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- ItemPaediatric COVID-19 Vaccination Coverage and Associated Factors Among Migrant and Non-migrant Children Aged 5–11 Years in Aotearoa New Zealand: A Population-Level Retrospective Cohort Study(Wiley, 2023-09-19) Charania, Nadia; Linda, Kirkpatrick; Janine, PaynterObjective Children with migrant and refugee backgrounds may experience immunisation inequities due to barriers to accessing and accepting vaccines. In Aotearoa New Zealand (NZ), national reporting can mask inequities in coverage by migration background. This study explored paediatric COVID-19 vaccine uptake among children with migrant and refugee backgrounds. Methods This population-level retrospective cohort study compared rates and determinants of paediatric COVID-19 vaccine uptake as of July 2022 amongst migrant and non-migrant children who were aged between 5 and 11 years as of January 2022. Linked de-identified administrative and health data available in Statistics NZ’s Integrated Data Infrastructure were used, and univariate and multivariable logistic regression were conducted to determine associations. Results Of the total study population (N = 451,323), 3.5% were overseas-born migrant children, 31.3% were NZ-born migrant children, and 65.3% were NZ-born non-migrant children. Only 50.8% (229,164 out of 451,323) of children had received at least one dose. Migrant children were significantly more likely to have received a COVID-19 vaccination than non-migrant children. Logistic modelling revealed that all factors, including ethnicity, gender, age, family type, household income, deprivation, region, parent COVID-19 vaccination status, and child’s previous COVID-19 infection, significantly influenced COVID-19 vaccine uptake. The largest contributing factor was parents’ COVID-19 vaccination status. Conclusions The findings suggest that NZ’s paediatric COVID-19 vaccination programme was able to address logistical and motivational barriers commonly identified amongst migrants and refugees. Implications for public health As parents’ vaccination status is an important factor in vaccinating their own children, continuous efforts are needed to support confident parental COVID-19 vaccine decision-making. To address social inequities, engagement with marginalised communities to co-design tailored and localised approaches is recommended.
- ItemDancing in a Red Dress: Empowering Metaphors of Academics’ Experiences of the Manuscript Peer Review Process(Informa UK Limited, 2023-09-07) Hammond, Kay; Trafford, JulieThe peer review of journal article manuscripts is a complex and emotionally fraught process. This article draws on how 25 academic authors used metaphor to describe their experiences of manuscript peer review. A critical analysis of these metaphors provided insight into the structures, relationships of power, and their emotional impacts. Over their careers, some academics reconceptualised their metaphors more powerfully to describe their evolving experiences and confidence over time. Their metaphors repositioned their sense of power within the reviewer/reviewee binary. We discuss how these reconceptualisations could guide new authors to manage feelings, thinking, and actions during peer review. This research makes an original contribution by extending the exploration of how metaphors and their reconceptualisations build emotional resilience. Academics new to publishing may gain a greater sense of empowerment while navigating the peer review process, reduce the negative emotional impacts, and prevent the resulting loss of valuable research.
- Item“I haven't even taken them to the doctors, because I have that fear of what to expect”: A Qualitative Description Study Exploring Perceptions and Experiences of Early Childhood Healthcare Among Ethnically Diverse Caregivers in Aotearoa New Zealand(Elsevier, 2023-09-08) Charania, Nadia; Bhatia, Anjali; Brown, Shirleyanne; Leaumoana, Tulua; Qi, Hongxia; Sreenivasan, Dharshini; Tautolo, El-Shadan Dan; Clark, TerryannSummary Background Equity underpins Aotearoa New Zealand's publicly funded healthcare system; however, ethnic inequality persists. This qualitative study explored the perceptions and experiences of ethnically diverse parents accessing health services for their children. Methods A qualitative description methodology informed interviews and focus groups that were conducted with caregivers of preschool aged children who identified as being of Māori, Pacific, Asian and/or European ethnicity (n = 145). Data were analysed following a reflexive thematic analytic approach. Findings Five themes were constructed. Hierarchies of knowledge and trust Caregivers relied on multiple sources of health information and particularly trusted providers or other caregivers who had children. Relational versus transactional health encounters Caregivers were often disappointed that health providers did not build trusting relationships to support positive experiences. Bad mother vibe Mothers often felt judged by providers when accessing care and felt pressure to conform. The ‘slow burn’ of waiting Caregivers were often frustrated by how slow and fragmented the health system was, which was particularly distressing if their child was unwell or required referral. Navigating complexity Caregivers had to be proactive and assertive to ensure their child received care amidst the numerous barriers they faced, including discrimination and bias. While many commonalities were shared by ethnicity, unique to Indigenous Māori caregivers were the ongoing colonial traumas that impacted their ability to trust the healthcare system. Interpretation A non-judgemental, competent, and culturally sensitive approach by healthcare professionals and services may help foster trusting relationships and positive health encounters. Strategies to improve trust, ease of access and navigation are needed to mitigate existing complexity, fragmentation, and counter-intuitive nature of the NZ healthcare system. Caregivers require more autonomy over decisions about their child's care and availability of services that reflect their cultural values. Policies are required to alleviate the indirect costs of accessing healthcare, prioritising of whānau/family-centred care, and addressing pervasive racism and bias within the system.
- ItemBarriers to and Recommendations for Equitable Access to Healthcare for Migrants and Refugees in Aotearoa, New Zealand: An Integrative Review(Springer, 2023-09-04) Kanengoni‑Nyatara, Blessing; Watson, Katie; Galindo, Carolina; Charania, Nadia; Mpofu, Charles; Holroyd, EleanorThe health system in Aotearoa New Zealand is predicated on equity in access to health services as a fundamental objective yet barriers to equitable access for migrant and refugees continue to exist. There is a paucity of studies that synthesise the experiences and realities of migrants, refugees and healthcare providers that hinder access to healthcare and provide recommendations to improve services. This review synthesised these barriers and recommendations, with an aim to improve equitable access to healthcare to migrants and refugees. An integrative review of 13 peer-reviewed research studies from EBSCOhost research databases published between January 2016 and September 2022. Studies included: (i) related to Aotearoa; (ii) had a focus on equitable delivery of healthcare to migrants and refugees; and (iii) had a full English text available. The PRISMA framework guided the reporting of the review. The findings were thematically analysed and presented using a narrative empirical synthesis. The findings were organised into three broad themes: attitudinal barriers, structural barriers, and recommendations. Attitudinal barriers included the lack of culturally competent healthcare providers, discrimination by healthcare providers, and personal, social, and cultural attributes. Structural barriers referred to policies and frameworks that regulated the accessibility of health services such as the cost of healthcare, accessibility and acceptability of interpreter services, length of allocated appointments and long waiting times for an appointment, difficulties navigating the health system, and logistical barriers. Recommendations focused on promoting a sense of belonging, enabling a whole-of-society approach that brings together all sectors involved in providing health care for collective impact, and advocating for government policies to create a system that addresses the core health service access needs. This review provides rich context-specific findings on the barriers to equitable access to healthcare and proposed interventions to enhance equitable health outcomes for migrants and refugees in Aotearoa. The review contributes to relevant policy decisions and has practical implications to build responsive health systems which are inclusive, equitable and best address the health needs of populations from diverse cultural backgrounds.
- ItemCritical Tiriti Analysis: A Prospective Policy Making Tool from Aotearoa New Zealand(SAGE Publications, 2023-04-19) Came, Heather; O'Sullivan, Dominic; Kidd, Jacquie; McCreanor, TimRestrictions on Indigenous peoples’ contributions to policymaking pervade post-settler societies like Australia, Canada and Aotearoa. Such effects are observed in spite of agreements like Te Tiriti o Waitangi in Aotearoa and the United Nations’ Declaration on the Rights of Indigenous Peoples. Te Tiriti, negotiated between the British Crown and Māori (Indigenous peoples of Aotearoa), may have been entered into honourably by both parties, but the Crown has consistently resisted its implementation. Contemporary colonialism is characterised by the entrenched and on-going displacement of Indigenous people’s authority by settler states, rationalised by race as a determinant of human worth. Impacts include land alienation, unsustainable resource exploitation and marginalising Indigenous voices from opportunities to make policy consistent with Indigenous values and preferred ways of living. Colonialism normalises institutional racism so that public policy outcomes are persistently unjust. This article describes Critical Tiriti Analysis (CTA), an original contribution to transforming colonial policy, which retrospectively evaluates whether any specific policy document is consistent with Te Tiriti. Substantial interest in CTA from policymakers, practitioners, and scholars led to the development of the tool as a prospective guide to making policy that is consistent with authoritative interpretations of Te Tiriti, and therefore, more likely effective in producing public policies which eliminate inequities. CTA was initially focused on health policy and built on a series of questions that arise from our interpretations of the text of Te Tiriti, contemporary Tiriti scholarship and jurisprudence, and our observations of the ways in which the method is being used by ourselves and others. Although deeply grounded in Aotearoa, we argue that CTA may be transferable to other colonial contexts, such as the Australian where treaties between First Nations and the state are being contemplated, and Canada which has passed legislation to implement the Declaration on the Rights of Indigenous Peoples.