Exploring indigenous perspectives on tobacco tax: how some Maori families are responding in Aotearoa New Zealand.

OBJECTIVE: High smoking prevalence rates, combined with a steep tax on tobacco and lower household income, mean that 5% of Maori (indigenous) whanau (family unit) expenditure in New Zealand is on tobacco. This paper outlines whanau perceptions of, and behavioural responses to, increasing tobacco tax. METHODS: This qualitative study was informed by the Kaupapa Maori theory and used a simplified interpretive phenomenological analysis thematic hybrid methodology. A semistructured, open-ended interview guide was designed and used in one-off focus group interviews. SETTING AND PARTICIPANTS: Interviews were separately conducted with each of 15 whanau units. A total of 72 participants, most of whom were smokers, took part in the interviews carried out in two geographical regions: one rural/provincial and one urban. RESULTS: Whanau were concerned about the rising cost of tobacco. However, this concern had not generally translated into quit attempts. Whanau had instead developed innovative tobacco-related practices. Working collectively within their whanau, they were able to continue to smoke, although in a modified fashion, despite the rising costs of tobacco. Whanau thereby resisted the intended outcome of the government's tobacco tax which is to reduce rates of smoking prevalence. CONCLUSION: In the face of significant government disinvestment in New Zealand tobacco control over the last 10 years, hypothecated taxes should be used to scale up Maori-specific cessation and uptake prevention programmes, supporting authentic Maori partnerships for endgame solutions including restricting the availability and appeal of tobacco.

Chronic conditions in the community: Preventative principles and emerging practices among Maori health services providers.

ISSUE: The pressing chronic conditions prevention needs of Maori (the Indigenous peoples of Aotearoa New Zealand) are yet to be adequately addressed using mainstream approaches. This study investigated how Maori health service providers (MHSP) are positioning themselves to better meet the chronic conditions prevention needs of Maori. METHODS: Kaupapa Maori methodology underpinned a three-phase research project that investigated three Maori health service provider-based chronic conditions prevention cases, in different regions of Aotearoa New Zealand, using an instrumental case study design. Two small group interviews with seven participants and 44 individual key informant interviews were conducted. All participants were associated with one of the three MHSP. Document reviews and observations were also carried out. Following the identification of a prevention case study, within each provider, in-depth investigation of prevention practices was undertaken. RESULTS: Achieving well-being through health service delivery is challenging for the three providers which are largely reliant on state funding to support their work through defined contract outputs. The drivers of service delivery norms impacting providers include the dominant medical conditions focused discourse and addressing the high levels of acute need characteristic of provider communities. There are examples of shifts in organisational structure and delivery configurations that demonstrate challenging and reframing these norms. We identified emerging approaches to prevention that move beyond being "the ambulance at the bottom of the cliff" to "building a fence at the top." CONCLUSION: Consolidation of provider prevention approaches, increased resources and a broader health services systems level response that prioritises prevention are required. SO WHAT?: MHSP are reframing services to better meet the well-being needs of the communities they serve.

Strategies to support culturally safe health and wellbeing evaluations in Indigenous settings in Australia and New Zealand: a concept mapping study.

BACKGROUND: In recent decades, financial investment has been made in health-related programs and services to overcome inequities and improve Indigenous people's wellbeing in Australia and New Zealand. Despite policies aiming to 'close the gap', limited evaluation evidence has informed evidence-based policy and practice. Indigenous leaders have called for evaluation stakeholders to align their practices with Indigenous approaches. METHODS: This study aimed to strengthen culturally safe evaluation practice in Indigenous settings by engaging evaluation stakeholders, in both countries, in a participatory concept mapping study. Concept maps for each country were generated from multi-dimensional scaling and hierarchical cluster analysis. RESULTS: The 12-cluster Australia map identifies four cluster regions: An Evaluation Approach that Honours Community; Respect and Reciprocity; Core Heart of the Evaluation; and Cultural Integrity of the Evaluation. The 11-cluster New Zealand map identifies four cluster regions: Authentic Evaluation Practice; Building Maori Evaluation Expertise; Integrity in Maori Evaluation; and Putting Community First. Both maps highlight the importance of cultural integrity in evaluation. Differences include the distinctiveness of the 'Respecting Language Protocols' concept in the Australia map in contrast to language being embedded within the cluster of 'Knowing Yourself as an Evaluator in a Maori Evaluation Context' in the New Zealand map. Participant ratings highlight the importance of all clusters with some relatively more difficult to achieve, in practice. Notably, the 'Funding Responsive to Community Needs and Priorities' and 'Translating Evaluation Findings to Benefit Community' clusters were rated the least achievable, in Australia. The 'Conduct of the Evaluation' and the 'Prioritising Maori Interests' clusters were rated as least achievable in New Zealand. In both countries, clusters of strategies related to commissioning were deemed least achievable. CONCLUSIONS: The results suggest that the commissioning of evaluation is crucial as it sets the stage for whether evaluations: reflect Indigenous interests, are planned in ways that align with Indigenous ways of working and are translated to benefit Indigenous communities Identified strategies align with health promotion principles and relational accountability values of Indigenous approaches to research. These findings may be relevant to the commissioning and conduct of Indigenous health program evaluations in developed nations.

Is routine alcohol screening and brief intervention feasible in a New Zealand primary care environment.

AIM: To test the feasibility of a systemised ABC alcohol screening and brief intervention (SBI) approach in general practice in a New Zealand region. METHOD: Data were collected on patients over 15 years who had their alcohol status recorded using the AUDIT tool. A concurrent independent process evaluation was conducted to assess effectiveness of ABC alcohol SBI related training and implementation of intervention. RESULTS: In an 8-month period, general practices in the Whanganui region documented alcohol consumption of 43% of their patients. Of the 43% of patients screened 24% were drinking contrary to ALAC's low risk drinking advice. Of these, 36% received brief advice or referral. Success of the approach can be attributed to the use of the Patient Dashboard reminder software and linked alcohol recording form. Other success factors included the use of a clinical champion and project leader, education and training, funding for extra GP and nurse assessment time and linking of the ABC alcohol SBI approach to existing services. CONCLUSION: Primary care in Whanganui has demonstrated the capacity to routinely query patient alcohol use and offer brief advice. If the approach was more widely adopted, there is considerable scope for general practice nationally to address potentially harmful patient alcohol use.