IntroductionReflection, a cornerstone of professional development and a core component of medical education, is increasingly challenged by the emergence of generative artificial intelligence (AI). AI’s capability to mimic human behaviour through real-time feedback, content generation, and conversational interfaces presents pressing ethical and pedagogical concerns regarding its use in reflection.AimThis qualitative study sought to explore the perspectives of educators on undergraduate medical students using AI in reflection.MethodsData were generated through two online focus groups with general practitioners in the role of expert participants, each lasting around one hour and including three participants. All six participants were academic undergraduate primary care educators who teach reflection skills to students.ResultsFive themes were conceptualised by reflexive thematic analysis: questioning assessment of reflection; professionalism in jeopardy; acceptability of using AI in learning; digital divide and educational equity; and institutional and educator readiness for AI. Educators faced complex tensions between embracing technological progress and protecting the relational and ethical foundations of medical education.DiscussionAlthough there was cautious optimism about AI’s role as a facilitative tool, participants uniformly emphasised that its educational value depends on critical, transparent, and ethically grounded implementation. This study highlights how undergraduate primary care educators should be cautious of the heightened challenges to academic integrity posed by AI. Uncertainty around fostering authentic student engagement in reflection suggests the need for further exploration in partnership with students. These findings highlight key areas for medical educators to support learners’ early engagement with AI.
IntroductionBrown Buttabean Motivation (BBM) is a community-based, Māori- and Pacific-led organisation providing free exercise classes and other support services in Aotearoa New Zealand. Ongoing participant engagement is critical for the success of community lifestyle programmes.AimThis study aimed to co-develop a systems logic model (Causal Loop Diagram) of the drivers of long-term engagement in BBM classes and activities.MethodsTwo cognitive mapping interviews and three group model-building workshops with BBM participants were used to create a CLD of the motivations and dynamics of engagement with BBM.ResultsThe foundations of Māori and Pacific cultures underpinned the four domains, and 19 feedback loops created the motivations for ongoing engagement. Within the organisational design domain, BMM culture, leadership, and lived experiences were prominent. In the social network domain, social media, storytelling, and mutual accountability maintained high connectivity. Engagement with other BBM activities reinforced the community support domain. Within the health domain, positive reinforcement from improved mental health was more prominent than from weight loss.DiscussionThis systems analysis of participant motivations to continued engagement with exercise classes shows how Māori and Pacific cultural values and ways of engaging have been incorporated into BBM to build ongoing participation and, thus, potential positive health outcomes. The multiple feedback loops provide further opportunities to refine the programme. The study also demonstrates the value of systems thinking for complex health challenges such as sustained weight loss. With reliable resourcing, BBM is well placed to make a difference to the obesity-related health inequities that disproportionately affect Māori and Pacific people.
IntroductionPacific peoples experience significant health inequities. National health data often aggregate diverse Pacific communities into a single category, potentially masking important differences in social-context health needs between subgroups.AimThis study aimed to describe the epidemiology and health indicators of Pacific Peoples enrolled at Pegasus Health Primary Health Organisation (PHO), Waitaha Canterbury, Aotearoa New Zealand (NZ), from the five largest ethnic subgroups: Samoan, Tongan, Cook Islands Māori, Niuean, and Fijian peoples.MethodThis cross-sectional study used anonymised administrative data from Pegasus Health PHO, NZ. All enrolled patients with Pacific ethnicity recorded at any level were identified (n = 14,209). Demographic characteristics, socioeconomic deprivation, smoking status, and diabetes diagnoses were analysed by ethnicity using descriptive statistics.ResultsSamoan patients comprised 52.8% of Pacific peoples enrolled (n = 7,498), followed by Fijian (18.4%), Tongan (14.3%), Cook Islands Māori (11.2%), and Niuean (3.4%). The population was predominantly young (mean age ranged from 27 to 32 years). Socioeconomic deprivation varied substantially: 33% of Samoan and 25% of Tongan patients lived in the most deprived areas (quintile 5), compared to 17% of Fijians who lived in quintile 5. Smoking prevalence ranged from 7.2% (Fijian) to 13.1% (Cook Islands Māori). Diabetes ranged from 5.5% (Cook Islands Māori) to 9.3% (Samoans).DiscussionSubstantial heterogeneity exists across Pacific subgroups in Canterbury regarding demographics, socioeconomic circumstances, and key health indicators. Disaggregated ethnicity data reveal distinct patterns that are obscured when Pacific peoples are treated as a single homogeneous group. This has important implications for targeting health services and designing interventions to achieve health equity.
IntroductionAnnual Diabetes Reviews (ADRs) are a key Ministry of Health initiative designed to ensure comprehensive annual assessment for people with diabetes in Aotearoa New Zealand. Although national guidance outlines core components, the consistency with which ADRs are delivered across primary care remains unclear.AimThis study aims to assess the structure, components, and delivery of ADRs in general practices, identifying gaps and opportunities for improving diabetes care.MethodsA National cross-sectional survey was conducted among a 10% random sample (n = 85) of Foundation Standard-certified practices. Practices were invited via email and phone, yielding a 40% response rate (n = 34). Data were collected through an anonymized online or phone survey covering ADR structure, provider roles, and recall systems.ResultsOf the 34 participating practices, 32 (94%) conducted ADRs. Nurses were the primary providers (91%), other providers included GPs, healthcare assistants, pharmacists, and Māori health workers. All practices included blood pressure checks, foot examinations, and retinal screening, whereas mental health assessment (56%) and contraception counselling (28%) were less common. Electronic recall systems were used by 94% of practices, though strategies varied.DiscussionMost practices have established processes for delivering ADRs, but implementation of key elements remains inconsistent. The proportion of patients receiving a comprehensive ADR is unclear. Further research involving medical record reviews across sociodemographic groups and qualitative studies of patient and whānau experiences could improve ADR processes.
IntroductionMāori in Aotearoa New Zealand (NZ) experience large and persistent inequities in infectious diseases and antimicrobial resistance. Appropriate antibiotic prescribing is one component of effective care that can be supported by the use of antibiotic guidelines.AimThis study aimed to gain insights into the perspectives of Māori regarding antibiotic guideline use in primary care and explore alignment with their expectations and aspirations for health and wellbeing.MethodsQualitative research methods were grounded in Kaupapa Māori theory and practice, supporting critical analysis that prioritised Māori and Māori knowledge. Participants aged 18 years and over who identified as Māori were recruited from an urban Māori health provider to attend a focus group. Sub-themes and themes were identified through inductive thematic analysis.ResultsFifteen Māori participants attended focus groups. Four interconnected themes that underpin the use of antibiotic guidelines in primary care were identified: Whakapono (trust and confidence), Māramatanga (clarity and understanding), Kairangi (culturally safe and quality care) and Hauora (holistic health and wellbeing aspirations).DiscussionAntibiotic guideline use is a relational practice situated within systems of trust, power and quality of care. When used within culturally safe, respectful and holistic models of care, guidelines can support high-quality care, build understanding and strengthen confidence in antibiotic decision-making. As NZ implements its first national antibiotic guidelines Te Whata Kura, there is a critical opportunity to ensure that use is culturally safe, barriers to access are addressed and that rongoā Māori (the traditional healing system of Māori) is accessible alongside biomedical approaches.
INTRODUCTION:New Zealand has maintained a low HIV prevalence through comprehensive screening, treatment, and prevention programmes. However, challenges remain with access to pre-exposure prophylaxis (PrEP) for at-risk populations, particularly men who have sex with men (MSM). AIM:This study aimed to evaluate the implementation and outcomes of a community-based project that expanded PrEP access via a Standing Order authorising peer HIV testers and pharmacists to initiate short-term PrEP prior to general practitioner follow-up. METHODS:Conducted between May 2020 and July 2021, the project involved collaboration between a community-based HIV support organisation, a general medical practice, and a community pharmacy in Auckland. Participants received an initial 10-day PrEP supply following a negative HIV rapid test and screening for contraindications, with follow-up laboratory testing and prescriptions managed by the practitioner and pharmacist team. RESULTS:Thirty-six clients enrolled (aged 22-60 years). Most identified as European (n = 16), Asian (n = 10), or Māori (n = 8). No participants seroconverted to HIV during the study. Six sexually transmitted infections were diagnosed and treated. A degree of hepatocellular damage was reported in one participant, and mild but transient liver enzyme elevation occurred in a further five participants. No renal toxicity was recorded. The mean duration of PrEP use was approximately 12 months. DISCUSSION:This project demonstrated that community-initiated PrEP under a Standing Order can be a safe, acceptable, and effective method for expanding HIV prevention services amongst MSM. This model supports future policy directions to broaden PrEP access through trained pharmacists and community channels.
INTRODUCTION:Rheumatoid arthritis (RA) is a chronic inflammatory condition that affects the joints, skin, eyes, lungs, heart, blood vessels, and nervous system. AIM:This study aims to estimate the incidence and prevalence of RA in New Zealand and compare the mortality of RA patients with the general population. METHODS:Patients with a SNOMED CT code for RA in 2018-2025 were identified from the Pinnacle dataset. The WHO (World Health Organization) age-standardised rate (ASR) of incidence and prevalence of RA were calculated by ethnicity and gender (women and men). The standardised mortality ratio (SMR) was estimated to compare the relative rate of observed deaths in RA patients with the expected deaths in the general population. RESULTS:We identified 3831 RA patients during the study period. The age-standardised incidence of RA was 26.9 (95% CI: 22.8-30.9) per 100,000 population. Women (34.8, 95% CI: 28.3-41.3, per 100,000) had around twice the incidence of RA than men (18.2, 95% CI: 13.5-22.9). The age-standardised prevalence of RA was 417.5 (95% CI: 402.8-432.1) per 100,000 population. The prevalence was 583.0 (95% CI: 558.8-607.2) per 100,000 for women and 237.6 (95% CI: 221.8-253.3) for men. Asians had the highest age-standardised incidence but the lowest age-standardised prevalence among all ethnic groups. The SMR of all the incident RA patients compared to the general population was 1.07 (95% CI: 0.80-1.34). DISCUSSION:The prevalence of RA in general practice aligns with rates observed in secondary care settings. The upward trend in RA prevalence raises concerns about escalating healthcare system burdens, including increased costs and resource demands. The rise in RA prevalence was driven by increasing incidence among Asian populations.
INTRODUCTION:Otitis media is a prevailing issue in the paediatric population, affecting up to 90% of Aboriginal and Torres Strait Islander children and contributing to childhood morbidity. AIM:This review investigates Australia's current health equity landscape by focusing on the ear health status of Aboriginal and Torres Strait Islander children, with a particular focus on otitis media and its associated risk factors. METHODS:Employing a narrative review methodology, this review draws upon academic and grey literature to examine the nature of ear health in Australian Aboriginal and Torres Strait Islander children over a period of 20 years (2004-2024). RESULTS:A total of 31 peer-reviewed academic journal articles and 30 grey literature documents were identified. These detail the continuing inequity in ear health outcomes, including significantly elevated otitis media rates among Aboriginal and Torres Strait Islander children. DISCUSSION:This review highlights the persistent influence of remote residence and crowded living conditions on ear health. In addition, minimal research focusing on the evaluation of health equity reforms and their impact on the current health status of specific communities was found. This review reinforces the importance of considering community-specific perspectives in formulating holistic approaches to Aboriginal and Torres Strait Islander health.
INTRODUCTION:The rapid advancement of artificial intelligence (AI) in health care necessitates that decision-makers consider end-user views on secondary data use and the application of AI in clinical settings. AIM:The aim of this study was to explore the perspectives of patients and health professionals on the use of personal health information for the development of AI tools and the implementation of these tools into health care. METHODS:An observational, cross-sectional study involving semi-structured, scenario-based interviews with 51 participants; grouped as health professionals, patients with chronic, mental health, or rare conditions, and individuals undergoing routine screening. RESULTS:Participants from all groups found it acceptable to use patient health information for AI on the condition that the information was intended to serve the greater good. All groups emphasised the potential for AI to support health professional staff by streamlining processes and reducing administration time. All groups also agreed on the importance of maintaining patient trust in health services and emphasised transparency, appropriate use of data, responsible data security measures, obtaining patient consent, and strong governance. Although these thematic overlaps demonstrated broad end-user agreement, there were also notable group-level differences in the emphases within these overarching themes. DISCUSSION:Although this research has shown that patients and health professionals shared broadly aligned but nuanced views on the use of AI in health care, a one-size-fits-all approach to seeking social licence in this area is unlikely to be possible. Recommendations include ongoing and continued engagement with health professionals and consumers that reflects the diversity of interest-holders and perspectives involved.
IntroductionAccess to effective vaccination is an important way to protect against infectious diseases. The Aotearoa–New Zealand immunisation handbook on safe and effective vaccination practice recommends a 38-mm needle length for intramuscular deltoid injections in very large individuals, using clinical judgment to ensure needle length is appropriate to reach muscle. It is not clear how vaccinators implement this guidance in practice.AimThis study aimed to explore vaccinators’ needle-length selection practice for big-bodied people and their views on a prototype arm circumference tool to guide needle choice.MethodVaccinators working with Māori and Pacific communities were recruited via researchers’ networks to take part in one of six in-person focus groups in the Wellington region, Horowhenua district, and Tairāwhiti region (August–October 2025). Data were analysed qualitatively using a reflexive thematic approach.ResultsTwenty-five primary care-based vaccinators with varied roles and experience participated. Themes identified in the discussion included prioritisation of patient-centred care, influences on decision making (familiarity with guidance, training, workflow and equipment), and strengthening practice in these areas. The prototype tool was viewed positively, with discussion highlighting its potential to improve familiarity with arm size and needle-length criteria. Practical, workflow, and patient-centred considerations were raised, with particular focus on the importance of communicating use of the tool in a sensitive manner.DiscussionEnsuring adequate supply and availability of 38-mm needles, along with clear guidance and education, are essential to support vaccinators’ clinical judgement and effective vaccine delivery to big-bodied people. Use of an arm circumference assessment tool could strengthen vaccinators’ decision making and help standardise needle length.
IntroductionChildhood immunisation coverage in Aotearoa New Zealand (NZ) is not meeting recommended targets. Enrolment and engagement with primary care are associated with timely immunisation uptake, yet enrolment and immunisation are inequitable, with Māori and Pacific children less likely to be enrolled and receive their 6-week vaccinations on time.AimThis study aimed to understand healthcare providers’ perceptions of barriers and enablers to primary healthcare enrolment from birth and provide recommendations to support enrolment, engagement, and immunisation, particularly for Māori whānau (families).MethodsThis qualitative study, guided by a Kaupapa Māori-aligned methodology, involved interviews and focus groups to explore barriers and enablers to enrolment from the perspective of people working within the NZ healthcare sector (n = 27). Analysis was undertaken using qualitative content analysis.ResultsMany participants expressed that the current system was contributing to inequitable enrolment and immunisation of pēpi (infants). Four categories were constructed: health services may not be accessible or practical for whānau; perceived complexity and skill shortages; the need to prioritise communication and engagement; and services must be built on cultural safety and trust.DiscussionReasons for inadequate enrolment include poorly designed systems, limited resourcing, and inconsistent approaches. Enrolment needs to be simplified, with integrated and automated systems to reduce administrative burden for staff. Flexible whānau-centred practices can help support enrolment, engagement, and immunisation of pēpi.
IntroductionData from Aotearoa–New Zealand’s 2021 COVID-19 mass vaccination programme revealed underutilisation of longer 38 mm needles, which are recommended for big-bodied people. This raises health equity concerns because correct needle length is necessary to achieve intramuscular vaccine delivery.AimThis study aimed to explore vaccinators’ awareness and implementation of needle-length guidance, and to identify barriers and enablers to use of long needles for big-bodied people in New Zealand.MethodBetween August and October 2025, an anonymous online survey was distributed to vaccinators in New Zealand through professional organisations with links to vaccinator health professionals. Data collection included demographics, education received on needle-length guidance, barriers and enablers to use of 38 mm long needles, and opportunities to support future practice. Data were summarised using descriptive statistics, and comments summarised using a qualitative descriptive approach.ResultsOf 196 respondents, 70% were aware of needle-length guidance and 48.5% recalled receipt of specific information or education about using longer needles. In total, 60% had ever used a 38 mm needle, but only 26% had used a longer needle for at least half of those they thought eligible in the past 12 months. Key barriers to long needle use included supply of vaccines with shorter needle lengths attached, information gaps and uncertainty in determining eligibility for a 38 mm long needle. A total of 62% saw a need for strategies to strengthen their implementation of needle-length guidance.DiscussionA range of strategies need to be implemented across multiple levels (from vaccinators through to policy makers) to overcome these barriers and to support safe and effective vaccine delivery to big-bodied people.
INTRODUCTION:Aotearoa New Zealand (NZ) has a significant general practitioner (GP) workforce shortage, which will increase with the large number of GPs retiring shortly. Early and mid-career GPs who will absorb this shortfall are largely women, and many will take a temporary work absence to have children. AIM:This article explores the experiences of GPs in NZ who take a temporary work absence for parental leave, focusing on challenges and facilitators, and how this understanding might inform workforce planning and policy. METHODS:A total of 137 participants contributed to an online qualitative survey about their experience of taking and returning from parental leave. Template analysis was used to develop a template and identify themes. RESULTS:Three identified themes encompassed the experience of parental leave, a return to work, and associated consequences. The reality of conflicting obligations and unexpected barriers as a parenting GP was a further integrative theme. DISCUSSION:This first study on GP parental leave in NZ reveals that parenthood influences career decisions, leave factors, and post-leave work patterns. General practice settings offer partial support, but reduced hours and role changes (including a shift towards narrower scope or episodic care) limit career progression and earning potential, disincentivising parenting GPs. With many GPs nearing retirement, the reality of current parental leave policies and general practice models that poorly accommodate GP parents risk exacerbating the primary care workforce crisis.
INTRODUCTION:As people age, some require care supports, and transition from home to aged residential care (ARC) is associated with improvement in some measures of physical and psychosocial wellbeing. Yet, Māori experience reduced access to ARC. AIM:To explore Māori experiences and expectations of health and social care within ARC. METHODS:We undertook a qualitative study in Hawkes Bay, Aotearoa. We included participants who were Māori with professional or personal/whānau experience of providing care to pakeke and/or kaumātua (older Māori). We interviewed participants one-on-one or in focus groups and analysed data using general inductive thematic analysis informed by kaupapa Māori theory. RESULTS:Thirty-five people participated in 13 focus groups or interviews held from October 2022 to September 2024. We identified three themes: Māori look after our own; expectations of a high-quality clinical care environment; and home environment aspirations. DISCUSSION:Transitions into ARC are shaped by more than clinical need; they reflect cultural expectations, emotional responsibility, financial considerations, and whānau perceptions and experiences relating to the quality and cultural safety of the care environment. ARC needs to provide high-quality clinical and cultural care and support home-like environments to reduce whānau guilt and support successful transitions and living environments for older Māori.
INTRODUCTION:People in rural Aotearoa New Zealand (NZ) face distinct health challenges, including limited access to health care, workforce shortages, and persistent disparities. Hauora Taiwhenua Rural Health Network NZ (HTRHN) is a collective organisation advocating for the health and well-being of rural New Zealanders. HTRHN aims to foster research that improves rural health and reduces inequities. AIM:This study aims to identify the research priorities for rural health in NZ from the perspectives of HTRHN members. METHODS:A modified Delphi methodology was used with expert panellists from HTRHN. In Round 1, panellists were asked to list broad research areas and specific research topics. Thematic analysis identified six broad research categories with specific research topics assigned to each. In Rounds 2 and 3, panellists rated the importance of the specific research topics using Likert scales. RESULTS:Round 1 was completed by 30 participants, Round 2 by 21, and Round 3 by 19. There was wide representation from HTRHN's membership. Six broad rural health research areas were identified, and consensus ratings prioritised 14 specific research topics. Top-rated research topics included 'Health of place effect' - how features of a place influence health outcomes; improving rural health data collection and analysis; and rural-focused acute palliative care management. DISCUSSION:The broad rural health research categories identified are consistent with those reported in comparable international contexts. These categories also mirror the 2023 New Zealand Rural Health Strategy. Final prioritised topics create a platform for continued rural health research in NZ, providing guidance for researchers/funders in developing future research projects.
