NEW ZEALAND MEDICAL JOURNAL最新文献

Aims: We sought to investigate the current state of education to support person- and whānau-centred care (PWCC) in our setting and to inform a new approach to teaching and learning. Additionally, we investigated the potential use case of an artificial intelligence (AI) tool to enable clinical communication skill development.

Methods: A mixed-method co-design approach was used, combining data from a consumer group, an anonymous staff survey (n=312) and a clinician focus group. The project captured lived experiences of communication in clinical care, enablers and barriers to effective training, and perspectives on future educational innovations including AI.

Results: Consumers emphasised the importance of individualised, culturally safe communication and clear, jargon-free language. Findings confirmed that while clinicians generally gain confidence with experience, existing training in communication and PWCC is inconsistent and often inaccessible. Clinicians identified a need for more frequent feedback and practical opportunities for skill development. This feedback should be from a person and whānau perspective. Notably, 90% of clinicians expressed openness to using an AI-based tool for improving communication skills.

Conclusion: Traditional workplace education models are insufficient to meet the growing need for effective PWCC, including culturally safe communication in healthcare. An AI-enabled, feedback-driven tool may present a viable complementary solution to current offerings, provided it is co-designed with consumers and clinicians, is culturally grounded and is integrated into existing systems. Further investigation into the development and validation of a tool is warranted.

Aims: This paper aims to explore the relationship between e-biking and health in the context of a novel, marae-led e-biking programme for Māori and Pacific adults in a suburban community.

Methods: Focus groups were conducted with participants in an e-biking programme (n=20) prior to receiving e-bikes, and individual interviews were conducted with participants at approximately 6 months (n=23) and 12 months (n=22).

Results: Wanting to improve health was a motivation for trying e-biking. E-biking supported better physical and mental health, including self-reported improvement in a range of long-term conditions. E-biking was often possible and enjoyable for people who experienced barriers to physical activity, although poor health could also act as a barrier to e-biking. Factors that supported ongoing e-biking included having someone to ride with, the enjoyable nature of e-biking, and integrating e-biking for active travel.

Conclusions: This study suggests that e-biking is possible and beneficial for a wide range of people who do not currently cycle. Recommendations from individual health practitioners are likely to be important alongside community and population level interventions to support the uptake of cycling. Practice points to support individual health practitioners to discuss e-biking are provided.

Aim: To describe the extent and nature of vaping behaviour in a high-risk group of adolescents compared to a regionally representative comparison group of same-age peers at 17.5 years (range 16-19). Vaping rates were examined by sex, age, socio-economic status (SES) and ethnicity.

Methods: Participants were 53 high-risk adolescents with prenatal substance exposure and family psychosocial adversity and 83 adolescents randomly recruited at birth. At mean age 17.5 years, participants were interviewed about current and lifetime vaping.

Results: Overall, two-thirds of adolescents reported having ever vaped, and 43% reported vaping regularly (>monthly). Adolescents in the high-risk group were more likely to report both ever (87% vs 55%; p<.001) and regular vaping (64% vs 30%; p<.001). Regular vaping was associated with lower family SES, although this effect was not significant after accounting for high-risk group status. Māori youth were significantly over-represented among regular vapers compared to non-vapers, but this association was largely explained by family SES.

Conclusion: Vaping rates among Canterbury youth are high, with findings suggesting elevated rates for already higher-risk health-vulnerable adolescents. Offering accessible support for existing users and stronger regulations to limit vape product accessibility will be critical to minimise population harm and reduce longer-term health impacts.

Persistent inequities in cancer outcomes for Māori and Pacific peoples remain one of the most significant challenges facing the Aotearoa New Zealand health system. These disparities are evident across incidence, stage at diagnosis, access to treatment and survival. While often attributed to behavioural risk factors, the predominant drivers are structural, including barriers to access, health system design, workforce limitations and broader socio-economic determinants. Despite long-standing recognition, progress has been inconsistent and insufficient. Addressing these inequities requires a shift from description to accountability, with equity embedded as a core performance metric. Culturally aligned services, improved access to care, strengthened primary care and the use of registry-based data to drive quality improvement are essential components of a system capable of delivering equitable outcomes. Comprehensive cancer centres could offer a further opportunity to reduce variation and improve access to high-quality multidisciplinary care. In parallel, screening policy must better reflect epidemiological realities, including the earlier onset of colorectal cancer among Māori. Equity in cancer care is fundamental to the definition of a high-performing health system. Without measurable progress, equity remains deferred-and therefore denied.

Aim: We aimed to conduct a comparative analysis of the open disclosure frameworks in Australia and New Zealand to identify the strengths, weaknesses and trade-offs of their respective approaches and to propose a hybrid model that integrates the best practices from both systems.

Method: This qualitative comparative policy analysis systematically reviewed key policy documents from Australia and New Zealand. Data extraction focussed on the principles, processes, governance, legal aspects and implementation strategies of each framework. A multi-theoretical approach was adopted, applying four core theoretical frameworks-institutional theory, regulatory governance, ethics of care and implementation science-to analyse the extracted data. The analysis involved thematic coding, a cross-country comparison through each theoretical lens and a synthesis of the findings to identify the trade-offs between the two models and to inform the development of a refined hybrid model.

Result: The analysis revealed that Australia's framework, which is embedded in national safety standards, emphasises system-wide governance and accreditation, offering flexibility but at the risk of implementation variability. In contrast, New Zealand's model, which is legally mandated under consumer rights legislation, prioritises individual accountability and patient rights, ensuring strong enforcement but potentially fostering a compliance-driven culture. The key differences between the two frameworks emerged in their legal specificity, enforcement mechanisms and the practicalities of their implementation. The analysis highlighted the critical role of ethical considerations, workforce capacity and organisational readiness for the effective implementation of open disclosure.

Conclusion: Both the Australian and New Zealand open disclosure frameworks offer valuable insights into the challenge of balancing systemic governance and consumer rights. A hybrid approach that integrates Australia's focus on systemic learning with New Zealand's robust legal mandate for patient rights and explicit ethical considerations could provide a more effective and equitable framework for open disclosure, and could enhance healthcare quality and transparency. Future research should focus on the empirical evaluation of the practical implementation and outcomes of such hybrid models.

Aim: Pasifika Futures Ltd, as a Whānau Ora commissioning agency, was part of phase two of the government-funded Whānau Ora initiative that was active between 2014 and 2025 in supporting Pacific families across Aotearoa New Zealand in improving health, education, housing and employment outcomes. This study investigated wellbeing outcomes of Pacific families engaged in Whānau Ora services over 8 years of this period to identify socio-demographic groups with the highest needs.

Method: This was an observational, national cross-sectional study of 11,999 Pacific families engaged with Whānau Ora services between July 2015 and June 2023. The Measurement Assessment Scoring Tool (MAST), a measure of multi-domain outcomes, was used to assess family wellbeing. Regression models yielded comparative mean differences and odds ratios.

Results: Multivariable-adjusted regressions showed that needs, assessed using MAST scores, were significantly higher in families with Sāmoan or Tuvaluan ethnicity, non-English speaking, larger family households or younger family age. Compared with Auckland, needs were higher (all p<0.0001) for those living in Northland and lowest for families living in the South Island (by 4.0), families living in Wellington (by 6.1) and families living in the Midland area (by 6.8).

Conclusion: Socio-demographic factors are associated with lower holistic wellbeing in Pacific families. These results can inform targeted interventions directed at reducing wellbeing disparities.