Journal of primary health care最新文献

Introduction: Pacific children in Aotearoa New Zealand (NZ), are four times more likely than non-Pacific and non-Māori children to be hospitalised for a skin infection. The Auckland region has the highest hospitalisation rates for skin infections in NZ. Tongan peopleare the second largest group of the Pacific diaspora in the Auckland region, yet they are underrepresented in research.

Aim: The study aimed to understand how Tongan mothers living in Auckland care for skin infections affecting their children.

Methods: A focus group with seven Tongan mothers was held. Constructivist Grounded Theory and the Kakala Framework informed the collection and analysis of the qualitative data.

Results: The emerging theory, Teolosia 'oe Kili pokua (Caring for Skin Infections), posits that Tongan mothers rely on three key resources: their Community, their past Experiences, and Awareness of skin infections when making decisions concerning how to care for skin infections affecting their children. Caring for skin infections is a collective endeavour underpinned by cultural mainstays such as tauhi vā, in which many Tongan people participate.

Discussion: Health systems can more effectively meet the needs of Tongan mothers and reduce health inequities by providing the Tongan community with culturally appropriate resources to prevent, recognise, and address skin infections.

Introduction: Type 2 diabetes (T2D) significantly impacts Māori populations in Aotearoa New Zealand (NZ) who experience health disparities including suboptimal disease management.

Aim: To explore culturally responsive approaches to supporting Māori living with T2D from the perspective of healthcare providers.

Methods: Nine semi-structured interviews were conducted with clinicians from various disciplines (general practitioner, podiatrist, exercise physiologist, three kaiāwhina, dietitian, two pharmacists); five clinicians identify as Māori, four as non-Māori. Kaupapa Māori inductive thematic analysis was used.

Results: Four key themes emerged: empowering patient-centred communication, whānau involvement, interprofessional collaboration, and culturally appropriate analogies.

Discussion: The findings underscore the need for holistic, culturally responsive T2D care that prioritises culturally appropriate communication to improve patient engagement, health outcomes and address Māori health disparities.

Introduction: Antenatal immunisation rates for influenza and pertussis in Aotearoa New Zealand (NZ) are low and inequitable. Culturally appropriate interventions are urgently needed.

Aim: This study aims to identify and prioritise culturally appropriate, equitable interventions to improve antenatal immunisation rates in NZ.

Methods: A three-round Delphi study was conducted. In the first round, interventions to increase antenatal immunisation rates were identified in qualitative interviews with 40 healthcare professionals. In the second and third rounds, 21 panellists (healthcare professionals and health policy and practice experts) rated 10 interventions for their feasibility, equity and impact on a five-point Likert scale. Median and interquartile ranges (IQRs) were calculated. For each parameter, consensus was defined as an interquartile range ≤1. In the third round, panellists selected their 'top three' prioritised interventions for NZ.

Results: Panellists rated all interventions arising from the first round highly for feasibility, equity and impact. Consensus for all parameters was achieved at the strongest level for 5 of the 10 interventions in the second round. At the completion of the third round, consensus had been achieved for all parameters for 8 of the 10 interventions. The introduction of outreach immunisation services for hapū māmā appeared most frequently in participants' 'top three' (selected by 55% of panellists).

Discussion: The 10 interventions identified by participants in the first round were rated highly for their feasibility, equity and impact by panellists in the second and third rounds of this Delphi study. These interventions should be considered by those developing interventions to increase antenatal immunisation rates in NZ.

Introduction: Chronic cough is burdensome for individuals and healthcare providers and is a symptom common to a number of health conditions, including bronchiectasis. The prevalence of respiratory conditions, particularly bronchiectasis, is disproportionately high among Pacific people residing in Counties Manukau. Barriers to healthcare access and engagement, both practical and cultural, contribute to delayed presentation and advanced illness.

Aim: This study aims to explore attitudes to cough and healthcare access by Sāmoan adults living in Counties Manukau.

Methods: Semi-structured interviews guided by Talanoa, a Pacific-specific method, were conducted focusing on cough duration and characteristics, treatment-seeking behaviours, and healthcare experiences. Data were analysed thematically and framed using the Fonofale Model of Health.

Results: Two overarching themes were constructed from seven Talanoa: 'Understanding my cough' and 'healing, curing and coping with cough'. Chronic kale/cough was found to impact on all pou (posts) of the Fonofale health model. Kale/cough management strategies were drawn from Sāmoan and Western health paradigms, perceived as complementary. Access to specialist services was valued and extended participants' coping repertoire further. Respect and trust shaped relationships with healthcare providers and influenced engagement.

Discussion: Models such as the Fonofale health model provide a framework for healthcare providers to better understand the multi-dimensional impact of cough. Recognising the cultural perspectives of populations underrepresented in the health workforce provides valuable insights to re-frame healthcare practice and service to optimise engagement with on-going symptoms such as cough and to support chronic conditions.

Introduction: In New Zealand, lower immunisation coverage is seen among those of Māori and Pacific ethnicity, as well as in communities with higher levels of socioeconomic deprivation. However, the impact of rurality on routine childhood immunisations has been incompletely investigated.

Aim: This study aims to measure the effect of rurality on second-dose measles-mumps-rubella vaccination (MMR2) within the Taranaki region.

Methods: This was a retrospective observational study using routinely collected health data. Participants were born in 2019, 2020, or 2021 and lived in the Taranaki region at age 24 months. Rurality was determined using the Geographic Classification for Health (GCH). The percentage of MMR2 coverage was calculated for each rurality grouping, and logistic regression was used to adjust for confounders.

Results: A total of 4596 participants were enrolled across three GCH levels. MMR2 coverage rates were 56.2% in the most rural group (R2 + 3), compared to 63.0% in R1 (Rural 1) and 62.3% in U2 (Urban 2). Adjusting for ethnicity and socioeconomic deprivation produced odds ratios (ORs) of 1.33 for R1 participants and 1.18 for U2 participants, compared to R2 + 3. It was also shown that Māori had lower immunisation coverage than non-Māori at every GCH classification.

Discussion: Children living in more rural areas had lower rates of MMR2 coverage at age 24 months. This may reflect inequitable impacts of the COVID-19 pandemic or uneven rollout of the 2020 changes to the National Immunisation Schedule.

Introduction: Aotearoa New Zealand's National Cervical Screening Programme uses human papillomavirus (HPV) self-testing. It is important for 25-year-olds to join the cervical screening programme so that cervical cancer can be prevented, detected, and ultimately eliminated, but screening uptake by younger women is low.

Aim: The study aimed to hear young women's thoughts, experiences, and knowledge of cervical screening, including their ideas for encouraging participation in the cervical screening programme.

Methods: The study was part of a wider mixed-methods implementation trial based in Te Tai Tokerau. This qualitative component was grounded in a Kaupapa Māori methodology, by, for, and with Māori, involving a structural analysis of inequities and hearing from participants via semi-structured interviews. Interviews with 24 women aged between 18 and 30 and one whānau (family) were undertaken.

Results: Data were organised into four pou (pillars): Rangatiratanga (self-determination, autonomy, sovereignty), Manaaki (support, encouragement, whanaungatanga), Kura (education, public health campaigns), and Mana Taurite (equity, access issues, system issues).

Discussion: The empowering and easy elements of the HPV self-test, and playing an active part in cervical cancer elimination, encourage young women to participate in cervical screening, but cost is the greatest barrier to screening access. General practice also plays a critical role in championing cervical screening. This has implications for better primary care resourcing to connect and support young women to screening. HPV self-testing in the National Cervical Screening Programme has the opportunity to flip the narrative of cervical screening from burden to action.