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Background Lung cancer screening reduces lung cancer mortality by at least 20%. If implemented equitably, it has the potential to reduce inequities for Māori (the Indigenous people of Aotearoa New Zealand), whose rates of lung cancer are significantly higher than non-Māori. Our aim was to inform the equitable implementation of potential future lung cancer screening in Aotearoa by understanding the acceptability, decision making processes and design preferences for Māori and their whānau. Methods In 2020, Māori potentially eligible for lung cancer screening ( n  = 388) and their whānau/family members ( n  = 103) completed separate cross-sectional surveys about how a future screening programme could be designed and delivered. The focus of the surveys was to determine the level of support for a lung screening programme and to explore decision making and design preferences for Māori and their whānau. The two surveys were analysed separately with pre-defined responses reported as frequencies and percentages. Fisher’s exact tests were used to compare responses between gender, region, age-group and smoking status. Significant differences were further explored using pairwise comparisons with Bonferroni correction. Free text comments were analysed thematically. Results There was a very high level of support for a lung screening programme. When deciding whether to take part in screening, the strongest preferences were to follow doctors’ advice, followed by deciding alone, or with their whānau. An almost equal proportion of participants preferred to receive an invitation from their GP, or from a screening programme. Preferences for receiving information about the programme varied, with the most common being talking directly to a doctor, followed by reading a brochure, or receiving information via email. The results showed clear differences in preferences between demographic groups, particularly between regions and age-groups. Conclusions Surveys of potentially eligible Māori participants and their whānau have revealed support for screening, but diverse preferences regarding decision making and programme design. These findings have informed a randomised controlled trial on lung cancer screening invitation approaches and will guide the development of a national lung screening programme.

Introduction Addressing the underrepresentation of indigenous health professionals is recognised internationally as being integral to overcoming indigenous health inequities. This literature review aims to identify 'best practice' for recruitment of indigenous secondary school students into tertiary health programmes with particular relevance to recruitment of Māori within a New Zealand context. Methodology/methods A Kaupapa Māori Research (KMR) methodological approach was utilised to review literature and categorise content via: country; population group; health profession ffocus; research methods; evidence of effectiveness; and discussion of barriers. Recruitment activities are described within five broad contexts associated with the recruitment pipeline: Early Exposure, Transitioning, Retention/Completion, Professional Workforce Development, and Across the total pipeline. Results A total of 70 articles were included. There is a lack of published literature specific to Māori recruitment and a limited, but growing, body of literature focused on other indigenous and underrepresented minority populations. The literature is primarily descriptive in nature with few articles providing evidence of effectiveness. However, the literature clearly frames recruitment activity as occurring across a pipeline that extends from secondary through to tertiary education contexts and in some instances vocational (post-graduate) training. Early exposure activities encourage students to achieve success in appropriate school subjects, address deficiencies in careers advice and offer tertiary enrichment opportunities. Support for students to transition into and within health professional programmes is required including bridging/foundation programmes, admission policies/quotas and institutional mission statements demonstrating a commitment to achieving equity. Retention/completion support includes academic and pastoral interventions and institutional changes to ensure safer environments for indigenous students. Overall, recruitment should reflect a comprehensive, integrated pipeline approach that includes secondary, tertiary, community and workforce stakeholders. Conclusions Although the current literature is less able to identify 'best practice', six broad principles to achieve success for indigenous health workforce development include: 1) Framing initiatives within indigenous worldviews 2) Demonstrating a tangible institutional commitment to equity 3) Framing interventions to address barriers to indigenous health workforce development 4) Incorporating a comprehensive pipeline model 5) Increasing family and community engagement and 6) Incorporating quality data tracking and evaluation. Achieving equity in health workforce representation should remain both a political and ethical priority.

Identifies and reviews through a Kaupapa Māori lens the current knowledge base related to cannabis and methamphetamine, and Māori. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.

Investigates Māori experiences of telehealth consultations (phone and online video), versus in-clinic healthcare in primary care settings, during the March 2020 COVID-19 lockdown. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.

Abstract Despite the inclusion of both individual interventions and population-based measures in the Aotearoa New Zealand (Aotearoa NZ) Tobacco Control Programme, the gap between Māori, Pacific peoples and European/Asian/Other (EAO) populations in tobacco use has not decreased significantly. Tobacco control interventions that focus on individual behaviour change have produced little impact towards reducing tobacco smoking inequities for Māori and Pacific peoples in Aotearoa NZ. Using data from the New Zealand Health Survey (NZHS), this research investigates the impact of the wider determinants of health and individual-level factors on inequities in tobacco use between Māori, Pacific peoples and EAO. A conceptual framework was developed to support the theoretical positioning of this research and to inform data categorization, framing, discourse, analyses and interpretation. We conducted hierarchical regression to examine the effect of factors from each domain on ethnic inequities in tobacco use. We found that socioeconomic factors accounted for a significant amount of the disparity in adults currently smoking between Māori and Pacific peoples and EAO. Our results suggest that socioeconomic factors may be a more effective target of intervention than individual behaviours for reducing tobacco-related inequities. Addressing the broader determinants of health through comprehensive cross-agency cooperation to reduce ethnic inequities in tobacco use in Aotearoa NZ is likely to be more effective than individual behaviour change approaches.

aim: As part of a broader lung cancer screening (LCS) research programme, this study explored Māori views on providing blood samples for LCS to inform future development in Aotearoa New Zealand. methods: Two groups (potential “screenees”, and their whānau tautoko [support people]) from Te Tai Tokerau (Northland) and Tāmaki Makaurau (Auckland) completed surveys about LCS design, including comfort with blood donation and key factors in blood collection and use. Descriptive statistics and Fisher’s tests were used to analyse responses and demographic differences. results: Most participants (83.7% screenees; 81.4% whānau) were at least “comfortable” donating blood. Key priorities were clear information about blood use (35.0%; 35.8%), protecting the health of future generations (24.1%; 23.8%) and being able to consent to specific uses (23.6%; 27.6%). Participants from Te Tai Tokerau were less comfortable donating blood than those in Tāmaki Makaurau, with additional demographic differences noted. conclusions: Māori participants generally supported using blood samples in LCS but with regional differences. Future LCS initiatives should uphold Māori principles, including community partnership, return of benefit to whānau, management of potential harms and protection of Indigenous data and tissue sovereignty through transparent, culturally safe and trusted engagement processes.

Tertiary institutions internationally aim to increase student diversity, however are struggling to achieve equitable academic outcomes for indigenous and ethnic minority students and detailed exploration of factors that impact on success is required. This study explored the predictive effect of admission variables on academic outcomes for health professional students by ethnic grouping. Kaupapa Māori and Pacific research methodologies were used to conduct a quantitative analysis using data for 2686 health professional students [150 Māori, 257 Pacific, 2279, non-Māori non-Pacific (nMnP)]. The predictive effect of admission variables: school decile; attending school in Auckland; type of admission; bridging programme; and first-year bachelor results on academic outcomes: year 2–4 grade point average (GPA); graduating; graduating in the minimum time; and optimal completion for the three ethnic groupings and the full cohort was explored using multiple regression analyses. After adjusting for admission variables, for every point increase in first year bachelor GPA: year 2–4 GPA increased by an average of 0.46 points for Māori ( p  = 0.0002, 95% CI 0.22, 0.69), 0.70 points for Pacific ( p  < 0.0001, CI 0.52, 0.87), and 0.55 points for nMnP ( p  < 0.0001, CI 0.51, 0.58) students. For the total cohort, ethnic grouping was consistently the most significant predictor of academic outcomes. This study demonstrated clear differences in academic outcomes between both Māori and Pacific students when compared to nMnP students. Some (but not all) of the disparities between ethnic groupings could be explained by controlling for admission variables.

ObjectiveTo determine associations between admission markers of socioeconomic status, transitioning, bridging programme attendance and prior academic preparation on academic outcomes for indigenous Māori, Pacific and rural students admitted into medicine under access pathways designed to widen participation. Findings were compared with students admitted via the general (usual) admission pathway.DesignRetrospective observational study using secondary data.Setting 6-year medical programme (MBChB), University of Auckland, Aotearoa New Zealand. Students are selected and admitted into Year 2 following a first year (undergraduate) or prior degree (graduate).Participants1676 domestic students admitted into Year 2 between 2002 and 2012 via three pathways: GENERAL admission (1167), Māori and Pacific Admission Scheme—MAPAS (317) or Rural Origin Medical Preferential Entry—ROMPE (192). Of these, 1082 students completed the programme in the study period.Main outcome measuresGraduated from medical programme (yes/no), academic scores in Years 2–3 (Grade Point Average (GPA), scored 0–9).Results735/778 (95%) of GENERAL, 111/121 (92%) of ROMPE and 146/183 (80%) of MAPAS students graduated from intended programme. The graduation rate was significantly lower in the MAPAS students (p<0.0001). The average Year 2–3 GPA was 6.35 (SD 1.52) for GENERAL, which was higher than 5.82 (SD 1.65, p=0.0013) for ROMPE and 4.33 (SD 1.56, p<0.0001) for MAPAS. Multiple regression analyses identified three key predictors of better academic outcomes: bridging programme attendance, admission as an undergraduate and admission GPA/Grade Point Equivalent (GPE). Attending local urban schools and higher school deciles were also associated with a greater likelihood of graduation. All regression models have controlled for predefined baseline confounders (gender, age and year of admission).ConclusionsThere were varied associations between admission variables and academic outcomes across the three admission pathways. Equity-targeted admission programmes inclusive of variations in academic threshold for entry may support a widening participation agenda, however, additional academic and pastoral supports are recommended.

Background Tertiary institutions are struggling to ensure equitable academic outcomes for indigenous and ethnic minority students in health professional study. This demonstrates disadvantaging of ethnic minority student groups (whereby Indigenous and ethnic minority students consistently achieve academic outcomes at a lower level when compared to non-ethnic minority students) whilst privileging non-ethnic minority students and has important implications for health workforce and health equity priorities. Understanding the reasons for academic inequities is important to improve institutional performance. This study explores factors that impact on academic success for health professional students by ethnic group. Methods Kaupapa Māori methodology was used to analyse data for 2686 health professional students at the University of Auckland in 2002–2012. Data were summarised for admission variables: school decile, Rank Score, subject credits, Auckland school, type of admission, and bridging programme; and academic outcomes: first-year grade point average (GPA), first-year passed all courses, year 2 – 4 programme GPA, graduated, graduated in the minimum time, and composite completion for Māori, Pacific, and non-Māori non-Pacific (nMnP) students. Statistical tests were used to identify significant differences between the three ethnic groupings. Results Māori and Pacific students were more likely to attend low decile schools (27 % Māori, 33 % Pacific vs. 5 % nMnP, p  < 0.01); complete bridging foundation programmes (43 % Māori, 50 % Pacific vs. 5 % nMnP, p  < 0.01), and received lower secondary school results (Rank Score 197 Māori, 178 Pacific vs. 231 nMnP, p  < 0.01) when compared with nMnP students. Patterns of privilege were seen across all academic outcomes, whereby nMnP students achieved higher first year GPA (3.6 Māori, 2.8 Pacific vs. 4.7 nMnP, p  < 0.01); were more likely to pass all first year courses (61 % Māori, 41 % Pacific vs. 78 % nMnP, p  < 0.01); to graduate from intended programme (66 % Māori, 69 % Pacific vs. 78 % nMnP, p  < 0.01); and to achieve optimal completion (9 % Māori, 2 % Pacific vs. 20 % nMnP, p  < 0.01) when compared to Māori and Pacific students. Conclusions To meet health workforce and health equity goals, tertiary institution staff should understand the realities and challenges faced by Māori and Pacific students and ensure programme delivery meets the unique needs of these students. Ethnic disparities in academic outcomes show patterns of privilege and should be alarming to tertiary institutions. If institutions are serious about achieving equitable outcomes for Māori and Pacific students, major institutional changes are necessary that ensure the unique needs of Māori and Pacific students are met.

Background Universities should provide flexible and inclusive selection and admission policies to increase equity in access and outcomes for indigenous and ethnic minority students. This study investigates an equity-targeted admissions process, involving a Multiple Mini Interview and objective testing, advising Māori and Pacific students on their best starting point for academic success towards a career in medicine, nursing, health sciences and pharmacy. Methods All Māori and Pacific Admission Scheme (MAPAS) interviewees enrolled in bridging/foundation or degree-level programmes at the University of Auckland were identified (2009 to 2012). Generalised linear regression models estimated the predicted effects of admission variables (e.g. MAPAS Maths Test ; National Certificate in Educational Achievement ( NCEA) Rank Score; Any 2 Sciences ; Followed MAPAS Advice) on first year academic outcomes (i.e. Grade Point Average (GPA) and Passes All Courses) adjusting for MAPAS interview year , gender , ancestry and school decile . Results 368 First Year Tertiary (bridging/foundation or degree-level) and 242 First Year Bachelor (degree-level only) students were investigated. NCEA Rank Score (estimate 0.26, CI: 0.18-0.34, p < 0.0001); MAPAS Advice Followed (1.26, CI: 0.18-1.34, p  = 0.0002); Exposure to Any 2 Sciences (0.651, CI: 0.15-1.15, p  = 0.012); and MAPAS Mathematics Test (0.14, CI: 0.02-0.26, p  = 0.0186) variables were strongly associated with an increase in First Year Tertiary GPA . The odds of passing all courses in First Year Tertiary study was 5.4 times higher for students who Followed MAPAS Advice (CI: 2.35-12.39; p < 0.0001) and 2.3 times higher with Exposure to Any Two Sciences (CI: 1.15-4.60; p  = 0.0186). First Year Bachelor students who Followed MAPAS Advice had an average GPA that was 1.1 points higher for all eight (CI: 0.45-1.73; p  = 0.0009) and Core 4 courses (CI: 0.60-2.04; p  = 0.0004). Conclusions The MAPAS admissions process was strongly associated with positive academic outcomes in the first year of tertiary study. Universities should invest in a comprehensive admissions process that includes alternative entry pathways for indigenous and ethnic minority applicants.