Maori/Indigenous Health Institute (MIHI)
http://hdl.handle.net/10523/318
2024-03-29T05:33:39ZComprehensive clinical assessment of home-based older persons within New Zealand: An epidemiological profile of a national cross-section
http://hdl.handle.net/10523/16098
Comprehensive clinical assessment of home-based older persons within New Zealand: An epidemiological profile of a national cross-section
2016
Schluter, P.J.; Ahuriri-Driscoll, A.; Anderson, T.J.; Beere, P.; Brown, J.; Dalrymple-Alford, J.; David, T.; Davidson, A.; Gillon, D.A.; Hirdes, J.; Keeling, S.; Kingham, S.; Lacey, C.; Menclova, A.K.; Millar, N.; Mor, V.; Jamieson, H.A.
Objective: Since 2012, all community care recipients in New Zealand have undergone a standardised needs assessment using the Home Care International Residential Assessment Instrument (interRAI-HC). This study describes the national interRAI-HC population, assesses its data quality and evaluates its ability to be matched.
Methods: The interRAI-HC instrument elicits information on 236 questions over 20 domains; conducted by 1,800+ trained health professionals. Assessments between 1 July 2012 and 30 June 2014 are reported here. Stratified by age, demographic characteristics were compared to 2013 Census estimates and selected health profiles described. Deterministic matching to the Ministry of Health's mortality database was undertaken.
Results: Overall, 51,232 interRAI-HC assessments were conducted, with 47,714 (93.1%) research consent from 47,236 unique individuals; including 2,675 Māori and 1,609 Pacific people. Apart from height and weight, data validity and reliability were high. A 99.8% match to mortality data was achieved. Conclusions: The interRAI-HC research database is large and ethnically diverse, with high consent rates. Its generally good psychometric properties and ability to be matched enhances its research utility.
Implications: This national database provides a remarkable opportunity for researchers to better understand older persons' health and health care, so as to better sustain older people in their own homes.
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2023-09-15T01:56:23ZKōrero o te Tāniko: Māori experiences of healthcare for bipolar disorder in Aotearoa. A Kaupapa Māori clinical, structural and organisational critique.
http://hdl.handle.net/10523/13473
Kōrero o te Tāniko: Māori experiences of healthcare for bipolar disorder in Aotearoa. A Kaupapa Māori clinical, structural and organisational critique.
2022
Haitana, Tracy Nicola
Background
Unfair, avoidable health inequities persist in New Zealand because they are deeply rooted in health and social systems that systematically privilege non-Māori. The ongoing impacts of colonisation can be seen in entrenched patterns of ethnic inequities, with Māori continuing to experience the poorest health status on most measures compared to other New Zealanders, including a higher community prevalence rate of bipolar disorder. There is some research data about Indigenous peoples with bipolar disorder, but a dearth of research designed on ways to improve health outcomes for this population.
Method
A Kaupapa Māori methodology and qualitative methods were used to carry out interviews with 24 Māori patients with bipolar disorder, and 19 members of their whānau. A semi-structured interview schedule, informed by a systematic literature review and adapted cultural competence framework, was used to explore the impact of the New Zealand healthcare system on Māori patient and whānau experiences of bipolar disorder. Questions explored how participants conceptualised the role of the determinants of hauora on their wellbeing over time. An adapted coding framework was used to analyse the impact of clinical, structural and organisational features of the New Zealand health system on hauora, and to identify barriers to and potential enablers of health equity at each level of healthcare for Māori with bipolar disorder and their whānau.
Results
Themes from the analysis of clinical factors were clinical care, clinical culture, and clinical work with whānau. This analysis of clinical factors identified that the efficacy of clinical care for bipolar disorder was dependent on Māori patients and whānau having clear pathways through care, and being able to access timely, consistent care from clinically and culturally competent staff. The safety of care for Māori was influenced by the clinical culture in bipolar disorder services, embedded into care settings, and expressed by staff. Clinical work with whānau needs to be prioritised, by equipping staff with skills and resources to tailor care and enhance whānau and patient wellbeing. Themes from the analysis of structural factors were accessibility, delivery, and scope. To improve the accessibility, delivery and scope of bipolar disorder services for Māori, a redesign of operational, environmental, staffing and navigation points is required to overcome equity barriers. Themes from the analysis of organisational factors were executive management, organisational culture, organisational design, incentive structures, and information management and technology. Analysis of organisational factors identified that extensive transformation and re-organisation of New Zealand healthcare is therefore needed to achieve health equity. Recommended changes include executive management implementing organisational changes to the culture of healthcare by establishing equity in partnerships with Māori, embedding cultural safety in the organisation of healthcare, and focusing on whānau wellbeing. To support organisational changes, healthcare incentive structures are needed to diversify, develop and retain a culturally competent health workforce, together with information management and technology systems to guide continued whole system equity-oriented improvements. Changes in health outcomes and health equity for Māori with bipolar disorder requires a consistent Crown commitment to resource structural, organisational and clinical transformation of the healthcare system.
2022-07-13T20:58:34ZEvaluation of a Self-Directed E-Learning Resource: Integrating Hauora Māori and Clinical Content for Undergraduate Medical Students
http://hdl.handle.net/10523/5504
Evaluation of a Self-Directed E-Learning Resource: Integrating Hauora Māori and Clinical Content for Undergraduate Medical Students
2015
Armstrong, Jarom
Despite e-learning becoming more established in medical education, there remains a lack of e-learning resources teaching indigenous health at the undergraduate level. There is markedly less evidence to support cultural competency e-learning resources that integrate clinical and cultural (specifically indigenous) teaching content in one package, and no published evaluation of such resources at the undergraduate or postgraduate level.
This study utilised a Kaupapa Maori Research (KMR) methodology to incorporate Māori beliefs, values and experiences and was conceived, planned and implemented with the intention to support Māori health gains. An e-learning resource designed to integrate Hauora Māori and clinical content (specifically schizophrenia) was developed and evaluated by fifth year medical students at the University of Otago, Christchurch (UOC) and Wellington (UOW) Schools of Medicine, and Rural Medical Immersion Programme (RMIP). The evaluation method consisted of a pre- and post-test of student knowledge, a student feedback questionnaire, a student course component comparison questionnaire, and a teaching staff review questionnaire.
The findings of this study suggest that an e-learning resource integrating indigenous health and clinical content could provide an innovative and useful means of adding teaching value to an indigenous health and clinical curriculum and be equally as effective across a number of demographic groups of undergraduate medical students. It appears that the benefits of developing such a resource outweigh any costs that may be incurred, and this type of integrated resource can serve as an effective means of delivering cultural competency training to future health practitioners, helping to decrease the burden of health inequality in indigenous populations.
2015-03-10T02:56:22Z