Fiona Cram

Age standardisation – an indigenous standard?

The study of inequities in health is a critical component of monitoring government obligations to uphold the rights of Indigenous Peoples. In Aotearoa/New Zealand the indigenous Māori population has a substantially younger age structure than the non-indigenous population making it necessary to account for age differences when comparing population health outcomes. An age-standardised rate is a summary measure of a rate that a population would have if it had a standard age structure. Changing age standards have stimulated interest in the potential impact of population standards on disparities data and consequently on health policy.This paper compares the age structure of the Māori and non-Māori populations with two standard populations commonly used in New Zealand: Segis world and WHO world populations. The performance of these standards in Māori and non-Māori mortality data was then measured against the use of the Māori population as a standard. It was found that the choice of population standard affects the magnitude of mortality rates, rate ratios and rate differences, the relative ranking of causes of death, and the relative width of confidence intervals. This in turn will affect the monitoring of trends in health outcomes and health policy decision-making. It is concluded that the choice of age standard has political implications and the development and utilisation of an international indigenous population standard should be considered.

Children's endorsement of ownership attributes

Abstract Childrens understanding of private ownership was examined by noting the attributes they used to endorse ownership. It was hypothesized that with increasing age childrens endorsement of higher level (i.e. contractual) attributes will increase, and their rejection of low-level (i.e. physical) and the lowest-level (i.e. egocentric) attributes will increase also. Children ( n = 172) between the ages of 5 and 12 years were shown computer generated cartoons depicting eleven ownership attributes representing the various levels. The results of the contractual and physical attributes supported the hypothesis; those of the egocentric attributes showed a trend in the hypothesized direction. There were no significant effects due to gender.

An indigenous approach to explore health-related experiences among Māori parents: the Pukapuka Hauora asthma study.

BackgroundThe prevalence of asthma for Indigenous New Zealand Māori is amongst the highest in the world. Recent evidence shows ethnic differences in asthma symptom prevalence in New Zealand have widened, with asthma symptoms and hospitalisation rates consistently higher for Māori across all age-groups, especially children and adolescents. This paper: outlines our qualitative, longitudinal research exploring the practical issues Māori children and their families face trying to achieve optimum asthma outcomes; details the research methods used within this study; and discusses the process evaluation findings of the features that made this approach successful in engaging and retaining participants in the study.MethodsThirty-two Māori families were recruited using a Kaupapa Māori (Māori way) Research approach. Each participated in a series of four in-depth interviews that were carried out at seasonal intervals over the course of one year. Families also took part in an interviewer-administered questionnaire and participated in a Photovoice exercise. All interviews were digitally recorded, transcribed verbatim and independently coded by two researchers. The research team then conducted the analysis and theme development. The questionnaires were analysed separately, with explanations for findings explored within the qualitative data.ResultsThe methodology produced a 100 percent retention rate of the participating families over the course of the follow-up. This was attributed to the research collaboration, the respectful research relationships established with families, and the families’ judgement that the methods used enabled them to tell their stories. The acceptability of the methodology will add to the validity and trustworthiness of the findings.ConclusionGiven the extent and persistence of ethnic disparities in childhood asthma management, it is imperative that an indigenous approach be taken to understanding the core issues facing Māori families. By conducting community-partnership research underpinned by an indigenous methodology, and employing a range of appropriate methods, we have successfully recruited and retained a cohort of Māori families with experiences of childhood asthma. We aim to make their voices heard in order to develop a series of culturally relevant interventions aimed at remediating these disparities.

Researching our relations: Reflections on ethics and marginalisation

Marginalisation occurs when a group of people are pushed to the periphery of a society. Many Māori reside at the margins of ‘mainstream’ society, while others are at the margins of Māori society. The present paper explores how ‘by Māori, for Māori’ research and evaluation can create spaces for voices from the margins to be heard. The paper arose out of a series of hui in which papers on the notion of marginalisation and Māori were presented and discussed, along with the broader topic of research ethics and protocols. Three themes that emerged from these hui are considered in this paper: relationships between researchers and participants/communities, researchers knowing themselves, and the safety aspects inherent within tikanga. The discussion of these themes draws upon the papers that were written for this project, the feedback from hui participants (researchers, students, health professionals, government workers, community providers), and local and international literature on research ‘by and with’ indigenous peoples. In making the ‘knowing’ we hold about these issues more explicit, this paper aims to generate more discussion as well as providing some small guidance for those who may be new to this thing called ‘research’.

Developing a Kaupapa Māori Research Project to Help Reduce Health Disparities Experienced by Young Māori Women and their Babies

Young Māori mothers experience stigma and their babies experience poor health outcomes. Interventions to reduce these health disparities need to understand the lives of these young women. This paper describes consultation to seek agreement for research with young Māori mothers to be conducted in two regions. Consultation occurred with tribal authorities, Māori health providers, district health boards, and community stakeholders. Endorsement was gained for strength-based research with young pregnant Māori women and their babies. The research also includes service provider interviews, and analysis of policy. Project oversight is by three advisory groups: Māori elders, young Māori mothers, and an academic group. Community feedback occurs throughout the project. Consultation is an ongoing process conducted within a relationship context. It enhances the development, implementation and translation of research that seeks to represent the lives of those who are vulnerable, and eliminate health disparities.

Talking Ourselves Up

The purpose of this paper is to examine the nature of talk and its place within kaupapa Māori research. Just as many Māori occasions rely on talk1 to define context and kaupapa, so do research and principles often seek to represent the talk of participants as defining their context and their kaupapa. Within these research processes there are ample opportunities for participants to be both marginalised and/or (re)victimised. The care taken within what has become a popular way of gathering research data, talking to people, rests on a researchers skills as an interviewer as well as their intrinsic interest in people. This paper therefore examines some of the issues both researchers and participants need to be aware of, with a particular focus on qualitative research that is conducted within a kaupapa Māori framework.

A Proportional Hazards Regression Analysis of Employee Turnover Among Nurses in New Zealand

Research on employee turnover has usually relied on employment status (quitters vs. stayers) to index the criterion variable (turnover), and on multiple regression (MR) to model the turnover process. In the present study, which was based on a national sample of nurses in New Zealand (n = 1249), we improved the criterion variable by combining employment status with a continuous measure, namely, job survival duration (length of employment starting from the time of survey). We then applied Coxs (1972) proportional hazards regression (PHR) analysis to the improved criterion, and compared the results with those obtained by applying MR on employment status. The comparisons favored PHR: (1) MR selected an extra predictor of quitting that turned out to be nonsignificant, and (2) the numbers of quitters estimated by PHR tended to be more accurate than those by MR.

Implementing non-invasive prenatal testing into publicly funded antenatal screening services for Down syndrome and other conditions in Aotearoa New Zealand

BackgroundNon-invasive prenatal testing (NIPT) is a relatively new screen for congenital conditions – specifically, common fetal aneuploidies including Down Syndrome. The test is based on isolating freely circulating fragments of fetal-placental DNA that is present in the mother’s blood. NIPT has a superior clinical performance compared to current screening, and has been available privately in Aotearoa New Zealand for the last 4 years.Main issueThe proposed implementation of NIPT as a publicly funded service may widen the inequity in access to optional antenatal screening that already exists in this country.ConclusionThis paper discusses precautions that can be taken at the health system, organisation, and personnel levels to ensure that access to NIPT is equitable, that services are culturally responsive, and women’s informed choice is promoted and protected. The adoption of NIPT into publicly funded services is an example of how genetic screening is becoming mainstreamed into health services; as such our approach may also have relevance around the introduction of other genetic and genomic screening initiatives.

A qualitative inquiry into women’s experiences of severe maternal morbidity

ABSTRACT Severe acute maternal morbidity (SMM) is a near-death experience during pregnancy, childbirth or termination of a pregnancy. Nine women recruited from hospital intensive care or high dependency units following the birth of their baby participated in two qualitative interviews about their SMM experience. The interpretative phenomenological analysis led to the identification of three superordinate themes related to participants: moving from a state of normal pregnancy to being severely unwell, being in critical care and returning to normal. Participants’ transition to a SMM event occurred quickly and was frightening, with participants expressing concerns about their husbands/partners’ trauma. Participants’ time in hospital was particularly hard for those separated from their baby, with this eased by staff kindness and family support. After discharge participants continued to seek explanations for their SMM. Implications include more formal support for mothering when women are in maternal critical care, and support for husbands/partners following a SMM event.

E Hine: Talking about Māori teen pregnancy with government groups

Despite improved access to health services in Aotearoa New Zealand there remains a significant socio-economic and health gap between Māori (Indigenous New Zealanders) and Pākehā (non-Māori). E Hine (Girl) is a qualitative Kaupapa Māori (by Māori, for Māori) research project seeking to identify barriers and facilitators to positive health outcomes for young Māori mothers (under 20 years) and their infants. We present the findings of a discourse analysis of six semi-structured interviews with 13 representatives from six government agencies who were asked how their agency catered to the needs of young Māori mothers. Interviews were conducted in Wellington in 2013. First, we discuss respondents’ perspectives on how their agencies work to increase positive health outcomes. Next, we discuss structural issues, such as resource distribution, organization, and “silence”, that may act as barriers to positive outcomes. Addressing these barriers is essential to successfully deliver policies and initiatives that meet the needs of young Māori mothers and their infants.