Exploring rural and remote patients’ experiences of health services for kidney disease in Aotearoa New Zealand: An in‐depth interview study

Nephrology ◽  
2022 ◽  
Author(s):  
Rachael C. Walker ◽  
Sandra Hay ◽  
Curtis Walker ◽  
David Tipene‐Leach ◽  
Suetonia C. Palmer
2021 ◽  
Author(s):  
Rachael Claire Walker ◽  
Sally Abel ◽  
Suetonia Palmer ◽  
Curtis Walker ◽  
Nayda Heays ◽  
...  

Abstract BackgroundReported experiences of racism in Aotearoa New Zealand are consistently associated with negative measures of health, self-rated health, life satisfaction, and reduced access to high quality healthcare with subsequent poor health outcomes. In this paper we report on perceptions and experiences of prejudice and racism by Indigenous Māori with kidney disease, their family members and donors who took part in a wider study about experiences of kidney transplantation.MethodsWe conducted semi-structured interviews with 40 Māori. Participants included those with kidney disease who had considered, were being worked up for, or who had already received a kidney transplant as well as family members and potential or previous donors. We examined the data for experiences of racism using a theoretical framework for racism on three levels: institutionalised racism, personally mediated racism, and internalised racism.ResultsWe identified subthemes at each level of racism: institutional (excluded and devalued by health system; disease stigmatisation; discriminatory body weight criteria, lack of power), personally-mediated (experiencing racial profiling; explicit racism) and internalized racism (shame and unworthiness to receive a transplant).ConclusionsThe wide-reaching experiences and perceptions of racism described by participants with kidney disease and their families in this research point to an unfair health system and suggests that racism may be contributing to kidney transplantation inequity in Aotearoa New Zealand. Addressing racism at all levels is imperative if we are to address inequitable outcomes for Māori requiring kidney transplantation.


2018 ◽  
Vol 31 (4) ◽  
pp. 570-577 ◽  
Author(s):  
Carola van Dipten ◽  
Wim J.C. de Grauw ◽  
Jack F.M. Wetzels ◽  
Willem J.J. Assendelft ◽  
Nynke D. Scherpbier-de Haan ◽  
...  

2014 ◽  
Vol 7 (3) ◽  
pp. 111-121 ◽  
Author(s):  
Jemaima Tiatia-Seath

Purpose – The purpose of this paper is to discuss the engagement of Pacific peoples in mental health services in Aotearoa New Zealand and Pacific strategies for suicide prevention. Design/methodology/approach – This qualitative study involved 22 interviews with Samoans who had made a suicide attempt and/or had suicide ideation, were engaged in a mental health service. Findings – Narratives of mental health services and suicide prevention focused on issues of cultural competency, the importance of family involvement, dichotomous views of western and traditional beliefs around mental illness and the unsuccessful engagement of Pacific youth. Originality/value – This research argues that cultural considerations for Pacific communities are of paramount importance if mental health service engagement and developments towards Pacific suicide prevention strategies are to be effective.


Author(s):  
Suetonia C. Palmer ◽  
Harriet Gray ◽  
Tania Huria ◽  
Cameron Lacey ◽  
Lutz Beckert ◽  
...  

Abstract Background Persistent inequities in health experiences and outcomes are observed for Māori compared to non-Māori in Aotearoa New Zealand. We conceptualised factors associated with Māori consumer experiences of health programs and services and characterise how the recommendations arising from qualitative research inform strategies to address inequities. Methods In this systematic review, electronic literature searching was conducted in February 2018. Qualitative studies reporting Māori consumer experiences of health services and programs in Aotearoa New Zealand were eligible. Māori consumer experiences of health services were mapped to the WHO Commission of Social Determinants of Health (CSDH) conceptual framework on health inequities as related to: (i) the socioeconomic and political context; (ii) socioeconomic positioning; or (iii) intermediary factors that increase exposure to health-compromising conditions. Recommendations to improve consumer experiences were mapped to the CSDH framework for tackling social determinants of health inequities as policy directions on: (i) unequal consequences of illness (individual interaction); (ii) risks of exposure to health-damaging factors (community); (iii) exposures to health-damaging factors (public policies); and (iv) mitigating effects of socioeconomic and political stratification (environment). Results Fifty-four studies were included. Māori consumer experiences mapped to social determinants of health inequities were most frequently related to direct interactions with health services and programs, particularly patient-clinician interactions (communication, relationships) and cultural competencies of clinicians and the system. Key recommendations by researchers mapped to potential strategies to address inequity were identified at all levels of the political, social and health system from individual interactions, community change, and broader public and system-level strategies. Recommendations were predominantly focused on actions to reduce risks of exposure to health-damaging factors including health literacy interventions, increased resources in cultural competencies and Māori capacity in health service development and workforce. Conclusions Māori consumer experiences of health services and programs are an important informer of variables that impact health inequity. Strategies to tackle health inequities informed by Māori consumer experiences can be drawn from existing empirical research. Future qualitative exploration of how socioeconomic, political and public policies influence Māori consumer experiences of health services and programs could inform a broader range of structural policies to address health inequities.


BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e048215
Author(s):  
Jaymie Tingkham Rogers ◽  
Joanna Black ◽  
Matire Harwood ◽  
Ben Wilkinson ◽  
Iris Gordon ◽  
...  

IntroductionIn Aotearoa New Zealand, Māori and Pacific people experience worse health outcomes compared with other New Zealanders. No population-based eye health survey has been conducted, and eye health services do not generate routine monitoring reports, so the extent of eye health inequality is unknown. This information is required to plan equitable eye health services. Here we outline the protocol for a scoping review to report the nature and extent of the evidence reporting vision impairment, and the use of eye health services by ethnicity in New Zealand.Methods and analysisAn information specialist will conduct searches on MEDLINE and Embase, with no limit on publication dates or language. We will search the grey literature via websites of relevant government and service provider agencies. Reference lists of included articles will be screened. Observational studies will be included if they report the prevalence of vision impairment, or any of the main causes (cataract, uncorrected refractive error, macular degeneration, glaucoma or diabetic retinopathy) or report the use of eye health services in New Zealand among people of any age. Two authors will independently review titles, abstracts and full-text articles, and complete data extraction. Overall findings will be summarised using descriptive statistics and thematic analysis, with an emphasis on disaggregation by ethnicity where this information is available.Ethics and disseminationEthical approval has not been sought as our review will only include published and publicly accessible data. We will publish the review in an open access peer-reviewed journal. We anticipate the findings will be useful to organisations and providers in New Zealand responsible to plan and deliver eye care services, as well as stakeholders in other countries with differential access to eye care.Registration detailsThe protocol has been registered with Open Science Framework (https://osf.io/yw7xb).


BMJ Open ◽  
2017 ◽  
Vol 7 (1) ◽  
pp. e013829 ◽  
Author(s):  
Rachael C Walker ◽  
Shayne Walker ◽  
Rachael L Morton ◽  
Allison Tong ◽  
Kirsten Howard ◽  
...  

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