School of Acute and Primary Health
Permanent link for this collectionhttps://hdl.handle.net/10292/1241
The School of Acute and Primary Health includes Paramedicine, Midwifery, Perioperative Practice and Oral Health.
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Item Foetal Movement Information and Maternal Concerns in the Third-Trimester: Findings of an Aotearoa New Zealand National Survey(Wiley, 2026-04-03) Bradford, Billie F; Thompson, John MD; McKinlay, Christopher JD; Dukkipati, Likhit S; Cronin, George D; Waller, Nimisha; McAra-Couper, Judith; Cornwall, Tania; McCowan, Lesley ME; Cronin, Robin SBACKGROUND: Promoting awareness of foetal movement (FM) is a recognised approach to addressing preventable stillbirth. However, provision of information is inconsistent, and rates of presentation for decreased FM may vary by maternal factors. Information is lacking on maternal views of FM information and knowledge of actions if concerned about FM. AIMS: To describe women's views of FM during late pregnancy in Aotearoa-New Zealand (Aotearoa-New Zealand), including factors that influence maternal actions if concerned. MATERIALS AND METHODS: Online survey of women with singleton third-trimester pregnancies in Aotearoa-New Zealand. Multivariable analysis adjusted for maternal factors. RESULTS: Eligible participants comprised European (1042, 63.5%), Māori (266, 16.2%), Pacific (119, 7.3%), Asian (160, 9.8%) and Other (35, 2.1%). Over half were nulliparous (916, 55.9%) and early third-trimester (median 31, IQR 28-34). Most (1366, 83.3%) had been concerned about FM. Groups that were less likely to seek advice when concerned, included Māori (aOR 0.69, 95% CI 0.51%-0.93%, p = 0.02), Pacific (aOR 0.58, 95% CI 0.38%-0.88%, p = 0.01) and parous (aOR 0.73, 95% CI 0.59%-0.90%, p = 0.003) women. Advice seeking was also less likely with a doctor as the main maternity provider (aOR 0.59, 5% CI 0.39%-0.92%, p = 0.02) compared to a midwife, and those who received fewer than recommended antenatal visits (aOR 0.55, 95% CI 0.34%-0.88%, p = 0.01). CONCLUSIONS: This study identified that FM worries are common in the third-trimester in Aotearoa-New Zealand. Yet, some groups of women were less likely to seek advice when concerned, indicating opportunities to reduce inequity and address barriers to accessing care.Item Underuse of Bystander Defibrillation on Females During Out-of-Hospital Cardiac Arrest: A Retrospective Observational Study in Aotearoa New Zealand(Elsevier BV, 2026-02-03) Todd, Verity; Hutchinson, Heather; Withanarachchie, Vinuli; Swain, Andy; Maessen, Sarah; Brett, Aroha; Dicker, BridgetIntroduction Early bystander CPR and defibrillation improve cardiac arrest survival. International studies show women receive fewer bystander interventions after out-of-hospital cardiac arrest (OHCA) than men. We investigated associations between sex and bystander interventions in OHCA in Aotearoa New Zealand. Methods Retrospective cohort study of adult OHCA with attempted resuscitation (January 2019–December 2023). Variables included demographics, ethnicity, socioeconomic deprivation, rurality, location type, and witness status. Logistic regression assessed associations between sex and bystander CPR and bystander defibrillation (shock delivered), adjusting for covariates. Results Of 9377 OHCA events, 29.6% occurred in females. Bystander CPR rates were similar between females (75.7%) and males (77.3%) (AOR 1.06, 95% CI: 0.94–1.18, p = 0.36). However, bystander defibrillation occurred in only 1.9% of females versus 5.4% of males. Females had 65% lower odds of receiving bystander defibrillation in unadjusted analysis (UOR 0.35, 95% CI: 0.26–0.47, p ' 0.001) and 39% lower odds after adjustment (AOR 0.61, 95% CI: 0.44–0.84, p = 0.002). Among shockable rhythm cases, sex disparity was not significant (AOR 0.83, 95% CI: 0.59–1.15, p = 0.26). Conclusion Despite equitable bystander CPR rates, females had significantly lower odds of receiving bystander defibrillation. In shockable rhythm cases, the disparity was not significant after adjustment for covariates, suggesting that patient and event characteristics mediate rather than confound this relationship. Findings highlight the need for targeted interventions addressing strategies to improve bystander defibrillation for females in cardiac arrest.Item Family Experiences of Out-of-Hospital Deaths Where Ambulance Services Respond in Aotearoa New Zealand(SAGE Publications, 2025-12-05) Satchell, Eillish; Gott, Merryn; Dicker, Bridget; Moeke-Maxwell, Tess; Anderson, Natalie EBackground: As ambulance services respond to a growing number of out-of-hospital deaths, supporting bereaved families is increasingly recognised as an important aspect of paramedic care. Actions from ambulance personnel can significantly shape family experiences, underscoring the need for compassionate, evidence-based care in the event of a death. However, currently, little is known about the needs and perspectives of families during these events, particularly from Indigenous and culturally diverse populations. This study explores the experience of Māori and non-Māori families from Aotearoa New Zealand who were present at a death where emergency ambulance services responded. Methods: This qualitative study, underpinned by kaupapa Māori research principles, explored family experiences of emergency ambulance care in the context of a death. Participants were recruited through purposive volunteer sampling, with invitations shared via local and social media. Semi-structured interviews employed a collaborative storytelling approach, where researchers and families co-constructed digital narratives of their experiences. Data were analysed using Braun and Clarke's reflexive thematic analysis. Results: We conducted 21 interviews with 23 bereaved family members. Families described having emotional, cultural and spiritual needs during out-of-hospital deaths. Four themes influenced the experiences of family. Making space for family highlighted the importance of meaningful presence and shared decision-making. Compassionate family care reflected the positive impact of compassionate actions. Communication, which was clear and timely, assisted family understanding. Finally, closure in crisis revealed how follow-up support is needed to help families process and accept death. Conclusion: Care that centres empathy, shared decision making, clear communication and responsiveness to individual family needs can improve the experiences of bereaved families. Greater consideration of family needs during resuscitation and its termination is needed to challenge current care paradigms, which equate family presence with family support. Enhancing cultural and spiritual responsiveness offers an opportunity to provide more holistic and culturally safe bereavement care.Item Preparing for Death, Dying and Bereavement Care: Student Paramedic Perspectives on a Novel Learning Module(Informa UK Limited, 2026-04-07) Anderson, Natalie Elizabeth; Satchell, Eillish; Tseng, Bruce; Shaw, Brayden; McAulay, MelEmergency ambulance personnel are commonly the last health professionals to care for people in the moments before death and the first to provide families with bereavement care, particularly when death is sudden or unexpected. Despite this, paramedic training seldom discusses, simulates or assesses termination of resuscitation, or breaking bad news to family. This paper describes paramedicine students’ experiences of a dedicated learning module designed to prepare them for patient death and caring for bereaved families. A lecture, small-group case studies and actor-led simulations were embedded into paramedic degree students’ final year of study. Students shared their perspectives on learning about death, dying, and bereavement through focus groups or an online survey. Students found talking about death and supporting acute grief unfamiliar and uncomfortable. Eager to provide reassurance in a crisis, many expressed ongoing concerns about saying the wrong thing. Participants wanted greater integration of challenging communication and cultural responsiveness throughout their degree, noting opportunities for learning during clinical placements were precious but limited. Actor-led simulation of patient death and family grief presented an important but unfamiliar divergence from standardized, action-packed resuscitation scenarios. Greater acknowledgement of death, dying and bereavement throughout training could better prepare paramedics for the realities of emergency ambulance work.Item Child Protection in Dental Practice: A Review of Legal and Professional Responsibilities in Aotearoa(Tuwhera Open Access, 2026-03-26) Han, HeuiwonSocial and health inequities persist across Aotearoa New Zealand, disproportionately impacting children and families facing systemic disadvantage. Dental practitioners are uniquely positioned to identify early signs of child abuse and neglect due to their regular interactions with children and their whānau. However, many report uncertainty about their legal and professional obligations when responding to child protection concerns, limiting their ability to provide effective support (Han et al., 2022). This review critically examines the legal statutes and professional standards that inform the role of dental practitioners in child protection (Han et al., 2024). It draws on key legislation, including the Oranga Tamariki Act 1989, and professional standards. A narrative analysis revealed that despite the legal and ethical expectations to report concerns and collaborate with child protection services, current professional guidelines lack the clarity necessary to support confident and timely clinical decision-making. Particularly, requirements to inform the child or their family about information sharing are often inconsistently addressed in organisational documents, creating uncertainty for practitioners and potentially interfering with protective actions. The review emphasises the importance of equity-focused, Te Tiriti-informed guidance to promote culturally responsive practice and enhance capacity to respond to child protection concerns. Key recommendations include providing scaffolded professional education, strengthening interdisciplinary collaboration, and developing practical, accessible protocols for both prevention and early intervention, rather than focusing on detection and reporting. Integrating culturally safe and legally sound child protection practices into oral health care is essential to upholding the rights and wellbeing of tamariki and their whānau. In this presentation, I aim to highlight the critical role of dental practitioners in child protection, explore the legal and ethical frameworks that guide their responsibilities, and propose actionable strategies to strengthen their capacity to respond confidently and culturally safely to concerns of abuse and neglect.Item Brushed Aside: A Social Epidemiological Perspective on Asian Children’s Oral Health in Aotearoa New Zealand(Te Mātāpuna AUT Library, 2026-03-24) Wang, Ru-Te; Han, Heuiwon; Lee, BibleDental caries remains a prevalent yet largely preventable non-communicable disease. In Aotearoa New Zealand, child caries persists despite publicly funded oral health services. This commentary applies a social epidemiological lens to children’s dental caries, examining how social, political and economic structures shape oral health, and highlighting gaps in evidence for Asian children. The paper draws on New Zealand and international literature on child caries, policy and governance, and equity frameworks, including Te Tiriti o Waitangi and Kaupapa Māori scholarship, with attention to ethnicity data practices and structural racism. National reporting demonstrates persistent inequities for Māori and Pacific children; however, Asian children are often aggregated into an “Other” category, obscuring heterogeneity. Where Asian children are analysed separately, emerging evidence indicates elevated odds of multiple caries at first dental visits and rising hospital admissions for dental treatment under general anaesthesia, challenging “model minority” assumptions. Explanations focused only on language, acculturation or “cultural beliefs” risk reinforcing Eurocentrism when detached from historical and structural determinants. Equity-oriented action requires culturally safe, structurally informed research and policy, including nationally standardised, ethnicity-disaggregated oral health data and prevention and access strategies co-designed with Asian communities.Item Why Community Water Fluoridation Matters in Clinical Practice: Evidence From the Public Health Association of New Zealand’s New Policy Statement(New Zealand Dental Association, 2026-03-27) Han, Heuiwon; Garland, LukeBackground: Oral health is fundamental to wellbeing in Aotearoa New Zealand, yet dental caries remains a leading cause of childhood hospitalisation and a persistent source of inequity. Community water fluoridation (CWF) is a proven, proportionate, and equitable population measure. This article synthesises the evidence for CWF and translates the Public Health Association of New Zealand’s (PHANZ) 2025 policy position for clinical practice. Methods: A review of national and international evidence on CWF was conducted, incorporating systematic reviews and policy analyses. Policy development drew on engagement with oral health and public health experts and the PHANZ Policy Subcommittee, followed by broader engagement with PHANZ members and final endorsement by the PHANZ Executive Council in June 2025. Findings: CWF can significantly reduce dental caries across the life course, particularly in communities experiencing socioeconomic deprivation. Evidence supports CWF as a safe, cost-effective, and scalable public health measure. The analysis also acknowledges community concerns regarding autonomy and consent, highlighting the importance of community partnership alongside culturally safe implementation of CWF. The PHANZ statement positions CWF as a foundational upstream intervention that should be integrated with broader strategies addressing poverty, access barriers, and wider systemic inequities. Conclusions: Oral health practitioners have a professional and ethical responsibility to advocate for and support CWF through evidence-based communication and culturally safe practice. Implementing and sustaining CWF aligns with clinical ethics and Aotearoa New Zealand’s commitment to equitable oral health outcomes.Item The Roles and Purposes of Caring Touch in Health Professional Practice: A Discourse Analysis(Wiley, 2026-03-23) Power, Nicola; Fadyl, Joanna; Walters, Simon; Payne, DeborahResearch literature concludes that caring touch contributes to physical and psychological wellness. However, in health practice, touch is constructed as acceptable in some situations and not in others. Utilising interviews with nurses and other health professionals, the aim of this study was to explore the discourses shaping the role and purpose of caring touch in health practice. Poststructural methodology, drawn from the work of Michele Foucault, was employed to make visible what discourses of caring touch were legitimised or marginalised in a health setting. At times, caring touch was constructed as an expression of humanness, whilst at others it was expressly part of a professional practice. Findings showed that discourses shaping choices to engage in acts of caring touch with patients were linked to the social construction of the relationship between the patient and the professional. Whilst some practitioners talked about integrating caring touch into practice with little difficulty, for others, caring touch was constructed as an ‘extra’. Discourses that shaped professional subjectivities were key to those differences. Findings from this paper build on existing understandings of caring touch in literature by highlighting the unique interplay of discourses in practice.Item Applying a Health Care Planning Model to Midwifery: Evidence from Germany and New Zealand(Oxford University Press (OUP), 2025-10-27) Griese, A; Schüssler, F; Fleming, T; Leinweber, JBackground Midwifery workforce planning is essential to ensure equitable access to maternal care but differs widely across countries. Because a dedicated planning tool is lacking, Germany currently does not perform demand-oriented planning for midwifery services. In contrast, New Zealand facilitates planning through centralized data collection and national coordination. This study investigates how planning approaches affect the distribution and accessibility of maternal health care in Germany and New Zealand. Methods Midwifery workforce and population data from Germany and New Zealand were analyzed using a German physician-based demand planning tool adapted for midwifery services. GIS mapping visualized workforce-to-population ratios, spatial accessibility, and socioeconomic disparities in service distribution. Regional care patterns were compared across both systems. Results Application of the adapted physician-based tool in Germany revealed substantial care gaps in rural and peripheral regions, reflecting the absence of a midwifery-specific planning framework. In contrast, assessment in New Zealand showed a more balanced distribution of midwifery services, including remote areas. Centralized workforce monitoring and register-based planning appear to support more equitable access and responsive resource allocation. Conclusions Germany's lack of a dedicated workforce planning system contributes to regional and social inequities in care provision, particularly affecting women with low socioeconomic status. In contrast, New Zealand's structured approach, including centralized monitoring and targeted planning, supports a more balanced distribution across income groups. Adopting such elements may help improve service equity. This study underlines the relevance of tailored planning systems for maternal health and informs policy development. Key messages • Germany’s lack of midwifery planning leads to inequitable access for rural and low-income groups. • New Zealand’s structured system enables more balanced midwifery service provision.Item Simulation of Phased Alerting of Community First Responders for Cardiac Arrest(Public Library of Science (PLoS), 2026-03-03) van den Berg, Pieter L; Henderson, Shane G; Li, Hemeng; Dicker, Bridget; Jagtenberg, Caroline JBACKGROUND: Community First Responders (CFRs) are commonly used for out-of-hospital cardiac arrests, and advanced systems send so-called phased alerts: notifications with built-in time delays. The policy that defines these delays affects both response times and volunteer fatigue. METHODS: We compare alert policies by Monte Carlo Simulation, estimating patient survival, coverage, number of alerts and redundant CFR arrivals. In the simulation, acceptance probabilities and response delays are bootstrapped from 29,307 rows of historical data covering all GoodSAM alerts in New Zealand between 1-12-2017 and 30-11-2020. We simulate distances between the patient and CFRs by assuming that CFRs are located uniformly at random in a 1-km circle around the patient, for different CFR densities. Our simulated CFRs travel with a distance-dependent speed that was estimated by linear regression on observed speeds among those responders in the above-mentioned data set that eventually reached the patient. RESULTS: The alerting policy has a large impact on the four metrics above, and the best choice depends on volunteer density. For each volunteer density, we are able to identify a policy that improves GoodSAM New Zealand's current policy on all four metrics. For example, when there are 30 volunteers within 1 km from the patient, sending out alerts to 7 volunteers and replacing each volunteer that rejects by a new one, is expected to save 10 additional lives per year compared to the current policy, without increasing volunteer fatigue. Our results also shed light on polices that would improve one metric while worsening another, for example, when there are 10 volunteers within 1 km from the patient, dispatching them all immediately increases our survival estimate by 11% compared to the current policy, with the downside of also increasing the redundant arrivals by 137%. CONCLUSIONS: Monte Carlo simulation can help CFR system managers identify a good policy before implementing it in practice. We recommend balancing survival and volunteer fatigue, aiming to ultimately further improve a CFR system's effectiveness.Item Mental Health Related Callouts to the Ambulance Service in Aotearoa New Zealand: A Descriptive Analysis(Pasifika Medical Association Group, 2026-02-27) Harding, Gabrielle; Fortune, Sarah; Ramalho,, Rodrigo; Swain, Andrew; Brett, Aroha; Dicker, BridgetAims: This study aimed to determine the association between demographic and clinical characteristics of mental health–related callouts to the ambulance services in Aotearoa New Zealand, focussing on differences among Māori, Pacific peoples and non-Māori non-Pacific peoples (NMNPP). Methods: A retrospective cross-sectional study analysed routinely collected data from electronic patient report forms between 1 July 2022 and 30 June 2023. Mental health–related callouts were identified using clinician-coded impressions from the Aotearoa New Zealand Paramedic Care Collection. Results: Of 26,847 callouts, a higher proportion involved individuals under the age of 24 among Māori (31.9%) and Pacific people (29.3%) compared to NMNPP (19.1%) (p<0.001). Callout proportion was higher in the most deprived areas, particularly among Māori (47.7%) and Pacific peoples (49.9%) versus NMNPP (24.5%) (p<0.001). Of total individual callouts, 15.8% presented more than once, with a higher proportion among Māori. Conclusions: This study demonstrates an association between ethnicity, deprivation and mental health–related ambulance callouts, with Māori and Pacific populations in deprived areas experiencing proportionately higher callouts. Findings highlight the need for culturally responsive interventions and equitable access to care. Ambulance data can inform policy and monitor mental health trends.Item 'Flipping the Chair': A Satellite Model for Dental Education in Rural and Remote Communities in Aotearoa New Zealand.(Wiley, 2025-12-28) Lansdown, Karen; Han, Heuiwon; Fernandez, Daniel; Cleland, Tanya; Martin, Melody; Hamer, Helen Paris; Khareedi, RohiniAIM: This article introduces an innovative educational model, 'flipping the chair,' a dynamic approach to delivering rural and remote education. Drawing on 4 years of satellite teaching experiences at Auckland University of Technology (AUT), we share key insights and lessons learnt to inform future initiatives in other university and educational settings. CONTEXT: Delivering comprehensive oral health education to rural and remote communities can be a complex challenge due to geographic isolation, limited resources, and workforce shortages. To address these inequities, a strategic partnership was formed in 2022 with Health New Zealand-Te Whatu Ora in Northland. This collaborative initiative prioritises the recruitment of Māori (Indigenous population of Aotearoa New Zealand) students who may experience significant barriers to accessing higher education in urban regions, with the benefit of academic study in familiar surroundings. APPROACH: Our satellite model of dental education was introduced in 2022 with an initial cohort of six first-year students, five students in 2023, nine in 2024, and five in 2025. Across all years, 56% of students identified as Māori. The first graduating cohort of five students completed the programme in 2024. This article discusses how AUT developed and implemented dental education within rural and remote communities. CONCLUSION: By adapting and 'flipping' the traditional university model, we have developed a sustainable approach to rural and remote dental education with promising educational outcomes.Item "The whole thing is just really difficult": Experiences of Dental Services for Children and Adults With Cerebral Palsy in Australia - A Qualitative Study(Informa UK Limited, 2025-11-29) Lansdown, Karen; Smithers-Sheedy, Hayley; Bulkeley, Kim; Zagreanu, Claudia; Irving, Michelle; McGrath, MargaretPURPOSE: People with cerebral palsy (CP) often experience significant barriers to accessing dental care, yet this area remains under researched in Australia. This study explored how people with CP and their caregivers experience dental services in Australia. METHODS: Semi structured interviews were conducted with a total of (n = 13) participants, including caregivers of children with CP (n = 4), adults with CP (n = 5) and caregivers of adults with CP (n = 4). RESULTS: Reflexive thematic analysis revealed three key themes: (1) "The whole thing is just really difficult-Difficulties in identifying and accessing dental services for people with CP," (2) When care stops at the chair-Ableism in oral health care and (3) Person-centred care-How the dental profession can be more welcoming to people with CP. Two of these themes included sub-themes. People with CP experience complex and often overlooked challenges in accessing dental services, influenced by clinical and structural barriers, as well as by systemic failures and the quality of interaction with dental practitioners. When dental care is positive, it is underpinned by trust, effective communication, respect, and genuine partnership. CONCLUSION: People with CP and their caregivers in this study identified structural and interpersonal barriers to dental service access, while also suggesting practical, inclusive, and coordinated solutions to improve access to dental care.Item Provider Perspectives on Heart Healthcare Inequities Among Māori and Pacific Peoples in Aotearoa New Zealand: A Qualitative Study(Elsevier BV, 2025-12-18) Taueetia-Su'a, T; Brewer, KM; Ameratunga, S; Hanchard, S; Selak, V; Dicker, B; Rahiri, JL; Grey, C; Harwood, MObjective: We explored service providers’ views on evidence–practice gaps and inequities in heart health care for Māori and Pacific peoples, alongside solutions to address these issues. Methods: Employing Kaupapa Māori and Pacific research methodologies, we recruited Māori, Pacific, and non-Māori/Pacific providers, purposively sampled from a range of disciplines. Semi-structured interviews were conducted individually and in focus groups. Differences in perspectives offered by Māori and Pacific providers are compared to those of non-Māori/Pacific providers. Results: Twenty-three providers, identifying as Māori (6), Pacific (5), or non-Māori/Pacific (12), shared their views of the healthcare system, experiences of providing care, and observations of Māori and Pacific patient and whānau experiences. Results were grouped into three themes: Tikanga Māori and Fa'a Pasifika versus non-Māori/Pacific ways; gaps in the health system for Māori and Pacific patients; and solutions. Māori and Pacific providers emphasised structural determinants, systemic failures and workforce inadequacies underlying inequities. Conclusions: There is a critical need for equity-focused, holistic and relational models of heart health care that are co-designed with Māori and Pacific patients and whānau, and delivered by a culturally safe workforce. Implications for Public Health: Adequately resourced services, designed by and for Māori and Pacific peoples, have the potential to achieve equitable heart health care outcomes.Item Emergency Ambulance Care of Families During Death, Dying, and Bereavement: A Document Analysis of Australian and Aotearoa New Zealand Clinical Practice Guidelines(Elsevier, 2025-06-26) Satchell, Eillish; Gott, Merryn; Juhrmann, Madeleine; Dicker, Bridget; Anderson, Natalie ElizabethBACKGROUND: Ambulance personnel play an important role in supporting families during death, dying, and bereavement. Evidence-based clinical practice guidelines are crucial for ensuring high-quality ambulance care. However, it is unknown what guidance currently informs care of bereaved families. This document analysis examines ambulance guidelines pertaining to family care in out-of-hospital death in Australia and Aotearoa New Zealand. METHODS: Clinical practice guidelines were sourced from all Australian and Aotearoa New Zealand ambulance services. Using qualitative document analysis, guidance addressing family care during death, dying, and bereavement was examined. Analysis was conducted using a customised coding framework informed by the Australian National Consensus Statement: Essential Elements for safe and high-quality end-of-life care. RESULTS: While most guidelines included essential elements of end-of-life care, there was significant heterogeneity in the scope, detail and nature of guidance. Care instructions varied between services, populations and clinical scenarios. Guidance pertaining to culturally safe care was limited. CONCLUSIONS: Ambulance clinical guidance remains focused on technical skills during resuscitation, death, and dying. More guidance is needed to inform important elements of family care such as communication, family partnership, and cultural safety. Incorporating evidenced-based principles of end-of-life care presents an opportunity to improve ambulance support for bereaved families.Item Te ara o Manawataki Fatu Fatu-Kaupapa Māori and Pacific Qualitative Co-design Hui to Explore Cardiovascular Disease Care for Māori and Pacific Peoples in Aotearoa New Zealand(Pasifika Medical Association Group, 2025-11-21) Rahiri, Jamie-Lee; Tuhoe, Jason; Hanchard, Sandra; Houma, Alyssa; Appleby, Noah; Brewer, Karen; Taueetia-Su'a, Tua; Tane, Taria; Ameratunga, Shanthi; Selak, Vanessa; Dicker, Bridget; Grey, Corina; Harwood, MatireAIM: Cardiovascular disease (CVD) inequities in Aotearoa New Zealand disproportionately affect Māori and Pacific peoples, who experience higher risk factors, hospitalisations and mortality than NZ Europeans. These disparities stem from the historical and contemporary effects of colonisation, including institutional racism, impacting access to healthcare and socio-economic resources. Despite guidelines for earlier CVD risk assessments (CVDRA), gaps in identification and management persist. METHOD: The Manawataki Fatu Fatu (MFF) for Māori and Pacific Hearts in Unison for Achieving Cardiovascular Care in Equity Studies (ACCESS) is a Māori and Pacific-led research programme examining CVD inequities in Aotearoa New Zealand. This study presents phase three, focussing on qualitative co-design hui (meetings) across Aotearoa New Zealand to gather insights from Māori and Pacific patients, whānau (family/supports) and kaimahi (healthcare workers) engaged with CVD services spanning primary to secondary care. RESULTS: A total of 105 participants attended four regional hui focussed on the heart healthcare experiences of Māori and Pacific peoples in Aotearoa New Zealand. Template analysis revealed four key themes for achieving equitable healthcare: the importance of the whānau/community, the need for providers to engage with patients at their level, the persistent barriers faced and a strong commitment to protecting Māori and Pacific communities and kaimahi. CONCLUSION: This study is a comprehensive qualitative investigation into heart healthcare for Māori and Pacific peoples in Aotearoa New Zealand. The findings reiterate that care must align with the realities of Māori and Pacific peoples and that interventions must address long-standing systemic barriers to care.Item Enhancing Birth Weight Outcomes Through Improved Antenatal Care in West African Countries: Evidence from Propensity Score Matching Analysis(Public Library of Science (PLoS), 2025-11-20) Hailegebireal, Aklilu Habte; Bizuayehu, Habtamu Mellie; Gele, Samuel Hailegebreal; Asnake, Angwach AbrhamWhile many underlying causes of low birth weight (LBW, < 2500 grams) are preventable through overall antenatal care (ANC) uptake, limited empirical evidence exists in West Africa quantifying the impact of the WHO-recommended four or more visits (ANC4+) and eight or more visits (ANC8+) models using rigorous causal inference techniques. Thus, this study aimed to examine the causal effect of those two models on birth weight outcomes in West African countries using propensity score matching (PSM). This study included a weighted sample of 51,455 women sourced from Demographic and Health Surveys (DHS) data from 14 West African countries (2012-2023). Covariates associated with treatments (ANC4+ and ANC8+) and birth weight were identified using Chi-square tests, one-way analysis of variance (ANOVA), and t-tests, and those deemed confounders were included in PSM. PSM was applied using a logit model to estimate the causal effects of ANC4+ and ANC8+ on birthweight. Average Treatment Effect on the Treated (ATT) and Average Treatment Effect (ATE) were calculated for each exposure. Quality of matching was assessed both statistically and graphically. Sensitivity analysis was done using Rosenbaum bounds to estimate unmeasured confounding and confirm the robustness of treatment effects. The mean birthweight was 3121.2 grams (±669.0), with 10.42% of newborns classified as LBW. Receiving ANC8+ and ANC4 + were associated with a birthweight increase of 102.36 and 83.89 grams, respectively. Across the entire population, ANC8+ and ANC4 + were linked to average birthweight increases of 89.09 and 75.81 grams, respectively. Of the weighted sample, 71.38% and 14.54% of women received ANC4+ and ANC8 + , respectively. All matching diagnostics demonstrated strong covariate balance and confirmed the validity of the treatment effect estimates. The treatment and control groups were well comparable for the baseline confounders after matching (p-value > 0.05). This study found that receiving ANC4+ or ANC8 + has a positive effect on birth weight, underscoring the importance of scaling up efforts to ensure comprehensive ANC coverage, especially ANC8 + , in the region to reduce LBW prevalence and improve neonatal survival.Item Independent Qualitative Evaluative Study of Calmbirth Antenatal Classes(Springer Publishing Company, 2025-02-28) Crowther, S; Hollingshead, B; McAra-Couper, J; Donald, H; Hotchin, CHigh childbirth intervention rates impose risk to women and infants. It is imperative that ways to mitigate this are found. Calmbirth is an antenatal program that incorporates a variety of strategies that could be helpful. The aim of this qualitative evaluation was to explore the acceptability and experiences of attending Calmbirth antenatal classes. Eighteen individual and/or couple postnatal interviews were conducted. Analysis using a psycho-emotional conceptual framework was applied to data. The study found that Calmbirth courses empowered participants, increased their health literacy, and provided them with more personal psychosocial coping strategies. While some participants found the classes not helpful, others experienced a positive reframing of childbirth. Although Calmbirth is acceptable and experienced positively by most women and partners, further work is required to address broader sociocultural influences in places of birth.Item A Participatory Virtual Audit of the Built Environment for Age-Friendliness(Springer Science and Business Media LLC, 2025-11-22) Curl, Angela; Watkins, Alison; Smithies, Amanda; Dares, Cushla; Pocock, Tessa; Williman, Jonathan; Todd, Verity; Dicker, Bridget; Keeling, SallyBACKGROUND: Geospatial studies that consider the relationships between the built environment and health typically rely on researcher-led 'objective' measurement of geospatial attributes of the built environment. Some studies can fail to find expected associations between environments and health outcomes where the geospatial measures do not reflect the experiences or perceptions of people themselves. We took a participatory approach to work with older adults with a concern for falling to assess the built environment in order that we could understand how their assessments relate to researcher assessments. We also wanted to assess whether specific demographic characteristics explained differences in assessments of the built environment between participants. Age-friendly environments can contribute to healthy active ageing. Falling and a fear of falling can lead to restricted outdoor activity. Therefore, understanding how the built environment contributes to fear of falling is important for age-friendly environments. METHODS: The study is a cross-sectional retrospective observational study of the built environment. We worked with older adults in workshop settings to undertake community audits of the built environment in Google Street View. They assessed locations where a fall had occurred. Researchers separately audited the same locations. We used descriptive statistics and ordinal regression cumulative link mixed models to estimate the odds that community members would rank a location one level higher than the researchers. RESULTS: There are significant differences in researcher and community auditor assessments of locations of attractiveness. Site related and individual attributes explain variation in how difficult locations were rated for walking, and for concern about falling. Only individual attributes explained variation in site attractiveness. Locations with more trip hazards and steeper slopes were rated as being more difficult to walk and were associated with greater concern for falling. CONCLUSIONS: Attributes of the built environment influence perceptions of difficulty walking and concern or falling at specific locations. Furthermore, there are some differences in how researchers and community auditors assess the same locations, meaning that geospatial studies which rely only on researcher assessments may be prone to bias. Involving older people in geospatial studies that measure age-friendly environments can make measurement more reflective of their experiences.Item Implementation of Telerehabilitation in Response to COVID-19: Lessons Learnt from Neurorehabilitation Clinical Practice and Education(New Zealand Journal of Physiotherapy, 2020-01-01) Signal, Nada; Martin, T; Leys, A; Maloney, R; Bright, FelicityThe health response to the COVID-19 pandemic has had significant impacts on neurorehabilitation provision both internationally and in New Zealand. Telerehabilitation, the delivery of rehabilitation at a distance using information and communication technologies, was advocated as a means of addressing the rehabilitation needs of our patients while maintaining physical distancing and reducing the risk of viral transmission. Despite research evidence indicating that telerehabilitation is as effective as in-person rehabilitation for people with neurological conditions, there were significant challenges in delivering and sustaining telerehabilitation practice. We draw upon our experiences in delivering telerehabilitation in neurorehabilitation clinical practice and education to reflect on the process of practice change and to consider how these experiences can inform practice development in the future. We propose that rehabilitation organisations and physiotherapists continue to develop capability to provide telerehabilitation; that physiotherapists and the physiotherapy profession focus on translating their communicative, relational and clinical skills to the digital space to ensure they are competent in telerehabilitation; and that, as a profession, we focus on what constitutes “best practice” in telerehabilitation, and how in-person and telerehabilitation can be integrated to provide engaging, evidence-based and person-centred rehabilitation.