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Indigenous Peoples have a rich and long-standing connection with the environments that they descend from—a connection that has informed a deep and multifaceted understanding of the relationship between human well-being and the environment. Through cultural narratives and practices, much of this knowledge has endured despite the ongoing effects that colonization has had on many Indigenous peoples across the world. Indigenous Peoples have a rich and long-standing connection with the environments that they descend from—a connection that has informed a deep and multifaceted understanding of the relationship between human well-being and the environment. Through cultural narratives and practices, much of this knowledge has endured despite the ongoing effects that colonization has had on many Indigenous peoples across the world. These narratives and practices, based on observation, experimentation, and practical application over many generations, have the potential to make compelling contributions to our understanding of the environmental microbiome and its relationship to health. Furthermore, the inclusion of Indigenous perspectives regarding the microbiome opens pathways to those who rarely engage with the field and its learnings. Within the scientific community, Indigenous perspectives have not always been acknowledged as valid contributions and are often seen as myth or lacking rigor. Thus, this paper aims to explore an Indigenous perspective of the microbiome as an unseen influence on health and well-being by framing the importance of the natural environment, Indigenous knowledge and leadership, and future research directions that can contribute to this domain. Although the Indigenous perspective in this article reflects the experiences, worldviews, and knowledge of two New Zealand Māori authors, it is hoped that the concepts discussed can relate to Indigenous peoples, and non-Indigenous advocates, globally.

INTRODUCTION: te Tiriti o Waitangi guarantees Māori the right to: self-determination, equitable health outcomes, be well informed, health care options, including kaupapa Māori and culturally safe mainstream services, and partnership in the health care journey. Despite integration of these principles into policy, there remains a lack of application in health service development, and health inequities remain.AIM: We aimed to use te Tiriti o Waitangi to structure the development of a culturally safe health intervention, using as an exemplar pharmacist-facilitated medicines review for Māori older adults.METHODS: Previous research undertaken by our group (a systematic review, and interviews with stakeholders including Māori older adults) was used to inform the aspects to include in the intervention. Kaupapa Māori theory was used to underpin the approach. Intended outcomes, requirements for change, and outcome measures to assess change were mapped to te Tiriti o Waitangi principles as a way to structure the pharmacist-facilitated medicines review intervention and research processes.RESULTS: Findings from our previous research identified 12 intended intervention outcomes, including that the intervention be flexible to adapt to diverse needs in a way that is acceptable and culturally safe for Māori and that it supports Māori older adults to control and have confidence in their medicine treatment and wellbeing.DISCUSSION: We present an approach to the development of a pharmacist-facilitated medicines review intervention for Māori older adults, structured around the principles of te Tiriti o Waitangi, to support the implementation of a culturally safe, pro-equity intervention.

Māori, Pacific, Indian, and New Zealand European pre-school children’s caregivers’ views on determinants of childhood obesity are needed to inform strategies that will reduce disparities in prevalence. Nineteen focus groups were conducted to explore the relative influence of factors contributing to body weight in children. Predetermined and participant-suggested factors were ranked. Discussion data were inductively analysed. The cost of healthy foods was the highest ranked factor across all groups. Ranked similarly were ease of access to takeaways and lack of time for food preparation. Cultural factors followed by screen time induced sedentariness in children and lack of time to ensure children exercised was next. Participant-raised factors included lack of familial, social, and health promotion support, and others’ behaviour and attitudes negatively impacting what children ate. All groups rejected stereotyping that blamed culture for higher obesity rates. Compared to the Māori and NZ European groups, the Pacific Island and Indian participants spoke of losing culture, missing extended family support, and not having access to culturally appropriate nutrition education or social support and services. Public health policies need to mitigate the negative effects of economic deprivation on food insecurity. Complementary interventions that increase access to healthier meal choices more often are needed.

Introduction: The activities and consultations undertaken by Māori health provider nurses are likely broad and operate within a Māori nursing model of care. However, there is little quantitative evidence to document and describe these encounters with clients. The Omaha coding system provides a mechanism in which to quantify nursing encounters through classifying client problems by domain, interventions and specific targets relating to interventions.Aim: The aim of this study was to document the types of encounters and interventions undertaken by Māori health provider nurses.Methods: An audit was undertaken of patient encounters occurring within a Māori health provider between 1 January 2020 and 31 December 2020. Encounters were randomly selected and problems, activities and interventions coded utilising the Omaha coding system. Simple descriptive statistics were used.Results: A total of 5897 nurse–client encounters occurred over the study period. Overall, 61% of the audited nurse–client encounters related to the physiological domain and only 6% of encounters were related to the psychosocial domain. And 29% of nursing interventions involved teaching/guiding/counselling and a further 29% of interventions were case management.Discussion: The wide variety of conditions seen and the number of interventions carried out indicate the broad scope of Māori health provider nurses. However, there were likely undocumented problems, which could reflect the medicalisation of the electronic health record. Redesigning electronic health records to apply more of a nursing and Māori health provider lens may facilitate more inclusive ways of documentation.

IntroductionSexual and reproductive health (SRH) is important for well-being, yet Indigenous peoples, including Māori, have poorer SRH outcomes than non-Indigenous peoples. Healthcare providers (HCPs) play a critical role in enhancing patients’ health literacy, directly impacting health outcomes by providing clear, accessible information and guidance. Therefore, it is important to explore the experiences that wāhine Māori (Māori women) have when interacting with HCPs and how they learn about SRH. Such research could guide interventions to improve dissemination of SRH knowledge to Māori.AimThis study aimed to explore the experiences wāhine Māori have of sexual health care and accessing SRH knowledge.MethodsWāhine were interviewed in this Kaupapa Māori study. Interviews were transcribed and coded, and thematic analysis was performed.ResultsTwelve wāhine were interviewed. An overarching theme, He mana tō te mātauranga (knowledge is power), was identified. There were four subthemes: being informed about contraceptive options is empowering, informed consent is important, high-stress situations call for better communication and improved dissemination of SRH knowledge is needed. The wāhine valued being well-informed about their health and options, however, their experiences of receiving information varied.DiscussionWāhine Māori want to be told more about their health and options when encountering HCPs regarding SRH. Being informed is empowering, while feeling uninformed results in a breakdown in trust in the healthcare system and inability to exercise mana motuhake (autonomy). Facilitating improved dissemination of knowledge about SRH may help improve SRH outcomes for Māori by supporting health literacy, so that Māori can make informed decisions about their health.

IntroductionMāori have poorer sexual and reproductive health (SRH) outcomes compared to non-Māori New Zealanders. Patient experiences of SRH services affect how they access, utilise, and benefit from services. Learning about how wāhine Māori (Māori women) experience care related to SRH could inform improvements in how services provide care for wāhine.AimThis study aimed to explore the experiences wāhine have when accessing SRH services.MethodsThis qualitative study utilised semi-structured interviews to explore the lived experiences of wāhine when accessing sexual healthcare. Inductive thematic analysis was performed to generate themes from the data.ResultsTwelve wāhine were interviewed. An overarching theme, Te Hāpai i te mana wāhine, te takahi i te mana wāhine (empowering women, disempowering women), was identified. This theme had four subthemes: creating comfortable spaces; manaakitanga (kindness and respect) overcomes barriers to care; patients are people, not numbers; and the importance of mana-enhancing care. The data showed that wāhine benefit from services and care that make them feel comfortable and respected and that dehumanising care can impact further engagement with services.DiscussionWāhine have variable experiences when accessing sexual healthcare, and although some of those experiences showed how positive interactions with healthcare staff facilitated effective care, many experiences demonstrated how dehumanising clinical care can sometimes be. Such care risks perpetuating health inequities indirectly by eroding the trust wāhine have in healthcare services, and directly by limiting the effectiveness of healthcare encounters. Recommendations are made to improve care provided to wāhine in sexual health settings.

Background Maternal vaccinations for influenza and pertussis are recommended in New Zealand to protect mothers and their infant from infection. However, maternal immunisation coverage in New Zealand is suboptimal. Furthermore, there is unacceptable inequitable maternal immunisation rates across the country with Māori and Pacific women having significantly lower maternal immunisation rates than those of other New Zealanders. Methods This research set out to explore what pregnant/recently pregnant Māori and Pacific women knew about immunisation during pregnancy and what factors influenced their decision to be vaccinated. A semi-structured interview guide was developed with questions focusing on knowledge of pertussis and influenza vaccination during pregnancy and decision-making. Māori and Pacific women aged over 16 years were purposively sampled and interviewed in Dunedin and Gisborne, New Zealand between May and August 2021. Interviews were analysed following a directed qualitative content approach. Data were arranged into coding nodes based on the study aims (deductive analysis) informed by previous literature and within these participant experiences were inductively coded into themes and subthemes. Results Not all women were aware of maternal vaccine recommendations or they diseases they protected against. Many underestimated how dangerous influenza and pertussis could be and some were more concerned about potential harms of the vaccine. Furthermore, understanding potential harms of infection and protection provided by vaccination did not necessarily mean women would choose to be vaccinated. Those who decided to vaccinate felt well-informed, had vaccination recommended by their healthcare provider, and did so to protect their and their infant’s health. Those who decided against vaccination were concerned about safety of the vaccines, lacked the information they needed, were not offered the vaccine, or did not consider vaccination a priority. Conclusions There is a lack of understanding about vaccine benefits and risks of vaccine-preventable diseases which can result in the reinforcement of negative influences such as the fear of side effects. Furthermore, if vaccine benefits are not understood, inaccessibility of vaccines and the precedence of other life priorities may prevent uptake. Being well-informed and supported to make positive decisions to vaccinate in pregnancy is likely to improve vaccine coverage in Māori and Pacific Island New Zealanders.

BackgroundCardiovascular disease is a major health issue for Māori that requires timely and effective first-response care. Māori report culturally unsafe experiences in health care, resulting in poor health outcomes. Research in the pre-hospital context is lacking. This study aimed to explore experiences of cultural (un)safety for Māori and their whānau who received acute pre-hospital cardiovascular care from paramedics.MethodsUtilising a qualitative descriptive methodology and Kaupapa Māori Research (KMR), in-depth semi-structured interviews were undertaken with 10 Māori patients and/or whānau, and a general inductive approach was used for analysis.ResultsThree key themes were identified: (1) interpersonal workforce skills, (2) access and service factors and (3) active protection of Māori. Participants described paramedics’ clinical knowledge and interpersonal skills, including appropriate communication and ability to connect. Barriers to accessing ambulance services included limited personal and community resources and workforce issues. The impact of heart health on communities and desire for better preventative care highlighted the role of ambulance services in heart health.ConclusionMāori experience culturally unsafe pre-hospital care. Systemic and structural barriers were found to be harmful despite there being fewer reports of interpersonal discrimination than in previous research. Efforts to address workforce representation, resource disparities and cultural safety education (focussing on communication, partnership and connection) are warranted to improve experiences and outcomes for Māori.

Aotearoa New Zealand implemented a Covid-19 elimination strategy in 2020 and 2021, which enabled a large majority of the population to be vaccinated before being exposed to the virus. This strategy delivered one of the lowest pandemic mortality rates in the world. However, quantitative estimates of the population-level health benefits of vaccination are lacking. Here, we use a validated mathematical model of Covid-19 in New Zealand to investigate counterfactual scenarios with differing levels of vaccine coverage in different age and ethnicity groups. The model builds on earlier research by adding age- and time-dependent case ascertainment, the effect of antiviral medications, improved hospitalisation rate estimates, and the impact of relaxing control measures. The model was used for scenario analysis and policy advice for the New Zealand Government in 2022 and 2023. We compare the number of Covid-19 hospitalisations, deaths, and years of life lost in each counterfactual scenario to a baseline scenario that is fitted to epidemiological data between January 2022 and June 2023. Our results estimate that vaccines saved 6650 (95% credible interval [4424, 10180]) lives, and prevented 74500 [51000, 115400] years of life lost and 45100 [34400, 55600] hospitalisations during this 18-month period. Making the same comparison before the benefit of antiviral medications is accounted for, the estimated number of lives saved by vaccines increases to 7604 [5080, 11942]. Due to inequities in the vaccine rollout, vaccination rates among Māori were lower than in people of European ethnicity. Our results show that, if vaccination rates had been equitable, an estimated 11%–26% of the 292 Māori Covid-19 deaths that were recorded in this time period could have been prevented. We conclude that Covid-19 vaccination greatly reduced health burden in New Zealand and that equity needs to be a key focus of future vaccination programmes.

The deepening climate crisis generates specific impacts that will exacerbate the already disproportionately negative health outcomes experienced by Indigenous people. Disparate health outcomes have not spontaneously emerged, but rather have been foreshadowed by existing inequities. This article summarizes a sample of the work from a two-year research project in Aotearoa New Zealand to understand existing policy processes and ascertain the extent to which health institutions give serious consideration to climate change impacts on Māori (Indigenous people) with health vulnerabilities. Speaking to tāngata whenua (Indigenous Māori), District Health Board (DHB) employees, and subject matter experts (SMEs), it was clear that policy processes were ad hoc and problematically silenced consistent Māori input. While research participants expressed their experiences of, and aspirations for, dealing with climate change, their voices were not evident in DHB policy development processes. The deficit within existing policy process reflects a lack of preparedness in the face of climate change. Despite clear resilience and adaptation strategies, structural change is needed to address identified disadvantages. Through a co-designed policy framework (“Haumanu Hauora”), we guide policy formation to mitigate climate change risk to Māori (and others). Central to the revised policy framework is the creation of space for both internal and external Māori voices to ensure consistent Māori input throughout the policy process. We also introduce a commissioning, refining, and monitoring stage (that includes evaluation). Haumanu Hauora considers whānau-centered healthcare knowledge, needs, resources, and aspirations, to contribute to a transformed and responsive health system. Above all, we believe that strengthening health institution responsiveness to Māori health needs is essential.