OBJECTIVE: To synthesise international literature to identify mechanisms that maintain racism in nursing and understand the factors that contribute to designing and implementing anti-racist praxis to inform nursing in Aotearoa New Zealand.
METHODS: An integrative literature review was undertaken, integrating Indigenous Kaupapa Māori methodologies to ensure a cultural and philosophical lens.
METHODS: Peer-reviewed literature published, between January 2011 and July 2023 were sourced. Of 1296 articles, 16 met the inclusion criteria and 4 were identified via citation chaining. In total, 20 articles were included. The Johns Hopkins Research Evidence Tool was applied, findings extracted, and thematic analysis completed utilising Indigenous Kaupapa Māori principles.
METHODS: Databases, including CINAHL, Scopus, PubMed and Aus/NZ Reference Centre, were searched in July 2023.
RESULTS: Two key themes were identified: (1) colonial active resistance to change; and (2) transformational, visionary, and proactive nursing.
CONCLUSIONS: Nurses are well-positioned to confront the structures that maintain racism in health and education systems but are often actors in maintaining status quo. Anti-racist praxis can be a mechanism for nurses to reimagine, redefine and transform nursing care, leadership, and nursing education to begin to eradicate racism.
UNASSIGNED: This integrative review adhered to the 2020 Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) method.
UNASSIGNED: No patient or public contribution.
UNASSIGNED: Racism remains prevalent in nursing and the healthcare system. It is necessary to implement anti-racist praxis and policies that resist, deconstruct, and dismantle power and racism while validating Indigenous values, beliefs and practices. This is vital to deliver equitable health care.
CONCLUSIONS: This integrative review presents lived realities and knowledge of Indigenous and racially minoritised nurses and scholars, alongside nursing allies to inform anti-racist praxis. This evidence signifies that it is time to walk the walk to challenge the colonising systems and processes that hold racism in place.

This article provides a summary of available data on Māori ocular health, highlighting significant disparities between Māori and non-Māori populations. Māori are more likely to develop diabetes, sight-threatening retinopathy and keratoconus, and present for cataract surgery earlier with more advanced disease. Limited data exists for macular degeneration and glaucoma, but there is some suggestion that Māori may have lower prevalence rates. The article emphasises the urgent need for robust national data on Māori ocular health to enable targeted interventions and funding allocation. Achieving equity for Māori in all aspects of health, including ocular health, requires concerted efforts from all stakeholders.

BACKGROUND: Ear and hearing care programs are critical to early detection and management of otitis media (or middle ear disease). Otitis media and associated hearing loss disproportionately impacts First Nations children. This affects speech and language development, social and cognitive development and, in turn, education and life outcomes. This scoping review aimed to better understand how ear and hearing care programs for First Nations children in high-income colonial-settler countries aimed to reduce the burden of otitis media and increase equitable access to care. Specifically, the review aimed to chart program strategies, map the focus of each program against 4 parts of a care pathway (prevention, detection, diagnosis/management, rehabilitation), and to identify the factors that indicated the longer-term sustainability and success of programs.
METHODS: A database search was conducted in March 2021 using Medline, Embase, Global Health, APA PsycInfo, CINAHL, Web of Science Core Collection, Scopus, and Academic Search Premier. Programs were eligible or inclusion if they had either been developed or run at any time between January 2010 to March 2021. Search terms encompassed terms such as First Nations children, ear and hearing care, and health programs, initiatives, campaigns, and services.
RESULTS: Twenty-seven articles met the criteria to be included in the review and described a total of twenty-one ear and hearing care programs. Programs employed strategies to: (i) connect patients to specialist services, (ii) improve cultural safety of services, and (iii) increase access to ear and hearing care services. However, program evaluation measures were limited to outputs or the evaluation of service-level outcome, rather than patient-based outcomes. Factors which contributed to program sustainability included funding and community involvement although these were limited in many cases.
CONCLUSIONS: The result of this study highlighted that programs primarily operate at two points along the care pathway-detection and diagnosis/management, presumably where the greatest need lies. Targeted strategies were used to address these, some which were limited in their approach. The success of many programs are evaluated as outputs, and many programs rely on funding sources which can potentially limit longer-term sustainability. Finally, the involvement of First Nations people and communities typically only occurred during implementation rather than across the development of the program. Future programs should be embedded within a connected system of care and tied to existing policies and funding streams to ensure long term viability. Programs should be governed and evaluated by First Nations communities to further ensure programs are sustainable and are designed to meet community needs.

Aotearoa New Zealand has been commended for the overarching effectiveness of its Covid-19 response. Yet, the lockdowns challenged the health of whānau Māori (Māori families) alongside their social, cultural and financial well-being. However, Māori have repeatedly demonstrated innovative means of resilience throughout the pandemic. This review aimed to document the local grassroots, community-level responses to Covid-19 lockdowns by Māori. Three sources for searching for evidence were used: academic, websites and media, and Māori community networks. A total of 18 records were reviewed. Four of these records comprised published academic literature, 13 comprised news, online and media articles, and one was a situation report. Findings were grouped into three categories: distributive networks, well-being and resource support. The findings of this review provide an exemplar for the strength of Māori leadership and agency, alongside value-driven holistic approaches to health and well-being that could positively impact the health of all.

Internationally, there is rising interest in measuring the value of sport and physical activity to society. A critical step in valuing the sector is first establishing the relationship between engagement in sport and physical activity and the societal outcomes that ensue. This paper summarises the findings of a literature review carried out as part of a larger study on the Social Return on Investment (SROI) of recreational physical activity in Aotearoa New Zealand. The review aimed to synthesise existing evidence on the relationship between recreational physical activity and wellbeing outcomes for all New Zealanders, including tangata whenua (Māori, who are Aotearoa New Zealand\'s Indigenous population). The methodology took the format of a scoping review and included a series of searches for academic and grey literature, including literature concerning Māori that might have been overlooked in a traditional academic search. The findings are grouped into five outcome areas: physical health; subjective wellbeing; individual development; personal behaviour; and social and community development. The review found some compelling evidence which shows examples of the links between sport and physical activity and outcomes in each of these areas for specific population sub-groups. In particular, for Māori, the findings demonstrate a strong impact on social and community development through building social capital and enhancing cultural identity. However, in all outcome areas, there is mixed quality evidence, a small amount of evidence on which to base definitive conclusions, and limited evidence relating to the monetary value of outcomes. The review concludes that there is a need for further research to strengthen the evidence base for social impact measurement, particularly around the impact of sport and physical activity for indigenous populations.

BACKGROUND: Research into the effectiveness of antenatal education classes is crucial for Indigenous Peoples from Aotearoa New Zealand, Australia, Canada and the United States who experience poorer maternal and infant health outcomes compared to non-Indigenous populations. Our systematic review questions were intended to determine the extent of Indigenous Peoples prioritisation and involvement in antenatal education classes, and to understand the experience of Indigenous Peoples from these countries in antenatal education classes.
METHODS: Using a standardised protocol, we systematically searched five electronic databases for primary research papers on antenatal education classes within the four countries noted and identified 17 papers that met the criteria. We undertook a qualitative meta-synthesis using a socio-critical lens.
RESULTS: Systematic review of the academic literature demonstrates that Indigenous Peoples of Aotearoa New Zealand, Australia, Canada and the United States are not prioritised in antenatal education classes with only two of 17 studies identifying Indigenous participants. Within these two studies, Indigenous Peoples were underrepresented. As a result of poor engagement and low participation numbers of Indigenous Peoples in these antenatal education classes, it was not possible to understand the experiences of Indigenous Peoples.
CONCLUSIONS: Given that Indigenous Peoples were absent from the majority of studies examined in this review, it is clear little consideration is afforded to the antenatal health needs and aspirations of Indigenous Peoples of Aotearoa New Zealand, Australia, Canada and the United States. To address the stark antenatal health inequities of Indigenous Peoples, targeted Indigenous interventions that consider culture, language, and wider aspects of holistic health must be privileged.
BACKGROUND: PROSPERO Registration ID: CRD4202017658.

Obesity and its sequelae are an increasing problem, disproportionally affecting Māori and Pacific peoples, secondary to multifactorial systemic causes, including the effects of colonisation and the impact of globalisation. There is limited synthesised evidence on interventions to address obesity in these populations. The objective of this review is to identify evaluated interventions for prevention and management of obesity amongst Māori and Pacific adults, assess the effectiveness of these interventions, and identify enablers and barriers to their uptake.
Systematic review of databases (Medline, PubMed, EMBASE, CINAHL, Scopus, CENTRAL), key non-indexed journals, and reference lists of included articles were searched from inception to June 2021. Eligibility criteria defined using a Population, Intervention, Control, Outcome format and study/publication characteristics. Quantitative and qualitative data were extracted and analysed using narrative syntheses. Study quality was assessed using modified GRADE approach.
From the 8190 articles identified, 21 were included, with 18 eligible for quantitative and five for qualitative analysis. The studies were heterogenous, with most graded as low quality. Some studies reported small but statistically significant improvements in weight and body mass index. Key enablers identified were social connection, making achievable sustainable lifestyle changes, culturally-centred interventions and incentives including money and enjoyment. Barriers to intervention uptake included difficulty in maintaining adherence to a programme due to intrinsic programme factors such as lack of social support and malfunctioning or lost equipment.
Normal weight trajectory is progressive increase over time. Modest weight loss or no weight gain after several years may have a positive outcome in lowering progression to diabetes, or improvement of glycaemic control in people with diabetes. We recommend urgent implementation of Māori and Pacific-led, culturally-tailored weight loss programmes that promote holistic, small and sustainable lifestyle changes delivered in socially appropriate contexts.

Māori (Indigenous people of New Zealand [NZ]) experience inequitable health outcomes compared to non-Māori, across the spectrum of clinical care, including those relating to medicines. Internationally, pharmacist-facilitated medicines review services have been shown to benefit older adults. Despite national policies calling for the increased implementation of these services, NZ data relating to them remain limited, and these services may increase disparities between Māori and non-Māori. There are currently no medicines review services developed specifically for Māori older adults. The current study aims to elicit stakeholder views of current and potential pharmacist services to help inform the development of a pharmacist-facilitated medicines review service for community-dwelling Māori older adults. Kaupapa Māori theory was applied within this qualitative research. Purposive sampling was used to recruit participants who were involved in providing, planning, funding developing or culturally supporting health services in Waitematā District Health Board, Auckland, NZ. Data were collected in semi-structured interviews and in a focus group and analysed using reflexive thematic analysis. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative research. Eleven participants took part in the research in one focus group (n = 4) and seven semi-structured interviews, conducted between November 2018 and March 2019. Three main themes were generated: (a) moving out of the shadows - claiming pharmacists\' unique role within a healthcare whānau (family); (b) \'give them the power to be able to ask\' - upholding the mana (self-esteem, pride, standing) and autonomy of kaumātua (Māori older adults) and (c) rights versus realities - reimagining pro-equity Māori health services within the constraints of the colonial health system. The right of Māori to experience equitable health outcomes needs to be included in policy and also operationalised in relation to medicines review services through improved utilisation of pharmacist skills and improving Māori older adults\' autonomy and control.

BACKGROUND: Improving indigenous health outcomes requires a strong indigenous nurse presence. Increasing the retention and success of nursing students during their education supports the critical mass needed to implement change in the health workforce to better address indigenous population health needs.
OBJECTIVE: To explore the factors affecting retention and success of Māori undergraduate nursing students in New Zealand.
METHODS: A Kaupapa Māori research framework was utilised within an integrative review design.
METHODS: CINAHL Plus, Scopus, and Google Scholar databases were searched using the keywords Māori, indigenous, nursing, health, education, retention and success.
METHODS: An iterative process was used to integrate and synthesize the literature. Thematic analysis was carried out to establish key concepts present in the literature and to establish gaps.
RESULTS: Māori student identity, institutional support factors and programme factors play a role in Māori student success and retention. Both the university environment and whānau (family) support contribute to a strong sense of identity. The institution\'s ability to facilitate peer mentoring, provide safe spaces for study and specialised support services also play a role. Finally, programme factors such as faculty culture, teaching practices and curriculum content affect the student\'s experience and desire to remain in nursing.
CONCLUSIONS: Improving student retention and success requires an environment which is welcoming and respectful of indigenous values and strengths. Strategies which encourage students to be self-empowered in their learning, ensure equity of opportunity, facilitate working together and enable the development of good relationships will meet the needs of all students, not just Māori.

Eliminating indigenous and ethnic health inequities requires addressing the determinants of health inequities which includes institutionalised racism, and ensuring a health care system that delivers appropriate and equitable care. There is growing recognition of the importance of cultural competency and cultural safety at both individual health practitioner and organisational levels to achieve equitable health care. Some jurisdictions have included cultural competency in health professional licensing legislation, health professional accreditation standards, and pre-service and in-service training programmes. However, there are mixed definitions and understandings of cultural competency and cultural safety, and how best to achieve them.
A literature review of 59 international articles on the definitions of cultural competency and cultural safety was undertaken. Findings were contextualised to the cultural competency legislation, statements and initiatives present within Aotearoa New Zealand, a national Symposium on Cultural Competence and Māori Health, convened by the Medical Council of New Zealand and Te Ohu Rata o Aotearoa - Māori Medical Practitioners Association (Te ORA) and consultation with Māori medical practitioners via Te ORA.
Health practitioners, healthcare organisations and health systems need to be engaged in working towards cultural safety and critical consciousness. To do this, they must be prepared to critique the \'taken for granted\' power structures and be prepared to challenge their own culture and cultural systems rather than prioritise becoming \'competent\' in the cultures of others. The objective of cultural safety activities also needs to be clearly linked to achieving health equity. Healthcare organisations and authorities need to be held accountable for providing culturally safe care, as defined by patients and their communities, and as measured through progress towards achieving health equity.
A move to cultural safety rather than cultural competency is recommended. We propose a definition for cultural safety that we believe to be more fit for purpose in achieving health equity, and clarify the essential principles and practical steps to operationalise this approach in healthcare organisations and workforce development. The unintended consequences of a narrow or limited understanding of cultural competency are discussed, along with recommendations for how a broader conceptualisation of these terms is important.