Feasibility and acceptability of a paearahi (Indigenous Whanau Ora navigator) intervention for unintentional injury prevention for older Maori: non-randomised, non-comparator trial study protocol.

BACKGROUND: Maori (the Indigenous population of Aotearoa New Zealand) experience increased burden of unintentional injury and reduced access to publicly funded injury prevention and rehabilitation services, compared with non-Maori. Maori-led models of care have been shown to improve outcomes for Maori. Paearahi navigate across sectors (including health, education, housing and employment) to advocate for the best possible outcomes for individuals and families. This study aims to (1) test the acceptability and feasibility and (2) undertake exploratory efficacy analysis of a paearahi injury intervention for Maori older adults. METHODS: A prospective non-randomised, non-comparator study with preintervention and postintervention measurements of predefined outcomes. Eligible participants who consented to participate (Maori, 55+ years, community-dwelling and enrolled in one of three study general practices) will undergo a multivisit paearahi intervention. The intervention includes home-hazard assessment, basic health screening, teaching of strength and balance exercises, education relating to injury prevention and access to injury-related, referral and connection to other health and social services) and participants can choose to have whanau (family) involved in the intervention. OUTCOMES: The primary outcome of interest is participant, whanau and paearahi acceptability of the intervention. Secondary outcomes include intervention feasibility, cost-effectiveness and exploratory efficacy (including preintervention and postintervention unintentional injury-related hospitalisation, primary care access and public injury-related claims). DISCUSSION: The findings of this intervention research will be used to inform injury care models for older Maori and process for Maori-led health intervention development more generally. TRIAL REGISTRATION NUMBER: ACTRN12621001691831p.

General practitioners' views about diagnosing and treating depression in Maori and non-Maori patients.

INTRODUCTION: The study investigated general practitioners' (GPs') views about recognising and treating depression among patients to establish possible reasons for reported lower levels of diagnosis and treatment of depression among Maori compared to non-Maori patients. METHODS: Semi-structured interviews with 23 GPs in the Auckland region, including both Maori and non-Maori GPs, elicited GPs' views about risk factors for depression, recognising depression and circumstances in which GPs would prescribe medication or recommend other treatments for depression. FINDINGS: A framework was developed which incorporated the strategies GPs reported using to diagnose and treat depression. This consisted of three categories: (a) how depression is identified, (b) factors influencing treatment decisions, and (c) treatment outcomes. Reasons reported by GPs as most likely to lead to ethnic differences in diagnosing depression were greater stigma relating to admitting depression among Maori patients, Maori patients being less likely to talk about being depressed, and the need for patients to have effective communication with their GP. Effective communication, where Maori patients felt free to talk about personal feelings, was more likely when there was an established relationship between the GP and patient. CONCLUSION: The findings are consistent with previous reports that depression is less likely to be diagnosed by GPs among Maori patients, compared to non-Maori patients. GPs who are able to establish effective communication with patients, gain their trust and take account of the reluctance of some Maori patients to talk about personal feelings, are more likely to diagnose and treat depression effectively.

Experiences of whanau/families when injured children are admitted to hospital: a multi-ethnic qualitative study from Aotearoa/New Zealand.

OBJECTIVES: Several quantitative studies in the international literature have described disparities in the provision of and access to health services for a variety of health conditions among 'minority' populations. This New Zealand qualitative study aimed to explore and describe the experiences of indigenous Maori and Pacific families (both minority populations) and Pakeha (New Zealand European) families when their children were admitted to hospital for an unintended injury. DESIGN: Twenty-three children (eight Máori, eight Pacific and seven Pákeha) who were admitted to hospital following an injury were selected using maximum variation sampling from a trauma database and snowball sampling. In-depth individual and group interviews undertaken with the child's whanau/family explored the issues they encountered in the hospital setting. The data were analysed by key ideas and coded into main themes. Each strand was analysed separately by lead researchers of the same ethnic group prior to a comparative synthesis of the overall findings. RESULTS: While many families praised the dedication of the staff, the interviews revealed important concerns regarding their encounters with hospitals and related health and support services. These could be broadly characterised as (a) inadequate communication and information; (b) difficulties negotiating an environment perceived as foreign; (c) the stress of conflicting demands placed on families; and (d) issues relating to ethnicity and cultural miscommunication. Of note, many Maori and Pacific whanau/families felt particularly alienated within the hospital setting and did not appear to see themselves as being entitled to high-quality information or services. CONCLUSION: The findings have important implications for the structure, professional and institutional practices in the delivery of health services. The research also indicates the need for wider societal policies that increase Maori and Pacific whanau/families' sense of entitlement to the full range of available support services, and reduce alienation within public institutions such as hospitals.