argue that these findings are reflective of inclusive access being vaguely defined and poorly measured in transport. Consequently, compared with transport policies such as road safety which have clearly measurable outcomes, improved equity of mobility is reliant on design standards and transport professionals’ awareness and training. It is recommended that inclusive access in transport policy is improved with measures that linkpolicy and design choices to outcomes, ultimately benefitting the health of all people, and that of older and disabled people in particular.
IntroductionThere is significant international interest in the economic impacts of persistent inequities in morbidity and mortality. However, very few studies have quantified the costs associated ...with unfair and preventable ethnic/racial inequities in health. The proposed study will investigate inequities in health between the indigenous Māori and non-Māori adult population in New Zealand (15 years and older) and estimate the economic costs associated with these differences.Methods and analysisThe study will use national collections data that is held by government agencies in New Zealand including hospitalisations, mortality, outpatient consultations, laboratory and pharmaceutical claims, and accident compensation claims. Epidemiological methods will be used to calculate prevalences for Māori and non-Māori, by age-group, gender and socioeconomic deprivation (New Zealand Deprivation Index) where possible. Rates of ‘potentially avoidable’ hospitalisations and mortality as well as ‘excess or under’ utilisation of healthcare will be calculated as the difference between the actual rate and that expected if Māori were to have the same rates as non-Māori. A prevalence-based cost-of-illness approach will be used to estimate health inequities and the costs associated with treatment, as well as other financial and non-financial costs (such as years of life lost) over the person’s lifetime.Ethics and disseminationThis analysis has been approved by the University of Auckland Human Participants Research Committee (Ref: 018621). Dissemination of findings will occur via published peer-reviewed articles, presentations to academic, policy and community-based stakeholder groups and via social media.
The philosophical assumptions that underpin the way in which health states are valued within economic measures of health are rarely made explicit and fail to capture the experiences of Indigenous ...peoples. Within a Kaupapa Maori theoretical paradigm, in-depth interviews were conducted with six Maori key informants who had cared for whanau (family) members through illness to give voice to dimensions of health and illness that Western economic measures of health fail to capture. An Indigenous measure of health needs to consider the individual within the context of the collective and the environment that they are connected to. Economic measures of health are widely used to inform decisions about resource allocation that have significant impacts on Indigenous health outcomes. This article sets out to start a conversation around what an Indigenous measure of health might look like and how it might value key dimensions of health.
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