ObjectivesDespite significant international interest in the economic impacts of health inequities, few studies have quantified the costs associated with unfair and preventable ethnic/racial health ...inequities. This Indigenous-led study is the first to investigate health inequities between Māori and non-Māori adults in New Zealand (NZ) and estimate the economic costs associated with these differences.DesignRetrospective cohort analysis. Quantitative epidemiological methods and ‘cost-of-illness’ (COI) methodology were employed, within a Kaupapa Māori theoretical framework.SettingData for 2003–2014 were obtained from national data collections held by NZ government agencies, including hospitalisations, mortality, outpatient and primary care consultations, laboratory and pharmaceutical usage and accident claims.ParticipantsAll adults in NZ aged 15 years and above who had engagement with the health system between 2003 and 2014 (deidentified).Primary and secondary outcome measuresRates of ‘potentially avoidable’ hospitalisations and mortality as well as ‘excess or underutilisation’ of healthcare were calculated, as the difference between actual rates for Māori and the rate expected if Māori had the same rates as non-Māori. These differences were then quantified using COI methodology to estimate the financial cost of ethnic inequities.ResultsIn this conservative estimate, health inequities between Māori and non-Māori adults cost NZ$863.3 million per year. Direct costs of NZ$39.9 million per year included costs from ambulatory sensitive hospitalisations and outpatient care, with cost savings from underutilisation of primary care. Indirect costs of NZ$823.4 million per year came from years of life lost and lost wages.ConclusionsIndigenous adult health inequities in NZ create significant direct and indirect costs. The ‘cost of doing nothing’ is predominantly borne by Indigenous communities and society. The net cost of adult health inequities to the government conceals substantial savings to the government from underutilisation of primary care and accident/injury care.
The objective of the current study was to identify challenges of making and sustaining healthy lifestyle changes for families with children/adolescents affected by obesity, who were referred to a ...multicomponent healthy lifestyle assessment and intervention programme in Aotearoa/New Zealand (NZ).
Secondary qualitative analysis of semi-structured interviews.
Taranaki region of Aotearoa/NZ.
Thirty-eight interviews with parents/caregivers (n 42) of children/adolescents who had previously been referred to a family-focused multidisciplinary programme for childhood obesity intervention, who identified challenges of making healthy lifestyle changes. Participants had varying levels of engagement, including those who declined contact after their referral.
Participant-identified challenges included financial cost, impact of the food environment, time pressures, stress, maintaining consistency across households, independence in adolescence, concern for mental health and frustration when not seeing changes in weight status.
Participants recognised a range of factors that contributed towards their ability to make and sustain change, including factors at the wider socio-environmental level beyond their immediate control. Even with the support of a multidisciplinary healthy lifestyle programme, participants found it difficult to make sustained changes within an obesogenic environment. Healthy lifestyle intervention programmes and families' abilities to make and sustain changes require alignment of prevention efforts, focusing on policy changes to improve the food environment and eliminate structural inequities.
Aim
It is important that intervention programmes are accessible and acceptable for groups most affected by excess weight. This study aimed to understand the barriers to and facilitators of engagement ...for Māori in a community‐based, assessment‐and‐intervention healthy lifestyle programme (Whānau Pakari).
Methods
Sixty‐four in‐depth, home‐based interviews were conducted with past service users. Half of these were with families with Māori children and half with non‐Māori families. The interviews were thematically analysed with peer debriefing for validity.
Results
Māori families experienced barriers due to racism throughout the health system and society, which then affected their ability to engage with the programme. Key barriers included the institutionalised racism evident through substantial structural barriers and socio‐economic challenges, the experience of interpersonal racism and its cumulative impact with weight stigma, and internalised racism and beliefs of biological determinism. Responses to these barriers were distrust of health services, followed by renewed engagement or complete disengagement. Participants identified culturally appropriate care as that which was compassionate, respectful, and focused on relationship building.
Conclusions
While Whānau Pakari is considered appropriate due to the approach of the delivery team, this is insufficient to retain some Māori families who face increased socio‐economic and structural barriers. Past instances of weight stigma and racism have enduring effects when re‐engaging with future health services, and inequities are likely to persist until these issues are addressed within the health system and wider society.
Maternal vaccinations for influenza and pertussis are recommended in New Zealand to protect mothers and their infant from infection. However, maternal immunisation coverage in New Zealand is ...suboptimal. Furthermore, there is unacceptable inequitable maternal immunisation rates across the country with Māori and Pacific women having significantly lower maternal immunisation rates than those of other New Zealanders.
This research set out to explore what pregnant/recently pregnant Māori and Pacific women knew about immunisation during pregnancy and what factors influenced their decision to be vaccinated. A semi-structured interview guide was developed with questions focusing on knowledge of pertussis and influenza vaccination during pregnancy and decision-making. Māori and Pacific women aged over 16 years were purposively sampled and interviewed in Dunedin and Gisborne, New Zealand between May and August 2021. Interviews were analysed following a directed qualitative content approach. Data were arranged into coding nodes based on the study aims (deductive analysis) informed by previous literature and within these participant experiences were inductively coded into themes and subthemes.
Not all women were aware of maternal vaccine recommendations or they diseases they protected against. Many underestimated how dangerous influenza and pertussis could be and some were more concerned about potential harms of the vaccine. Furthermore, understanding potential harms of infection and protection provided by vaccination did not necessarily mean women would choose to be vaccinated. Those who decided to vaccinate felt well-informed, had vaccination recommended by their healthcare provider, and did so to protect their and their infant's health. Those who decided against vaccination were concerned about safety of the vaccines, lacked the information they needed, were not offered the vaccine, or did not consider vaccination a priority.
There is a lack of understanding about vaccine benefits and risks of vaccine-preventable diseases which can result in the reinforcement of negative influences such as the fear of side effects. Furthermore, if vaccine benefits are not understood, inaccessibility of vaccines and the precedence of other life priorities may prevent uptake. Being well-informed and supported to make positive decisions to vaccinate in pregnancy is likely to improve vaccine coverage in Māori and Pacific Island New Zealanders.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The objective of this study was to understand how participants referred to a childhood obesity intervention programme prefer to receive health information, and secondly, to determine acceptability of ...digital technologies such as a social media platform or IT application for programme engagement. This study includes a subset of interviews (n = 64) of a wider study of the barriers and facilitators of engagement in a multidisciplinary healthy lifestyle programme for childhood obesity, based in Taranaki, Aotearoa/New Zealand. The topics of health information and social media and/or app use were covered in 53 and 30 interviews, respectively. Participants were parents and caregivers of children and adolescents referred to the programme, and interviews were mostly conducted in family homes. Findings showed that participants consulted a range of people, places and resources for information about their health, notably the internet, health professionals, and family and friends. Participants reported using the internet to complement or supplement information from health professionals. A strong relationship with health professionals built on trust was important. Use of digital technologies such as an IT application or social media platform for engagement with the programme was generally acceptable, with the caveat that this did not replace face‐to‐face communication with their primary care provider. In conclusion, the high usage of digital sources of health information requires accurate and reliable information. Digital technologies such as IT applications or social media platforms may have a role in terms of supplementing the patient journey; however, the importance of in‐person communication and an ongoing relationship with a health professional or practice remains paramount.
In a recent issue of the BMC Public Health journal, Littlewood et al. described the results of a systematic review of interventions to prevent or treat childhood obesity in Māori or Pacific Island ...peoples. They found that studies to date have had limited impact on improving health outcomes for Māori and Pacific Island peoples, and suggest this may be due to a lack of co-design principles in the conception of the various studies. Ensuring that interventions are appropriate for groups most affected by obesity is critical; however, some inaccuracies should be noted in the explanation of these findings. There is a risk with systematic reviews that the context of intervention trials is lost without acknowledging the associated body of literature for programmes that refer to the ongoing commitment to communities and groups most affected by obesity.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objective: To determine the impact of a family-based assessment-and-intervention healthy lifestyle programme on health knowledge and beliefs of children and families affected by obesity. Second, to ...compare the health knowledge of the programme cohort to those of a national cohort in Aotearoa/New Zealand (NZ). Design: This mixed-methods study collected health knowledge and health belief data in a questionnaire at baseline and 12-, 24-, and 60-month follow-up assessments. Health knowledge over time was compared with baseline knowledge and with data from a nationally representative survey. A data-driven subsumption approach was used to analyse open-text responses to health belief questions across the study period. Setting: Taranaki region, a mixed urban−rural setting in NZ. Participants: Participants (caregiver/child dyads) from the Whānau Pakari randomised trial. Results: A greater proportion of the cohort correctly categorised foods and drinks as healthy or unhealthy at 12 months compared to baseline for most questionnaire items. Retention of this health knowledge was evident at 24- and 60-month follow-ups. More than twice as many participants correctly reported physical activity recommendations at follow-up compared to baseline (p < 0.001). Health knowledge of participants was similar to the national survey cohort at baseline, but surpassed it at 12 and 24 months. Participant beliefs around healthy lifestyles related to physical functioning, mental and emotional wellbeing, and enhancement of appearance, and gained greater depth and detail over time. Conclusions: This study demonstrates the important role that community-level healthy lifestyle programmes can have in knowledge-sharing and health promotion.
Examining the pathways and causes of ethnic inequities in health is integral to devising effective interventions. Explanations set the scope for solutions. Understandings of ethnic health inequities ...are often situated in victim blaming and cultural deficit explanations, rather than in the root causes. For Indigenous populations, colonisation and racism are fundemental determinants of health inequities. Using a conceptual framework can support understanding of the fundamental causes of Indigenous health inequities. This article presents an Indigenous adaptation of the ‘Williams model’ for understanding the causes of racial/ethnic disparities in health. The Te Kupenga Hauora Māori modified model foregrounds colonisation as a critical determinant of health inequities, underpinning all levels from basic to surface causes. The modified model also attempts to reflect the dynamic interplay between causes at different levels, rather than a simple unidirectional relationship. We include the influence of worldviews/positioning as a cause and emphasise that privilege alongside racism plays a causative role in Indigenous health inequities. We also critique some of the limitations of this framework in reflecting the complex pathways of causation for ethnic health inequities, and indicate areas for further strengthening.
Introduction The 'Raising Healthy Kids (RHK) health target ' recommended that children identified as having obesity body mass index (BMI) ≥98th centile through growth screening at the B4 School Check ...(B4SC) be offered referral for subsequent assessment and intervention. Aim To determine the impact of the 'RHK health target ' on referral rates for obesity in Aotearoa New Zealand (NZ). Methods A retrospective audit was undertaken of 4-year-olds identified to have obesity in the B4SC programme in Taranaki and nationally in 2015-19. Key outcomes were: 'RHK health target ' rate proportion of children with obesity for whom District Health Boards (DHBs) applied the appropriate referral process; Acknowledged referral rate (proportion of children with a referral for obesity whose referral was acknowledged by DHBs); and Declined referral rate (proportion of children offered a referral for obesity who declined their referral). Results Data were audited on 266 448 children, including 7464 in Taranaki. 'RHK health target ' rates increased markedly between 2015-16 and 2016-17 following the health target implementation (NZ: 34-87%; P P Acknowledged referral rates also increased post-target nationally (56-90%; P Declined referral rates across NZ (26-31%) and in Taranaki (although variable: 38-69%). Discussions The 'RHK health target's' focus on referral rather than intervention uptake limited the policy's impact on improving preschool obesity. Future policy should focus on ensuring access to multidisciplinary intervention programmes across NZ to support healthy lifestyle change.
ObjectivesRecruitment and retention in child and adolescent healthy lifestyle intervention services for childhood obesity is challenging, and inequalities across social groups are persistent. This ...study aimed to understand the barriers and facilitators to engagement in a multicomponent assessment-and-intervention healthy lifestyle programme for children and their families, based in the home and community.DesignQualitative interview-based study of past users (n=76) of a family-based multicomponent healthy lifestyle programme in a mixed urban–rural region of New Zealand. Semistructured, home-based interviews were conducted and thematically analysed with peer debriefing for validity.ParticipantsFamilies were selected through stratified random sampling to include a range of levels of engagement, including those who declined their referral, with equal numbers of interviews with Indigenous and non-Indigenous families.ResultsThree interactive and compounding determinants were identified as influencing engagement in Whānau Pakari: acute and chronic life stressors, societal norms of weight and body size and historical experiences of healthcare. These determinants were present across societal, system and healthcare service levels. A negative referral experience to Whānau Pakari often resulted in participants declining further input or disengaging from the programme. A fourth domain, respectful and compassionate healthcare, was identified as a mitigator of these three themes, facilitating participant engagement despite previous negative experiences.ConclusionsWhile participant engagement in healthy lifestyle programmes is affected by determinants which appear to operate outside immediate service provision, the programme is an opportunity to acknowledge past instances of stigma and the wider challenges of healthy lifestyle change. The experience of the referral to Whānau Pakari is important for setting the scene for future engagement in the programme. Respectful, compassionate care is critical to enhanced retention in multidisciplinary healthy lifestyle programmes and ongoing engagement in healthcare services overall.
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