ISSN 1178-6191

Maori Health Review

Making Education Easy Issue 57 – 2015

Maori Health Review
Maori Health Review

‘No matter what the cost’: A qualitative study of the financial costs faced by family and whānau caregivers within a palliative care context

Authors: Gott M et al.

Summary: This Auckland-based group of researchers explored family and whānau carers’ experiences of the financial impact of caring within a palliative care context. Semi-structured interviews were held with 30 family/whānau caregivers who were either currently caring for a person with palliative care needs or had done so in the past year. The data were analysed using narrative analysis, which identified impacts and costs at the personal, interpersonal, sociocultural and structural levels. Participants reported significant costs involved in caregiving, resulting in debt for some people or even bankruptcy. A range of direct (transport, food and medication) and indirect costs (related to employment, cultural needs and own health) were reported. A multi-level qualitative analysis revealed how costs operated at a number of levels (personal, interpersonal, sociocultural and structural). The palliative care context increased costs, as meeting needs were prioritised over cost. In addition, there was confusion among caregivers as to what statutory (government) help was available in the context of ‘being palliative’.

Comment: A really important and considered description of the wider ripples of impact that caregiving has for whānau.

Reference: Palliat Med. 2015;29(6):518-28


Ethnicity and risk of lower limb amputation in people with Type 2 diabetes: a prospective cohort study

Authors: Robinson TE et al.

Summary: For this study, primary care data were examined from a large national multi-ethnic cohort of patients with type 2 diabetes in New Zealand and linked hospital records. The primary outcome was time from initial data collection to first lower limb amputation. There were 892 lower limb amputations recorded among 62,002 patients (2.11 amputations per 1000 person-years), followed for a median of 7.14 years (422,357 person-years). In Cox proportional hazards analyses that adjusted for demographic and socioeconomic variables, Māori had the highest risk of lower limb amputation in comparison with Europeans (hazard ratio [HR] 1.84; 95% CI, 1.54 to 2.19), whereas East Asians (HR 0.18; 95% CI, 0.08 to 0.44) and South Asians (HR 0.39; 95% CI, 0.22 to 0.67) had the lowest risk. Adjusting for available clinical variables (smoking status, height and weight, blood pressure, HbA1c, total cholesterol/HDL ratio and albuminuria)

Comment: Ethnic disparities for diabetic complications (renal failure, lower limb amputations, eye problems and heart disease) are disproportionately higher than for prevalence; that is, Māori with diabetes are more likely to have more severe disease. There are many reasons but evidence suggests that ethnic inequalities in access to, and the quality of, diabetes care plays a role. Programmes that screen for and aggressively manage complications must prioritise Māori. However, tackling root causes is also required in any effort to eliminate disparities.

Reference: Diabet Med. 2015 May 16. [Epub ahead of print]


Factors influencing the use of oral health services among adolescents in New Zealand

Authors: Børsting T et al.

Summary: Cross-sectional data from the 2009 New Zealand Oral Health Survey were examined in this investigation, which sought to determine the impact of parental use of dental services, ethnicity and socioeconomic background on adolescents’ recent use of dental services. The study sample consisted of 509 participants aged 12–17 years. Four in five adolescents reported having visited a dental provider within the last year (79.9%); almost half had last visited a private general dental practice (46.6%). No significant associations were found for either outcome with the primary caregiver exposure factor: most recent dental visit outcome fully adjusted odds ratio [OR] (primary caregiver not visited) 0.93 (95% CI, 0.32 to 2.72); visited provider other than private general dental practice outcome fully adjusted OR (primary caregiver not visited) 1.60 (95% CI, 0.39 to 6.57). Compared to European/Other adolescents, Māori and Pacific adolescents were significantly more likely to have not visited in the last year (Māori 12–14 years fully adjusted OR 4.20; 95% CI, 1.54 to 11.50; Pacific 12–17 years fully adjusted OR 2.61; 95% CI, 0.84 to 8.07 – the latter was not significant after adjusting for socioeconomic deprivation), and significantly less likely to have last visited a private general dental practice (Māori 12–17 years fully adjusted OR 2.16; 95% CI, 1.13 to 4.12; Pacific 12–17 years fully adjusted OR 5.15; 95% CI, 1.69 to 15.74).

Comment: A significant health issue for our tai tamariki. I think cost, and even perceived costs, are major barriers here.

Reference: Reference: N Z Dent J. 2015;111(2):49-57


Maori Health Review

Health promotion funding, workforce recruitment and turnover in New Zealand

Authors: Lovell SA et al.

Summary: This nationwide survey of health promotion providers sought to identify trends in recruitment and turnover in New Zealand’s health promotion workforce. Surveys were sent to 160 organisations identified as having a health focus and employing one or more health promoter. Respondents, primarily health promotion managers, were asked to report budget, retention and hiring data for the period 1 July 2009 through 1 July 2010. Responses were received from 53% of organisations. Among respondents, government funding for health promotion declined by 6.3% in the year ended July 2010 and health promoter positions decreased by 7.5% (equalling 36.6 full-time equivalent positions). Among staff who left their roles, 79% also left the field of health promotion. Forty-two organisations (52%) reported employing health promoters on time-limited contracts lasting ≤3 years; this employment arrangement was particularly common in public health units (80%) and primary health organisations (57%). Among new hires, 46% (n=55) were identified as Māori.

Comment: There has been a lot of focus recently on personally mediated racism in the health workforce recently, particularly for medical students. This paper and the recently highlighted inequities in midwives’ salaries provide good examples of institutionalised racism and sexism that exist for our health workforce.

Reference: J Prim Health Care. 2015;7(2):153-7


Early engagement with a Lead Maternity Carer: Results from Growing Up in New Zealand

Authors: Bartholomew K et al.

Summary: This paper describes the timeliness of lead maternity carer (LMC) engagement and discusses factors associated with timely engagement, using data from the Growing Up in New Zealand longitudinal study, which enrolled a diverse sample of 6822 pregnant women during 2009 and 2010. Timely engagement was defined as before 10 weeks’ gestation. Of 6661 women (98%) who stated they had a LMC, 6012 (90%) reported the time taken to engage a LMC. Eightysix to 92% of women engaged a LMC in a timely manner, depending upon the estimate of gestational time used. Factors independently associated with delayed engagement were Māori (OR 0.59; 95% CI, 0.44 to 0.80), Pacific (OR 0.63; 95% CI, 0.46 to 0.86), or Asian (OR 0.51; 95% CI, 0.39 to 0.67) ethnicity; first pregnancy (OR 0.71; 95% CI, 0.58 to 0.88); age <20 years (OR 0.62; 95% CI, 0.41 to 0.94); socioeconomic deprivation (OR 0.69; 95% CI, 0.52 to 0.92); and LMC type being a hospital midwife (OR 0.47; 95% CI, 0.38 to 0.60), or a combination of care providers (OR 0.60; 95 CI, 0.42 to 0.90).

Comment: As stated in the introduction of this paper, antenatal care is critical to the ‘best start to life’ for our tamariki, and its status reflects the level or quality of a health care system. The fact that Māori, Pacifica, Asian, young and first-time mums living in areas of social deprivation are missing out speaks volumes to the (under)valuing of these groups of women, and their pēpi, by our health system.

Reference: Aust N Z J Obstet Gynaecol. 2015;55(3):227-32


Indigenous inequities in the presentation and management of stomach cancer in New Zealand: a country with universal health care coverage

Authors: Signal V et al.

Summary: These researchers investigated the presentation, management and survival of stomach cancer in a cohort of newly diagnosed Māori and non-Māori patients. They reviewed the clinical notes of all Māori from the North Island diagnosed between 2006 and 2008, and a random equivalent sample of non-Māori (final cohort n=335). Compared to non-Māori, Māori patients had a younger average age at diagnosis, a higher prevalence of congestive heart failure and renal disease, and were more likely to be diagnosed with distal disease (43% Māori vs 26% non-Māori; p=0.004). Stage and grade distributions were similar between ethnic groups. Two-thirds (66%) of stage I–III patients had definitive surgery; rates were similar rates between Māori and non-Māori (71% vs 68%). Māori were less likely to have surgery performed by a specialist upper gastrointestinal surgeon (38% Māori vs 79% non-Māori; p<0.01) and less likely to be treated in a main centre (44% Māori vs 87% non-Māori; p<0.01). In multivariate analyses adjusted for age, sex, stage, tumour site and comorbidity, survival was poorer among Māori (hazard ratio 1.27; 95% CI, 0.96 to 1.68).

Comment: Another example of unequal treatment and inequities in cancer outcomes between Māori and non-Māori in Aotearoa. I liked that the authors have highlighted the fact that this is supposedly ‘a country with universal health care’!

Reference: Gastric Cancer. 2015;18(3):571-9


Stroke awareness and knowledge in an urban New Zealand population

Authors: Bay JL et al.

Summary: This study used a structured oral questionnaire to assess the awareness of stroke risk, symptoms, detection, and prevention behaviours in an urban New Zealand population. Although personal experience of stroke increased awareness of symptoms and their likeliness to indicate the need for urgent medical attention, only 42.7% of the respondents (n=850) identified stroke as involving both blood and the brain. Higher educational achievement (at or above a trade certificate, apprenticeship, or diploma) was associated with an increased level of awareness of stroke symptoms compared with not having any formal education. Pacific Island respondents were less likely than New Zealand Europeans to identify a number of stroke risk factors. Māori, Pacific Island, and Asian respondents were less likely to identify symptoms of stroke and indicate the need for urgent medical attention.

Comment: For those people that know me, stroke prevention and management is a major area of research interest. What stood out for me were the findings showing a lower likelihood of having knowledge about stroke symptoms and importance of acute stroke care amongst the Māori respondents. I asked my aunty, who’d had a major stroke but stayed home, would she have done differently if someone had explained to her that acute treatment (such as stroke unit care) is

Reference: J Stroke Cerebrovasc Dis. 2015;24(6):1153-62