Use of the CONSIDER statement by eye health researchers when conducting and reporting research involving Indigenous peoples: an online survey.

BACKGROUND: Indigenous peoples experience worse eye health compared to non-Indigenous peoples. Service providers and researchers must avoid perpetuating this inequity. To help achieve this, researchers can use the CONSolIDated critERia for strengthening the reporting of health research involving Indigenous peoples (CONSIDER) statement. This study aimed to identify the degree to which the CONSIDER statement has been used by eye health researchers when conducting and reporting research with an Indigenous component, and how they perceive its relevance in their future research. METHODS: We used purposive sampling to recruit eye health researchers from any country who have undertaken research with an Indigenous component. The online survey collected quantitative and qualitative data and was analysed using descriptive statistics and reflexive thematic analysis. Responses were gathered on a four-point Likert scale (1 to 4), with four being the most positive statement. RESULTS: Thirty-nine eye health researchers from nine countries completed the survey (Aotearoa New Zealand, Argentina, Australia, Brazil, Canada, Colombia, Guatemala, Panama, Peru); almost two-thirds (n = 24) undertake epidemiological research. On average, participants disclosed only 'sometimes' previously reporting CONSIDER items (2.26 ± 1.14), but they thought the items were relevant to eye health research and were motivated to use these guidelines in their future research. Some participants requested clarity about how CONSIDER aligned with existing guidelines, and when and how to apply the statement. Others shared rich experiences of the benefits to their research of Indigenous leadership and collaboration. CONCLUSIONS: The CONSIDER statement is perceived as a valuable tool by these eye health researchers, and there are opportunities to maximise uptake and use, including increasing awareness of the statement, clarity about when it applies, and availability of institutional-level support.

Nga whakaro hauora Maori o te karu: Maori thoughts and considerations surrounding eye health.

CLINICAL RELEVANCE: Research highlighting Indigenous patient perspectives is essential in the pursuit of understanding and addressing longstanding health inequities. BACKGROUND: Evidence indicates that disparities in ocular health outcomes between Maori and non-Maori are pervasive in the New Zealand health system. Evidence shows the cause of these inequities is often multifactorial; due to factors such as colonisation, ongoing marginalisation, racism, socioeconomic status, poverty and culturally unsafe practice between health professionals and Maori patients. METHODS: This project used kaupapa Maori methodology to identify the perceptions of Maori surrounding ocular healthcare within a Maori context in Aotearoa New Zealand. Three focus groups with Maori community members and three individual interviews with Maori eyecare practitioners were conducted. Participants discussed sub-topics relating to Maori health, ocular health consultations, ocular examination and access to ocular health services in Aotearoa New Zealand. Reflexive thematic analysis was undertaken using NVivo qualitative research software. RESULTS: Five key themes were derived from the data: (1) the importance of effective clinician-patient communication; (2) historical experiences of patients inform their health attitudes; (3) barriers to access are systemic; (4) Maori health is important to Maori and (5) Te Ao Maori, Tikanga and Tapu are significant cultural concepts for Maori. Overall, Maori patients recognise the value of ocular healthcare and the importance of acknowledging Maori models of health within services. CONCLUSION: The key issues Maori patients face within ocular health services resonate strongly with wider concepts intrinsically important to Maori. These are the right to cultural safety within clinical settings, the right to accurate and pertinent communication of information between clinician and patient and the respect of cultural beliefs and acknowledgement of power imbalances within the wider healthcare system. Participant discussions and suggestions raise possible pathways to begin addressing ocular ethnic disparities in healthcare delivery.

Ethnic Differences in Access to Stroke Reperfusion Therapy in Northern New Zealand.

BACKGROUND: In New Zealand, Maori and Pacific people have higher age-adjusted stroke incidence rates, younger age at first stroke, and higher mortality at 12 months than other ethnic groups. We aimed to determine if access to acute stroke reperfusion therapy with intravenous thrombolysis (IVT) or endovascular thrombectomy (EVT) is equitable among ethnic groups. METHODS: Data were obtained from the Northern Region component of the New Zealand Stroke Registry over the 21 months between January 1, 2018 and September 30, 2019. Data recorded included demographic details, self-identified ethnicity, treatment times, and clinical outcomes. National hospital discharge coding of patients admitted with ischemic stroke and stroke unspecified was used to determine the proportion of patients treated by ethnic group. RESULTS: There were 537 patients normally resident in the Northern Region who received reperfusion therapy: 281 received IVT alone, 123 received EVT after bridging IVT, and 133 received EVT alone. Of the 537 patients treated with IVT or EVT, there were 81 (15.1%) Maori, 78 (14.5%) Pacific, 57 (10.6%) Asian, and 341 (63.5%) NZ European/other ethnicity patients. There were no ethnic differences in treatment process times. When compared with NZ European/others, Maori and Pacific people were younger, and Maori had worse neurological impairment at admission. A higher proportion of Maori were treated with EVT with a trend to higher proportion treated with IVT. Day 90 modified Rankin Scale (mRS) for EVT-treated patients was similar apart from Asian patients who had worse outcome when compared with NZ European/others (mRS 3 vs. 2; p = 0.03). CONCLUSIONS: This study has shown equitable access to acute stroke reperfusion therapies and largely similar outcomes in different ethnic groups in northern New Zealand.

Harm reduction as a strategy for supporting people who self-harm on mental health wards: the views and experiences of practitioners.

BACKGROUND: Harm reduction has had positive outcomes for people using sexual health and substance misuse services. Clinical guidance recommends these approaches may be appropriately adopted by mental health practitioners when managing some people who self-harm. There has, however, been very little research in this area. METHODS: We explored practitioners' views of harm reduction as a strategy for supporting people who self-harm. The Self Harm Antipathy Scale (SHAS) was administered to a random sample of 395 mental health practitioners working on 31 wards in England, semi-structured interviews were then conducted with 18 survey respondents. RESULTS: Practitioners who had implemented the approach reported positive outcomes including a reduction in incidence and severity of self-harm and a perceived increase in empowerment of service users. Practitioners with no experience of using harm reduction were concerned that self-harm would increase in severity, and were unsure how to assess and manage risk in people under a harm reduction care plan. Some fundamentally disagreed with the principle of harm reduction for self-harm because it challenged their core beliefs about the morality of self-harm, or the ethical and potential legal ramifications of allowing individuals to harm themselves. LIMITATIONS: This study was conducted solely with practitioners working on inpatient units. The majority of staff interviewed had no experience of harm reduction and so their concerns may not reflect challenges encountered by practitioners in clinical practice. CONCLUSIONS: Harm reduction is being used to support people who self-harm within inpatient psychiatry and some practitioners report potential benefits of this approach. However, this raises particularly complex practical, ethical and legal issues and further research is needed to assess the safety, acceptability and efficacy of the approach.