Publications

2023 Upholding te mana o te wā: Māori patients and their families’ experiences of accessing care following an out-of-hospital cardiac event

Journal Article

Upholding te mana o te wā: Māori patients and their families’ experiences of accessing care following an out-of-hospital cardiac event – ScienceDirect

Abstract

Objective

The purpose of this study was to explore the experiences of Māori patients and their families accessing care for an acute out-of-hospital cardiac event and to identify any barriers or enablers of timely access to care.

 

Design

Eleven interviews with patients and their families were conducted either face-to-face or using online conferencing. Interviews were audio-recorded and transcribed for thematic analysis using Kaupapa Māori methodology.

 

Results

Data analysis identified three themes: (1) me and the event, (2) the people (3) upholding te mana ō te wā or self-determined heart wellbeing. Knowledge of symptoms and a desire to maintain personal dignity at the time of the event affected emergency medical service initiation. Participants described relationships with health professionals, the importance of good quality information, having family support, and drawing on cultural practices as vital for their health care journey.

 

Conclusion

Systemic barriers including racism, discrimination, and inadequate resourcing exist for Māori journeying to and through care following an out of hospital cardiac event. Improving the cultural safety of health professionals, better access to community defibrillation, and improving understanding of the life-long impacts a cardiac event has on patients and whānau is recommended.

  • BibTex Key
  • Authors B. Dicker | C. Grey | K. Brewer | M. Harwood | R. Newport | S. Amertunga | S. Hanchard | T. Tuaeetia-Su'a | V. Selak
  • Tags acute cardiac care | Māori health | Pre-hospital
  • DOI Number https://doi.org/10.1016/j.ahjo.2023.100341

    2023 Who are Pacific peoples in terms of ethnicity and country of birth? A cross sectional study of 2,238,039 adults in Aotearoa New Zealand’s integrated data infrastructure

    Journal Article

    Abstract

    Background

    The aggregation of Indigenous peoples from Pacific Island nations as ‘Pacific peoples’ in literature may mask diversity in the health needs of these different groups. The aim of this study was to examine the heterogeneity of Pacific groups according to ethnicity and country of birth.

    Methods

    Anonymised individual-level linkage of administrative data identified all NZ residents aged 30–74 years on 31 March 2013 with known ethnicity and country of birth. All participants were described according to ethnicity and country of birth. Pacific participants were also described according to the number of ethnicities they identified.

     

    Findings

    A total of 2,238,039 NZ residents were included, of whom 117,957 (5·0%) were Pacific. Nearly two-thirds of Pacific peoples (65·7%) were born overseas, ranging from 45·3% (Cook Islands Māori) to 82·7% (Fijian) (Māori 2·3%, non-Māori non-Pacific 28·9%). Among NZ-born Pacific peoples, 46·9% (Samoan) to 81·9% (Fijian) were multi-ethnic; the proportion was much lower for overseas-born Pacific peoples (ranging from 3·7% [Tongan] to 23·9% [Tokelauan]).

     

    Interpretation

    There is substantial heterogeneity among Pacific peoples in their country of birth and identification with sole or multiple ethnicities. Assumptions regarding homogeneity in the needs of Pacific peoples are not appropriate and government statistics should therefore disaggregate Pacific peoples whenever possible.

     

    Funding

    Supported by the Health Research Council of New Zealand and a part of Manawataki Fatu Fatu, a programme of research funded by the National Heart Foundation of New Zealand and Healthier Lives – He Oranga Hauora – National Science Challenge of New Zealand.

     

    Keywords

    PacificPacific peoplesPasifikaEthnicityCountry of birth

    • BibTex Key
    • Authors C. Grey | J. Paynter | J. Winter-Smith | M. Harwood | V. Selak
    • Tags Pacific health
    • DOI Number https://doi.org/10.1016/j.dialog.2023.100152

      2023 Widening ethnic inequities in heart failure incidence in New Zealand

      Journal Article

      Chan DZ, Grey C, Doughty RN, et al
      Widening ethnic inequities in heart failure incidence in New Zealand
      Heart Published Online First: 03 August 2023
      Objective
      Ethnic inequities in heart failure (HF) have been documented in several countries. This study describes New Zealand (NZ) trends in incident HF hospitalisation by ethnicity between 2006 and 2018.
      Methods
      Incident HF hospitalisations in ≥20-year-old subjects were identified through International Classification of Diseases, 10th Revision-coded national hospitalisation records. Incidence was calculated for different ethnic, sex and age groups and were age standardised. Trends were estimated with joinpoint regression.
      Results
      Of 116 113 incident HF hospitalisations, 12.8% were Māori, 5.7% Pacific people, 3.0% Asians and 78.6% Europeans/others. 64% of Māori and Pacific patients were aged <70 years, compared with 37% of Asian and 19% of European/others. In 2018, incidence rate ratios compared with European/others were 6.0 (95% CI 4.9 to 7.3), 7.5 (95% CI 6.0 to 9.4) and 0.5 (95% CI 0.3 to 0.8) for Māori, Pacific people and Asians aged 20–49 years; 3.7 (95% CI 3.4 to 4.0), 3.6 (95% CI 3.2 to 4.1) and 0.5 (95% CI 0.4 to 0.6) for Māori, Pacific people and Asians aged 50–69 years; and 1.5 (95% CI 1.4 to 1.6), 1.5 (95% CI 1.3 to 1.7) and 0.5 (95% CI 0.5 to 0.6) for Māori, Pacific people and Asians aged ≥70 years. Between 2006 and 2018, ethnicity-specific rates diverged in ≥70-year-old subjects due to a decline in European/others (annual percentage change (APC) −2.0%, 95% CI −2.5% to −1.6%) and Asians (APC −3.3%, 95% CI −4.4% to −2.1%), but rates remained unchanged for Māori and Pacific people. In contrast, regardless of ethnicity, rates either increased or remained unchanged in <70-year-old subjects.
      Conclusion
      Ethnic inequities in incident HF hospitalisation have widened in NZ over the past 13 years. Urgent action is required to address the predisposing factors that lead to development of HF in Maori and Pacific people.
      • BibTex Key
      • Authors A. Kerr | C. Grey | D. Chan | K. Poppe | M. Harwood | M. Lund | MAW. Lee | R. Doughty
      • Tags heart failure
      • DOI Number 10.1136/heartjnl-2023-322795

        2023 How pharmacist-led health services are tailored to minoritized populations, their acceptability and effectiveness: A scoping literature review

        Journal Article

        Hutchings, J.L., Grey, C., Brewer, K.M. and Aspden, T.J., 2023. How pharmacist-led health services are tailored to minoritized populations, their acceptability and effectiveness: A scoping literature review. Research in Social and Administrative Pharmacy.

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          2023 Reasons for ethnic disparities in pre-hospital care pathway following an Out of Hospital Cardiac Events: protocol of a systematic review.

          Journal Article

          Newport R, C. Dicker, B. Ameratunga, S. Harwood, M. Reasons for ethnic disparities in pre-hospital care pathway following an Out of Hospital Cardiac Events: protocol of a systematic review. JMIR Res Protoc (forthcoming). 2023

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            2023 Understanding the barriers and facilitators that influence access to quality cardiovascular care for rural Indigenous peoples: protocol for a scoping review

            Journal Article

            Understanding the barriers and facilitators that influence access to quality cardiovascular care for rural Indigenous peoples: protocol for a scoping review | BMJ Open

            Abstract

            Introduction Māori (the Indigenous peoples of New Zealand) are disproportionately represented in cardiovascular disease (CVD) prevalence, morbidity and mortality rates, and are less likely to receive evidence-based CVD healthcare. Rural Māori experience additional barriers to treatment access, poorer health outcomes and a more significant burden of CVD risk factors compared with non-Māori and Māori living in urban areas. Importantly, these inequities are similarly experienced by Indigenous peoples in other nations impacted by colonisation. Given the scarcity of available literature, we are conducting a scoping review of literature exploring barriers and facilitators in accessing quality CVD healthcare for rural Māori and other Indigenous peoples in nations impacted by colonisation.

            Methods and analysis A scoping review will be conducted to identify and map the extent of research available and identify any gaps in the literature. This review will be underpinned by Kaupapa Māori Research methodology and will be conducted using Arksey and O’Malley’s (2005) methodological framework. A database search of MEDLINE (OVID), PubMed, Embase, SCOPUS, CINAHL Plus, Australia/New Zealand Reference Centre and NZResearch.org will be used to explore empirical research literature. A grey literature search will also be conducted. Two authors will independently review and screen search results in an iterative manner. The New Zealand Ministry of Health Te Tiriti o Waitangi (Treaty of Waitangi) Framework principles will be used as a framework to summarise and construct a narrative of existing literature. Existing literature will also be appraised using the CONSolIDated critERia for strengthening the reporting of health research involving Indigenous Peoples (CONSIDER) statement.

            Ethics and dissemination Ethical approval has not been sought for this review as we are using publicly available data. We will publish this protocol and the findings of our review in an open-access peer-reviewed journal. This protocol has been registered on Open Science Framework (DOI:10.17605/osf.io/xruhy).

            • BibTex Key
            • Authors K.Eggleton | M. Harwood | T.Tane | V. Selak
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              2023 Te Whatu Ora Te Tai Tokerau – Manager – Patient Experience

              Presentation

              • BibTex Key
              • Authors T.Tane
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