Ensuring cultural equivalence of measurement tools for comparability across settings, populations, and languages is a challenge for global health research. Development of a guide to interpret the meaning of dimensions within tools is an important but neglected part of transcultural translation. Our objective was to transculturally translate the EuroQol Research Foundation’s EQ-5D-5L in Nepali and develop an interpretation guide for Nepal. The EQ-5D-5L was translated into Nepali using modified guidelines from the EuroQol Version Management Committee. We conducted forward translations (n = 2), backward translations (n = 3), and cognitive debriefing interviews (n = 26; 13 female; 17–72 years old). Cognitive debriefing demonstrated different understandings of EQ-5D-5L dimensions and severity rankings by age and gender. Younger adults interpreted mobility as exercise, working age adults as movement needed to complete livelihood tasks. Usual activities were interpreted by female respondents as household obligations, and by men as work outside the home. Younger adults interpreted anxiety and depression as occurring due to life dissatisfaction. Older adults described anxiety as occurring due to physical or emotional pain or unfulfilled desires, and depression due to grief. One shortcoming of the tool was its timeline being restricted to the current day. Based on these interpretations, a guide was created with indicator meanings according to gender and age. Given the differences in interpretation, cost effectiveness analysis with EQ-5D-5L would benefit from age and gender specific analysis. Ultimately, developing an interpretation guide can facilitate contextualized understandings of transculturally adapted instruments in global health.

Racism is a recognised determinant of health internationally and in New Zealand (NZ). Racism is instantiated through racial discrimination, including discriminatory attitudes and practices. Associations between racial discrimination and unfavourable health-related experiences and outcomes have been reported for specific groups in NZ, including for Māori (the Indigenous people of NZ) and for those of Asian and Pacific ethnicities. However, less appears to be known about NZ migrants’ (those defined as non-NZ born) experiences of racial discrimination. This paper reports injured NZ migrants’ experiences of racial discrimination through qualitative analyses of free-text responses to a set of racism-related questions within the ‘Prospective Outcomes of Injury Study 10 Years On’ project. Participants reported experiences of racial discrimination in a range of contexts, including at work, in public, in housing-related contexts(in neighbourhoods and whilst seeking housing) and in health settings. Experiences comprised physical violence and intimidatingbehaviour, racially motivated verbal abuse, discrimination based on appearance or communication, stereotyping, and having their “NewZealand-ness” challenged. Reported impacts of racial discrimination included reduced work opportunities and feeling ‘othered.’ Migrants’ experiences of racial discrimination (across a range of contexts) are potentially underpinned by structural racism in NZsociety. This can affect migrants’ health and well-being through compromised socio-economic opportunities (and by corollary, reduced access to resources) and potentially, lower engagement with societal supports and services. We call for similar research internationally to investigate potential links between experiences and impacts of racial discrimination and future engagement with societal supports, including health and injury services.

OBJECTIVES:This paper describes work participation trajectories 12-years following injury for a cohort of working age New Zealanders, identifying characteristics of membership of the trajectory groups. METHODS:Participants, injured between 2007-2009, were recruited from New Zealand's universal entitlement Accident Compensation Corporation (ACC) scheme. Trajectories considering work participation at 2- and 12-years following injury were summarised using frequencies and percentages. RESULTS:Four trajectories were defined: sustained participation (69%), sustained absence (2%), interrupted participation (12%) and exited workforce (16%). Compared to those with sustained participation, the strongest associations were with the interrupted participation group for trade/manual workers (aRR 1.20, 95% CI 1.10 to 1.30) and low-income workers (<$NZ 50,000 aRR 1.24, 95% CI 1.17 to 1.32). DISCUSSION:Early efforts to maintain sustained employment to 12 years following injury should also include sociodemographic, injury, health and work factors.

Health-related quality of life (HRQoL) measures are widely used in research and clinical practice; however, their application among children and adolescents in low- and middle-income countries (LMICs), where most of the world’s youth reside remains underexplored. This scoping review aims to identify generic HRQoL instruments used in LMICs and describe their applications and reported psychometric properties. Guided by Arksey and O’Malley’s framework, a search for peer-reviewed papers published between 2000 and 2024 was conducted in six databases (Medline, Embase, PubMed, Scopus, CINAHL, and Web of Science). The review included papers reporting the use of generic HRQoL instruments among individuals aged 0–19 years in LMICs. A total of 152 papers originating from 22 (of 75) LMICs were included. Nearly half of the papers were from India 50 (32.9

Internationally, and within New Zealand (NZ), specialist mental health and addiction service-users (SMHAS-users) experience increased risks of comorbidities and premature mortality, and poorer health outcomes, compared to the general population. In particular, Indigenous Māori SMHAS-users face significant inequities compared to non-Māori. Integrated care has been found to improve outcomes by improving quality and coordination between services. This research aimed to develop a model of integrated care relevant to SMHAS-users in a NZ context, to inform the development of a questionnaire intended to assess SMHAS-users experiences of integrated care, support SMHAS to improve their services, and in turn, improve outcomes for SMHAS-users. Key informants working for, and/or with lived experience of, SMHAS were interviewed about existing integrated and people-centred care concepts. Barriers to integration were identified. The team met frequently to review and discuss coding, themes, and model development. Ten informants from across NZ were recruited, including five with lived experience of mental distress, and three who were Māori. Singer et al.,’s (Medical Care Research and Review, 68(1), 112–127, 2011) integrated patient care framework and the World Health Organization’s (2016) concept of people-centred care were found to be acceptable, although people-centred constructs were needed more clearly at a model’s core. SMHAS-user controlled funding and participation in multi-disciplinary team meetings were identified as key opportunities alongside other concepts such as cultural responsiveness, de-centralising services (to re-centralise people), and peer navigators. The resulting People-Centred Joined Up Care (PCJUC) model is proposed to convey a paradigm shift from a service-centric system, organised around the efficiencies and needs of services, to a people-centred system. Irrespective of the health workforce’s best intentions, the current service-centric orientation does not empower SMHAS-users. A people-centred model requires power structures to be inverted and the paramount authority of health professionals as the ‘decision-making experts’ to be challenged. Research is now underway exploring the use of a questionnaire developed to measure the concepts within the PCJUC model, to inform service improvements.

OBJECTIVES:Internationally, little is known about long-term postinjury outcomes among older adults. This report describes older adults' injury-related, disability and physical and psychosocial characteristics 12 years postinjury, including for older Māori (Māori are the Indigenous people of New Zealand). METHODS:The Prospective Outcomes of Injury Study (POIS) recruited 2856 New Zealanders, injured between 2007 and 2009. Interviews were conducted 3, 12 and 24 months postinjury. Twelve years postinjury, 1543 participants completed a follow-up interview. Data were analysed for 833 adults (98 Māori) aged greater than 55 years fora range of domains, including disability (World Health Organization Disability Assessment Schedule II; WHODAS), health-related quality of life (EQ-5D-5L), psychological distress (Kessler-6) and life satisfaction 12 years postinjury. RESULTS:Twelve years postinjury, 49% reported ongoing problems with their injury. Considerable disability (WHODAS ≥ 10) was reported by 20% overall, and by 29% of Māori. Almost two-thirds (65%) reported problems with EQ-5D-5L (e.g. 57% reported pain or discomfort and 33% reported mobility problems). The EQ-5D-5L and most WHODAS outcomes did not differ between age groups; however, a higher proportion of participants aged 55-64 years reported difficulties maintaining a friendship (10%) compared to those aged greater than 70 years (4%). A higher proportion of those aged greater than 70 years reported 'excellent/very good' health (64%) and no trouble accessing health care (88%) compared to those aged 55-64 years (51% and 80%). CONCLUSIONS:Descriptive findings suggest older adults experience long-term problems with mobility, and pain and discomfort postinjury; however, considerable disability did not differ between age groups.

OBJECTIVES:Research into methods for eliciting adolescents' health state preferences has mostly avoided tasks for identifying health states worse than dead, which is required for calculating quality-adjusted life years for economic evaluations. This study investigated the feasibility of eliciting the health state preferences of older adolescents, including for states worse than dead, using the EQ-5D-Y-5L (Y-5L) and EQ-5D-5L (5L), and compared participants' preferences across the 2 instruments. METHODS:Two online surveys were created for the Y-5L and 5L, respectively, using the Potentially All Pairwise Rankings of all Possible Alternatives method, a type of adaptive discrete choice experiment, and a binary search algorithm for identifying health states worse than dead. The surveys were completed by 24 adolescents aged 16 to 19 years in 2 think-aloud sessions, with semistructured interviews at the end of each session. Dimension preference weights and rankings for the Y-5L and 5L were compared using intraclass correlation coefficients, Bland-Altman plots, and paired t tests. RESULTS:The adolescents were capable of valuing health states and identifying states worse than dead. There is no evidence of a difference in mean preference weights between the Y-5L and 5L, and the rankings of dimensions are similar. CONCLUSIONS:Eliciting the health state preferences of older adolescents, including for states worse than dead, is feasible and acceptable. The similarity in Y-5L and 5L mean preference weights suggests that their corresponding value sets, if obtained using the methods used in this study, would be similar. Data quality was enhanced by the surveys being administered in a supportive environment.

Many Indigenous- specific research paradigms are used internationally. Kaupapa Māori is one such paradigm that privileges and legitimises Māori knowledge, culture, language, customs and protocols. The qualitative Kaupapa Māori paradigm presented here includes establishing an expert advisory rōpū and a Māori-led research team, developing and pilot testing a Māori data collection method (wānanga interviews), conducting wānanga, and analysing the collected data. Two wānanga were held with groups of rangatahi and whānau. Wānanga 1 centred around components of hauora important for rangatahi Māori. This led to the creation of a provisional model, in which an atua Māori represented hauora rangatahi Māori. The findings from wānanga 1 were presented to participants in wānanga 2 to initiate discussion around the model. Kaupapa Māori principles informed the methods, analysis and resulting model, and inductive thematic analysis was applied to the wānanga data. This paper illustrates the importance of research being informed by Indigenous worldviews, knowledge systems and practices to produce meaningful, substantive, positive and transformational change.

AIM:With the phase one Royal Commission COVID-19 report published, it is an opportune time to reflect on the various public health interventions used to consider if they were effective and how they could be improved. As we look to the future, it is important to understand if digital contact tracing (DCT) was an effective public health intervention during the COVID-19 pandemic and how it could be improved. METHOD:We summarise a series of articles detailing the population and public uptake of the various DCT technologies implemented in Aotearoa New Zealand during the COVID-19 pandemic. RESULTS:New Zealand had one of the highest population uptakes of DCT in the developed world. However, there were additional barriers to the full implementation of these tools that likely reduced their efficacy. CONCLUSION:DCT was just one of many interventions aiming to eliminate, and then suppress, COVID-19. This context makes it difficult to isolate and conclude that the efficacy of DCT during this pandemic would translate to future pandemic conditions, especially if there is improved design and implementation. However, this research shows that the self-service survey approach worked better than expected, and that there is some promise in automating notification processes.

Background The ‘Prospective Outcomes of Injury Study–10 years on’ (POIS-10) aims to contribute to improving long-term disability, health and well-being outcomes for injured New Zealanders. This brief report describes recruitment, characteristics and key outcomes to 12 years post-injury. Methods Between 2007 and 2009, the study recruited 2856 people, including 566 Māori, from New Zealand’s Accident Compensation Corporation’s entitlement claims register. People experienced a range of injury types, causes and settings; 25% had been hospitalised for their injury. POIS-10 data were primarily collected via interviewer-administered structured questionnaires. Results Of the original participants, 2068 (92%) were eligible for follow-up in POIS-10. Of these, 1543 (75%) people participated between March 2020 and July 2021, including 240 Māori. Half of the participants (n=757; 50%) reported ongoing problems attributed to their injury 12 years earlier. Most reported difficulties with items assessing disability (WHO Disability Assessment Schedule II). For health-related quality of life (HRQoL), measured using the EQ-5D-5L, the prevalence of problems was higher 12 years post-injury compared with 12 months post-injury for four of five dimensions. Importantly, the prevalence of problems did not reduce to pre-injury levels for any HRQoL dimension. Discussion POIS-10 highlights the importance of early post-injury interventions to improve health, disability and well-being outcomes of injured New Zealanders.

Background A substantial proportion of people who experience an injury will experience a subsequent injury event. Intervening to try to prevent subsequent injuries offers an important opportunity to contribute to reducing the overall burden of injury. Objectives This study aims to determine the feasibility of a potential intervention aimed at preventing subsequent injuries and optimising recovery among people who have had a musculoskeletal injury involving an Accident Compensation Corporation entitlement claim. Feasibility objectives are to determine: 1) How soon post-injury can we recruit potential participants?, 2) How long will it take to recruit the necessary number of Māori (Indigenous population of New Zealand) and non-Māori participants?, 3) What is the best timing and number of telephone interviews?, 4) Is the nature and content of the telephone interviews acceptable and appropriate to both Māori and non-Māori participants and interviewers? and 5) Is the training programme adequate, and delivery of the intervention acceptable, to interviewers? Methods Participants were randomly allocated to receive either 2 (control group) or 4 (intervention group) short interviews via telephone over ~6 months. Following their final telephone interview, intervention group participants and the Kaiāwhina Whara/Injury Liaison Interviewers were invited to participate in a qualitative interview to explore their experience of the study to help inform a future planned larger study. Results Of 56 potential participants contactable, 63% (n=35) agreed to take part; 18 intervention (9 Māori, 9 non-Māori) and 17 control group participants (9 Māori, 8 non-Māori). The median duration from date of injury to obtaining participant consent was 35 days (IQR 27–54). For Māori, this was 28 (24–46) and for non-Māori 40 (35–80). Qualitative interviews explored a range of aspects regarding participant and interviewer perceptions of the study and the nature and content of the telephone follow-ups. Both quantitative and qualitative findings have allowed for reflection on a variety of aspects that will strengthen and enhance future research. Conclusion This study has provided valuable insights that are translatable into different injury prevention research contexts such as considerations for the timing of interventions, optimising participant management systems, considerations for data analysis, and managing unexpected interruptions to the project.

To ensure the recognition and participation of all potential respondents in health research, surveys and care, including LGBTQIA + broadly, and trans people, specifically, the use of inclusive language should be considered. This scoping review aimed to identify and describe strategies considered for gender inclusivity in development and use of health questionnaires and Patient Reported Outcomes Measures (PROMs). A systematic search of peer reviewed publications between January 2000 and September 2022 was conducted in Scopus, ProQuest Central, Ovid Medline (PubMed and EBSCO). Two reviewers independently screened identified publications titles and abstracts, followed by full text screening and data extraction from eligible articles. The search of over 5000 publications, retained 18; most acknowledged gaps in representation and advocated for gender-inclusive language. Eight articles discussed exclusion from health care and health research for gender minority groups due to the use of gendered language. Improved reliability, validity and response rates were associated with the use of gender-neutral language in seven articles. Only one article reported finding irritation among cisgender males when non-binary gender response options were used. One paper, focussing on instruments for Rheumatoid Arthritis, discussed gaps in representation if diverse gender identities were not considered when developing PROMs. This scoping review points to the importance of adopting gender-inclusive language in health questionnaires and surveys to reduce the risk of excluding gender minority groups. Despite finding very few specific examples of how others have used gender-inclusive language in health questionnaires, many strengths of gender-inclusive language usage were identified. People from the LGBTQIA + communities are often excluded from health research and from completing heath surveys as they are not able to identify with the questions about male or female genders. This scoping review aimed to examine the literature for any strategies developers of health questionnaires may have come up with to ensure inclusion of all demographic groups. Most of the identified literature highlights the importance of adopting gender-inclusive language in health questionnaires to reduce the risk of excluding gender minority groups. Despite many strengths of gender-inclusive language usage being identified, only a few specific examples were identified of how others have used gender-inclusive language in health questionnaires.

AbstractBackgroundDigital contact tracing (DCT) was a central component of the global response to containing COVID‐19. Research has raised concerns that DCT could exacerbate inequities, yet the experiences of diverse communities at greater risk from COVID‐19 are typically underrepresented.MethodsThe present study aimed to understand the perceived barriers to the adoption of the app amongst Māori, Pasifika, and disabled people. Focus groups and interviews were undertaken with Māori, Pasifika, and disability sector stakeholders and community participants.ResultsParticipants (n = 34) generally expressed willingness to utilise DCT and support its adoption within the communities. Simultaneously, participants revealed how the app could marginalise community members who struggled with the usability and those distrusting of the government's COVID‐19 interventions.ConclusionsThe findings highlight how addressing communication inequality can assist in the development of contact‐tracing responses that are both effective and equitable. The study provides insights about the role of information and communication technologies as health resources.Patient or Public ContributionConsulting with members of the target communities was central throughout the present study, including recommendations for potential participants, participation in interviews and sharing early findings for feedback. This study reports on focus groups and interviews with individuals from Māori and disability sectors.

Patient and Public Participation (PPP) is key to improving health systems. Yet, studies have shown that PPP implementations across many countries have been largely tokenistic. Particularly, in Ghana, whilst PPP is prioritized in national health policies and legislation, there appears to be little research focused on understanding PPP’s role in health system improvement. The aim of this study, therefore, is to examine how PPP is working across the Ghanaian health system levels, as well as to understand the perspectives and experiences of participants on how PPP contributes to health system improvement. The qualitative study was undertaken in six communities in three districts in the Ashanti region of Ghana. Data were collected from semi-structured individual interviews. The selection of participants was purposive, based on their PPP-related roles. As a result, findings of this study may not reflect the experiences of others who are not directly involved in PPP initiatives. Thirty-five participants, mainly health service users and health professionals, were interviewed. Data were transcribed and analysed descriptively using Braun and Clarke’s (2006) thematic analysis approach. Overall, participants noted PPP implementation was largely limited at higher health system levels (i.e. national, regional and district levels), but was functioning at the community level. PPP also improved access to health services, responsiveness to patient needs, community-health worker relationships, health-seeking behaviours, empowered healthcare users and improved health outcomes. The study, therefore, recommended the need to undertake PPP across all levels of the health system to maximize PPP’s role in health system improvement. Finally, the study suggested prioritizing PPP, especially for resource-poor countries, to complement government’s efforts in improving accessibility of healthcare services to many communities and also provide a more patient-centred healthcare system responsive to patients’ and public needs.

Digital contact tracing apps were developed to help control the spread of COVID-19 but research exploring these apps has underrepresented both ‘at-risk’ communities and contact tracers. Our study examines perspectives of the New Zealand COVID Tracer app among 53 participants, comprising policy advisors, contact tracers, and Māori, Pacific, and disability stakeholders, underpinned by the theory of social construction of which positions technology within the social context in which it evolves, operates, and is negotiated. Although community stakeholders believed the app helped safeguard communities from COVID-19, the health officials' views on the app's usefulness in contact tracing varied. Participants who oversaw the app’s technical development generally perceived it as being more useful, particularly regarding Bluetooth proximity detection, in contrast with contact tracers’ perceptions. The findings highlight a disconnection between public sentiment and operational reality in the use of the app and the need for improved collaboration and consultation in future contact tracing responses.

There is a growing body of literature outlining the influence of interviewers on the success of research studies, yet a paucity of research has focused on understanding the experiences of interviewers themselves. Considering this knowledge gap, this opportunistic qualitative study examined the experiences of interviewers conducting structured telephone follow-up interviews for the paired longitudinal cohort studies of injured New Zealanders, ‘The Prospective Outcomes of Injury Study 10 years on’ (POIS-10) and ‘POIS-10 Māori: Outcomes and experiences in the decade following injury’ (POIS-10 Māori). Based in Aotearoa me Te Waipounamu/New Zealand (NZ), this paper aimed to examine interviewers’ experiences of contacting participants after a 10 year interval, conducting long-term follow-up interviews, and interviewing during a global pandemic. Interviewers employed for POIS-10 and/or POIS-10 Māori were invited to take part in a group interview. With interviewers’ permission, interviews were audio-recorded, transcribed verbatim, and thematically analysed. Nine interviewers participated in the study. Three key themes (with several related sub-themes) were identified: ‘reconnecting’, ‘sustaining balance’, and ‘the pandemic—the ordinary amongst the extraordinary’. This study provides useful insights about interviewers’ experiences of working on two paired national longitudinal studies engaging with participants who have had a long connection to the research projects. It is hoped that these findings, and the strategies that interviewers reported, may be useful to other researchers and interviewers undertaking longitudinal research.

Background In Ghana, the community-based health planning and services (CHPS) policy highlights the significance of both community health management committees (CHMCs) and community health volunteers (CHVs) in the Ghanaian health system. However, research into their specific effects on health system improvement is scarce. Some research has focussed on the roles of the CHMCs/CHVs in implementing specific targeted health interventions but not on improving the overall health system. Therefore, this research aims to examine the role of the CHMCs and CHVs in improving the Ghanaian health system. Methods The study was conducted in three districts in the Ashanti region of Ghana. A total of 35 participants, mainly health service users and health professionals, participated in the study. Data were collected using semi-structured individual in-depth interviews. Participants were selected according to their patient–public engagement or community health activity roles. Data were transcribed and analysed descriptively using NVIVO 12 Plus. Results We found that the effectiveness of CHMCs and CHVs in health systems improvement depends largely on how members are selected. Additionally, working through CHMC and CHVs improves resource availability for community health services, and using them in frontline community health activities improves health outcomes. Conclusions Overall, we recommend that, for countries with limited healthcare resources such as Ghana, leveraging the significant role of the CHMCs and CHVs is key in complementing government’s efforts to improve resource availability for healthcare services. Community health management committees and CHVs are key in providing basic support to communities with limited healthcare personnel. Thus, there is a need to strengthen their capacities to improve the overall health system.

IntroductionLittle appears to be known regarding the work-related injury (WRI) experiences of migrants (those born in a country other than their identified host country) and specifically, women migrants.MethodsAs part of a wider PhD project investigating the WRI experiences of New Zealand (NZ) migrants, a review of NZ mainstream media coverage of migrants WRIs was undertaken, which identified no representations of migrant women's WRI experiences. In turn, a scoping review was undertaken to identify peer-reviewed publications reporting empirical findings about WRI experiences and outcomes for migrants in Organization for Economic Co-operation and Development (OECD) member countries, including NZ. This paper aims to identify and describe findings for migrant women specifically. From 2,243 potential publications, 383 proceeded to full text review; ultimately 67 were retained. These 67 publications were reviewed to identify findings specifically for occupationally injured migrant women; 22 such publications (from 21 studies) were found. This paper reports: the characteristics of identified studies; characteristics of migrant women within; frameworks and theories used, and knowledge (and gaps) related to occupationally injured migrant women.ResultsPublications came from only four OECD countries, the United States, Canada, Australia, and Spain. A range of study designs, and topic areas (working conditions, legal rights, identities, the role of gatekeepers, and precarity), were identified; however, only three studies reported findings for longer-term experiences and outcomes of WRIs. Nine publications considered theoretical models underpinning research, including theories about precarious work, stigmatization, and citizenship. However, there was a paucity of analyses of the WRI experience throughout the life-course, highlighting a gap in understanding of how these experiences are “lived” over the long term by occupationally injured migrant women.DiscussionScoping review findings were synthesized using a provisional “matryoshka framing narrative” model, to be refined through forthcoming qualitative interviews with occupationally injured NZ migrant women. This model highlights the multitude of influences in WRI experiences, potentially specific to migrant women, suggesting the consequences of WRIs may be uneven, with migrant women experiencing different, and potentially, greater disparities in outcomes. These findings provide an impetus to investigate knowledge gaps and urgently address potential disparities in WRI outcomes for migrant women specifically.

Injury is a leading cause of health loss in Aotearoa me Te Waipounamu (New Zealand; NZ). The NZ Trauma Registry was established in 2015 to monitor outcomes in those experiencing severe injury and to identify ways of improving the quality of care for these patients. Few NZ studies have assessed outcomes in trauma patients using patient-reported outcome measures (PROMs) despite increasing recognition that the impacts of injury are better understood through PROMs. Our aim was to estimate the prevalence of self-reported problems with health-related quality of life (HRQoL) outcomes six months post-injury, and identify factors associated with these, in a cohort of Māori (the Indigenous population of NZ) and non-Māori individuals who had experienced major trauma. HRQoL outcomes were measured according to the five dimensions of the EQ-5D-5L. This information, along with sociodemographic data, was collected via structured telephone interviews. Participants (n=870), aged 16 years or more, were recruited following admission to a trauma hospital in one of three (of NZ's four) trauma regions. Multivariable models were developed using modified Poisson Regression to identify factors associated with outcomes for both Māori and non-Māori patients. The prevalence and severity of problems across each of the five EQ-5D-5L dimensions was similar for Māori and non-Māori except for Anxiety/Depression. The prevalence and severity of problems with Anxiety/Depression was greater for Māori. Factors associated with HRQoL problems at six-months were also largely similar for each cohort. Those commonly associated with outcomes were age, hospital length of stay, adequacy of household income, and participants’ expectations regarding recovery from injury. Further research examining recovery expectations in trauma patients to determine which factors contribute to formulating recovery expectations, and the potential impact of recovery expectations on treatment and rehabilitation, would be of value. Should expectations, at least in part, influence HRQoL outcomes, then routinely collecting data on patients’ recovery expectations, adequacy of household income and potential barriers to treatment and rehabilitation, could help inform post-hospital treatment plans, and identify those who may require additional support following discharge from hospital.

Background Refugee health is an issue of global importance. Refugees have high and complex mental, physical and social needs and poor health outcomes. There is a clear need for more research prioritising refugees’ perspectives of health care in their settlement countries; however, a number of methodological and ethical challenges can make this process difficult. Methods This methodological paper is an analysis of our recent experience conducting qualitative research with former refugees in Southern New Zealand. We utilized our research team’s discussions, reflections and fieldnotes and the relevant literature to identify the key processes of our successful engagement with former refugees. Results Successful engagement with former refugees in qualitative health research entails: establishing relationships, recognising interpreters as cultural brokers, having a responsive suite of methods and finding meaningful ways to communicate. Conclusions This paper offers suggestions and guidance on conducting qualitative health research with former refugees.