What we do matters: Supporting anti-racism and decolonisation of public health teaching and practice through the development of Maori public health competencies.

OBJECTIVE: This research sought to expand on a set of core Maori hauora a-iwi/public health competencies initially designed for teaching and to enable their use in workplaces. METHODS: The research used a kaupapa Maori methodology in four stages including the development of draft levels of competence for all core competencies, consultation hui (meetings), analysis of feedback and redrafting, and respondent validation. RESULTS: Key themes elicited in relation to the content of the competencies included increasing language expectations, the importance of strength-based approaches and self-determination, and the need for individual responsibility to address structural racism. Reflective practice was identified as a fundamental cross-cutting competency. Participants suggested planetary health and political ideologies be included as additional socio-political determinants of health with equity impacts. Key concerns related to the application of the competency document included the need for cultural safety and ensuring that all public health practitioners are 'seen'. CONCLUSIONS: The Maori hauora a-iwi/public health competencies have been published under a Creative Commons licence. IMPLICATIONS FOR PUBLIC HEALTH: The process of drafting a set of Maori public health competencies elicited key themes potentially relevant for public health practice in other countries and resulted in a competency document for use by universities and workplaces.

Mental health promotion practice in Aotearoa New Zealand: findings from a qualitative study.

Mental health promotion (MHP) is integral to improving the overall health and well being of individuals, communities, and populations. However, knowledge and reporting about MHP which occurs throughout Aotearoa New Zealand (NZ) is limited. This article reports findings from a qualitative study that sought to understand NZ health promotion practitioners' (HPPs) MHP practice. Semi-structured interviews were undertaken with 15 HPPs employed at various health promotion organizations. Thematic analysis of interview transcripts identified three key themes. Two themes (planning and evaluation) related to practice directly and included various subthemes: needs assessment; principles/approaches/frameworks; operationalizing equity and te Tiriti o Waitangi; collaborative approaches; planning for evaluation; process evaluation domination; and evaluation challenges. The third theme related to the context of practice and encompassed various system influences restricting HPPs from practising as they wished. These were represented in four subthemes: contractual agreements; field fragmentation; in the shadows of mental ill-health and workforce capacity. Study findings highlight several opportunities to improve MHP practice in NZ. Most pertinently, the need for system-level action to address the factors restricting HPPs' practice.

Transdisciplinary stakeholder understandings of antimicrobial resistance: An integrative approach in Aotearoa New Zealand.

OBJECTIVE: Antimicrobial resistance (AMR) is a complex public health issue, with a range of influences across human, animal, and environmental health. Given the complexity of the problem, the diversity of stakeholders, and the failure of current policies to curb AMR worldwide, integrative approaches are needed to identify effective actions. Underpinned by systems thinking and One Health principles, this qualitative study explored how diverse AMR experts in Aotearoa New Zealand perceive the main drivers and effects of AMR. METHODS: Semi-structured interviews with clinical, academic, policy, community, and industry representatives were designed to elicit mental models of the causes and outcomes of AMR across dimensions. RESULTS: Thematic analysis revealed contrasting understandings of AMR causes across four domains: food-producing animals (livestock), healthcare, community, and environment. AMR was often framed as a problem of individual behaviour, despite many implicit references to underlying structural economic influences. The politics of collaboration was a further major underlying theme. The interviews highlighted fundamental connections between AMR and other complex issues, including poverty and environmental pollution. IMPLICATIONS FOR PUBLIC HEALTH: This study brings together the understandings of AMR of transdisciplinary stakeholders, providing some immediate insights for policy makers and setting the foundation for developing a collaborative system model of AMR as a basis for decision-making.

National Sporting Organisation policies: A health promotion opportunity?

ISSUE ADDRESSED: The objective was to identify whether National Sporting Organisations (NSOs) have policy documentation on healthy behaviours (smokefree, sun-protection, healthy food/beverages and alcohol) and, for organisations with such documentation, whether this was in-line with current scientific evidence of past best practice in cancer prevention. METHODS: This cross-sectional policy analysis study was performed September to December 2018 in Aotearoa/New Zealand. A content analysis was undertaken using NSO policy documents matched against a framework of key indicators for best practice within health behaviours of interest. Data analysis of the policy process was undertaken through key informant telephone interviews with NSO staff using semi-structured qualitative interviews. RESULTS: Of 96 NSOs, nearly half (49%) mentioned smokefree at least once in one of their policy documents, and 47% had an alcohol policy, although in both instances the policies lacked comprehensiveness. Two NSOs had a reasonably comprehensive sun protection policy. Seventeen had at least one specific nutrition policy/guideline. The contents of the latter were primarily related to short-term athletic performance rather than non-communicable disease prevention, specifically promoting hydration during sports participation, and food and nutrition to support sporting performance. Two NSOs had policies relating to the promotion of healthy food/nutrition more widely. For some NSOs, the lack of health-related policies was not a conscious choice but just not considered previously. Other NSOs reported they lacked resources or had other priorities. CONCLUSIONS: Although this study clearly demonstrates that many NSOs lack adequate health-related policies, this is not necessarily a conscious choice, but the result of a lack of resources, other priorities, or just that they had not considered developing policies in these areas. A number expressed support for these types of policies although it was apparent that some, particularly smaller NSOs, would require assistance in policy template development. It seems probable that the development of health-related policies will only occur if partner agencies become involved.

A Photoaging Intervention Delivered to Adolescents in Secondary Schools: A Feasibility Study.

Excessive exposure to ultraviolet radiation during adolescence can have a lasting effect on long-term skin cancer risk. Skin cancer prevention interventions for adolescents have been less commonly investigated than those for children and adults. The study objectives were to develop and evaluate the feasibility of a secondary school-based appearance focused intervention, including the development and testing of protocols and instruments, as a resource module that could be efficiently integrated into the secondary school science curriculum. This longitudinal study was conducted with a convenience sample of 38 13-14 year-old students attending one New Zealand (NZ) urban secondary school. The recruitment rate was excellent with only one student not participating because of parental concern. In terms of the implementation practicality, the intervention, as it stands, was extremely resource intensive, involving four research staff to deliver. This will not work if delivered in a classroom setting by a single teacher. However, the intervention was well received by students, so it shows promise if a less resource intensive version could be produced. The acceptability of the intervention with the students was good with the majority (61%) having no suggestions for improvements. Suggested improvements were minor and could be easily addressed.

Effectiveness of Sun Protection Interventions Delivered to Adolescents in a Secondary School Setting: A Systematic Review.

AIM: The aim of this systematic review is to summarise the evidence of the effectiveness of interventions targeted to adolescents (13 to 18 years inclusive) and delivered in a secondary school setting with the purpose of improving sun protection behaviour, reducing ultraviolet radiation (UVR) exposure, and/or improving physiological outcomes related to UVR exposure (such as erythema or naevi development). METHODS: Peer-reviewed journal articles were identified from seven database searches (Cochrane, Embase, CINAHL, Scopus, Medline, PsycInfo, and Web of Science) to January 2020, forward citation searches of relevant articles, and monitoring of WHO INTERSUN UVR list server for recent publications. Relevant articles were collected and critically analysed using the Effective Public Health Practice framework. Two reviewers independently reviewed, and when deemed eligible, extracted data and performed quality appraisals for each study. RESULTS: Thirteen studies met the criteria for inclusion in the review. There were no studies that met a "strong" quality rating, five received a "moderate" quality rating, and eight studies a "weak" quality rating. Three of those with a moderate rating found evidence for effectiveness. The most promising interventions overall (including the pilot/uncontrolled studies) were those that moved beyond a pure health education approach and used innovative approaches such as the provision of shade, or use of technology (e.g., appearance-based apps or real-time ultraviolet index (UVI) monitors). CONCLUSIONS: There is a lack of high-quality published studies investigating the interventions delivered in a secondary school setting to protect students from UVR. The evidence could be strengthened if researchers used consistent, standardised outcome measures for sun protection exposure and behaviour. Other factors limiting the strength of evidence were short follow-up times (largely less than 6 months) and/or nonrobust study design.

A qualitative analysis on participants' perspectives on oral implants.

BACKGROUND: Quantitative research methods provide clinicians with information about the effectiveness of interventions and determined causal-effect relationships, whereas qualitative research investigates other aspects of clinical implant practice, particularly the participants' perspectives and expectations. The aim of the qualitative study was to understand the experience of participants with immediate single molar implants. METHODS: In-depth, audiorecorded, semistructured interviews were conducted with 15 participants who had participated in a controlled clinical trial of immediate molar implants. Participants were aged 36-77 years. Nine participants received single implants in mandibular molar fresh extraction sockets while the remaining participants had their implants in healed sites. The interviews that assessed participants' perspectives of the pre-operative, operative, and postoperative phases of therapy were transcribed verbatim and analysed using inductive and content analysis. RESULTS: Participants took part in the clinical trial mainly because it offered oral implant therapy at a reduced cost. The affordability of implant treatment was the main factor in determining restorative options. Minimal differences were found between male and female participants of different age groups in terms of their perceptions of function and aesthetics. However, single molar implants did not have an impact on aesthetics and self-esteem. Participants' expectations regarding the longevity of oral implants were not realistic and their knowledge about future maintenance needs was not adequate. CONCLUSIONS: Using face-to-face verbal conversation more frequently may improve communication between clinicians and participants and minimize misunderstanding about the procedures of different treatment modalities. Special emphasis should be placed on understanding the importance of maintenance by spending more time with the participants to identify any future barriers to maintaining good outcomes of oral implants.

Is New Zealand water fluoridation justified?

Public health programmes extend beyond the clinical context and focus on measures that affect the lives of large subgroups or the population as a whole. An example of this is community water fluoridation (CWF), the altering of fluoride levels in the water supply with the aim of preventing the initiation and slowing the progression of dental caries lesions for the benefit of entire populations. Despite the unfeasibility of randomised controlled trials of CWF, a large volume of evidence is available on the topic. However, CWF remains a polarising and keenly contested issue. CWF is also an intervention where it is difficult to provide everyone affected with a choice. The Nuffield Council on Bioethics is an independent body that examines and reports on ethical questions, and they have provided a useful ethical framework for considering CWF via the 'stewardship' model. This commentary aims to discuss each of the public health aims and how they can be applied and weighed to reach a justified position about CWF.

Impact evaluation of a farm safety awareness workshop in New Zealand.

OBJECTIVE: Farming is a hazardous occupation, with high rates of injury and death. FarmSafe, a whole-country approach, sought to address work-related injury on New Zealand sheep, beef, and dairy farms. More than 10 000 farmers participated in 630 workshops held over two years. This short communication presents the results of an impact evaluation of the FarmSafe Awareness Workshop (FSAW) in its first two years of operation. METHODS: All FSAW participants completed, and received credit for, formal educational assessments. Pass rates were used to assess safety knowledge, and a quasi-experimental design with intervention and comparison groups was applied to assess attitudes, safety behaviors, and environmental determinants of injury. RESULTS: An intervention (N=111) and two comparison groups (C1, N=409, and C2, N=78) completed before and after questionnaires. At follow-up, the intervention group (IG) showed a small improvement in attitudes toward safety (IG=79.3, C1=77.4; C2=77.4, P=0.035), but there were no differences between groups for personal safety practice or the safety environment of the farm. However, if a respondent registered their interest in the workshop, but a different person from the same farm attended, there was some improvement in the safety of the farm environment score. CONCLUSION: Well-conducted safety training tailored to farmers was still not enough to change safety practice. Future interventions may be more likely to achieve progress if they are comprehensive, include environmental and enforcement features, and target more than one participant per farm.

Adults with intellectual disability: a mixed-methods investigation of their experiences of dental treatment under general anaesthetic.

OBJECTIVES: This study aimed to explore the experiences of dental care under general anaesthesia in adults with an intellectual disability. METHODS: The study used an explanatory mixed-methods design. In the initial quantitative phase of the study, a clinical audit of oral health services provided for adults with intellectual disabilities was carried out for individuals who underwent a general anaesthetic (GA) for dental treatment at Christchurch Hospital during a 5-year period. In a qualitative second phase, fifteen semi-structured interviews were carried out for 13 individuals with an intellectual disability to investigate the experience and perceptions of individuals with an intellectual disability (and caregivers and guardians) relating to their oral health care. RESULTS: The majority of the treated patients lived in care, and many had severe medical problems. Most had both restorative treatment and tooth extractions carried out under GA. Their major concern was anxiety associated with the dental visits. Support people/ guardians shared this concern, and played a vital role in helping to manage this anxiety. Many of the latter had difficulty identifying dental problems in their charges, and they often relied on detection of changes in the individual's behaviour or demeanour. The time spent waiting in waiting rooms for treatment was a frequently reported cause of stress. CONCLUSIONS: As a group, these individuals present challenges for the provision of oral health care, given their severe disability and medical conditions, and many require a high level of support for daily activities. When dental treatment is required, a GA is often necessary in order to carry it out. The management of anxiety was a key issue for the patient group and support people play a vital role in helping to manage this anxiety, and achieve a successful visit. There is potential to improve the service with a multidisciplinary approach to coordinate other health services during treatment episodes, reduced time spent in waiting rooms, and improved waiting room layout.

Patients' perspectives on zirconia and titanium implants with a novel distribution supporting maxillary and mandibular overdentures: a qualitative study.

OBJECTIVES: This qualitative study explored the perceptions of edentulous patients regarding their rehabilitation with maxillary and mandibular implant-supported overdentures employing a protocol that featured novel implant sites and distribution. MATERIAL AND METHODS: In-depth semi-structured interviews were conducted with 16 participants who have taken part in a randomized controlled trial. Each received implant overdentures supported by either titanium or zirconia one-piece implants. Participants received four implants in the maxilla and three implants in the mandible. The implant distribution was: in the maxilla, a mid-palatal implant, and three anterior implants in the incisor and first premolar regions; in the mandible, a mid-symphseal implant, and bilateral distal implants in the first molar region. All interviews were conducted by a researcher not involved with the clinical aspect of the randomized controlled trial and were transcribed verbatim and analyzed using a thematic inductive analysis approach. RESULTS: The perceived advantages of the treatment were functional improvement and increased social confidence. Cost was a significant barrier for edentulous patients seeking implant treatment. Previous experience with complete dentures, age and length of treatment was further factors that influenced decisions regarding prosthodontic rehabilitation. The novel implant protocol was acceptable to patients. CONCLUSIONS: Implant overdentures improve the quality of life of edentulous patients. Acceptance of dental implants may be increased by mitigating the cost of treatment. The mid-palatal implant site may be a potential alternative to extensive surgical procedures during the prosthodontic rehabilitation of atrophic maxillary ridges. The mandibular design offers patients the advantages of a removable prosthesis with increased retention.

An outcome evaluation of a New Zealand farm safety intervention: a historical cohort study.

BACKGROUND: There is limited evidence that farm safety-related interventions based solely on an educational element have an effect on injury rates. Our aim was to evaluate a New Zealand national educational program, FarmSafe™ Awareness, for its effect on injury rates. METHODS: We used a before-after design followed by a historical cohort study of sheep, beef, and dairy farmers/workers. The outcomes were work-related injuries, identified from workers compensation data. Cox regressions were used to compare intervention with matched control group rates. RESULTS: FarmSafe™ Awareness was associated with significantly higher rates of work-related injury, than matched controls. CONCLUSIONS: It is difficult to see how FarmSafe™ Awareness could be causing an increased rate of work-related injury. We detected no reporting bias, and selection bias is likely to act in the opposite direction to the observed results. We conclude that there is no evidence that FarmSafe™ Awareness prevents farm injury.

Reducing disease burden and health inequalities arising from chronic disease among indigenous children: an early childhood caries intervention in Aotearoa/New Zealand.

BACKGROUND: Maaori are the Indigenous people of New Zealand and do not enjoy the same oral health status as the non-Indigenous majority. To overcome oral health disparities, the life course approach affords a valid foundation on which to develop a process that will contribute to the protection of the oral health of young infants. The key to this process is the support that could be provided to the parents or care givers of Maaori infants during the pregnancy of the mother and the early years of the child. This study seeks to determine whether implementing a kaupapa Maaori (Maaori philosophical viewpoint) in an early childhood caries (ECC) intervention reduces dental disease burden among Maaori children. The intervention consists of four approaches to prevent early childhood caries: dental care provided during pregnancy, fluoride varnish application to the teeth of children, motivational interviewing, and anticipatory guidance. METHODS/DESIGN: The participants are Maaori women who are expecting a child and who reside within the Maaori tribal area of Waikato-Tainui.This randomised-control trial will be undertaken utilising the principles of kaupapa Maaori research, which encompasses Maaori leadership, Maaori relationships, Maaori customary practices, etiquette and protocol. Participants will be monitored through clinical and self-reported information collected throughout the ECC intervention. Self-report information will be collected in a baseline questionnaire during pregnancy and when children are aged 24 and 36 months. Clinical oral health data will be collected during standardised examinations at ages 24 and 36 months by calibrated dental professionals. All participants receive the ECC intervention benefits, with the intervention delayed by 24 months for participants who are randomised to the control-delayed arm. DISCUSSION: The development and evaluation of oral health interventions may produce evidence that supports the application of the principles of kaupapa Maaori research in the research processes. This study will assess an ECC intervention which could provide a meaningful approach for Maaori for the protection and maintenance of oral health for Maaori children and their family, thus reducing oral health disparities. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12611000111976.

A qualitative investigation of specialist orthodontists in New Zealand. Part 1. Orthodontists and orthodontic practice.

BACKGROUND: Current knowledge of orthodontic practice is largely anecdotal and the lack of systematic knowledge can create barriers to better identifying the factors that make a successful orthodontist. The aim of this study was to investigate the routine practising lives of New Zealand orthodontists in order to generate an understanding of the reality of orthodontic specialist practice and its effects on their professional and personal lives. METHODS: Semi-structured interviews were conducted involving 19 practising orthodontists (four females, 15 males; mean age 50 years) throughout New Zealand.Transcribed interviews were analysed for themes using an applied grounded theory approach. RESULTS: A core category of 'practising orthodontists' was derived, and related themes were grouped under the sub-categories of: (a) NZ orthodontic specialist practice; (b) NZ specialist orthodontists; and (c) work-life balance. The present paper reports on the first two subcategories. Themes elucidated under the specialist practice sub-category included modernisation, changing social norms, practice arrangement, branch practice, staffing, competition, legislation, advertising, the future and the provision of orthodontics by non-specialists. Themes in the orthodontic specialist sub-category were prior experience, postgraduate training, recent graduates, reasons for specialising, generational differences, females in orthodontics, NZ and overseas practice, the ageing profession and the prospect of an orthodontist shortage. CONCLUSIONS: This investigation has shed light on orthodontists and the practice of orthodontics in New Zealand and determined aspects rarely discussed in the current or previous literature. It will be valuable to observe how orthodontists and orthodontic practice continue to evolve in response to changes in NZ society.

An exploratory study of the acceptability of delivering oral health information in community pharmacies.

OBJECTIVE: The community pharmacy is an accessible service which, with further training and support, could be used to deliver oral health messages. This is important especially for those with systemic diseases such as diabetes mellitus and cardiovascular disease, where the oral environment may have a negative impact. This qualitative study assessed the feasibility of pharmacists delivering oral health messages in community pharmacies. DESIGN AND METHODS: Semi-structured interviews were conducted with 49 pharmacists in Dunedin and Auckland, New Zealand, with a focus on the pharmacists' current knowledge, attitudes and possibilities for providing oral health information to patients with diabetes and cardiovascular disease. FINDINGS: There is potential for community pharmacists to provide oral health information to patients, dependent on the approach of the pharmacist and the patient response. The majority of pharmacists agreed that providing oral health advice was within their role; however, few did so proactively. They highlighted a lack of available resources relating to oral health and systemic disease. Further training relating to oral health and systemic disease would be necessary to provide the knowledge to support any resources. The preferred option by pharmacists for such training was an evening course or workshop.

An exploratory study of pregnant women's knowledge of child oral health care in New Zealand.

BACKGROUND: To be maximally effective, oral health preventive strategies should start at birth. There appear to be few reports on pregnant women's knowledge of oral health care for their developing children. OBJECTIVES: This exploratory study assessed Dunedin expectant mothers' knowledge of the oral health care of their future children. METHODS: A questionnaire was developed to assess expectant mothers' knowledge of child oral health and appropriate prevention strategies. Three public Lead Maternity Carer (LMC) organisations and 30 private individual LMCs were asked to distribute the questionnaire to their clients attending appointments during a one-month period. Questions focused on the mother's knowledge of oral health practices for their future children, including oral hygiene and access to dental care. RESULTS: Fewer than half of the participants thought they had enough information about their child's oral health needs. One-quarter thought that toothbrushing should not start until after two years of age. The majority thought their child should not be seen by a dental professional until this age, while one-fifth did not think their child should be seen until four years old. Poorer child oral health knowledge was found in first-time mothers, younger women, those from low-SES groups, and those who were not New Zealand (NZ) Europeans. CONCLUSIONS: A substantial number of participants were unaware of how to provide appropriate oral health care for their children despite the available information. This lack of awareness needs to be taken into account when designing oral health promotion strategies for parents of very young children.

A qualitative investigation of specialist orthodontists in New Zealand: part 2. Orthodontists' working lives and work-life balance.

BACKGROUND: Orthodontics is the most widely practised form of specialist dentistry in New Zealand. To date, no known qualitative research has been published examining the work-life balance of practitioners. The aim of this study was to investigate the working lives and work-life balance of NZ orthodontists in order to generate an understanding of the reality of orthodontic specialist practice and its effects on orthodontists' professional and personal lives. METHODS: Semi-structured interviews were conducted involving 19 practising orthodontists (four females, 15 males; mean age 50 years) from throughout New Zealand and selected for maximum variation in the sample. Transcribed interviews were analysed for themes using an applied grounded theory approach. RESULTS: A core category of 'practising orthodontist' was derived, and related themes were grouped under the sub-categories of: (a) NZ orthodontic specialist practice; (b) NZ specialist orthodontists; and (c) Work-life balance. The present paper reports on the final sub-category. Themes emerging from the work-life sub-category were further divided into two sub-themes of 'work' and 'life'. Themes in the 'work' subgroup included time off, injuries and illness, regrets, personality traits, job stress and criticism, establishing a practice, peer support and contact, and success in orthodontics. Themes in the 'life' sub-group were personal development, family life, life balance and interests outside work, and financial security. CONCLUSIONS: This was the first qualitative investigation of the orthodontic profession in New Zealand. The findings provided a valuable insight into the working lives of New Zealand orthodontists and effects on their day-today lives. It will be revealing and interesting to observe how the modernisation of orthodontic practice will affect the work-life balance of New Zealand orthodontists in the future.

Obtaining health information from farmers: interviews versus postal questionnaires in a New Zealand case study.

PURPOSE: To compare the effectiveness of interviewer-led and postal surveys in gathering adequate health data for occupational health programmes among farmers. METHODS: Two cross-sectional studies of farmers from southern New Zealand were conducted. Farms were randomly selected from the public land valuation roll and all farmers and farm workers invited to participate in the farmers' health study. First, 477 farms were invited to participate in an interviewer administered questionnaire and health check; and second, a further 432 farms were selected and invited to participate in a self-administered postal survey. Both groups completed the same questionnaire. RESULTS: The response for the interviewer-led and postal surveys was 65.4 % and 51.6 % respectively. The 2 groups differed demographically, with fewer young farm workers in the postal survey, but were similar in all areas of health information collected, except that men in the interviewer-led survey were significantly more likely to have a psychological disturbance than men in the postal survey (chi ( 2 ) =5.06, df=1, p=0.024). CONCLUSIONS: Despite the interviewer-led survey having a higher response rate, the postal survey produced similar health data, which is adequate for planning occupational health programmes for farmers. Extra effort should be made to recruit younger farm workers in future research.