The global burden of disease arising from exposure to inadequate housing is a significant public health concern. In New Zealand over 25,000 children are hospitalized annually with preventable housing-related conditions, with Māori and Pacific children particularly at risk. The Healthy Homes Initiative (HHI) is a community-led, government-funded, multicomponent intervention aimed at improving health outcomes for children at risk of housing-related illness in low-income families. In this study, we examined hospitalizations for children enrolled in the HHI between 2014 and 2023. Using Poisson regression, we show that the HHI was associated with a 29% five-year reduction in childhood hospitalizations, equal to approximately 2,817 hospitalizations or 16,027 hospitalizations per 100,000 people. Community-led interventions such as the HHI are an effective mechanism to address housing as a social determinant of health. When given sustained government support, they have the potential to make a significant impact on health outcomes and contribute to the wider public good.

Māori Data Sovereignty and Māori Data Governance are articulationsand expressions of our Māori rights to be self-determining as sovereign peoples. Over the last decade, there has been considerable growth in scholarship, theorising and advocacy around Māori Data Sovereignty with a number of frameworks, models and sets of principles developed. Underpinned by Kaupapa Māori theory and informed by the PRISMA and CONSIDER guidelines, this scoping literature review examined the application of Te Ao Māori concepts, values, principles and/or practices to operationalisation of Māori Data Sovereignty and/or Māori Data Governance. Of the 2413 records identified, 32 full texts met our inclusion criteria. We identified 21 Te Ao Māori concepts, values, principles and/or practices (listed in order of frequency): 'Katiakitanga'; 'Rangatiratanga'; 'Whakapapa'; 'Whanaungatanga'; 'Manaakitanga'; 'Kotahitanga'; 'Tapu/Noa'; 'Mauri'; 'Mana'; 'Hau'; 'Wairua(tanga)'; 'Pūkenga(tanga)'; 'Rāhui'; 'Pōwhiri'; 'Wānanga'; 'Pūrākau'; 'Tika'; 'Pono'; 'Mana Motuhake'; 'Tino rangatiratanga'; and 'Ūkaipōtanga'. We describe their interpretation and application to Māori Data Sovereignty and/or Māori Data Governance. We also identified lesser focus in the literature of the Māori Data Sovereignty aspirations and priorities of specific Māori population groups, for example, tamariki and rangatahi Māori, tāngata whaikaha Māori and takatāpui Māori, and discuss implications for Māori data futures.

AIMS:This paper aims to explore the relationship between e-biking and health in the context of a novel, marae-led e-biking programme for Māori and Pacific adults in a suburban community. METHODS:Focus groups were conducted with participants in an e-biking programme (n=20) prior to receiving e-bikes, and individual interviews were conducted with participants at approximately 6 months (n=23) and 12 months (n=22). RESULTS:Wanting to improve health was a motivation for trying e-biking. E-biking supported better physical and mental health, including self-reported improvement in a range of long-term conditions. E-biking was often possible and enjoyable for people who experienced barriers to physical activity, although poor health could also act as a barrier to e-biking. Factors that supported ongoing e-biking included having someone to ride with, the enjoyable nature of e-biking, and integrating e-biking for active travel. CONCLUSIONS:This study suggests that e-biking is possible and beneficial for a wide range of people who do not currently cycle. Recommendations from individual health practitioners are likely to be important alongside community and population level interventions to support the uptake of cycling. Practice points to support individual health practitioners to discuss e-biking are provided.

BACKGROUND:Whānau-centredness is core to Māori wellbeing. Western models of health, in contrast, tend to be deficit-framed and individualistic, although a more collective model can be seen in the concept of syndemics: conditions that cluster in populations and are amplified by health inequities. Through the voices of whānau and key informants, we investigated how a whānau-ora approach can inform the management of syndemics of long-term conditions and infectious diseases within primary health care. METHODS:The study team was gifted the Māori name Pūriri [a medicinal tree] by a community leader, enabling the concept of syndemics to be considered in a Te Ao Māori context. We undertook a qualitative kaupapa Māori study, conducting focus groups and interviews with purposively selected participants. We utilised descriptive and inductive thematic analysis. RESULTS:We identified several themes to guide appropriate management of syndemic conditions in primary care. Participants stressed the importance of whakawhanaungatanga and strengths-based practices when working with whānau; culturally appropriate services that are grounded in Māori worldviews; whānau engagement in care; and whakawhanaungatanga, which is also vital at the Provider level. CONCLUSIONS:This paper reports findings from a Māori-led study, building on existing research focused on whānau-centred care and established approaches to Māori health. Building trusting, respectful connections through whakawhanaungatanga was seen as a central practice for engaging with Māori. Grounded in the symbolism of the Pūriri, these findings highlight pathways for primary health care to partner with whānau and communities in a whānau-ora approach to create enduring and equitable solutions to syndemics.

Indigenous Māori are imprisoned on a mass scale by the nation-state currently known as New Zealand, driven by racialised inequities that occur across the criminal legal system and a rapidly expanding carceral state. Lack of reliable data limits the ability to monitor and evaluate the health and disability impacts of imprisonment on Māori. We examined ethnicity data quality; specifically, potential miscounting of Māori in prison. All individuals who experienced at least one night of imprisonment between 2018 and 2021 were selected from the Department of Corrections (Corrections) data in the Stats NZ Integrated Data Infrastructure (IDI). We compared counts and proportions of Māori using two sources of ethnicity information; Corrections and IDI’s core data. Within this cohort, we compared self-identified ethnicity from the 2018 Census with ethnicity recorded in Corrections data available in the IDI (via individual linkage), to assess levels of match between datasets and calculate net undercount. Lesser numbers of Māori were recorded in the Corrections data compared to the IDI’s core data (52

BACKGROUND:Indigenous Māori experience mass imprisonment in New Zealand secondary to colonisation, coloniality and racism. In addition to high risks of morbidity and mortality, community re-entry from prison presents multiple challenges to accessing healthcare and other critical services. In New Zealand's publicly funded health and disability system, primary care acts as the entry point and gatekeeper to secondary services, facilitating linkages to other supports. Guided by lived experience and using deidentified linked national administrative data, we examined the primary care experiences of Māori over the 12-months post-release from prison. RESULTS:A total of 7398 Māori were released from prisons between June 1, 2021 and May 31, 2022. Over half experienced reimprisonment during the 12-months post-release. Only 76 % were enrolled with a primary health organisation meaning 24 % did not have access to subsidised primary care. Over 12-months, 47 % had accessed primary care consults, 63 % received medication, and 23 % had a community laboratory test. In the 12-months post-release, 26 % presented to an emergency department and 5 % were admitted for ambulatory sensitive hospitalisations. CONCLUSIONS:Whilst our findings indicate that Māori released from prisons access primary care, there are financial barriers to access. We also found (across a range of access and quality measures) that primary care services are not meeting their high health needs, demonstrating governmental breach of Indigenous rights to health. High-quality primary care is critical to successful community re-entry and to preventing adverse outcomes. There is an urgent requirement for evidence-informed culturally safe strategies that guarantee equitable access to high-quality primary care, developed and designed in ways that privilege the views of Māori with lived experience of imprisonment, those of their families, and communities.

BACKGROUND:Various observational studies have suggested that infants and young children who regularly sleep in synthetic bedding materials are more likely to experience wheezing and asthma, while children who use feather duvets and/or feather pillows are less likely to wheeze. METHODS:In Wellington, New Zealand, we conducted a three-armed, parallel, randomised trial of 460 infants who were assigned to use different bedding materials: synthetic, wool or feather bedding in the form of sleepsacks from 3 months of age to 2 years of age to test the hypothesis that children exposed to feather materials are less likely to develop wheezing. Pregnant women were recruited before birth. Parents were unaware of the primary research hypothesis and were told this was a study of child warmth and wheezing. We have reported wheezing (parental and GP), a variety of respiratory health parameters and atopic status at 2 years. RESULTS:One hundred and forty-seven infants received a synthetic sleepsack, 150 wool and 144 feather. We have found no significant differences in reported or doctor-diagnosed wheezing or other respiratory health measures by bedding material used. For frequency of wheezing presentation at GP surgery, there was a significant increased rate for children using feather materials compared to synthetic, relative rate 2.00 (95% CI: 1.14, 3.52). CONCLUSION:This study does not support earlier observational studies that suggest higher rates of wheezing for children using synthetic bedding or lower rates for feather materials, at least for early childhood wheezing. Our study suggests that the explanation for the observational study findings may lie in selection bias, where the parents of at-risk children avoid feather bedding materials.

This study aimed to identify the supportive care needs of, and associated assessment tools for, family caregivers of Indigenous people with cancer. We searched Scopus, Web of Science, Ovid Medline, Embase, and Google databases, for published journal articles and gray literature. Separate searches were carried out for needs and tools. Eleven articles were included in the review of supportive care needs. Evidence suggests that while caregivers of Indigenous people with cancer report some similar needs to carers of non-Indigenous patients, there are additional and specific needs requiring consideration. Needs identified included practical, cultural, communication, mental and emotional, health system, physical health, financial, familial, educational, and spiritual needs. Practical, cultural, communication, and mental/emotional were the most prevalent. No articles were found that fit the search criteria for tools to assess the supportive care needs of family caregivers of Indigenous peoples with cancer. Family caregivers of Indigenous people with cancer experience different supportive care needs than cancer caregivers from the general population. Despite these differing needs and a higher burden of cancer among Indigenous peoples globally, no assessment tools have been created that identify the needs of this group, highlighting a gap in the literature and potentially in cancer care.

Chronic or persistent pain disproportionately affects Māori and their whānau (family and significant others). Our previous engagement with Māori living with persistent pain has identified significant barriers for Māori to accessing primary, secondary, and tertiary services. This paper describes the insights obtained from Māori living with persistent pain by using a creative art-based data collection method as part of a co-design process to understand how they would like to be supported in their pain management journey. We used brainstorming discussion sessions and a creative art session to encourage divergent thinking and to stimulate innovative ideas for better pain management support for Māori. The creations showed a deep connection to taiao (nature) and the support of whānau as sources of strength. Connecting with other whānau living with pain in a safe space (i.e. community setting or a marae (community meeting place)) was an aspiration. Existing mainstream services were viewed as deficit-focused with an overwhelming support for Māori-led solutions delivered kanohi-ki-te-kanohi (face-to-face). Creative activities can be used as a culturally appropriate research method for both generating rich insights into the lived experiences of Māori living with persistent pain and how to deliver culturally responsive pain services.

BACKGROUND:Chronic non-cancer pain is a major burden worldwide. Indigenous communities experience additional inequities in pain care and management influenced by long-standing impacts of colonization, including systemic racism, oppression, and marginalization. Traditional healing knowledges, practices and methods are valued by Indigenous people when managing their pain. However, mainstream health services often disregard this knowledge and fail to provide culturally safe management strategies. AIM:To understand how Indigenous peoples across the globe make sense of pain when experiencing chronic non-cancer pain. METHODOLOGY AND METHODS:This integrative literature review is reported according to the PRISMA checklist and CONSIDER statement. We focused on qualitative data reported by Indigenous adults with chronic non-cancer pain in empirical and theoretical studies. Electronic searches were performed in databases from health and humanities scopes, in addition to grey literature, from 1990 to August 2023. We drew from critical theory approaches to thematically analyze data from the included studies, privileging Indigenous perspectives through a Western intellectual framework (Two-Eyed Seeing epistemology). Data extraction and thematic analysis were managed using NVivo. Primary data were mapped according to geography and theoretical framework. RESULTS:After removal of duplicates, 1352 studies were screened using title and abstract, from which 99 full texts were assessed and 29 studies and 3 dissertations/theses were included. Included studies reported lived experiences of chronic pain among Indigenous peoples from Oceania, North America, and South America. Thematic analysis derived four main themes that indicated pain is entwined with nature, Indigenous identity, historical trauma, and the collective. Our findings suggest that pain is interconnected to a broader scenario of feelings, thoughts, peoples and places. CONCLUSION:Our findings highlight the layered and complex aspects of the lived experiences of chronic pain among Indigenous people. Indigenous-led alternatives focusing on culturally safe care can guide approaches to clinical pain practice and contribute to achieving health equity.

Background: Equity-focused e-bike support programmes are likely to have an important role in growing the mode share of cycling. In Aotearoa New Zealand, equitable approaches to cycling need to include approaches that are led by and for Maori. Previous work promoting cycling in Indigenous Maori communities has identified the need for culturally relevant, inclusive programmes which focus on cycling as an activity that benefits families and communities as well as individuals. This research explores the holistic health effects of a long-term Indigenous e-bike programme. Methodology: HIKO is an e-bike programme providing long-term e-bike loans and wrap-around cycling support in a suburban community in Aotearoa New Zealand, through a Maori health and social service provider. Focus groups and interviews were conducted with 26 HIKO participants over the first 12 months of the programme. Data were analysed thematically, using an Indigenous Maori framework of holistic health and wellbeing (Te Pae Mahutonga). Results: Participants used their e-bikes for recreational and transport cycling. Prior to the programme participants did not cycle regularly, if at all, and largely described e-biking as an unfamiliar activity. Using the domains of Te Pae Mahutonga, we explore four themes: the necessity of trusted leaders, strong relationships and community input; e-biking as supporting cultural and environmental connections; e-biking as supporting healthy lifestyles; and e-biking as enabling greater social participation and family connectedness. Conclusions: Appropriately designed e-bike support programmes have an important role in broadening equitable access to cycling. This study underscores the importance of considering the needs of families in designing cycling programmes, infrastructure and policies. It also highlights the role of health improvement as a motivating factor for taking up e-biking.

A group-based, online-delivered version (iSelf-help) of an existing group-based in-person pain management programme was developed. Development included Māori (New Zealand's Indigenous population) cultural considerations of content. This study determined whether offering iSelf-help was non-inferior to the in-person pain management programme in reducing pain-related disability at six months. The study used a non-inferiority randomised, two-arm, parallel, open-label trial with blinding of assessors, including health economic and process evaluations. Participants were adults (age≥18 years) with persistent non-cancer pain referred to a hospital-based regional pain service who were deemed eligible for a pain management programme. iSelf-help groups participated in two 60-minute video-conferencing sessions (first, peer support facilitated; second, clinician facilitated) weekly for 12 weeks with access to resources via smartphone app and website. In-person groups received 12-week in-person pain management programme. The primary outcome was the Modified Roland Morris Disability Questionnaire. Secondary outcomes included anxiety, depression, stress, pain severity and interference, health related quality of life, self-efficacy, acceptance, and satisfaction. Recruited were 113 participants (56 iSelf-help, 57 in-person), mean(SD) age 38.2(13.7) years, 75% female, 16% Māori. Using modified intention-to-treat analysis on the primary outcome at six months (n=73), iSelf-help was non-inferior to in-person pain management programme with a point estimate (95% one-sided CI) of -0.4 (∞, 1.5). It was also non-inferior for secondary outcomes of anxiety, depression, stress, activity interference, health related quality of life, and self-efficacy. iSelf-help was cheaper, had similar overall satisfaction, but higher accessibility, scores. iSelf-help showed non-inferior clinical outcomes for improving pain-related disability in people with persistent non-cancer pain. PERSPECTIVE: This article evaluates a novel online-delivered pain management programme (iSelf-help) co-created with people with persistent pain, with committed and ongoing collaboration with Māori whānau (Indigenous population of New Zealand). iSelf-help may improve access to the regional pain service used in this study for more people living with persistent pain.

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.

Context. Delirium is prevalent in the hospice population. Despite causing significant distress to patients and families, delirium is under-recognised. There is a need to better understand delirium prevention and outcomes in this population including people's experiences of delirium-prevention strategies in different cultural contexts. Objectives. To determine whether the "PRESERVE Aotearoa" delirium prevention intervention was feasible and acceptable for Maori (indigenous peoples of Aotearoa/ New Zealand) and non-Maori patients with advanced cancer, their families (called whanau in this paper), and clinical staff. Methods. A qualitative semistructured interview substudy of a cohort PRESERVE Aotearoa feasibility study codesigned with a Maori partner to ensure inclusion of Maori-centred values. The study was underpinned conceptually by He Awa Whiria (braided rivers)-combining Western and Maori knowledges. Data were analysed using Hopwood and Srivasta's framework. Results. Twenty-six patients and their whanau, 21 clinical staff and five researchers from two stand-alone hospices in the North Island, Aotearoa/New Zealand. Finding showed that, for the most part, participants considered the study interventions feasible and acceptable. Inductive analysis resulted in four themes highlighting the importance to whanau of their participation in the study: benefits of learning about delirium; the affirmation of the caregiver role and whanau-centred care; valuing fundamentals of care; and research as legacy. Conclusion. This qualitative study found that it is feasible and acceptable to study multicomponent nonpharmacological delirium-prevention interventions in Aotearoa/New Zealand hospice inpatient units. The study also highlights the value of Maori-centred approaches and whanau involvement in these settings. (c) 2024 The Authors. Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine.

Background Multidomain interventions in older adults offer the best opportunity to prevent, delay or reverse existing symptoms in the earlier stages of frailty and improve independence but can be costly, and difficult to deliver at scale. However, digital health interventions enable personalised care and empowerment through self-management of long-term conditions, used at any time and when combined with health coaching offer the potential to enhance well-being and facilitate the achievement of health-related goals. We aim to evaluate the feasibility and acceptability of a digital health platform for long-term disease management combined with health coaching for people living with mild-moderate frailty, targeting self-identified goals—activity, nutrition, mood, enhancing social engagement and well-being.Methods and analysis This is a non-randomised feasibility, single-group, pretest/post-test study, using qualitative and quantitative methods. The digital health coaching intervention (DIALOR—DIgitAL cOaching for fRailty) has been developed for implementation to older adults, aged 65 years or older with mild to moderate frailty and diagnosis of one or more long-term health conditions in the community. Participants will receive 12 weeks of health coaching and have access to a mobile health platform for 6 months. The primary outcome measure is the acceptability and feasibility of DIALOR along with a range of secondary outcome measures (including frailty, functioning measures, quality of life, social engagement, diet quality and self-reported indicators) collected at baseline and at 6 months. The findings will inform whether a wider effectiveness trial is feasible and if so, how it should be designed.Ethics and dissemination Ethical approval has been granted by the Southeast Scotland Research Ethics Committee 02 (reference: 22/SS/0064). Research findings will be disseminated in a range of different ways to engage different audiences, including publishing in open-access peer-reviewed journals, conference presentations, social media, dissemination workshop with patients, carers, and healthcare professionals and on institution websites.

Chronic or persistent non-cancer pain disproportionately affects Māori - the Indigenous population of Aotearoa New Zealand (NZ) and their whānau (family and significant others). In a previous study with a Māori community service provider - Tū Kotahi Māori Asthma and Research Trust - Tū Kotahi, identified a need for a Kaupapa Māori (by Māori, for Māori) pain management programme (PMP) with embedded principles of Whānau Ora (care focusing on the wellbeing of the individual and their significant others as a collective). Using a qualitative case-study design, the main aims were to describe (1) the implementation of a community-based, whānau-focused PMP; (2) the participant experiences of the programme. This is community-based participatory action research guided by a Māori-centred research approach. Based on our previous co-design study with Tū Kotahi, a 6-week PMP (July - August 2021) was implemented at Kokiri Marae (community meeting place). Eight whānau living with persistent pain participated in the 6 sessions led by our Māori community partner and a pain management physiotherapist including a dedicated session on Rongoā Māori (Māori traditional treatment). Supporting resources were co-developed with our community partner, pain service clinicians, a Māori Health literacy expert, and a Māori illustrator. On completion, whānau reported enhanced confidence towards managing pain with "more tools to manage". The role of meaningful relationships, co-design, use of metaphors, and inclusion of traditional treatments - Rongoā were key aspects for the successful implementation. This initiative provides an exemplar for community and mainstream pain service partnership to address inequities in accessing pain management services for Māori. PERSPECTIVE: This study explains the key cultural processes of implementing a community-based pain management programme for Māori with persistent pain in Aotearoa New Zealand. The principles from our engagement could be applicable globally to engage with Indigenous and culturally and linguistically diverse communities with persistent pain to address longstanding health inequities.

Objective This study explores experiences of the Healthy Housing Initiative (HHI). Aimed at children at risk of housing-related illness, the HHI package includes the provision of items such as curtains, heaters, bedding, and insulation, advocacy to encourage landlords to install improvements, and education and advice to help people optimise their home environment. Methods We conducted semi-structured, in-depth interviews with 20 people living in rental housing who received the HHI intervention. Results Participants felt heard and supported by HHI assessors. They reported that the intervention increased the warmth and dryness of the home, improved their respiratory and mental health, reduced their bills, and enabled the use of more parts of their home. However, some continued to live in cold and damp conditions due to structural inadequacies and energy poverty. Conclusions The qualitative evidence presented in this study shows how health-focussed interventions also benefit quality of life. Implications for public health This research emphasises that healthy housing interventions can yield extensive benefits by adopting a holistic and home-based approach. Such interventions have the potential to create improvements in individuals' lives far beyond health.

AIMS:To test if a New Zealand food-based Mediterranean diet (NZMedDiet) with behavioural intervention improves cardiometabolic health and wellbeing. METHODS:A randomised controlled trial comparing 12 weeks of the NZMedDiet to usual diet in participants with increased cardiometabolic risk (metabolic syndrome severity score [MetSSS] > 0.35). The intervention group was 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. RESULTS:Two hundred individuals with mean (SD) age 49.9 (10.9) years of which 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% confidence interval [CI]) of -0.05 (-0.16 to 0.06), p = 0.35. The Mediterranean diet score (PyrMDS) was greater in the intervention group 1.6 (1.1-2.1), 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, and improved across all domains. For example, the physical component summary score difference (95% CI) was 4.0 (2.4-5.7), p < 0.001, and the mental component summary score difference was 3.0 (0.7-5.2), p = 0.01. CONCLUSION:In participants with increased cardiometabolic risk, food provision with a Mediterranean dietary pattern and a behavioural intervention did not improve metabolic risk scores but was associated with reduced weight and improved quality of life.

BACKGROUND:The Aotearoa New Zealand COVID-19 pandemic response has been hailed as a success story, however, there are concerns about how equitable it has been. This study explored the experience of a collective of Māori health and social service providers in the greater Wellington region of Aotearoa New Zeland delivering COVID-19 responses.METHODS:The study was a collaboration between a large urban Māori health and social service provider, Tākiri Mai Te Ata whānau ora collective, and public health researchers in Aotearoa New Zealand. Two online workshops were held with staff of the Māori service provider, collectively developing a qualitative causal loop diagram and generating systemic insights. The causal loop diagram showed interactions of various factors affecting COVID-19 response for supporting whānau (Māori family/households) at a community level. The iceberg model of systems thinking offered insights for action in understanding causal loop diagrams, emphasizing impactful changes at less visible levels.RESULTS:Six interacting subsystems were identified within the causal loop diagram that highlighted the systemic barriers and opportunities for effective COVID-19 response to Māori whānau. The medical model of health service produces difficulties for delivering kaupapa Māori services. Along with pre-existing vulnerability and health system gaps, these difficulties increased the risk of negative impacts on Māori whānau as COVID-19 cases increased. The study highlighted a critical need to create equal power in health perspectives, reducing dominance of the individual-focused medical model for better support of whānau during future pandemics.CONCLUSIONS:The study provided insights on systemic traps, their interactions and delays contributing to a relatively less effective COVID-19 response for Māori whānau and offered insights for improvement. In the light of recent changes in the Aotearoa New Zealand health system, the findings emphasize the urgent need for structural reform to address power imbalances and establish kaupapa Māori approach and equity as a norm in service planning and delivery.

Significant effort is underway to address the housing crisis in Aotearoa New Zealand (Aotearoa), including rapid investment in public and community housing. As Maori (the Indigenous people of Aotearoa) face many systemic barriers and impediments to home ownership, delivery and development of housing options and make up a significant proportion of public housing tenants, developing and managing housing and associated neighbourhoods that enable and support Maori wellbeing is of critical importance. To support this, we introduce A Whakawhanaungatanga Maori Wellbeing Model for Housing and Urban Environments - for use by researchers, developers, designers, managers and regulators - that emphasises whakawhanaungatanga (relationship building and creating connectedness) as central to wellbeing outcomes for Maori. Here we outline seven key concepts from Te Ao Maori built into our model, and pose questions to help guide researchers and housing and urban development actors in their respective research and development activities. While the model is primarily intended to contribute to Maori wellbeing outcomes in Aotearoa, it may also be of broader international interest to those working toward wellbeing outcomes in relation to housing and urban environments, particularly for Indigenous peoples.