ISSN 1178-6191

Maori Health Review

Making Education Easy Issue 104 – 2023

Maori Health Review

Culturally safe neonatal care: talking with health practitioners identified as champions by indigenous families

Authors: Adcock A et al.

Summary: Health practitioners have important roles in eliminating inequities and sustaining Māori self-determination, according to a Kaupapa Māori study. Ten health practitioners who had been identified as champions by whānau of preterm Māori infants were interviewed for the study. Champions felt collaboration between health practitioners and whānau was crucial to enabling whānau autonomy. Connectivity and relationships were central to this concept, as was the appreciation that childbirth is a sacred time that is potentially disrupted when an infant is born prematurely. The authors stated that their findings were an exemplar of what culturally safe care looks like in day-to-day practice with Māori.

Comment: Wonderful that most people interviewed, identified as ‘champions for preterm Māori infants’ by whānau, were not Māori. Also, interesting that there was only one doctor ‘champion’….

Reference: Qual Health Res. 2023;33(6):531-542.


Is there equity of patient health outcomes across models of general practice in Aotearoa New Zealand?

Authors: Sheridan N et al., and The Primary Care Models Study Group

Summary: A national cross-sectional study has shown that being Māori or Pasifika, or living in material deprivation, is associated with poorer health outcomes, regardless of the type of primary care offered. Outcomes assessed were polypharmacy in individuals aged ≥65 years, glycosylated haemoglobin testing in adults with diabetes, childhood immunisations received by 6 months of age, ambulatory sensitive hospitalisations in those aged 0-14 years and 45-64 years, and emergency department attendances. A total of 924 primary care practices with 4,491,964 enrolled patients were included in the study. While 73% of the population were enrolled in traditional primary care practices, the proportion of Māori, Pasifika and individuals living in material deprivation was low in these practices. Māori, Pasifika and trust/non-governmental organisation practices had disproportionate enrolments of patients with high health needs. Although patients with higher health needs received more clinical input, this was insufficient to achieve equity across all outcomes. No one model of primary care out-performed others for all health outcomes.

Comment: A critical investigation on primary care models in Aotearoa, there is an incredible amount of information here. A couple of key messages for me: there are few Māori and Pasifika patients enrolled in individual ‘traditional’ clinics (I hear this from health students); and different models of care were associated with different outcomes, yet most clinics stuck with one type of model. For those of us working in primary care, a lot to think about.

Reference: Int J Equity Health. 2023;22(1):79.


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Disclaimer: This publication is not intended as a replacement for regular medical education but to assist in the process. The reviews are a summarised interpretation of the published study and reflect the opinion of the writer rather than those of the research group or scientific journal. It is suggested readers review the full trial data before forming a final conclusion on its merits.

Research Review publications are intended for New Zealand health professionals.

Variation in the use of compulsory community treatment orders between district health boards in New Zealand

Authors: Lees M et al.

Summary: Compulsory community treatment order (CTO) use is higher in Māori, young adults and in areas of socioeconomic deprivation, according to a study of national databases from 2009 to 2018. The annualised CTO rate for New Zealand was 95.5 per 100,000 population over the study period. However, CTO rates ranged from 53 to 184 per 100,000 population across district health boards, and adjustment for sociodemographic factors could not explain this variation. CTO rates were more than three times higher for Māori than Caucasian individuals, and were also higher in males and young adults. The CTO rate increased with socioeconomic deprivation severity.

Reference: Australas Psychiatry. 2023;31(3):349-352.


Racism, early psychosis and institutional contact: a qualitative study of Indigenous experiences

Authors: Manuel J et al.

Summary: A study informed by critical race theory has shown that organisational cultures may differentially affect Indigenous and minority people to impact early psychosis. A total of 23 Indigenous individuals participated in four family focus group interviews and 13 individual interviews, comprising youth, family members and mental health professionals. Themes identified included selective responses based on racial stereotypes, race-related risk assessment bias, and institutional racism in the mental health workforce. Impacts of racism were noted as inaction in the face of social need, increased coercion and an under-resourced Indigenous workforce. Important targets for anti-racism efforts include social responsiveness, risk discourse and the distribution of workforce expenditure, concluded the study authors.

Comment: Great examples of qualitative and quantitative studies informing research on inequities. The focus on organisational culture and policy here, as areas to focus anti-racism interventions, is excellent.

Reference: Int Rev Psychiatry. 2023;35(3-4):323-330.


Maori Health Review
Maori Health Review