Reciprocal relations between cardiovascular disease, employment, financial insecurity, and post cardiac event recovery among Māori men: a case series.

BACKGROUND: Disparities in cardiovascular outcomes between Māori and non-Māori persist despite technological advances in the treatment of cardiovascular disease and improved service provision. Little is known about how social determinants of health, such as income [in]security affect Māori men's access, treatment, and recovery from cardiovascular disease. This paper explores the contexts within which cardiovascular disease is experienced and healthcare becomes embedded. METHODS: This study utilized a case-comparative narrative approach to document and make sense of the patient experiences of four male Māori patients who, in the previous 6 months, had come through cardiac investigation and treatment at Waikato Hospital, a large tertiary cardiac center in New Zealand. Participant accounts were elicited using a culturally patterned narrative approach to case development, informed by Kaupapa Māori Research practices. It involved three repeat 1-3-hour interviews recorded with participants (12 interviews); the first interviews took place 5-16 weeks after surgery/discharge. RESULTS: Each of the four case studies firstly details a serious cardiac event(s) before describing the varying levels of financial worry they experienced. Major financial disruptions to their lives were at the forefront of the concerns of those facing financial insecurity-as opposed to their medical problems. Financial hardship within the context of an unresponsive welfare system impacted the access to care and access to funding contributed to psychological distress for several participants. Economic security and reciprocal relationships between employers and employees facilitated positive treatment experiences and recovery. CONCLUSION: Findings suggest that although multiple factors influence participant experiences and treatment outcomes, financial [in]security, and personal income is a key determinant. The heterogeneity in participant narratives suggests that although general inequities in health may exist for Māori as a population group, these inequities do not appear to be uniform. We postulate diverse mechanisms, by which financial insecurity may adversely affect outcomes from treatment and demonstrate financial security as a significant determinant in allowing patients to respond to and recover from cardiovascular disease more effectively.fals

RCT of Harti Hauora Tamariki: a holistic family-centred programme for child health and equity

Abstract Background In Aotearoa New Zealand (NZ), paediatric admissions (&amp; readmissions) with diseases of poverty are common &amp; this preventable burden is more severe for Māori (Indigenous) tamariki (children) &amp; their whānau (families). In response, the Harti Hauora Tamariki (HHT) programme was developed. This is family-centred multilevel programme that consists of: culturally safe engagement for whānau; comprehensive high-quality wellbeing screening; standardised evidence-based protocols for addressing identified need(s); &amp; navigation for and with whānau into services &amp; support. Methods In 2019, over 980 children (0-4 years) admitted to the acute paediatric ward at Waikato Hospital in Aotearoa NZ were randomised (with their whānau) to intervention (HHT) or usual clinical care. Measures of effectiveness include the level of unmet need identified; the impact of HHT on meeting those needs &amp; achieving improved outcomes for tamariki; qualitative assessment of how HHT led to the outcomes; &amp; whānau satisfaction with hospital care. The primary quantitative endpoint is relative readmission risk. Results Qualitative case studies demonstrate the importance of engagement with staff and services, and that the HHT programme can create a high trust environment where whānau feel safe to reveal their needs. Needs are common. Many needs identified that impact whānau wellbeing (such as food insecurity and lack or resources including carseats) are not recognised through standard hospital care. Quantitative primary and secondary outcome analyses are underway. Conclusions Enhanced health promotion and prevention measures are required to achieve health equity for children in Aotearoa NZ, and the whole of health system (including secondary hospital care) has the responsibility and ability to manage such measures. The HHT programme is whānau-centred, adaptable, evidence-based, and able to address the broader determinants of common paediatric illness as well as support wellbeing and whānau ora. Key messages A family-centred holistic screening programme, with culturally safe engagement, improves inpatient care and enhances the determinants of health. Indigenous leadership and commitment to Indigenous wellbeing and health equity facilitates effective evolution and programme improvement, within the framework of a randomised controlled trial. </jats:sec