Brendan Hokowhitu

Prospective outcomes of injury study

Background: In New Zealand (NZ), 20% of adults report a disability, of which one-third is caused by injury. No prospective epidemiological studies of predictors of disability following all-cause injury among New Zealanders have been undertaken. Internationally, studies have focused on a limited range of predictors or specific injuries. Although these studies provide useful insights, applicability to NZ is limited given the importance of NZ’s unique macro-social factors, such as NZ’s no-fault accident compensation and rehabilitation scheme, the Accident Compensation Corporation (ACC). Objectives: (1) To quantitatively determine the injury, rehabilitation, personal, social and economic factors leading to disability outcomes following injury in NZ. (2) To qualitatively explore experiences and perceptions of injury-related outcomes in face-to-face interviews with 15 Māori and 15 other New Zealanders, 6 and 12 months after injury. Setting: Four geographical regions within NZ. Design: Prospective cohort study with telephone interviews 1, 4 and 12 months after injury. Participants: 2500 people (including 460 Māori), aged 18–64 years, randomly selected from ACC’s entitlement claims register (people likely to be off work for at least 1 week or equivalent). Data: Telephone interviews, electronic hospital and ACC injury data. Exposures include demographic, social, economic, work-related, health status, participation and/or environmental factors. Outcome measures: Primary: disability (including WHODAS II) and health-related quality of life (including EQ-5D). Secondary: participation (paid and unpaid activities), life satisfaction and costs. Analysis: Separate regression models will be developed for each of the outcomes. Repeated measures outcomes will be modelled using general estimating equation models and generalised linear mixed models.

Prospective Outcomes of Injury Study: recruitment, and participant characteristics, health and disability status

The Prospective Outcomes of Injury Study aims to identify predictors of disability following injury. Participants were selected from the entitlement claims register of New Zealands no-fault compensation insurer, the Accident Compensation Corporation, and followed up by interview for 2 years. This report describes changes to intended Prospective Outcomes of Injury Study methods and key characteristics of the cohort, with an emphasis on general health and disability before injury and soon afterwards. There were 2856 injured participants in the first interview, which occurred 3.2 months (median) after injury. The recruitment period was extended to enable inclusion of sufficient Māori participants. At the first interview, most participants were experiencing worse health status and increased disability compared to before injury, despite less than one-third reporting admission to hospital because of their injury. Analysis of outcome predictors related to post-injury function, disability and return-to-work soon after injury and 1 year later is now under way.

Rangatiratanga and Oritetanga: responses to the Treaty of Waitangi in a New Zealand study.

Introduction. Although opportunities exist for positive experiences in research, Māori in New Zealand, like other indigenous people colonised by Europeans in the nineteenth century, have also been subject to research and associated policies that have had long-lasting negative consequences. Researchers have subsequently been challenged by Māori to conduct research that is acceptable, accountable and relevant. Much of this debate has taken place within the framework of the Treaty of Waitangi, a treaty of cession signed between Māori and British Crown representatives in 1840. Nowadays, health and health research statutes exist that require researchers to respond to the ‘principles’ of the Treaty. Few practical examples of how health researchers have undertaken this have been published. Aims. We examine how, in developing a national study of injury outcomes, we responded to the Treaty. Our study, the Prospective Outcomes of Injury Study, aims to quantitatively identify predictors of disability following injury and to qualitatively explore experiences and perceptions of injury outcomes. Discussion. Responses to the Treaty included: consultation with Māori groups, translation of the questionnaire into te reo Māori, appointment of interviewers fluent in te reo Māori, sufficient numbers of Māori participants to allow Māori-specific analyses and the inclusion of a Māori-specific qualitative component. While this article is located within the New Zealand context, we believe it will resonate with, and be of relevance to, health researchers in other former settler societies. We do not contend this project represents an ‘ideal’ model for undertaking population-based research. Instead, we hope that by describing our efforts at responding to the Treaty, we can prompt wider debate of the complex realities of the research environment, one which is scientifically, ethically and culturally located.

Factors associated with non-participation in one or two follow-up phases in a cohort study of injured adults

Objective To identify factors associated with non-participation at the 12-month and 24-month follow-up phases of a prospective cohort study of injury outcomes. Methods Associations between non-participation at follow-up phases and a range of sociodemographic, injury, health, outcome and administrative factors were examined. Results An individuals non-participation at 12 months did not necessarily mean non-participation at 24 months. Sociodemographic factors were the most salient for non-participation, regardless of the number of follow-up phases or specific phase considered. Conclusions Retention rates in prospective cohort studies of injury outcome may be improved by follow-up of everyone irrespective of previous non-participation, focusing resources to retain men, young adults, indigenous people and those living with people other than family members, and by ensuring that multiple alternative participant contacts are obtained. There is sufficient evidence to be concerned about potential bias given that several of the factors we, and others, have identified as associated with non-participation are also associated with various functional and disability outcomes following injury. This suggests detailed investigations are warranted into the effect non-participation may be having on the estimates for various outcomes.

Indigenous injury outcomes: life satisfaction among injured Māori in New Zealand three months after injury

BackgroundMāori, the indigenous population of New Zealand, experience numerous and consistent health disparities when compared to non-Māori. Injury is no exception, yet there is a paucity of published literature that examines outcomes following a wide variety of injury types and severities for this population. This paper aims to identify pre-injury and injury-related predictors of life satisfaction three months after injury for a group of injured Māori.MethodsThe Māori sample (n = 566) were all participants in the Prospective Outcomes of Injury Study (POIS). POIS is a longitudinal study of 2856 injured New Zealanders aged 18–64 years who were on an injury entitlement claims’ register with New Zealand’s no-fault compensation insurer. The well-known Te Whare Tapa Whā model of overall health and well-being was used to help inform the selection of post-injury life satisfaction predictor variables. Multivariable analyses were used to examine the relationships between potential predictors and life satisfaction.ResultsOf the 566 Māori participants, post-injury life satisfaction data was available for 563 (99%) participants. Of these, 71% reported satisfaction with life three months after injury (compared to 93% pre-injury). Those with a higher injury severity score, not satisfied with pre-injury social relationships or poor self-efficacy pre-injury were less likely to be satisfied with life three months after injury.ConclusionsThe large majority of Māori participants reported being satisfied with life three months after injury; however, nearly a third did not. This suggests that further research investigating outcomes after injury for Māori, and predictors of these, is necessary. Results show that healthcare providers could perhaps put greater effort into working alongside injured Māori who have more severe injuries, report poor self-efficacy and were not satisfied with their pre-injury social relationships to ensure increased likelihood of satisfaction with life soon after injury.

Māori Rugby and Subversion: Creativity, Domestication, Oppression and Decolonization

This article examines the genesis of racialized discourse and whiteness in Aotearoa/New Zealand through rugby, the ‘national game’. The construction of historical racial parameters will be investigated through accounts of the Māori All Blacks, a ‘race’-based team that, since its inception, has facilitated the allegorical logic of race in Aotearoa/New Zealand by anchoring Pākehā whiteness in contrast to the brown skin of Māori rugby players. The article traces the changing nature of dominant constructions of Pākehā whiteness in relation to Māori, firstly, as imperialists, colonizers and assimilators, secondly, as proponents of racial equality (especially in relation to ‘the old foe’– South Africa) and, more recently, as advocates of biculturalism. The article achieves this by examining historical case studies where racialized discourses were prominent, including the debate whether to include Māori All Blacks in All Black tours to South Africa and, more recently, the discourse surrounding the ‘hanging by a fingernail’ saga, which developed when a number of prominent players who ‘did not look Māori’ were selected to play for the Māori All Blacks.