Publications

Experiences and perspectives of thriving (or not) as Māori and Pacific allied health professionals

Fri, 23 Jan 2026 00:11:08 GMT

2025

Authors

Tofi, U., Kayes, N., Wilson, B.

Abstract

To explore the perspectives and experiences of Māori and Pacific allied health professionals (AHPs) regarding what enables them to thrive or flourish in their first 2 years of practice, within a large public hospital setting. methods: A qualitative study grounded in shared Māori and Pacific peoples’ values and practices was undertaken, which drew on tenets of appreciative inquiry (AI) with thematic analysis of wānanga talanoa (referring to traditional and culturally informed Māori and Pacific processes, which provide a physically, spiritually and culturally safe space for discussion, knowledge sharing and co-creating meaning). Participants were Māori or Pacific AHPs (n=11) employed at a publicly funded, urban health organisation. results: Three interrelated themes were constructed, including: 1) valuing cultural intelligence, 2) surviving, rather than thriving, and 3) it takes a village. Participants provided a range of ideas for how things could be different, which underpin tangible recommendations for health organisations to support Māori and Pacific AHPs to thrive. conclusion: Informed by both Māori and Pacific peoples’ values and principles, this study highlighted experiences, challenges and opportunities relevant to thriving as Māori and Pacific AHPs in their first 2 years of practice. Rather than minimising the impact that negative experiences of ongoing colonisation and racism have on AHP wellbeing, the purposefully adopted strengths-based approach highlighted collective strengths and solutions for positive change.

Publication Link

https://nzmj.org.nz/journal/vol-138-no-1615/experiences-and-perspectives-of-thriving-or-not-as-maori-and-pacific-allied-health-professionals

Strategies that impact the workforce retention of physiotherapists and other allied health professionals: a scoping review

Fri, 23 Jan 2026 00:04:30 GMT

2025

Authors

Watson, G., Rodger, R., Buhler, M., Tofi, U., Gauld, R., Perry, M.A.

Abstract

Background

Retaining physiotherapists is essential for addressing health workforce shortages and maldistribution. The limited amount of existing research has focused on what factors influence physiotherapists’ intent to stay. This review aimed to synthesise research measuring the impact of workforce strategies on the retention of allied health professionals (AHPs) and the implications for physiotherapy, with a secondary focus on workforce diversity and inclusion.

Method

A scoping review was conducted following PRISMA and JBI guidelines. Comprehensive searches of academic and grey literature databases were completed. Two reviewers independently screened and reviewed the studies for eligibility using Covidence®. Key characteristics of eligible studies were extracted into a data charting table.

Results

Of the 5957 studies retrieved, 22 met the eligibility criteria. Twelve studies recruited participants from a single discipline, including five uni-professional studies on physiotherapists. Ten studies involved participants from multiple AHP disciplines. Strategies were deductively themed into five core retention groupings. Fifteen studies reported strategies with positive effects, three found no effect, and four reported negative impacts on workforce retention. No studies included or reported on outcomes of retention interventions of allied health professionals who were Indigenous, ethnically diverse and/or disabled.

Conclusions

Workplace strategies can both positively and negatively impact AHP retention. Key recommendations for physiotherapy leaders are to optimise opportunities for personal growth; reduce workplace stressors such as workload, rostering and physical demands of the job; and measure workforce retention when implementing healthcare change or restructuring activities. Research is needed to examine strategies that could positively impact workforce diversity and inclusion.

Publication Link

https://www.tandfonline.com/doi/full/10.1080/21679169.2025.2469108#abstract

Te Ara Poutama: Living Well With Heart Disease

Fri, 23 Jan 2026 00:00:10 GMT

2025

Authors

Korohina, E.

Abstract

Te Ara Poutama – Living Well with Heart Disease (TAP) is a Māori-led heart health research programme grounded in aspirations, values, and knowledge systems of Māori communities in Aotearoa New Zealand. Anchored at Manawaora Research, an integrated Indigenous health and research centre, this programme responds to the longstanding impacts of colonisation and systemic inequities in cardiovascular health for Māori.

Rather than fitting Indigenous knowledge into pre-existing health systems, TAP reimagines these systems by centring Māori leadership, lived experiences, and worldviews. A multidisciplinary team—including clinicians, scientists, public health experts and data specialists—supports this Māori-led approach through collaborative, relational practice grounded in shared values and Indigenous self-determination.

Partnerships with Māori health providers and communities have been crucial to building trust and relevance. Across four regions, a national co-design process unfolded through a series of community-led workshops, shaped by the cultural protocols of each host community. These gatherings created culturally safe spaces for Māori families to share experiences and shape research priorities.

Alongside the co-design, two major initiatives sit at the heart of TAP. The Māori Heart Health Survey collected responses from over 1,000 Māori, creating one of the largest Indigenous-led heart health datasets in the country. The Kura Raumati internship supports the next generation of Māori heart health researchers by embedding students in community-based research grounded in Māori knowledge systems and scientific methods.

TAP offers a compelling model of Indigenous-led, community-driven, multidisciplinary research that transforms systems, centres Indigenous voices, and creates solutions that are locally resonant and globally relevant.

Publication Link

https://www.heartlungcirc.org/article/S1443-9506(25)00346-4/fulltext

Te Mauri o te Mana Māori

Thu, 22 Jan 2026 23:58:15 GMT

2025

Authors

Tohu‑Hapati, P., Camp, J., Russell‑Camp, T., Lyndon, M., Korohina, E.

Abstract

Aim

The project aims to amalgamate the types of mauri from the environmental space and abridge these to the context of health based on whanau need and utility in the clinical interaction.

Methods

A literature review was conducted and the search terms used were: “Mauri” OR “Indigenous Health AND Cardiac Health”; “Mauri” AND Health Equity ; “Mauri” AND “Health OR Indigenous Health OR Mental Health”; “Mauri” AND “Health OR Indigenous Health”. The Ovid and Knowledge Basket databases were used.

Results

The research highlights important indicators for the implementation of mauri into health. These namely being: 1) clinician-patient communication; 2) patients health attitudes; 3) barriers to health access; 4) Māori health; and 5) Te Ao Māori.

This research highlights the impact of colonisation on Māori and offers insight into a culturally appropriate management strategy that highlights and encourages cultural narratives into the clinical interaction. The research renders new mauri types pertinent to the continuation of mauri driven methods of health practice for Māori in Aotearoa and has potential to permeate into other indigenous narratives clinical practices as well.

Conclusions

As we foster models of health management beyond the biomedical and utilise the strengths of Kaupapa Māori (Māori methodologies) approaches can we begin to deconstruct the internal system barriers and beliefs that have deeply permeated into that same health system. If mauri-based models of care were consistently used and their cause effect measured we could then adopt a health modality approach that centres itself on traditional Māori knowledge synonymous with the Māori way of thinking to foster long lasting positive impacts on mauri tau and health outcomes that are self-determined by whānau.

Publication Link

https://www.heartlungcirc.org/article/S1443-9506(25)00398-1/fulltext

Te Aorerekura : towards eliminating family violence – reflections from the Atawhai project

Thu, 22 Jan 2026 23:32:58 GMT

2025

Authors

Eppel, E., Gear, C., Hape, H., Koziol‑McLain, J., Rolleston, A., Timutimu, N., Ahomiro, H., Healy, C., Hegarty, K., Isham, C.

Abstract

Family violence is an under-recognised contributor to ill-health. Atawhai, a three-year research project focusing on sustainable responses to family violence in primary healthcare services, suggests that relationships and networks among locality-based service providers and local communities will help in making New Zealand’s strategy to eliminate family violence a reality. More is needed than joining up the government agencies delivering services to those experiencing family violence. Building relationships between communities and healthcare providers to harness the contextual and cultural knowledge of those most affected has to be integral to a sustainable response that begins to address the causes of this wicked problem, along with developing place-based solutions.

Publication Link

https://ojs.victoria.ac.nz/pq/article/view/9730

Lipoprotein(a) concentrations and secondary outcomes following first-time acute coronary syndrome: The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS)

Thu, 22 Jan 2026 23:30:51 GMT

2025

Authors

Legget, M.E., Earle, N.J., Poppe, K.K., Bradbury, K.E., Pilbrow, A.P., Logue, G., Choi, Y., Devlin, G., Gladding, P.A., Grey, C., Harrison, W., Henare, K., Howson, J.M.M., Jones, G.T., Kerr, A.J., Lumley, T., Pera, V., Porter, G., Richards, A.M., Stewart, R., Troughton, R., Wihongi, H., Cameron, V.A., Rolleston, A., Doughty, R.N.

Abstract

Background and aims

Lipoprotein(a) (Lp[a]) is an established predictor of cardiovascular risk but associations with secondary events are less certain, and data on understudied ethnic groups are scarce. This study aimed to assess the association between Lp(a) and secondary events and explore variation in Lp(a) levels by ethnicity in first-time acute coronary syndrome (ACS) patients, to inform future risk prediction models.

Methods

The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS) is a longitudinal multi-centre cohort study of 1900 patients enrolled during their ACS admission. Baseline plasma Lp(a) concentrations were measured using an isoform-insensitive assay measured in nmol/L. The primary outcome was a composite of all-cause mortality or cardiovascular readmission, ascertained through national health datasets. Cox regression models were used to assess the association between Lp(a) levels and outcomes, adjusted for clinical risk factors.

Results

The mean age was 61 years, 20 % were female, and 73 % were European, 14 % Māori, 5 % Pacific peoples, 4 % Indian and 3 % other ethnicities. Of 1890 alive at discharge, 493 (26 %) experienced the primary outcome over a median follow-up of 4.9 years. Higher Lp(a) levels were associated with increased risk of secondary events. Compared to the lowest quartile (≤7 nmol/L), the adjusted hazard ratio for the highest quartile (>92 nmol/L) was 1.46 (95 %CI 1.12–1.89, p = 0.004). In this ACS cohort, Lp(a) concentrations varied by ethnicity, being highest amongst Indian participants (median 27 nmol/L) and lowest amongst Māori participants (median 12 nmol/L).

Conclusions

Elevated Lp(a) concentrations are associated with secondary events following ACS. Further research is needed to define optimal thresholds for increased risk and explore ethnic-specific implications for secondary prevention.

Publication Link

https://www.atherosclerosis-journal.com/article/S0021-9150(25)01414-5/fulltext

Communities getting things done: Māori community leadership during the COVID-19 pandemic

Thu, 22 Jan 2026 23:26:22 GMT

2025

Authors

Robertson, J., Burton, T., Rolleston, A.

Abstract

Purpose

In 2023, researchers from Tauranga, Aotearoa New Zealand (hereinafter referred to as Aotearoa) carried out a study to explore the unique strengths of Māori (Indigenous people of Aotearoa) services in addressing the needs of their communities during the COVID-19 pandemic.

Methods

Two case studies of Māori providers in the North Island’s Bay of Plenty region were undertaken. A qualitative kaupapa Māori (philosophical doctrine) approach was utilised across three methods to inform the research: 1) review of community materials, 2) whakawhiti kōrero (reciprocal discussions), and 3) whānau (family) narratives. The research included 34 participants, sourced from three groups: kaiwhakahaere (leadership), kaimahi (workforce), and whānau.

Main findings

Community-led pandemic responses within Māori communities included a drive for coordinated, localised and Indigenous leadership, and a need for urgent community-led action that interrupted the trajectory of Crown-determined processes. Successful health interventions leveraged local knowledge, whakapapa (genealogical) connections, and services through community-led action. This required levels of leadership and self-determination that cannot be replicated through Crown-led, Crown-determined responses to healthcare. This research provides an evidence-based framework consisting of 23 strategies to increase equitable health outcomes for Indigenous and other marginalised and/or isolated communities.

Principal conclusions

This research underscores the importance of enabling communities to lead through their own models of leadership and community development, recognising that they possess the intimate knowledge and understanding necessary to effectively respond to the specific needs of their people at whānau, hāpori (community), hapū and iwi (tribal) levels. Six generations of evidence show that the health system is not working equally for all parts of Aotearoa. It is time for an urgent response to those everyday health issues that have become an area of pandemic need. This research concluded to seriously consider the evidence that Māori communities, Māori providers and Māori clinicians led the way during the pandemic. As a nation, if we want to genuinely change the trajectory of Māori health outcomes and health outcomes for all, we need to utilise the evidence that is before us in terms of recognising the value added in having Indigenous, community-led solutions.

Publication Link

https://www.lowitjajournal.org.au/article/S2949-8406(25)00038-5/fulltext

Considerations for study design and analysis for ethically and culturally safe DNA methylation research in Aotearoa New Zealand

Thu, 22 Jan 2026 23:23:39 GMT

2025

Authors

Rolleston, A., Jones, G.T., Earle, N.J., Gibbs, S., Pilbrow, A., Faatoese, A., Poppe, K.K., Henare, K., Cameron, V.A., Macartney‑Coxson, D., Legget, M.E., Doughty, R.N.

Abstract

Epigenetic research, particularly DNA methylation (DNAm), holds significant potential for improving cardiovascular disease (CVD) risk prediction, yet its application must be guided by ethical and culturally responsive considerations. This paper examines the integration of a values-based framework to ensure the culturally safe conduct of DNAm research within the Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS) cohort. Grounded in Te Tiriti o Waitangi principles and kaupapa Māori methodologies, this study emphasises equity, social accountability, and indigenous data sovereignty. This study was not designed as a discovery epigenome wide analysis, but rather performed, as an exemplar, a SWOT analysis that identified both the potential of DNAm markers, such as cg05575921 in AHRR for smoking exposure assessment, and key risks, including genetic confounding, population-specific variation, and the potential for individual and transgenerational stigma. Findings underscore the importance of ensuring multi-ethnic validation of DNAm markers to prevent exacerbation of health inequities. This paper advocates for the adoption of ethical, culturally attuned research frameworks in epigenetics to enhance equitable health outcomes and support Māori health advancement.

Publication Link

https://www.sciencedirect.com/science/article/pii/S2352827325001430?via%3Dihub

Menopausal Status and Sex Hormones in New Zealand Women With First-Time Acute Coronary Syndromes

Thu, 22 Jan 2026 23:19:52 GMT

2025

Authors

Earle, N., Poppe, K., Rolleston, A., Logue, G., Pilbrow, A., Devlin, G., Wihongi, H., Gladding, P., Troughton, R., Kerr, A., Porter, G., Henare, K., Lumley, T., Grey, C., Richards, M., Pera, V., Coffey, S., Williams, M., Pegg, T., Ternouth, I., Harrison, W., Cameron, V., Heather, A., Doughty, R.

Abstract

Aim

To examine the relationships between menopausal status, clinical factors and sex hormones in New Zealand women with acute coronary syndromes (ACS), addressing the lack of specific data within this group.

Method

A substudy of the Multi-Ethnic NZ Study of ACS enrolled women from 10 hospitals. Plasma estradiol, testosterone, sex-hormone binding globulin (SHBG) and follicle-stimulating hormone (FSH) were measured. Here, univariate associations between menopausal status, sex hormones, and clinical factors were assessed using independent samples t-tests and chi-squared tests.

Results

786 women were enrolled in the substudy. Self-reported menopausal status was collected in 355 women (mean age 67, SD10). 311 (88%) were post-menopausal (mean age at final menstrual cycle=46 years). Ethnicities were 250 European, 90 Māori, 13 Pacific Peoples, 7 Other. Post-menopausal status was associated with lower estradiol (p=0.007) and higher FSH (p<0.001). No association was found between menopausal status and lipid profiles, BMI, history of hypertension, diabetes, extent of coronary disease on angiogram or left ventricular ejection fraction (LVEF). SHBG levels decreased with higher triglycerides (p<0.001), and were lower in women with hypertension (p=0.019) or diabetes (p<0.001). Higher FSH was associated with lower triglycerides (p<0.001), BMI (p<0.001), eGFR (p=0.047), LVEF (p=0.007), and lower diabetes prevalence(p=0.018). Increased testosterone was associated with higher haemoglobin (p=0.038). Estradiol and testosterone:estradiol were not significantly associated with clinical factors.

Conclusion

Preliminary results indicate associations between sex hormones, menopausal status, and clinical factors in women with ACS. Future analysis incorporating menopausal hormone therapy data and adjustment for relevant covariates including age will provide further insights.

Publication Link

https://www.heartlungcirc.org/article/S1443-9506(25)01024-8/fulltext

Tackling cardiovascular disease in the Asia–Pacific region: a new Lancet Commission

Thu, 22 Jan 2026 23:17:43 GMT

2025

Authors

Lam, C.S.P., Cader, F.A., Chew, N.W.S., Chow, C.K., Grey, C., Guo, Y., Nelson, A.J., Rolleston, A., Sawano, M., Tan, K.C.B., Tromp, J., Yan, L.L., Nicholls, S.J.

Abstract

The Asia–Pacific region has a high global burden of cardiovascular disease.1 The region, home to more than 60% of the world's population, spans the vast and diverse geographies from Oceania through east, central, southeast, and south Asia and includes the world's most populous nations and many of its most rapidly ageing societies.2 Sociocultural, economic, and health system diversity also characterise this region. While cardiovascular disease remains the leading cause of death worldwide,3 its impact is profound in the Asia–Pacific region with crude cardiovascular mortality projected to almost double by 2050 in Asia.4 Addressing cardiovascular disease in this region is not only a local necessity, but also a global imperative.

Publication Link

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01494-1/abstract

Cardiovascular Health Equity: Indigenous Leadership in Heart Health

Thu, 22 Jan 2026 23:14:36 GMT

2025

Authors

Rolleston, A., Brown, A.

Abstract

The 4th Indigenous Cardiovascular Health Conference of the Cardiac Society of Australia and New Zealand (CSANZ) will take place in Gadigal, Sydney, Australia, from 17–19 June 2025. This gathering marks a critical moment in the ongoing pursuit of cardiovascular health equity for Aboriginal, Torres Strait Islander, Māori, and Pacific peoples. CSANZ has intensified its focus on addressing the persistent burden of cardiovascular disease (CVD) in Indigenous communities, acknowledging that while the inequities are well-documented, the imperative now is to accelerate action and drive meaningful change.

Previous Indigenous cardiovascular health meetings in 2009, 2011, and 2019 have laid the groundwork for reform, producing key recommendations that, when implemented, have had the potential to transform health outcomes [1–7]. In Australia, outcomes from these meetings have informed national programs and policy efforts to reduce CVD disparities. However, achieving true health equity demands more than policy shifts, it requires a commitment by the health system to Indigenous leadership, self-determination, and community-driven solutions.

This forthcoming conference will move beyond reiterating the well-established gaps in Indigenous cardiovascular health outcomes. Instead, it will focus on solutions, innovation, and the power of Indigenous-led models of care. By prioritising Indigenous knowledge systems, strengthening workforce development, and advancing health system reforms, this conference aims to empower Indigenous communities with the tools, strategies, and partnerships needed to drive cardiovascular health equity forward. In this special supplement issue of Heart, Lung and Circulation we include more than 70 abstracts that cover many of these important issues and new insights that will be presented at this conference.

CVD remains one of the most pressing health challenges for Indigenous peoples across Australia, Aotearoa New Zealand, and the Pacific [3,8,9]. Despite decades of research and intervention, stark inequities persist, disproportionately impacting Aboriginal, Torres Strait Islander, Māori, and Pacific communities [10,11]. While we acknowledge that the health system will always require access to data that evidences the need, our focus is on action, pushing forward with real solutions for real people. Some of the questions we are keen to hear the answers to are:

• What are the most promising innovations in Indigenous cardiovascular health?

• How can we shift the conversation from disparity-focused research to action-oriented change?

• What mechanisms ensure data remains accessible without impeding solution-focused progress?

A key focal point of the conference is to articulate the steps required to achieve cardiovascular health equity. We are interested in knowing the essential steps to embedding Indigenous knowledge into health care systems. Highlighting community-led initiatives and how they contribute to improved cardiovascular outcomes. The policy or funding mechanisms that can support Indigenous-driven solutions is an important discussion point for both Australia and Aotearoa.

There is emphasis in the programme of a life-course approach to cardiovascular health, recognising the developmental origins of disease and extending through to elder care. Indigenous communities have long championed holistic, intergenerational perspectives on health, and this conference will provide a platform to share and strengthen those insights within clinical and public health frameworks. In particular how does a life-course approach differ from traditional models of cardiovascular care?

The role of Indigenous narratives in shaping policy, practice, and research is currently poorly recognised, let alone implemented. When Indigenous voices lead the discourse, policy frameworks become more attuned to the realities faced by communities and are more likely to result in meaningful change [12,13]. Successful Indigenous-led policy in CVD prevention and treatment, innovative models of acute and long-term care, and strategies for workforce development to empower the next generation of Indigenous health professionals are needed.

Addressing the challenges and opportunities in Indigenous and rural and remote health service delivery is not a new cause. Access to high-quality cardiovascular care remains a significant barrier in many Indigenous communities [14], requiring a systems-level response that prioritises equity, culturally competent care, and structural reform. This conference will highlight practical solutions and innovative models that are already making a difference, with the aim of scaling and embedding these approaches within the broader health system.

This conference seeks to drive forward an actionable agenda for health system transformation. The outcomes can shape a roadmap for cardiovascular health equity for the next five years and beyond. By cementing the progress made and envisioning the future, we reaffirm our collective responsibility to ensure that all Aboriginal, Torres Strait Islander, Māori, and Pacific peoples receive the heart health care they deserve. Only through sustained commitment, Indigenous leadership, and cross-sector collaboration can we achieve the goal of equity in cardiovascular health for all Australians and New Zealanders.

Publication Link

https://www.heartlungcirc.org/article/S1443-9506(25)00413-5/fulltext

Physical activity of young Māori and Pasifika wāhine: a strengths-based qualitative study in Aotearoa New Zealand

Thu, 22 Jan 2026 23:11:46 GMT

2025

Authors

Nemani, M.J., Thorpe, H., Rolleston, A., Hemi, K., Richards, J.

Abstract

Young Māori (Indigenous New Zealanders) and Pasifika (Pacific Islanders born outside their country of heritage) wāhine (women) in Aotearoa—Māori name for New Zealand—are reported as being less active compared to other young women and men. Taking strengths-based approaches, we amplify the voices of physically active young Māori and Pasifika wāhine to provide insights that can inform policy and practice. Weaving Indigenous methodologies and qualitative methods, we engage 31 young Māori and Pasifika wāhine (16–25 years) from cities in Aotearoa. Our objective is to understand their (a) motivations to participate, (b) preferred activities and (c) perspectives on participation. Using thematic-analysis, we discovered they were influenced by cultural knowledges including hauora (a Māori concept of health and well-being) and whanaungatanga (building relationships). Based on our findings we suggest physical activity for young Māori and Pasifika wāhine focuses on improving mental hauora, and use group activities that include learning new skills.

Publication Link

https://journals.sagepub.com/doi/10.1177/11771801251374148

Intergenerational Heart Health: A Case of Unfathomable Inequity

Thu, 22 Jan 2026 23:09:33 GMT

2025

Authors

Berning, H., McGowan, R., Smith, S., Cotter, J., Reihana, K., Bullen, C., Matthews, K., Burton, N., Daniels, N., Roxburgh, B., Davies, L., Rolleston, A.

Abstract

Background

Westernisation exposes cardiovascular systems, en masse, to stressors that constrain cardiovascular health, use resource-intensive interventions, and comprise the leading cause of death. Indigenous knowledge and perspectives are concurrently marginalised, yet important for decolonisation and valuing intra- and inter-generational equity and sustainability. An enormous yet ignored consequence of this focus on individuals’ autonomy and longevity jeopardises the heart health (and existence) of unfathomably more lives. Therefore, the aims of this project were to 1) develop and critique representative cases of current and future lives to display how the environment impacts their heart health, and 2) use this evidenced extent of inequity to identify the changes required for intergenerational equity.

Methods

Six cases were developed, based upon New Zealand Treasury’s Living Standards Framework for population wealth, and were evidenced using publicly-available data for the heart health categories that aligned almost directly with the Framework’s four pillars (human capability, social cohesion, natural environment, and physical and financial capital). Cases were normalised for relative population size.

Outcomes and Implications

Aim 1: The six cases - within and between themselves - illustrate the enormity of heart health inequity propagating intra-generationally and inter-generationally. For example, today’s heart-health environment contributes in multiple ways directly and indirectly to humanity living outside most planetary boundaries and jeopardising heart health of potentially >10,000 times more future people’s lives (based on the timespan of a typical species).

Aim 2: Changes required for an equitable future include honouring Te Tiriti o Waitangi and incorporating the Living Standards Framework in policy processes. Finally, reflective questions were developed that intend to support the initial application across disciplines of the six cases.

Publication Link

https://www.heartlungcirc.org/article/S1443-9506(25)00372-5/fulltext

An Interdisciplinary Assessment of the Heart Health Environment

Thu, 22 Jan 2026 23:05:56 GMT

2025

Authors

Daniels, N., McGowan, R., Smith, S., Cotter, J., Reihana, K., Bullen, C., Matthews, K., Burton, N., Berning, H., Roxburgh, B., Davies, L., Rolleston, A.

Abstract

Background

Heart health and the approach to its management in Australasia reflect our dominant cultural contexts i.e., of western values, knowledge, and systems — which have strengths but also limitations and unaccounted costs. Western systems regard people and their health as somewhat autonomous, intra-generational and independent from the biosphere, thereby contrasting Indigenous perspectives. Herein lies inequity that may amplify greatly for future generations. We, therefore, undertook an interdisciplinary assessment of the heart-health environment (HHE).

Methods

As an interdisciplinary research team, we (a) identified categories that shape the HHE for current and future generations (e.g., treatment, education); (b) compiled and summarised research, clinical guidelines and public policy sourced from subject matter experts; (c) filled gaps therein and incorporated relevant Te Ao Māori frameworks; (d) categorised NZ Health Research Council (HRC) funding; and (e) discussed key evidence and messages via dialogic conversations in a 3-day wananga.

Outcomes

Western and Te Ao Māori emphases on heart health differ starkly. Western (knowledge) systems emphasis is overwhelmingly on medical and biological factors and treatment, which receive 95% of HRC funding for cardiovascular health (cf. 4% on public health), and focusses on maximising lifespan within the current generation(s). It is disconnected from nature and contributes to unsustainability, thereby acting directly and indirectly against the HHE of future generations. Therefore, we need to braid different approaches. Te Ao Māori emphasises whenua and mauri, connection to whenua and whānau, living a full life while accepting its limits, and with clear concern for future generations and non-human life.

Conclusion

The HHE lacks but requires Indigenisation.

Publication Link

https://www.heartlungcirc.org/article/S1443-9506(25)00335-X/fulltext

He Rourou Whai Painga; A collaborative community-based research partnership testing the impact of a New Zealand Mediterranean dietary pattern on cardiometabolic health and wellbeing

Thu, 22 Jan 2026 23:03:10 GMT

2025

Authors

Krebs, J.D., Parry‑Strong, A., Braakhuis, A., Worthington, A., Merry, T.L., Gearry, R.B., Foster, M., Weatherall, M., Davies, C., Mullaney, J., Ross, C., Conroy, D., Rolleston, A., Lithander, F.E.

Abstract

Cardiometabolic diseases, including type 2 diabetes (T2DM) and cardiovascular disease (CVD), are common. Approximately one in three deaths annually are caused by CVD in Aotearoa New Zealand (AoNZ)(1). The Mediterranean dietary pattern is associated with a reduced risk of cardiometabolic disease in epidemiological and interventional studies(2,3). However, implementing the Mediterranean diet into non-Mediterranean populations can be challenging(4). Some of these challeanges include facilitating consumption of unfamiliar foods and the cultural and social context of food consumption. AoNZ produces a rich source of high-quality foods consistent with a Mediterranean dietary pattern. He Rourou Whai Painga is collaborative project combining contributions from food industry partners into a Mediterranean Diet pattern and providing foods, recipes and other support to whole household/whānau. The aim was to test if a New Zealand food-based Mediterranean diet (NZMedDiet) with behavioural intervention improves cardiometabolic health and wellbeing in individuals at risk. This presentation will review the background to the research, the process of forming a collaboration between researchers and the food industry, the design and implementation of a complex study design (see protocol paper)(5), with results from the initial randomised controlled trial. We conducted several pilot studies(6,7,8) to inform the final design of the research, which was a combination of two randomised controlled trials (RCT 1 and 2) and a longitudinal cohort study. RCT-1 compared 12-weeks of the NZMedDiet to usual diet in participants with increased cardiometabolic risk (metabolic syndrome severity score (MetSSS) >0.35). The intervention group were provided with food and recipes to meet 75% of their energy requirements, supported by a behavioural intervention to improve adherence. The primary outcome measure was MetSSS after 12 weeks. Two hundred individuals with mean (SD) age 49.9 (10.9)yrs with 62% women were enrolled with their household/whānau. After 12 weeks, the mean (SD) MetSSS was 1.0 (0.7) in the control (n = 98) and 0.8 (0.5) in the intervention (n = 102) group; estimated difference (95% CI) of -0.05 (-0.16 to 0.06), p=0.35. A Mediterranean diet score (PyrMDS) was greater in the intervention group 1.6 (1.1 to 2.1), p<0.001, consistent with a change to a more Mediterranean dietary pattern. Weight reduced in the NZMedDiet group compared with control (-1.9 kg (-2.0 to -0.34)), p=0.006 and wellbeing, assessed by the SF-36 quality of life questionnaire, improved across all domains p<0.001. In participants with increased cardiometabolic risk, food provision with a Mediterranean dietary pattern and a behavioural intervention did not improve a metabolic risk score but was associated with reduced weight and improved quality of life.

Publication Link

https://www.cambridge.org/core/journals/proceedings-of-the-nutrition-society/article/he-rourou-whai-painga-a-collaborative-communitybased-research-partnership-testing-the-impact-of-a-new-zealand-mediterranean-dietary-pattern-on-cardiometabolic-health-and-wellbeing/0EE5CF166D978BB5DDA454770B113FC0

Te Ara Whakamārama: Assessing our Current States of Health Literacy in Aotearoa and it’s Translations into our Health Outcomes

Thu, 22 Jan 2026 22:59:29 GMT

2025

Authors

Lockyer , M., Haimona-Ngawharau Taleni , M., Camp , J., Russell-Camp , T., Korohina , E., R ollest on, A.

Abstract

Aim

This study explores the role of health literacy in achieving health equity for Indigenous communities, particularly Māori. It examines the integration and application of Indigenous knowledge systems into health education and the importance of Indigenous narratives in shaping equitable health policies and practices.

Method

A narrative review of health literacy research in Aotearoa was conducted, analysing both quantitative and qualitative data. Key Māori health models were examined to understand culturally safe approaches to cardiovascular care. National health surveys were reviewed to assess trends in health literacy and its impact on cardiovascular health outcomes. Additional insights were drawn from Indigenous-led health initiatives.

Results

Findings indicate that low health literacy is a key determinant of cardiovascular health disparities among Indigenous populations, contributing to poor disease prevention, delayed treatment, and lower adherence to medical advice. Systemic barriers, including inaccessible health information, culturally inappropriate communication, and rural/remote healthcare inequities, further exacerbate disparities.

Despite these challenges, community-driven health solutions have demonstrated significant potential to improve health outcomes. The decolonisation of health literacy, through the reclamation of Indigenous knowledge systems and whānau-driven health sovereignty, is identified as a crucial step towards equity.

Conclusions

Achieving cardiovascular health equity for Indigenous communities requires a shift in healthcare research and delivery — one that prioritises Indigenous voices, integrates traditional knowledge, and fosters self-determination. Strengthening health literacy from early childhood health education to elderly care is essential for sustainable improvements in heart health. Policy and practice must be guided by Indigenous narratives to ensure culturally safe, and structurally transformative solutions that address the unique challenges faced by Indigenous and rural/remote populations

Publication Link

hhttps://www.heartlungcirc.org/article/S1443-9506(25)00384-1/fulltext

Dietary patterns of patients with acute coronary syndrome in the multi-ethnic New Zealand study of acute coronary syndromes (MENZACS)

Thu, 22 Jan 2026 22:51:56 GMT

2025

Authors

Bradbury K. , Earle N. , Rolleston A. , Fyfe C. , Grey C. , Korohina E. , Mehta S. , Cameron V. , Choi Y. , Devlin G. , Gladding P. , Harrison W. , Henare K. , Kerr A. , Logue G. , Lumley T. , Perak V. , Pilbrow A. , Porter G. , Stewart R. , T roughton R. , Wihongi H. , Legget M. , Doughty R. , Wall C.

Abstract
Background and aims

In Aotearoa-New Zealand (NZ) approximately 8000 people are admitted with a first-time acute coronary syndrome (ACS) annually. In this cross-sectional analysis, we describe the dietary patterns of patients who present with their first ACS and examine their associations with socio-demographic and clinical characteristics.

Methods and results

The Multi-Ethnic NZ study of Acute Coronary Syndromes (MENZACS) is a multi-centre, longitudinal cohort study of patients with first-time ACS. At study enrolment, patients (n = 1914) completed a validated short food frequency questionnaire asking about dietary intakes in the 12 months preceding their ACS. Three dietary patterns were identified using Principal Component Analysis. The Convenience pattern was characterised by high intakes of take-aways, and participants with higher scores were on average younger, more likely to be male, live in the most deprived areas, and current smokers (all p for trend<0.001). The Harvest pattern was characterised by high intakes of vegetables and fruit, and participants with higher scores were on average older, less likely to be male, more likely to live in the least deprived areas, and have a history of hypertension, and less likely to be current smokers (all p for trend<0.05). The Comfort pattern was characterised by high intakes of potatoes, biscuits, tea/coffee, meat, and jam, and participants with higher scores were on average older and more likely to be male (both p for trend<0.05).

Conclusion

Three distinct dietary patterns were found in patients presenting with first-time ACS in NZ and these patterns were associated with various socio-demographic and clinical factors.

Publication Link

https://www.nmcd-journal.com/article/S0939-4753(25)00191-7/fulltext

The Prognostic Value of Cardiac Troponin in a Revascularized Cohort with First-Time Myocardial Infarction

Thu, 22 Jan 2026 22:47:18 GMT

2025

Authors

Earle, N., Poppe, K., Pilbrow, A., Logue, G., Rolleston, A., Wihongi, H., Henare, K., Lumley, T., Porter, G., Kerr, A., Devlin, G., Stewart, R., Cameron, V., Legget, M., Doughty, R.

Abstract
Introduction: The prognostic value of cardiac troponins in revascularized patients with myocardial infarction (MI) is uncertain. This study examined the relationship between peak troponin levels and adverse outcomes in a revascularized cohort from the Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS). Methods: MENZACS enrolled patients with a first-time acute coronary syndrome from 2015 to 2019. Peak high sensitivity troponin was standardized by dividing the observed peak troponin by the upper limit of normal. The primary outcome was a composite of all-cause death or cardiovascular readmission, determined through national datasets. Troponin’s relationship with outcomes was analysed using penalized spline Cox regression. Results: Among 1,645 revascularized patients (81% male, mean age 61, 74% European, 14% Māori, 5% Pacific, 5% Indian, 3% Other; 46% ST-elevation MI (STEMI), 54% non-STEMI), higher peak troponin was associated with male sex, STEMI, current smoking, and elevated N-terminal pro-B-type natriuretic peptide levels. Over a median of 4.9 years, 402 (24%) people experienced the primary outcome. Peak troponin levels were not significantly associated with this outcome. Conclusion: In this revascularized cohort surviving a first-time MI, the magnitude of peak troponin elevation was not associated with all-cause death or cardiovascular readmission.

Publication Link

https://karger.com/crd/article/doi/10.1159/000548210/933693/The-Prognostic-Value-of-Cardiac-Troponin-in-a

Fostering Tino Rangatiratanga: Empowering Māori and Pasifika Heart Health Professionals Through Strengthening Connections

Thu, 22 Jan 2026 22:41:47 GMT

2025

Authors

R. Eddington , E. Korohina , W. Harrison , T. Russell-Camp , S. Hanchard , A. Rolleston A, J. Agnew

Abstract

Cardiovascular disease is a major contributor to health inequities for Māori and Pasifika peoples, driven by the ongoing impacts of colonisation. Indigenous heart health clinicians and researchers play a critical role in addressing these inequities but often face systemic barriers, cultural workload, and limited leadership opportunities. Te Whare Tukutuku was established as an Āhuru Mōwai (safe space) for Māori and Pasifika professionals to connect, share experiences, and weave strategies for a culturally safe work environment.

An initial wānanga (workshop) in Auckland brought together 27 Māori and Pasifika heart health professionals to identify key challenges and develop recommendations for the Cardiac Society of Australia and New Zealand (CSANZ). These focused on improving engagement with Indigenous members, embedding cultural safety in governance, and supporting Indigenous leadership and workforce development.

A second wānanga in Christchurch saw 38 participants work on developing a pātaka (storehouse) of support—a practical framework to reduce cultural workload burdens, strengthen professional networks, and improve well-being.

Key outcomes include recommendations for CSANZ to establish culturally safe spaces, enhance Indigenous representation, and embed an equity-focused framework. Workforce development priorities include strengthening mentorship, leadership training, and Indigenous-led research. The pātaka of support outlines strategies such as wairua check-ins, cultural mentorship, a digital networking platform, and clear terms for cultural workload to improve well-being and career sustainability.

Implementing these recommendations provides an international exemplar for embedding equity, cultural safety, and Indigenous leadership in heart health. Commitment from CSANZ and other institutions is essential to uphold these initiatives and foster meaningful Indigenous participation in heart health.

Publication Link

https://www.heartlungcirc.org/article/S1443-9506(25)00512-8/fulltext

Capturing the emergence of change in complex systems: The ‘Atawhai’ study in Aotearoa/New Zealand

Thu, 22 Jan 2026 22:36:10 GMT

2025

Authors

Gear, C, Koziol-McLain, J, Eppel, E, Hape, H, Rolleston, A, Manuel, C, Timutimu, N, Ahomiro, H, Healy, C, and Isham, C

Abstract

A wide range of evaluative evidence is necessary to capture change within complex systems as findings shape the form and interpretation of outcomes, how they are valued, and actions moving forward. The Atawhai study worked with primary health care professionals in a series of workshops to distil ways to make it easier to respond to family violence as a key determinant of ill health. This article describes three methods used to evaluate the emergence of change from the perspective of the Atawhai research participants including pre/post-readiness surveys, social network analysis and qualitative exit interviews. Each method provides a unique perspective on the complexity involved and triangulation across the methods indicates validation of findings. Capturing change within complex systems requires methodological agility and overlaying of diverse evidence. The contribution of ‘soft infrastructure’ in developing and sustaining complex interventions should not be underestimated.

Publication Link

https://journals.sagepub.com/doi/10.1177/13563890251315451

Tū Wairua: Development of an Indigenous Rongoā Māori approach to healing with psilocybin containing mushrooms

Thu, 22 Jan 2026 00:33:06 GMT

2025

Authors

Anna-Leigh Hodge, Anna Forsyth, Tehseen Noorani, Suresh Muthukumaraswamy, Anna Rolleston, and Patrick McHugh

Abstract

Psilocybin, a naturally occurring psychedelic compound found in certain fungi has long been used by Indigenous cultures within ritual and ceremony for healing and spiritual purposes (Spiers et al., 2024). While emerging evidence points to psychedelic agents being novel avenues for the treatment of substance use disorders, the predominantly Western medical models of psychedelic-assisted therapy (PAT) being developed lack Indigenous wisdom and input, raising concerns about cultural safety, efficacy, ownership, and continuing colonial dynamics. In Aotearoa (New Zealand), the enduring impacts of colonisation on Māori include the suppression of Indigenous wisdom, even as research affirming the knowledge and practice of traditional Māori healing is on the rise.

The Tū Wairua project will explore the integration of rongoā Māori (traditional Māori healing practices) with PAT for addressing problematic methamphetamine use (PMU) in Māori communities. This Māori-led project is driven by Kaupapa Māori methodology, rongoā Māori conceptualisations of health and informed by biomedical psychedelic science. Based at Rangiwaho Marae in Te Tairāwhiti (Gisborne), a community with a high Māori population and a significant burden of PMU, the project aims to develop a decolonised culturally-appropriate approach to PAT to explore the efficacy of psilocybin in treating PMU.

This research represents a shift toward health interventions that respect and extend Indigenous wisdom, addressing the unique needs of Māori communities. It also seeks to develop a skilled Māori workforce to continue these healing practices, and challenge current legislation that restricts the use of Indigenous psychedelic medicines. In creating sustainable pathways for collective healing through a community-driven, culturally-resonant PAT, Tū Wairua charts new directions in Indigenous-led psychedelic science.

Publication Link

https://akjournals.com/view/journals/2054/9/4/article-p369.xml

Collaboration in research: weaving Kaupapa Māori and computer science

Sun, 09 Jun 2024 21:40:37 GMT

2021

Authors

Anna K Rolleston , Judy Bowen, Annika Hinze, Erina Korohina and Rangi Matamua

Abstract

We describe a collaboration between Māori (Indigenous people of Aotearoa/New Zealand) and Tauiwi (non-Māori) researchers on a software engineering project.

Te Tiriti o Waitangi (The Treaty of Waitangi) provides the basis for Māori to lead research that involves Māori as participants or intends to impact Māori outcomes. Through collaboration, an extension of the traditional four-step software design process was created, culminating in a nine-step integrated process that included Kaupapa Māori (Māori ideology) principles.

The collaboration experience for both Māori and Tauiwi highlighted areas of misunderstanding within the research context based on differing worldviews and our ability to navigate and work through this. This article provides context, guiding principles, and recommended research processes where Māori and Tauiwi aim to collaborate.

Publication Link

https://journals.sagepub.com/doi/10.1177/11771801211043164

Our story: a Māori perspective of flourishing whānau

Sun, 09 Jun 2024 21:40:36 GMT

2021

Authors

Anna Rolleston, Marama McDonald, Philippa Miskelly

Abstract

This kaupapa Māori qualitative study explores the concept of flourishing for whānau Māori (Māori families) and how this is enacted in their everyday lives.

Fourteen semi-structured interviews were conducted with whānau groups comprising at least two generations of the same family, and thematic analysis was based on Māori understandings of the world using NVivo software. Eight main themes emerged, depicted as ‘pou’ or markers that whānau considered intrinsic to flourishing: uaratanga (values); whanaungatanga (kinship relationships); manaakitanga (support); hauora (health and wellbeing); whakapāwera (hardship); kai (food); tikanga (customs), and hangarau (technology).

The findings offer a counter-narrative to negative discourses about Māori deprivation and inequities. The study provides information which could support the strategic development of programmes for Māori, as well as accountability measures, underpinned by the principles of flourishing whānau, at national and local government and community-based levels.

Publication Link

https://www.tandfonline.com/doi/full/10.1080/1177083X.2021.1981955

Optimising function and well-being in older adults: protocol for an integrated research programme in Aotearoa/New Zealand

Sun, 09 Jun 2024 21:40:34 GMT

2022

Authors

Sue Lord, Ruth Teh, Rosie Gibson, Moira Smith, Wendy Wrapson, Murray Thomson, Anna Rolleston , Stephen Neville, Lyn McBain, Silvia Del Din, Lynne Taylor, Nicola Kayes, Andrew Kingston, Rebecca Abey-Nesbit & Ngaire Kerse

Abstract

Maintaining independence is of key importance to older people. Ways to enable health strategies, strengthen and support whanāu (family) at the community level are needed. The Ageing Well through Eating, Sleeping, Socialising and Mobility (AWESSOM) programme in Aotearoa/New Zealand (NZ) delivers five integrated studies across different ethnicities and ages to optimise well-being and to reverse the trajectory of functional decline and dependence associated with ageing.

Well-being, independence and the trajectory of dependence are constructs viewed differently according to ethnicity, age, and socio-cultural circumstance. For each AWESSoM study these constructs are defined and guide study development through collaboration with a wide range of stakeholders, and with reference to current evidence. Themes or target areas of sleep, physical activity, oral health, and social connectedness complement social capital and community integration in a balanced programme involving older people across the ability spectrum.

Outcomes and process analysis from this research will inform about novel approaches to implement relevant, socio-cultural interventions to optimise well-being and health, and to reverse the trajectory of decline experienced with age.

Publication Link

https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-022-02845-7

Cultural context in New Zealand: incorporating kaupapa Māori values in clinical research and practice

Sun, 09 Jun 2024 21:40:34 GMT

2022

Authors

Anna Rolleston, Philippa Miskelly, Marama McDonald, Janine Wiles, Katrina Poppe, Rob Doughty

Abstract

We examined the importance of understanding and incorporating cultural context within Aotearoa/New Zealand when engaging in clinical research and practice. This paper reports on the qualitative findings of a mixed methods study aimed at determining what effect a cardiac risk reduction exercise and lifestyle management programme, embedded within a kaupapa Māori methodological approach, had on Māori participants.

Our study revealed how the kaupapa Māori approach empowered participants to examine and evaluate not only their own health and lifestyle choices, but those of family and the wider community. Combining biomedical and kaupapa Māori components into the programme was found to benefit participants’ mental, physical, spiritual and family well-being.

Publication Link

https://academic.oup.com/heapro/article-abstract/37/3/daac065/6631488?redirectedFrom=fulltext

Navigating the space between co-design and mahitahi: Building bridges between knowledge systems on behalf of communities

Sun, 09 Jun 2024 21:40:32 GMT

2022

Authors

Anna K. Rolleston PhD, Erina Korohina BSc, Marama McDonald PhD

Abstract

It is well known that the health system in Aotearoa/New Zealand does not provide culturally responsive services, programmes or approaches. Indigenous, remote and vulnerable populations that are not well served by medical and scientific models would be better served by the underlying premise of co-design methodology. However, co-design is a Western methodology.

Mahitahi is presented here as a culturally responsive method of co-design that builds approaches by utilising the worldview of the people that the health system most needs to have impact upon. Co-design and mahitahi have synergies, and working at the interface between Western and Māori knowledge systems can provide innovative solutions that draw on the strengths of both approaches.

The use of Indigenous knowledge systems, using Māori as the case example, will be outlined.

Recommendations will be provided to guide researchers, health professionals and policy makers when planning a co-design approach with remote and vulnerable communities.

Publication Link

https://onlinelibrary.wiley.com/doi/10.1111/ajr.12916

Prognostic modelling of clinical outcomes after first-time acute coronary syndrome in New Zealand

Sun, 09 Jun 2024 21:40:32 GMT

2023

Authors

Nikki J Earle, Katrina K Poppe, Anna Rolleston , Anna Pilbrow, Sara Aish, Kathryn Bradbury, Yeunhyang Choi, Gerry Devlin, Patrick A Gladding, Corina Grey, Wil Harrison, Kimiora Henare, Joanna Howson, Andrew Kerr, Thomas Lumley, Vijaya Pera, Graeme Porter, Ralph Stewart, Richard W Troughton, Helen Wihongi, A Mark Richards, Vicky A Cameron, Malcolm E Legget, Robert N Doughty

Abstract

The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS) was established to investigate the drivers of secondary events after first-time acute coronary syndrome (ACS), including addressing inequitable outcomes by ethnicity. Herein, the first clinical outcomes and prognostic modelling approach are reported.

Of the 2015 MENZACS participants (mean age 61 years, 79% male, 73% European, 14% Māori, 5% Pacific people), 2003 were alive at discharge. Of the 2003, 416 (20.8%) experienced all-cause death/cardiovascular readmission over a median of 3.5 years. In a simple model, age, male sex, Māori ethnicity and NT-proBNP levels were significant predictors of outcome. After adjustment for the clinical summary score, which includes age and sex, NT-proBNP and ethnicity were no longer statistically significant.

In 2015 patients with first-time ACS, recurrent events were common (20.8%). Increasing NT-proBNP levels and Māori ethnicity were predictors of death/cardiovascular readmission, but not after adjustment for the 20 clinical risk factors represented by the clinical summary score.

Publication Link

https://heart.bmj.com/content/109/14/1088

He Rourou Whai Painga, an Aotearoa New Zealand dietary pattern for metabolic health and whānau wellbeing: protocol for a randomized controlled trial

Sun, 09 Jun 2024 21:40:31 GMT

2023

Authors

Fiona E. Lithander, Amber Parry Strong, Andrea Braakhuis, Anna Worthington, Meika Foster, Anna Rolleston , Cheryl Davies, Jane Mullaney, Cecilia Ross, Denise Conroy, Troy L. Merry, Richard Gearry, Mark Weatherall, Jeremy D. Krebs

Abstract

Cardiometabolic diseases are highly prevalent in Aotearoa New Zealand. Dietary intake is a modifiable risk factor for such diseases and certain dietary patterns, specifically the Mediterranean diet (MedDiet), are associated with improved metabolic health.

This study aims to test whether an intervention including a Mediterranean dietary pattern incorporating high quality New Zealand foods (NZMedDiet pattern) and behavior change science can improve the metabolic health of participants and their household/whānau.

This is a multi-center, three-stage trial with two parallel group superiority randomized controlled trials (RCTs), and a longitudinal cohort study embedded within the trial design. The primary outcome measure for each stage is the metabolic syndrome severity score (MetSSS). The total recruitment target is 200 index participants and their household/whānau members who participate with them, and the primary analyses will be intention to treat on index participants.

The trial will test whether the NZMedDiet pattern and behavior change support improves the cardiometabolic health of people in Aotearoa New Zealand.

Publication Link

https://www.frontiersin.org/articles/10.3389/fnut.2023.1298743/full

‘You made us feel at home’: towards Indigenous feminist methodologies with young wāhine in sport and exercise

Sun, 09 Jun 2024 21:40:30 GMT

2023

Authors

Mihi Nemani, Holly Thorpe, Keaka Hemi & Anna Rolleston

Abstract

Decades of research on Indigenous and culturally diverse young women in sport and exercise has been underpinned by deficit models where these groups are portrayed as ‘lacking’, ‘at risk’, and/or ‘vulnerable’. Such approaches have been heavily critiqued for ignoring broader structural and systemic inequities that have produced such health disparities. These approaches also reproduce racialised ideologies of Indigenous and culturally diverse women where they are seen as a ‘problem group’ in sport, exercise and health research.

Over recent years, a growing body of research is advancing culturally appropriate methodologies and methods that aim to prioritise the voices and lived experiences of Indigenous and culturally diverse women. This paper contributes to this literature by providing an example of research that used Indigenous methodologies (Mana Wahine and Masi Methodology) to engage young Māori and Pasifika wāhine in Aotearoa New Zealand.

We start by positioning this paper in relevant literature, then detail the cultural underpinnings of the methodological approach we used. We then outline the research and offer some practical considerations in, i) recruiting young women within one’s community, ii) using methods such as wānanga (meetings), digital diaries and kai (food), and iii) weaving care and reciprocity. In so doing, we highlight the importance of using locally specific feminist methodologies throughout research with, by and for young Indigenous and culturally diverse young women.

Publication Link

https://www.tandfonline.com/doi/full/10.1080/2159676X.2023.2250536

How do Māori navigate advice about nutrition? A review that spans the mātauranga Māori, western science, and social media divides

Sun, 09 Jun 2024 21:40:29 GMT

2023

Authors

Erina Korohina, Anna Rolleston, Zirsha Wharemate , Isaac Warbrick

Abstract

Cardiovascular disease is one of the leading causes of death in Aotearoa (New Zealand). Life expectancy for Māori (Indigenous people of Aotearoa) is 7 years less than that for non-Māori. Maintaining a healthy nutrition lifestyle is vital to reduce cardiovascular disease risk and improve overall well-being.

Though diet and nutrition campaigns are standard parts of health promotion and campaigns have been developed to target Māori, little is known about the way Māori navigate nutrition advice. This review explored mātauranga Māori (Māori knowledge) and western science as bodies of knowledge for nutrition advice and social media as a platform to disseminate nutrition information to understand how communities get their nutrition advice.

The findings suggest that for Māori to navigate nutrition advice and messaging effectively, advice needs to be tailored in a way that is acceptable to a Māori worldview while working within the interface of mātauranga Māori, western science, and social media.

Publication Link

https://doi.org/10.1177/11771801231185357

Hā Ora: secondary care barriers and enablers to early diagnosis of lung cancer for Māori communities

Sun, 09 Jun 2024 21:40:28 GMT

2021

Authors

Jacquie Kidd, Shemana Cassim, Anna Rolleston , Lynne Chepulis, Brendan Hokowhitu, Rawiri Keenan, Janice Wong, Melissa Firth, Karen Middleton, Denise Aitken & Ross Lawrenson

Abstract

Lung Cancer is the leading cause of cancer deaths in Aotearoa New Zealand. Māori communities in particular have higher incidence and mortality rates from Lung Cancer. Diagnosis of lung cancer at an early stage can allow for curative treatment.

This project aimed to document the barriers to early diagnosis and treatment of lung cancer in secondary care for Māori communities. Nine community hui (focus groups) and nine primary healthcare provider hui were carried out in five rural localities in the Midland region. Hui data were thematically analysed. Barriers and enablers to early diagnosis of lung cancer were categorised into two broad themes: Specialist services and treatment, and whānau journey.

The barriers and enablers that participants experienced in specialist services and treatment related to access to care, engagement with specialists, communication with specialist services and cultural values and respect, whereas barriers and enablers relating to the whānau journey focused on agency and the impact on whānau.

The study highlighted the need to improve communication within and across healthcare services, the importance of understanding the cultural needs of patients and whānau and a health system strategy that meets these needs. Findings also demonstrated the resilience of Māori and the active efforts of whānau as carers to foster health literacy in future generations.

Publication Link

https://doi.org/10.1186/s12885-021-07862-0

Co-opting or valuing the indigenous voice through translation? A decision for research teams

Sun, 09 Jun 2024 21:40:27 GMT

2019

Authors

Kidd, J., Cassim, S., Rolleston, A. , & Keenan, R.

Abstract

Although te reo Māori is an official language of Aotearoa New Zealand, translation of research material such as information sheets, consent forms and questionnaires into te reo Māori remains highly variable. Translation tends to occur in research projects where Māori lead the work and that exclusively focus on Māori communities and topics. Translations are not offered or undertaken as a matter of course for all research.

As a team of Māori and Indigenous researchers working within the health sector, we believe that there are important questions that need to be explored around the practice of using Indigenous languages, rich in similes and metaphors, to convey English/Western concepts/constructs/ideologies. In this paper, we draw on the story of one project to deconstruct and challenge the hegemonic terms through which translation of research material occurs. We explore the messages that translated material sends to potential research participants.

We contend that the choice about whether to translate research material into te reo Māori is one that should be undertaken within a robust decision-making framework that considers the reasons for a translation and its impact on the participants. Translation should not be undertaken primarily to attract Māori participants, but should reliably signal that the research is being undertaken in a way that honours a Māori worldview.

Publication Link

https://researchcommons.waikato.ac.nz/items/e9fffebe-120f-4f32-a791-619b93b3245e

WHAKAPIKI WAIRUA - Co-designing and implementing a Māori mindfulness mental health intervention in a wharekura

Tue, 04 Jun 2024 03:05:57 GMT

2021

Authors

Marama McDonald , Waikaremoana Waitoki, Anna Rolleston

Abstract

This article explores the process of co-designing a mātauranga-Māori-informed mindfulness intervention with rangatahi in a wharekura and examines the effects on wellbeing. Mahitahi co-design methodology underpinned the design, implementation and evaluation of the intervention, and quantitative psychological tests measured improvements in wellbeing and dispositional mindfulness.

Findings showed positive indications for a decrease in levels of psychological distress, improvements in Māori quality of life domains, and higher levels of dispositional mindfulness. The effective mātauranga-Māori-informed wellbeing components of the intervention were he āhuru mōwai, mahi a ngā tīpuna, ngā kaitiaki, te taiao, whanaungatanga, and hohou te rongo.

Future application of the intervention in mainstream schools and communities is needed to assess the efficacy of the intervention for rangatahi in other environments, the sustainability of mindfulness practice for rangatahi, and the long-term effects on wellbeing.

Publication Link

https://researchcommons.waikato.ac.nz/server/api/core/bitstreams/ece78a2a-a26a-4710-b4c0-58bd90e40bf3/content

Where are the opportunities to address system barriers preventing equitable cardiovascular outcomes for indigenous populations?

Tue, 04 Jun 2024 03:05:56 GMT

2021

Authors

Katharine F McBride, Anna Rolleston

Abstract

The health and wellbeing of indigenous communities across the globe are affected by the substantial burden of cardiovascular disease. Burden disproportionally sits with younger indigenous people compared with non-indigenous populations, affecting the cultural, social, and economic strength of communities.

Publication Link

https://www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X(21)00270-9.pdf

The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS): Design and Methodology

Tue, 04 Jun 2024 03:05:56 GMT

2021

Authors

Malcolm. E. Legget, Vicky. A. Cameron, Katrina. K. Poppe, Sara Aish, Nikki Earle, Yeunhyang Choi, Kathryn. E. Bradbury, Clare Wall, Ralph Stewart, Andrew Kerr, Wil Harrison, Gerry Devlin, Richard Troughton, A. Mark Richards, Graeme Porter, Patrick Gladding, Anna Rolleston and Robert N. Doughty

Abstract

Each year, approximately 5,000 New Zealanders are admitted to hospital with first-time acute coronary syndrome (ACS). The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS) is a prospective longitudinal cohort study embedded within the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry in six hospitals.

The objective of MENZACS is to examine the relationship between clinical, genomic, and cardiometabolic markers in relation to presentation and outcomes post-ACS.

MENZACS represents a cohort with optimal contemporary management and will be a significant epidemiological bioresource for the study of environmental and genetic factors contributing to ACS in New Zealand’s multi-ethnic environment. The study will utilise clinical, nutritional, lifestyle, genomic, and biomarker analyses to explore factors influencing the progression of coronary disease and develop risk prediction models for health outcomes.

Publication Link

https://www.mdpi.com/2035-8148/11/2/10

Māori, Pacific, Aboriginal and Torres Strait Islander Women’s Cardiovascular Health: Where Are the Opportunities to Make a Real Difference?

Tue, 04 Jun 2024 03:05:54 GMT

2021

Authors

Katharine F. McBride, Anna Rolleston , Corina Grey, Natasha J. Howard, Catherine Paquet, Alex Brown

Abstract

Māori and Pacific women in New Zealand and Aboriginal and Torres Strait Islander women in Australia are recognised as nurturers and leaders within their families and communities. However, women’s wellbeing, and that of their communities, are affected by a high burden of cardiovascular disease experienced at a younger age than women from other ethnic groups. There has been little focus on the cardiovascular outcomes and strategies to address heart health inequities among Māori, Pacific, Aboriginal and Torres Strait Islander women. The factors contributing to these inequities are complex and interrelated but include differences in exposure to risk and protective factors, rates of multi-morbidity, and substantial gaps within the health system, which include barriers to culturally responsive, timely and appropriate cardiovascular care.

Cardiovascular disease in women impacts not only the individual, but their family and community, and the burden of living with disease limits women’s capacity to fulfil their roles and responsibilities which support and sustain families and communities. Our response must draw on the strengths of Māori, Pacific, Aboriginal and Torres Strait Islander women, acknowledge health and wellbeing holistically, address the health and social needs of individuals, families and communities, and recognise that Indigenous women in New Zealand, Australia and across the Pacific must be involved in the design, development and implementation of solutions affecting their own health.

Publication Link

https://www.heartlungcirc.org/article/S1443-9506(20)30442-X/fulltext

Hā Ora: Reflecting on a Kaupapa Māori Community-Engaged Co-design Approach to Lung Cancer Research

Tue, 04 Jun 2024 03:05:53 GMT

2021

Authors

Jacquie Kidd, Shemana Cassim, Anna Rolleston , Rawiri Keenan, Ross Lawrenson, Nicolette Sheridan, Isaac Warbrick, Janette Ngaheu, Brendan Hokowhitu

Abstract

Co-designed research is gaining prominence within the health care space. Community engagement is a key premise of co-design and is also particularly vital when carrying out kaupapa Māori research. Kaupapa Māori describes a “by Māori, for Māori” approach to research in Aotearoa/New Zealand.

This article discusses the research process of Hā Ora: a co-design project underpinned by a kaupapa Māori approach. The objective was to explore the barriers to early presentation and diagnosis of lung cancer, barriers identified by Māori.

This article highlights and unpacks the complexities of carrying out community- engaged co-design with Māori who live in rural communities. In particular, we draw attention to the importance of flexibility and adaptability in the research process. We highlight issues pertaining to timelines and budgets, and also the intricacies of involving co-governance and advisory groups. Overall, through this article, we argue that health researchers need to prioritise working with and for participants, rather than on them, especially when working with Māori communities.

Publication Link

https://jps.library.utoronto.ca/index.php/ijih/article/view/33106

Outcomes for working age patients after first-time acute coronary syndrome - ANZACS-QI 35

Tue, 04 Jun 2024 03:05:52 GMT

2021

Authors

Nikki J Earle, Katrina K Poppe, Anna Rolleston , Gerard Devlin, Andrew J Kerr, Malcolm E Legget, Robert N Doughty

Abstract

Acute coronary syndrome (ACS) events and the ongoing burden of disease can have a significant impact on the subsequent life-course of working age people.

The high risk factor burden and subsequent high rate of clinical events in working age patients reinforces the need for a longer-term focus on strategies to improve clinical outcomes following first-time ACS.

Publication Link

https://pubmed.ncbi.nlm.nih.gov/33278419/

Indigenous perspectives on breaking bad news: ethical considerations for healthcare providers

Tue, 04 Jun 2024 03:05:51 GMT

2021

Authors

Shemana Cassim, Jacquie Kidd, Rawiri Keenan, Karen Middleton, Anna Rolleston , Brendan Hokowhitu, Melissa Firth, Denise Aitken, Janice Wong, Ross Lawrenson

Abstract

Most healthcare providers (HCPs) work from ethical principles based on a Western model of practice that may not adhere to the cultural values intrinsic to Indigenous peoples. Breaking bad news (BBN) is an important topic of ethical concern in health research. While much has been documented on BBN globally, the ethical implications of receiving bad news, from an Indigenous patient perspective in particular, is an area that requires further inquiry.

This article discusses the experiences of Māori (Indigenous peoples of New Zealand) lung cancer patients and their families, in order to investigate the ethical implications of receiving bad news.

The findings of this study were categorised into two key themes: communication and context. Avenues for best practice include understanding the centrality of the HCP-patient relationship and family ties in the healthcare journey, and providing patients with the full range of viable treatment options including hope, clear advice and guidance when the situation calls for it. Overall, the findings of this study hold implications for providing culturally safe and humanistic cancer care when BBN to Māori and Indigenous patients.

Publication Link

https://pubmed.ncbi.nlm.nih.gov/33419938/

Does potentially inappropriate prescribing predict an increased risk of admission to hospital and mortality? A longitudinal study of the ‘oldest old’

Tue, 04 Jun 2024 02:47:53 GMT

2020

Authors

Karen Cardwell, Ngaire Kerse, Carmel M. Hughes, Ruth Teh, Simon A. Moyes, Oliver Menzies, Anna Rolleston , Joanna B. Broad & Cristín Ryan

Abstract

Potentially inappropriate prescribing (PIP) is associated with negative health outcomes, including hospitalisation and mortality. Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ) is a longitudinal study of Māori (the indigenous population of New Zealand) and non-Māori octogenarians. Health disparities between indigenous and non-indigenous populations are prevalent internationally and engagement of indigenous populations in health research is necessary to understand and address these disparities.

Using LiLACS NZ data, this study reports the association of PIP with hospitalisations and mortality prospectively over 36-months follow-up. PIP was associated with an increased risk of hospitalisation and mortality in this cohort.

Omissions appear more important for Māori in predicting hospitalisations, and PIMs were more important in non-Māori in predicting mortality.

These results suggest understanding prescribing outcomes across and between population groups is needed and emphasises prescribing quality assessment is useful.

Publication Link

https://doi.org/10.1186/s12877-020-1432-4

Rights, interests and expectations: Indigenous perspectives on unrestricted access to genomic data

Tue, 04 Jun 2024 02:47:52 GMT

2020

Authors

Maui Hudson, Nanibaa' A Garrison, Rogena Sterling, Nadine R Caron, Keolu Fox, Joseph Yracheta, Jane Anderson, Phil Wilcox, Laura Arbour, Alex Brown, Maile Taualii, Tahu Kukutai, Rodney Haring, Ben Te Aika, Gareth S Baynam, Peter K Dearden, David Chagné, Ripan S Malhi , Ibrahim Garba, Nicki Tiffin, Deborah Bolnick, Matthew Stott, Anna K Rolleston , Leah L Ballantyne, Ray Lovett, Dominique David-Chavez, Andrew Martinez, Andrew Sporle, Maggie Walter, Jeff Reading, Stephanie Russo Carroll

Abstract

Addressing Indigenous rights and interests in genetic resources has become increasingly challenging in an open science environment that promotes unrestricted access to genomic data. Although Indigenous experiences with genetic research have been shaped by a series of negative interactions, there is increasing recognition that equitable benefits can only be realized through greater participation of Indigenous communities. Issues of trust, accountability and equity underpin Indigenous critiques of genetic research and the sharing of genomic data.

This Perspectives article highlights identified issues for Indigenous communities around the sharing of genomic data and suggests principles and actions that genomic researchers can adopt to recognize community rights and interests in data.

Publication Link

https://pubmed.ncbi.nlm.nih.gov/32251390/

Seeing the unseen: evidence of kaupapa Māori health interventions

Tue, 04 Jun 2024 02:47:51 GMT

2020

Authors

Anna K Rolleston , Shemana Cassim, Jacquie Kidd, Ross Lawrenson, Rawiri Keenan and Brendan Hokowhitu

Abstract

Māori in Aotearoa have higher incidence, prevalence and mortality from chronic disease. The dominant narrative in Aotearoa about the reasons for Māori ill health neglects to acknowledge the history of colonisation and failures of the health system, alongside the holistic view of health taken by Māori focusing on collective, whānau-based outcomes.

In this article, we review health interventions for chronic disease that have a kaupapa Māori philosophical basis. Our findings demonstrate that there is no clear process in health service design, delivery, research and funding that values and understands mātauranga Māori. Western knowledge systems are inadequate for collecting and presenting Māori knowledge. Overall, we highlight that the tension between acknowledging that a “by Māori, for Māori” approach is best, and the difficulty in defining appropriate evidence collection methodology and outcome measures when funders and policy makers continue to require Western-centric interventions is an obstacle to improving Māori health outcomes.

Publication Link

https://journals.sagepub.com/doi/10.1177/1177180120919166

Hā Ora: Barriers and enablers to early diagnosis of lung cancer in primary healthcare for Māori communities

Tue, 04 Jun 2024 02:47:49 GMT

2020

Authors

Shemana Cassim, Jacquie Kidd, Anna Rolleston , Rawiri Keenan, Denise Aitken, Melissa Firth, Karen Middleton, Lynne Chepulis, Janice Wong, Brendan Hokowhitu, Ross Lawrenson

Abstract

The objective of this research was to document the barriers to early presentation and diagnosis of lung cancer within primary healthcare, identified by Māori whānau (families) and primary healthcare providers in the Midland region of Aotearoa New Zealand.

Barriers and enablers to early diagnosis of lung cancer were categorised into three key themes: GP relationship and position in the community, health literacy and pathways to diagnosis.

This study demonstrates that culturally responsive, patient-centred healthcare, and positive GP–patient relationships are significant factors for Māori patients and whānau serving as barriers and enablers to early diagnosis of lung cancer.

Publication Link

https://onlinelibrary.wiley.com/doi/10.1111/ecc.13380

Diagnostic accuracy of a global cognitive screen for Māori and non-Māori octogenarians

Tue, 04 Jun 2024 02:47:48 GMT

2019

Authors

Kristina Zawaly, Simon A. Moyes, Phil C. Wood, Gary Cheung, Anna Rolleston , Stephen Buetow, Lynette Tippett, Ngaire Kerse

Abstract

We assessed the sensitivity and specificity of the Modified Mini–Mental State Examination (3MS) in predicting dementia and cognitive impairment in Māori (indigenous people of New Zealand) and non-Māori octogenarians.

The 3MS demonstrated strong diagnostic accuracy to detect dementia with areas under the curve of 0.87 for Māori and 0.9 for non-Māori. Our cutoffs displayed ethnic variability and are approximately 5 points greater than those commonly applied.

Cutoffs that are not age or ethnically appropriate may compromise the accuracy of cognitive screens. Consequently, older age and indigeneity increase the risk of mislabeled cognitive status.

Publication Link

https://alz-journals.onlinelibrary.wiley.com/doi/10.1016/j.trci.2019.08.006

Decolonizing Sport Science: High Performance Sport, Indigenous Cultures, and Women's Rugby

Tue, 04 Jun 2024 02:47:45 GMT

2019

Authors

Holly Thorpe, Julie Brice, and Anna Rolleston

Abstract

To date, there is little research focusing on the role of culture and Indigenous ways of knowing in Western science-dominated high performance sporting environments. This paper takes inspiration from the emerging field of Postcolonial Science Studies and feminist Indigenous scholars to explore how Aotearoa (New Zealand) Black Ferns Sevens players from Māori and Samoan descent make meaning of their bodies within Westernized high performance sporting spaces.

Drawing upon a thematic analysis of semi-structured interviews with 18 members of the Black Ferns Sevens squad, we illustrate how players navigate divergent cultural value systems within and across various aspects of the high performance sport environment, including training, nutrition, menstruation, and the everyday quantification of their bodies. This paper also reveals some of the important considerations, learnings, and vulnerabilities experienced during this cross-cultural research collaboration, and highlights the need for more research by/with/for Indigenous women in high performance sport environment.

Publication Link

https://www.researchgate.net/publication/338406623_Decolonizing_Sport_Science_High_Performance_Sport_Indigenous_Cultures_and_Women's_Rugby

Walking an Indigenous Pathway: Bridging the Gap in Cardiovascular Health

Tue, 04 Jun 2024 02:47:44 GMT

2019

Authors

Alex Brown; Anna Rolleston

Abstract

Protein intake and its food sources is important to prevent age related loss of muscle mass and strength. An even protein intake distribution throughout the day has been suggested as necessary to stimulate muscle protein synthesis.

This study examined the prevalence and determinants of inadequate protein intake, primary food sources and mealtime distribution of protein in Māori and non-Māori of advanced age.

Publication Link

https://www.heartlungcirc.org/article/S1443-9506(19)30309-9/abstract

Protein Intake, Distribution and Food Sources in Adults of Advanced Age: Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ)

Tue, 04 Jun 2024 02:47:43 GMT

2019

Authors

Anishka Ram, Ngaire Kerse, Simon Moyes, Anna Rolleston and Carol Wham

Abstract

This study examined the prevalence and determinants of inadequate protein intake, primary food sources and mealtime distribution of protein in Māori and non-Māori of advanced age.

Publication Link

https://www.researchgate.net/publication/364092624_Protein_Intake_Distribution_and_Food_Sources_in_Adults_of_Advanced_Age_Life_and_Living_in_Advanced_Age_A_Cohort_Study_in_New_Zealand_LiLACS_NZ

Challenged but not threatened: Managing health in advanced age

Tue, 04 Jun 2024 02:47:42 GMT

2018

Authors

Janine Wiles, Philippa Miskelly , Oneroa Stewart, Ngaire Kerse, Anna Rolleston , Merryn Gott

Abstract

In this paper we reflect on discussions with people of advanced age in Āotearoa New Zealand, and draw on theoretical frameworks of resilience and place in old age, to explore insights about the ways older people maintain quality of life and health.

People in advanced age saw themselves as challenged, rather than threatened, by adversities, and positioned themselves as able to draw on a lifetime of experience and resourcefulness and collaborations with supporters to deal with challenges. Key strategies include downplaying illness and resisting biomedical discourses of complexity, positioning embodied selves as having agency, and creative adaptation in the face of loss.

People in advanced age exhibit resilience, maintaining wellbeing, autonomy and good physical and mental quality of life even while living with challenges such as functional decline and multi-morbidities. These findings have significance for supporters of older people, emphasising the need to move away from a narrow focus on problems to working together WITH people in advanced age to offer a more holistic approach that encourages and enhances adaptation and flexibility, rather than rigid and counterproductive coping patterns.

Publication Link

https://www.researchgate.net/publication/325875136_Challenged_but_not_threatened_Managing_health_in_advanced_age

Genomic medicine must reduce, not compound, health inequities: the case for hauora-enhancing genomic resources for New Zealand

Tue, 04 Jun 2024 02:47:41 GMT

2018

Authors

Stephen P Robertson, Jennie Harré Hindmarsh, Sarah Berry, Vicky A Cameron, Murray P Cox, Ofa Dewes, Robert N Doughty, George Gray, Jessie C Jacobsen, Albert Laurence, Elizabeth Matisoo-Smith, Susan Morton, Andrew N Shelling, Dianne Sika-Paotonu, Anna Rolleston , Jonathan R Skinner, Russell G Snell, Andrew Sporle, Cristin Print, Tony R Merriman, Maui Hudson, Philip Wilcox

Abstract

Precision medicine seeks to draw on data from both individuals and populations across disparate domains to influence and support diagnosis, management and prevention in healthcare at the level of the individual patient and their family/whānau. Central to this initiative is incorporating the effects of the inherent variation that lies within genomes and can influence health outcomes.

Māori, and more broadly Pacific peoples, differ substantially in terms of genomic variation compared to the more closely studied European and Asian populations. In the absence of accurate genomic information from Māori and Pacific populations, the precise interpretation of genomic data and the success and benefits of genomic medicine will be disproportionately less for those Māori and Pacific peoples.

In this viewpoint article we, as a group of healthcare professionals, researchers and scientists, present a case for assembling genomic resources that catalogue the characteristics of the genomes of New Zealanders, with an emphasis on peoples of Māori and Polynesian ancestry, as a healthcare imperative. In proposing the creation of these resources, we note that their governance and management must be led by iwi and Māori and Pacific representatives.

Assembling a genomic resource must be informed by cultural concepts and values most especially understanding that, at a physical and spiritual level, whakapapa is embodied within the DNA of a person. Therefore DNA and genomic data that connects to whakapapa (genealogy) is considered a taonga (something precious and significant), and its storage, utilisation and interpretation is a culturally significant activity. Ongoing oversight and governance of such taonga by Māori and Pacific representatives will maximise hauora (health) while also minimising the risk of misuse of this information.

Publication Link

https://www.researchgate.net/publication/327102201_Genomic_medicine_must_reduce_not_compound_health_inequities_The_case_for_hauora-enhancing_genomic_resources_for_New_Zealand

Community-Based Maintenance Cardiac Rehabilitation

Tue, 04 Jun 2024 02:47:39 GMT

2018

Authors

Sandra Mandic, Anna Rolleston , Garrick Hately, Stacey Reading

Abstract

Community-based cardiac rehabilitation programs play an important role in restoring and maintaining functional capacity and psychological well-being in patients w ith cardiovascular disease. The overarching goal of community-based programs is to promote and support long-term adherence to exercise and healthy lifestyle behavior. These programs exist in a continuum of forms ranging from those that offer services similar to hospital-based outpatient clinics, to clubs operated and managed by patients themselves. Most programs not only are centered on providing exercise training but also may provide health-related education, nutritional guidance, and behavioral counseling. The most successful programs are grounded in scientific best practice while maintaining cultural and social sensitivity to the individuals and communities they serve.

This chapter discusses outcomes of participation in community-based cardiac rehabilitation, adherence to such programs and special considerations including cultural aspects and program implementation in rural communities. We provide examples of several cardiac rehabilitation programs and recommendations for setting up such programs.

Publication Link

https://www.sciencedirect.com/book/9780128112793/lifestyle-in-heart-health-and-disease

https://www.sciencedirect.com/science/article/abs/pii/B9780128112793000148

Patterns of multi-morbidity and prediction of hospitalisation and all-cause mortality in advanced age

Tue, 04 Jun 2024 02:47:37 GMT

2018

Authors

Ruth O Teh, Oliver H Menzies, Martin J Connolly, Rob N Doughty, Tim J Wilkinson, Avinesh Pillai, Thomas Lumley, Cristin Ryan, Anna Rolleston , Joanna B Broad, Ngaire Kerse

Abstract

Multi-morbidity is associated with poor outcomes and increased healthcare utilisation. We aim to identify multi-morbidity patterns and associations with potentially inappropriate prescribing (PIP), subsequent hospitalisation and mortality in octogenarians.

In octogenarians, hospitalisation and mortality are better predicted by profiles of clusters of conditions rather than the presence or absence of a specific condition. Further research is required to determine if the cluster approach can be used to target patients to optimise resource allocation and improve outcomes.

Publication Link

https://doi.org/10.1093/ageing/afx184

High nutrition risk related to dietary intake is associated with an increased risk of hospitalisation and mortality for older Māori: LiLACS NZ

Tue, 04 Jun 2024 02:47:36 GMT

2018

Authors

Sylvia M. North, Carol A. Wham, Ruth Teh, Simon A. Moyes, Anna Rolleston , Ngaire Kerse

Abstract

To investigate the association between domains of nutrition risk with hospitalisations and mortality for New Zealand Māori and non‐Māori in advanced age.

Nutrition risk among older Māori is identifiable and treatable. Effort is needed to engage relevant community and whānau (family) support to ensure older Māori have food security and cultural food practices are met.

Publication Link

https://doi.org/10.1111/1753-6405.12793

Text4Heart II – improving medication adherence in people with heart disease: a study protocol for a randomized controlled trial

Tue, 04 Jun 2024 02:47:34 GMT

2018

Authors

Ralph Maddison, Ralph Stewart, Rob Doughty, Tony Scott, Andrew Kerr, Jocelyne Benatar, Robyn Whittaker, Jonathan C. Rawstorn, Anna Rolleston , Yannan Jiang, Paul Estabrooks, Rachel Karen Sullivan, Hannah Bartley & Leila Pfaeffli Dale

Abstract

Cardiac rehabilitation (CR) is an essential component of contemporary management for patients with coronary heart disease, including following an acute coronary syndrome (ACS). CR typically involves education and support to assist people following an ACS to make lifestyle changes and prevent subsequent events. Despite its benefits, uptake and participation in tradition CR programs is low. The use of mobile technologies (mHealth) offers the potential to improve reach, access, and delivery of CR support. We aim to determine the effectiveness and cost-effectiveness of a text-messaging intervention (Text4Heart II) to improve adherence to medication and lifestyle change in addition to usual care in people following an ACS. A second aim is to use the RE-AIM framework to inform the potential implementation of Text4Heart II within health services in New Zealand.

Publication Link

https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-018-2468-z

The effect of a 12-week exercise and lifestyle management programme on cardiac risk reduction: A controlled trial using a Kaupapa Māori philosophy

Mon, 03 Jun 2024 23:53:33 GMT

2017

Authors

Anna K Rolleston , Marama McDonald , Maraea Walker , Katrina Poppe, Janine L Wiles & Robert N Doughty

Abstract

To provide evidence for the 12-week lifestyle management programme and the use of exercise, nutrition and stress management strategies in preventing heart disease.

Publication Link

https://www.thecentreforhealth.co.nz/research/

Burden of atrial fibrillation in Māori and Pacific people in New Zealand: a cohort study

Mon, 03 Jun 2024 23:53:30 GMT

2017

Authors

Yulong Gu, Robert N. Doughty, Ben Freedman, John Kennelly, Jim Warren, Matire Harwood, Richard Hulme, Chris Paltridge, Ruth Teh, Anna Rolleston , Natalie Walker

Abstract

Atrial fibrillation (AF) is a major risk factor for ischaemic stroke and cardiovascular events. In New Zealand (NZ), Māori (indigenous New Zealanders) and Pacific people experience higher rates of AF compared with non-Māori/non-Pacific people.

This study aims t o describe a primary care population with AF in NZ. Stroke risk and medication adherence according to ethnicity are also detailed. In conclusion - AF screening and stroke thromboprophylaxis in Māori and Pacific people could start below the age of 65 years in NZ.

Publication Link

https://onlinelibrary.wiley.com/doi/10.1111/imj.13648

Testosterone in advance age: a New Zealand longitudinal cohort study: Life and Living in Advanced Age (Te Puāwaitanga o Ngā Tapuwae Kia Ora Tonu)

Mon, 03 Jun 2024 23:53:29 GMT

2017

Authors

Martin J Connolly; Ngaire Kerse; Tim Wilkinson; Oliver Menzies; Anna Rolleston ; Yih Harng Chong; Joanna B Broad; Simon A Moyes; Santosh Jatrana; Ruth Teh

Abstract

Serum testosterone (T) levels in men decline with age. Low T levels are associated with sarcopenia and frailty in men aged > 80 years. T levels have not previously been directly associated with disability in older men. We explored associations between T levels, frailty and disability in a cohort of octogenarian men.

Data was used from all men from Life and Living in Advanced Age Cohort Study in New Zealand, a longitudinal cohort study in community-dwelling older adults.

In conclusion - men over 80 years, we confirm an association between T levels and baseline frailty scores. The new finding of association between T levels and disability is potentially relevant to debates on T supplementation in older men, though, as associations were not present at 24 months, further work is needed.

Publication Link

https://bmjopen.bmj.com/content/7/11/e016572

Ethnic and Gender Differences in Preferred Activities among Māori and non-Māori of Advanced age in New Zealand

Mon, 03 Jun 2024 23:53:27 GMT

2017

Authors

Valerie A. Wright-St Clair; Angela Rapson, Mere Kepa, Martin Connolly, Sally Keeling, Anna Rolleston , Ruth Teh, Joanna B. Broad, Lorna Dyall, Santosh Jatrana, Janine Wiles, Avinesh Pillai, Nick Garrett & Ngaire Kerse

Abstract

This study explored active aging for older Māori and non-Māori by examining their self-nominated important everyday activities. The project formed part of the first wave of a longitudinal cohort study of aging well in New Zealand. Māori aged 80 to 90 and non-Māori aged 85 were recruited.

These findings reveal fundamental ethnic divergences in preferences for active aging with implications for enabling participation, support provision and community design.

Publication Link

https://link.springer.com/article/10.1007/s10823-017-9324-6

Attachment to place in advanced age: A study of the LiLACS NZ cohort

Mon, 03 Jun 2024 23:53:26 GMT

2017

Authors

Janine L. Wiles; Anna Rolleston ; Avinesh Pillai; Joanna Broad; Ruth The; Merryn Gott; Ngaire Kerse

Abstract

An extensive body of research theorises that attachment to place is positively associated with health, particularly for older people. Building on this, we measure how indicators of attachment to place are associated with health for in people of advanced age in New Zealand. We use data from a cohort study (LiLACS NZ), which includes an indigenous Māori cohort aged 80–90 years and a non-Māori cohort aged 85 years from a mixed urban/rural region in New Zealand.

We demonstrate that people in advanced age hold strong feelings of attachment to place. We also establish some positive associations between attachment to place and health in advanced age, and show how these differ for the indigenous and non-indigenous cohorts. Place attachment, and particularly its relationship to health, operates in different ways for different groups.

Publication Link

https://www.sciencedirect.com/science/article/abs/pii/S0277953617303003?via%3Dihub

Integration of kaupapa Māori concepts in health research: a way forward for Māori cardiovascular health?

Mon, 03 Jun 2024 23:53:24 GMT

2016

Authors

Anna K Rolleston ; Robert Doughty; Katrina K Poppe (Auckland University)

Abstract

Kaupapa Māori is a research methodology underpinned by critical theory in which Māori beliefs and values are the central focus and findings are applied based on a Māori worldview. Kaupapa Māori research emphasises relationships and is cross-disciplinary rather than based on categorisations and disciplinary divisions. In New Zealand, research using Māori methods is important for equity, especially in an environment where Māori have poor health outcomes. Integration of Māori methods into western medical research and practice is a challenge because of divergent philosophies.

Using the concept of an interface space where researchers draw the best from both Māori and western medicine concepts and then combine the two, a new way forward is created that provides Māori as well as western medical, appropriate outcomes. This essay discusses this integrated research approach, using a cardiovascular research project as an exemplar.

Publication Link

https://www.researchgate.net/publication/301657277_Integration_of_kaupapa_Maori_concepts_in_health_research_A_way_forward_for_Maori_cardiovascular_health

Macronutrient intake in advanced age: Te Pua - waitanga o Nga - Tapuwae Kia ora Tonu, Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ)

Mon, 03 Jun 2024 23:53:22 GMT

2016

Authors

Carol Wham; Ruth The; Simon A. Moyes; Anna Rolleston; Marama Muru-Lanning; Karen Hayman; Ashley Adamson; Ngaire Kerse

Abstract

As part of the 12-month follow-up of the longitudinal cohort study, Life and Living in Advanced Age: A Cohort Study in New Zealand, dietary intake was assessed in 216 Māori and 362 non-Māori octogenarians using repeat 24-h multiple pass recalls. Energy and macronutrient intakes were calculated, and food items reported were allocated to food groups used in the New Zealand Adult Nutrition Survey (NZANS). Intakes were compared with the nutrient reference values (NRV) for Australia and New Zealand.

For both ethnic groups, the median energy levels were similar, percent carbohydrate tended to be lower and percent fat higher compared with adults aged >70 years in NZANS. These unique cross-sectional data address an important gap in our understanding of dietary intake in this growing section of our population and highlight lack of age-appropriate NRV.

Publication Link

https://pubmed.ncbi.nlm.nih.gov/27546175/

The Effect of a 12 - Week Exercise and Lifestyle Management Programme on Cardiac Risk Reduction: A Pilot Using a Kaupapa Maori Philosophy

Mon, 03 Jun 2024 23:53:17 GMT

2017

Authors

Anna Rolleston; Rob Doughty; Katrina K Poppe

Abstract

Cardiovascular disease remains the leading cause of premature death and disability for all New Zealanders. Māori, the Indigenous people of New Zealand, are disproportionately affected. The New Zealand Māori Health Strategy recognises that “health and wellbeing are influenced and affected by the ‘collective’ … and the importance of working with people in their social contexts, not just with their physical symptoms” (Ministry of Health, 2002, p. 1). In a Māori worldview, a holistic approach to health is innate.

This project piloted a kaupapa Māori approach within an existing 12-week clinical exercise and lifestyle management programme. The aims of the study were to determine the effectiveness of a kaupapa Māori 12-week exercise and lifestyle management programme on parameters of cardiac risk and quality of life.

Publication Link

https://www.researchgate.net/publication/318690296_The_effect_of_a_12-week_exercise_and_lifestyle_management_programme_on_cardiac_risk_reduction_A_pilot_using_a_kaupapa_Maori_philosophy

Cohort Profile: Te Puawaitanga o Nga Tapuwae Kia Ora Tonu, Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ)

Mon, 03 Jun 2024 23:53:15 GMT

2015

Authors

Ngaire M Kerse; Ruth The; Simon Alexander Moyes; Joanna B Broad; Anna Rolleston ; Merryn Gott; Mere Kepa; Carol A Wham; Karen J Hayman; Santosh Jatrana; Ashley J Adamson; Thomas Lumley

Abstract

The ageing of the population globally and in New Zealand (NZ) was the main driver for this study. In Aoteoroa, New Zealand, little is known about Māori and non-Māori of advanced age, yet population projections predict a trebling of the number of Māori and a doubling of non-Māori octogenarians in the next 10 years.

This study was set up under joint leadership of Māori and non-Māori investigators and was a collaborative effort between the University of Auckland, University of Otago, Massey University and Auckland University of Technology in NZ.

Publication Link

https://www.researchgate.net/publication/281192023_Cohort_profile_Te_Puawaitanga_o_Nga_Tapuwae_Kia_Ora_Tonu_life_and_living_in_advanced_age_a_cohort_study_in_New_Zealand_LiLACS_NZ

Te Pākeketanga: Living and dying in advanced age - A study protocol

Mon, 03 Jun 2024 23:53:14 GMT

2015

Authors

Merryn Gott; Tess Moeke-Maxwell; Lisa Ann Williams; Stella Black; Gabriella Trussardi; Janine L Wiles; Rangimarie Mules; Anna Rolleston ; Ngaire M Kerse

Abstract

Background The number of people dying in advanced old age is increasing rapidly and building the evidence base regarding end - of - life care for older people has been identified as an international policy priority. The unique opportunity to link longitudinal studies of ageing with studies exploring the end of life circumstances of older people remains under-exploited internationally. Very little is known about the specific circumstances, cultural needs and care preferences of indigenous older people, including Māori, at end - of - life and the needs of their whānau/ extended family carers.

Ultimately this study has the potential to inform better outcomes for the growing numbers of people dying in advanced old age both in New Zealand and internationally, as well as their whānau and family caregivers. It also highlights the ability to generate an in-depth understanding of end-of-life circumstances by appending studies of palliative and end-of-life care onto existing longitudinal studies.ion) over and above usual CR services in New Zealand adults diagnosed with CHD.

Publication Link

https://www.researchgate.net/publication/287806231_Te_Pakeketanga_Living_and_dying_in_advanced_age_-_A_study_protocol

Improving coronary heart disease self-management using mobile technologies (Text4Heart): A randomised controlled trial protocol

Mon, 03 Jun 2024 23:53:13 GMT

2014

Authors

Leila Pfaeffli Dale; Robyn Whittaker; Yannan Jiang; Ralph A H Stewart; Anna Rolleston ; Ralph Maddison

Abstract

Cardiac rehabilitation (CR) is a secondary prevention program that offers education and support to assist patients with coronary heart disease (CHD) make lifestyle changes. Despite the benefits of CR, attendance at centre-based sessions remains low. Mobile technology (mHealth) has potential to reach more patients by delivering CR directly to mobile phones, thus providing an alternative to centre-based CR. The aim of this trial is to evaluate if a mHealth comprehensive CR program can improve adherence to healthy lifestyle behaviours (for example, physically active, fruit and vegetable intake, not smoking, low alcohol consumption) over and above usual CR services in New Zealand adults diagnosed with CHD.

This study is one of the first to examine an mHealth-delivered comprehensive CR program. Strengths of the trial include quality research design and in-depth description of the intervention to aid replication. If effective, the trial has potential to augment standard CR practices and to be used as a model for other disease prevention or self-management programs.

Publication Link

https://www.researchgate.net/publication/260483499_Improving_coronary_heart_disease_self-management_using_mobile_technologies_Text4Heart_A_randomised_controlled_trial_protocol

The remote exercise monitoring trial for exercise-based cardiac rehabilitation (REMOTE-CR): a randomised controlled trial protocol

Mon, 03 Jun 2024 23:53:12 GMT

2014

Authors

Ralph Maddison, Jonathan C Rawstorn, Anna Rolleston , Robyn Whittaker, Ralph Stewart, Jocelyne Benatar, Ian Warren, Yannan Jiang & Nicholas Gant

Abstract

Exercise is an essential component of contemporary cardiac rehabilitation programs for the secondary prevention of coronary heart disease. Despite the benefits associated with regular exercise, adherence with supervised exercise-based cardiac rehabilitation remains low. Increasingly powerful mobile technologies, such as smartphones and wireless physiological sensors, may extend the capability of exercise-based cardiac rehabilitation by enabling real-time exercise monitoring for those with coronary heart disease. This study compares the effectiveness of technology-assisted, home-based, remote monitored exercise-based cardiac rehabilitation (REMOTE) to standard supervised exercise-based cardiac rehabilitation in New Zealand adults with a diagnosis of coronary heart disease.

Publication Link

https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-14-1236

The effect of a cycling stage race on whole-body protein turnover

Fri, 31 May 2024 09:26:43 GMT

2010

Authors

Anna K. Rolleston , Nancy J. Rehrer, Ien J. Hellemans, Elaine Rush, Cheryl Murphy, Benjamin F. Miller

Abstract

Marked energy expenditure, independent of energy balance, could change whole-body protein turnover. The aims of the present study were to determine the effect of participation in a 6-day, 10-stage cycling stage tour on whole-body protein turnover in elite male cyclists, and to determine whether energy and protein turnover are related to fatigue and over-reaching. 13C-leucine was used to determine 18-h whole-body protein turnover in cyclists both before and immediately after a cycling stage race. The 18-h period included two feeding periods to simulate a normal evening meal and a normal breakfast meal, and two fasted periods including overnight. Blood was drawn for the determination of plasma cortisol and serum ferritin on days 2, 4, and 6 and a Profile of Mood States questionnaire was administered on alternate days during the tour event for determination of markers of over-reaching. Mean leucine rate of appearance was unchanged from pre- to post-tour during both fed and fasted conditions and mean energy balance was maintained. Serum ferritin concentration declined and plasma cortisol concentration remained stable over the 6 days. Markers of overtraining were evident in one athlete who pulled out of the tour event due to fatigue on the second to last day. Our main finding was that high energy output over a 6-day period did not significantly change protein turnover during fed, fasted or overnight conditions.

Publication Link

https://onlinelibrary.wiley.com/doi/10.1080/17461391003699054

Energy intake and expenditure during a 6-day cycling stage race

Fri, 31 May 2024 09:22:31 GMT

2010

Authors

N. J. Rehrer; I. J. Hellemans; A. K. Rolleston ; E. Rush; B. F. Miller

Abstract

Energy intake (EI) and energy expenditure (EE) are relatively easy to measure accurately over short periods in a laboratory setting, but less so during a multi-day competition. Our goal was to measure EI and EE as accurately as possible during a 6-day, 10-stage cycling race. We prepared all meals and supplements, assessed EI (weighed diet-records) and macrontrient intake, total EE (doubly labelled water), resting metabolic rate (respiratory gas exchange), exercise EE (power meters), and body mass. Body composition was measured several days before and after racing (dual x-ray absorptiometry). Body mass remained stable over the course of the race. The mean EI (27.3±3.8 MJ/day) nearly matched EE (27.4±2.0 MJ/day). The majority (62%) of EE was exercise EE. Macronutrient intake was within or exceeded the recommendations. Lean body mass increased and fat mass decreased in most of our participants. Our study indicates that EI can match high EE with adequate macronutrient intake during multi-day cycle racing and may be facilitated by appropriate foods being available at appropriate times. This optimization of nutritional provision supports positive changes in body composition.

Publication Link

https://onlinelibrary.wiley.com/doi/10.1111/j.1600-0838.2009.00974.x

Bone formation is increased to a greater extent than bone resorption during a cycling stage race

Fri, 31 May 2024 09:20:38 GMT

2010

Authors

Pamela S. Hinton, Anna Rolleston , Nancy J. Rehrer, Ien J. Hellemans, and Benjamin F. Miller

Abstract

This study examined the effects of participation in the Tour of Southland, a 6-day bicycle race, on serum markers of bone turnover in 5 elite male cyclists. During the race, energy intake matched expenditure. Osteocalcin was increased ~300% on days 1–5; and C-terminal telopeptide of type I collagen was elevated (43%) on day 3. Participation in a cycling stage race does not appear to have deleterious effects on bone turnover.

Publication Link

https://cdnsciencepub.com/doi/full/10.1139/H10-025