NIHI is committed to satisfying Treaty of Waitangi obligations and improving responsiveness of health research to Māori. Particular emphasis is placed on ensuring that the focus on affordable prevention and treatment intervention strategies is relevant to Māori, and on workforce development for Māori.
Examples from across our themes of working to achieve these aims are highlighted below:
RAUORA is a single-blind, randomised, non-inferiority randomised controlled trial examining the effectiveness, safety and cost-effectiveness of cytisine (Tabex®) compared to varenicline (Champix®) for smoking cessation in Māori and whānau of Māori. The trial is led by Associate Professor Natalie Walker and is a collaboration with the School of Pharmacy, University of Auckland, Brunel University London, and the Lakes District Health Board. The trial is aiming to enrol 2,140 participant who are daily smokers (≥18 years), live in the Lakes District Health Board region of NZ, self-identify as Māori or whānau of Māori, are motivated to quit, and are eligible for subsidised varenicline under special authority conditions. The trial is funded by a three-year grant from the Health Research Council of NZ.
TextMATCH is a text message health information service for pregnant women and their families that continues until the child is aged 2 years. This service was developed as part of the Healthy Babies, Healthy Future initiative - led by a consortium of community-based organisations working with Māori, Pacific, Asian and South Asian families. The text messages were developed from national guidelines and culturally adapted and translated in collaboration with the community organisations. The result is 16 different versions adapted for culture, language and family relationship to the baby. Māori, Pacific, Asian and South-Asian families are approached by the community organisations and offered a range of services including group education programmes and TextMATCH. TextMATCH has had over 2000 participants with overwhelmingly positive feedback from qualitative interviews and ad hoc feedback. It is being formally evaluated in 2017.
SMS4BG is a text message self-management support programme for people with poorly controlled diabetes. A Māori Advisory Group was facilitated by Dr Matt Shepherd with representation from people with diabetes, clinicians and service providers from Waitemata DHB. This group helped to develop and test a Māori version of SMS4BG, and to design study processes. A pilot in primary and secondary care in Waitemata DHB showed some great indicative improvement in diabetes control and consistently positive feedback from participants. A national RCT on the effectiveness of this programme is currently underway.
OL@-OR@ is a four- year project to design and evaluate a mobile-phone delivered (mHealth) healthy lifestyle support tool for Māori and Pasifika in New Zealand.
Phase 1 involved co-designing the tool with Māori and Pasifika communities. From this phase an app and website were developed that aims to support Māori and Pasifika communities to make small positive lifestyle changes for their health, their whānau and their iwi/community.
Phase 2 involves a cluster randomised control trial to evaluate the effectiveness of this mHealth tool in Māori and Pasifika communities. The trial aims to recruit 24 Māori and 24 Pasifika community clusters with approx. 40 participants per community (1920 participants in total).
The IMPACT trial aimed to assess whether a cardiovascular disease (CVD) medication strategy using a fixed dose combination pill ('polypill') could improve prescribing and adherence to recommended medications, lower blood pressure and improve lipids compared with current care over 12 months.
513 participants who had previous CVD events or were at high risk of CVD were enrolled, half of whom were Māori. Participants were identified, enrolled and prescribed either the polypill or current medications at their usual primary health care practice, with medications (including the polypill) dispensed through local community pharmacies.
Among this population, a CVD polypill improved adherence to the combination of all recommended drugs but improvements in clinical risk factors were small and did not reach statistical significance. Acceptability was high for both general practitioners and patients. There was no difference in effect between Māori and non-Māori participants.
This study aimed to determine the efficacy of a family-centred tobacco control program about environmental tobacco smoke (ETS), to reduce health care presentations for respiratory illness in Indigenous infants up to 12 months of age. Families were recruited from Darwin City and the Greater Darwin area in the Northern Territory, Australia and from within the Counties Manukau District Health Board region, New Zealand. This work was supported by the National Health and Medical Research Council of Australia; the Health Research Council of NZ; Cure Kids NZ and the James Russell Lewis Trust, NZ.
This study was NIHI's original text message smoking cessation intervention and was tested in a national RCT in 2002. A Māori version of the text message programme was developed by Māori co-investigators and offered to Māori participants. The trial found that those participants receiving STOMP were twice as likely to quit as those in the control group. STOMP was shown to be as effective for Māori participants as for non-Māori participants.
MEMO was a multimedia mobile phone messaging programme that aimed to prevent the onset of depression in adolescents. It was based on cognitive behavioural therapy and delivered via a group of Māori, Pacific and pakeha teens in short video messages, and mobisodes of a cartoon about another group of teens. Content and study processes were developed with Māori co-investigators (Dr Matt Shepherd), service providers, young people and industry partners. The results of a large RCT across 15 high schools in Auckland will be published in 2017.