Harti Hauora Tamariki: randomised controlled trial protocol for an opportunistic, holistic and family centred approach to improving outcomes for hospitalised children and their families in Aotearoa, New Zealand

BackgroundHealth and wellbeing inequities between the Indigenous Māori and non-Māori populations in Aotearoa, New Zealand continue to be unresolved. Within this context, and of particular concern, hospitalisations for diseases of poverty are increasing for tamariki Māori (Māori children). To provide hospitalised tamariki Māori, and their whānau (families) comprehensive support, a wellbeing needs assessment; the Harti Hauora Tamariki Tool (The Harti tool) was developed. The purpose of this study is to determine how effective the Harti tool is at identifying wellbeing needs, ensuring the documentation of needs, enabling access to services and improving wellbeing outcomes for tamariki and their whānau.MethodsThe study uses a Kaupapa Māori methodology with qualitative and quantitative methods. Qualitative methods include in-depth interviews with whānau. This paper presents an overview of a randomised, two parallel, controlled, single blinded, superiority trial for quantitative evaluation of the Harti programme, and hospital satisfaction with care survey. Participants will be Māori and non-Māori tamariki/children aged 0–4 years admitted acutely to the paediatric medical wards at Waikato Hospital, Hamilton, Aotearoa New Zealand. They will be randomised electronically into the intervention or usual care group. The intervention group will receive usual care in addition to the Harti programme, which includes a 24-section health needs assessment delivered by trained Māori navigators to whānau during the time they are in hospital. The primary endpoint is the relative risk of an acute hospital readmission in the 30 days following discharge for the intervention group patients compared with control group patients. Secondary outcomes include access and utilisation of preventative health services including: oral health care, general practice enrolment, immunisation, healthy home initiatives, smoking cessation and the Well Child Tamariki Ora universal health checks available free of charge for children in Aotearoa New Zealand.DiscussionRandomised controlled trials are a gold standard for measuring efficacy of complex multifaceted interventions and the results will provide high quality evidence for implementing the intervention nationwide. We expect that this study will provide valuable evidence for health services and policy makers who are considering how to improve the configuration of paediatric hospital services.Trial registrationThe study is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), registration number: ACTRN12618001079235

Will access to COVID-19 vaccine in Aotearoa be equitable for priority populations?

AIM: This research examines the equity implications of the geographic distribution of COVID-19 vaccine delivery locations in Aotearoa New Zealand under five potential scenarios: (1) stadium mega-clinics; (2) Community Based Assessment Centres; (3) GP clinics; (4) community pharmacies; and (5) schools. METHOD: We mapped the distribution of Aotearoa New Zealand’s population and the location of potential vaccine delivery facilities under each scenario. Geostatistical techniques identified population clusters for Māori, Pacific peoples and people aged 65 years and over. We calculated travel times between all potential facilities and each Statistical Area 1 in the country. Descriptive statistics indicate the size and proportion of populations that could face significant travel barriers when accessing COVID-19 vaccinations. RESULTS: Several areas with significant travel times to potential vaccine delivery sites were also communities identified as having an elevated risk of COVID-19 disease and severity. All potential scenarios for vaccine delivery, with the exception of schools, resulted in travel barriers for a substantial proportion of the population. Overall, these travel time barriers disproportionately burden Māori, older communities and people living in areas of high socioeconomic deprivation. CONCLUSION: The equitable delivery of COVID-19 vaccines is key to an elimination strategy. However, if current health services and facilities are used without well-designed and supported outreach services, then access to vaccination is likely to be inequitable

Family structure and change in early childhood and the wellbeing of tamariki Maori

Internationally there is growing evidence that family structure, and changes in structure, have an impact on children’s health and wellbeing and the intergenerational transmission of inequity. The effects, however, vary by socio-economic context and ethnicity. Using longitudinal data from Growing Up in New Zealand (n = 1349), we examine family structure and change for tamariki Māori during early childhood, and the potential impacts on their development and wellbeing. We find that a stable two-parent family is the primary experience for tamariki Māori, and sole parenthood is transitory. Diverse family trajectories appear to be linked to poorer cognitive and socio-emotional outcomes but are not the main driver. More important are maternal factors, notably age and education, and material hardship. Importantly, higher levels of cultural connectedness among tamariki Māori, which are associated with diverse family forms, seem to promote socio-emotional development. Our study provides further incentive for policy and programmes that centre equity and support access to the determinants of health for tamariki Māori

Cup of tea to keep warm

The way people source, prepare, and consume food is deeply interconnected with social practice. Drawing on theories of everyday life and social practice, we consider the everyday food-related practices and tactics for survival of six people experiencing homelessness. In doing so, we identify ways in which the realities of homelessness force people to conduct domestic activities in public view and discuss how the inability to engage in simple and taken-for-granted practices such as making a cup of tea is psychologically detrimental. This research documents the oft-overlooked ways that people experiencing homelessness demonstrate tenacity and resourcefulness and the agentive ways in which they respond to difficult circumstances. Our analysis broadens understanding of the disruptive mechanisms of homelessness as they pertain to food-related social practices. Additionally, we present new considerations of the ways in which people who previously experienced homelessness do their best to ‘mend’ disruptions through processes of ‘re-mooring’ and adopting tactics for survival

Supporting Child Wellbeing: a health assessment tool for the Hamilton Children’s Team

The Hamilton Children’s Team received its first referral in 2015, with dedicated lead professionals appointed for each child referred. The role of these lead professionals is to assess need, develop a plan for each child, and coordinate a cross-sector Child Action Network to improve care and wellbeing. Challenges were identified in Hamilton for the assessment, identification and coordination of health need within the Children’s Team, particularly for lead professionals from outside the health sector. Therefore, a health assessment package was developed in partnership with the Hamilton Children’s Team, the Waikato District Health Board and other relevant agencies. The use of a standardised and systematic approach, with training and relationship development, resources and referral pathways, resulted in identification of significant unmet need. A number of referrals to the health sector resulted from this assessment and there are implications that such a process can support ongoing attendance at health appointments, monitoring of outcomes from the Children’s Team process, and improvements to physical, emotional and mental wellbeing for families. This approach was well received by lead professionals and families, and future use is likely to enhance the Children’s Team programme and service delivery, and improve wellbeing outcomes

“We’re trying to heal, you know?” A mixed methods analysis of the spatial equity of General Practitioner services in the Waikato District Health Board region

Inequitable access to health services can cause and exacerbate inequities in health outcomes and should therefore be monitored regularly to ensure that service distributions match population needs. Health service accessibility includes several factors and can be monitored using both quantitative and qualitative methods. We present an exploratory analysis of the spatial equity of general practice services in the Waikato District Health Board region using a mixed methods approach. Geographic Information Systems are used to assess the spatial accessibility of GP services, and in-depth qualitative interviews provide a better understanding of not only where inequities exist, but why they occur

Classifying multiple ethnic identifications: Methodological effects on child, adolescent, and adult ethnic distributions

Background: The burgeoning global multi-ethnic population, in conjunction with the importance of accurate ethnic group counts for research and policy purposes, make classification of multiple ethnic responses a complex but important issue. There are numerous possible classification approaches, differing in ethical implications and ease of statistical application. Objective: This study empirically examines the validity and consistency of three comparatively accessible ethnic classification methods (total response, administrative-prioritisation, and self-prioritisation) in increasingly ethnically diverse age cohorts (adults, adolescents, and children). Methods: We utilised secondary data from two large-scale studies in Aotearoa/New Zealand which asked children (N = 6,149; responded via mother proxy), adolescents (N = 8,464), and adults (N = 11,210) to select (1) all the ethnicities they identified with, and (2) their main ethnicity. The data were coded, then analysed using descriptive statistics and z-tests for proportional differences. Results: The majority of multi-ethnic participants were able to select a main ethnic group when required, but around 20Š could not or refused to do so, and there was over 60Š discrepancy between self-prioritised ethnicity and administrative-prioritised ethnicity. Differences by age group and ethnic combination were apparent. Comparison of overall ethnic group proportions outputted by the three classification methods revealed within-group variation, particularly where there were higher rates of multi-ethnic identification. Contribution: This study empirically demonstrates that researchers' choice of ethnic classification method can have a strong influence on ethnic group proportions. Researchers should therefore select the classification method most appropriate for their research question and clearly report the method employed

The development of guidelines for indigenous research ethics in Aotearoa/New Zealand.

The development of Indigenous frameworks for research ethics has been a key component of progressing Indigenous aspirations for research around the world. They have provided a focal point for challenging approaches to research that prioritise non-Indigenous methods and values, and allow non-Indigenous researchers to claim expert status over Indigenous peoples, places and knowledges. The theme of self-determination underpins contemporary approaches to Indigenous development and the repositioning of state-Indigenous nation relationships. This paper describes the background, development, and implementation by Māori communities and researchers of an Indigenous ethical framework in Aotearoa/New Zealand

Patterns of Exposure to Cumulative Risk Through Age 2 and Associations with Problem Behaviors at Age 4.5: Evidence from Growing Up in New Zealand.

Exposure to cumulative risk (CR) has important implications for child development, yet little is known about how frequency, persistence, and timing of CR exposure during early childhood predict behavioral problems already before school start. We examine prospective longitudinal associations between patterns of CR exposure from third trimester through 2 years and subsequent behavior problems at 4.5 years. In 6156 diverse children in the Growing Up in New Zealand longitudinal study, the presence of 12 risk factors, spanning maternal health, social status, and home and neighborhood environment, defined CR and were assessed at last trimester and 9 months and 2 years of age. At child age 4.5 years, mothers completed the Strengths and Difficulties Questionnaire, where a score ≥ 16 indicated an abnormal level of problem behaviors (ALPB). Children exposed to a CR ≥ 1 at least once in early development, compared to those with consistent CR = 0, showed a significantly higher likelihood of ALPB at 4.5 years. Consistent high exposure to CR ≥ 4 across all three assessments had the highest prevalence (44%) of ALPB at age 4.5. Children with high CR exposure on two of three, compared to on all three, time points in early development did not evidence a significantly reduced prevalence (32%-41%) of ALPB. The common co-occurrence of risk factors and their significant developmental impact when accumulated early in life underscore the need for systematic multisector intervention and policy implementation during pregnancy and shortly after birth to improve outcomes for vulnerable children

Housing First in Hamilton: Who were first housed?

The People’s Project (TPP) in Hamilton (NZ) is a collaborative effort between 13 local organisations which takes a Housing First approach to homelessness. A Ministry of Business, Innovation and Employment funded collaboration between the Universities of Waikato and Otago and TPP has allowed the gathering of evidence regarding the Housing First approach to homelessness in Hamilton, the people served, and their engagement in services in the years leading up to registering for support. A better understanding of the sociodemographic characteristics, as well as the specific needs and experiences of this cohort, helps to consider how to most appropriately implement the principles of Housing First to meet the requirements of the local population and contex