Elana Curtis

University of Auckland · Te Kupenga Hauora Māori

Hikitia te Ora (Certificate in Health Sciences) is a 1 year Indigenous bridging foundation programme at the University of Auckland, Aotearoa New Zealand. The programme aims to increase Māori and Pacific health workforce representation. This qualitative study applied a Kaupapa Māori positioning to elucidate the strengths, challenges, and opportuniti...

Introduction The COVID-19 pandemic has had both direct and indirect impacts on the health of populations worldwide. While racial/ethnic health inequities in COVID-19 infection are now well known (and ongoing), knowledge about the impact of COVID-19 pandemic management on non-COVID-19-related outcomes for Indigenous peoples is less well understood....

In Aotearoa/New Zealand (NZ), the Indigenous Māori population have been more severely impacted than non-Māori throughout the COVID-19 pandemic, and less well served by NZ’s COVID-19 response. This case-study describes an innovative Indigenous-led service delivery model, which was designed and implemented to improve the case and contact management o...

Introduction In Aotearoa New Zealand (NZ), socioeconomic status and being of Māori ethnicity are often associated with poorer health outcomes, including after surgery. Inequities can be partially explained by differences in health status and health system biases are hypothesised as important factors for remaining inequities. Previous work identifie...

Examining the pathways and causes of ethnic inequities in health is integral to devising effective interventions. Explanations set the scope for solutions. Understandings of ethnic health inequities are often situated in victim blaming and cultural deficit explanations, rather than in the root causes. For Indigenous populations, colonisation and ra...

Aim: This paper reports the findings of a literature review to answer the research question, "What are the barriers and facilitators of access to hospital services for Māori?" Method: MEDLINE (Ovid) and PsycINFO were searched using keywords to identify relevant literature published between 2000 and 2020. The data analysis was informed by a Kaupa...

In this chapter, the health needs and rights of Indigenous peoples are discussed. This discussion covers current challenges beginning with how indigeneity is defined. Within this context, current data on Indigenous health are described with a critique of how Indigenous health is framed. In an attempt to make sense of global patterns of the health o...

Objective There is increasing evidence that EDs may not operate equitably for all patients, with Indigenous and minoritised ethnicity patients experiencing longer wait times for assessment, differential pain management and less evaluation and treatment of acute conditions. Methods This retrospective observational study used a Kaupapa Māori framewo...

Addressing the underrepresentation of Māori in the health workforce is expected to improve Māori health status and contribute to a reduction in Māori health inequities. This research aimed to understand the strengths, challenges and opportunities of the Whakapiki Ake Project (WAP) – an Indigenous tertiary recruitment programme that engages with Māo...

Objective Internationally, Indigenous and minoritised ethnic groups experience longer wait times, differential pain management and less evaluation and treatment for acute conditions within emergency medicine care. Examining ED Inequities (EEDI) aims to investigate whether inequities between Māori and non‐Māori exist within EDs in Aotearoa New Zeala...

Despite Māori (Indigenous population of New Zealand, NZ) having high Emergency Department (ED) use, few studies have explored for ethnic inequities in ED within NZ. ED healthcare can be time-pressured, complex and demanding. Clinical decision-making in this context may facilitate provider prejudice, stereotyping and bias. The Examining Emergency De...

Background: Eliminating indigenous and ethnic health inequities requires addressing the determinants of health inequities which includes institutionalised racism, and ensuring a health care system that delivers appropriate and equitable care. There is growing recognition of the importance of cultural competency and cultural safety at both individu...

Objectives Ethnic inequities in health outcomes have been well documented with Indigenous peoples experiencing a high level of healthcare need, yet low access to, and through, high‐quality healthcare services. Despite Māori having a high ED use, few studies have explored the potential for ethnic inequities in emergency care within New Zealand (NZ)....

The determinants of health inequities between Indigenous and non-Indigenous populations include factors amenable to medical education’s influence—for example, the competence of the medical workforce to provide effective and equitable care to Indigenous populations. Medical education institutions have an important role to play in eliminating these i...

Although health provider racial/ethnic bias has the potential to influence health outcomes and inequities, research within health education and training contexts remains limited. This paper reports findings from an anonymous web-based study examining racial/ethnic bias amongst final year medical students in Aotearoa/New Zealand. Data from 302 stude...

Characteristics of study participants, by wave, overall, and compared to total eligible sample. Table notes: * Top response category was “Aged 30+”, treated as 30 for calculation of median and IQR. (DOCX)

Participation in study modules, numbers and percentages. (DOCX)

Responses to vignette bias questions by randomised patient ethnicity, means and mean differences. Table notes: a The ethnicity of the patient in the vignette was randomised. These are two separate groups. Also note that the composition of groups is different for the "Presented with CVD vignette with patient as European" and "Presented with mental h...

A national health target for length of stay in emergency departments (ED) was introduced in 2009 to reduce crowding and improve quality of care. We aimed to determine whether the target was associated with changes in time to CT and appropriateness of CT imaging, as markers of care quality for suspected acute traumatic brain injury (TBI). We underto...

Background Health professional racial/ethnic bias may impact on clinical decision-making and contribute to subsequent ethnic health inequities. However, limited research has been undertaken among medical students. This paper presents findings from the Bias and Decision-Making in Medicine (BDMM) study, which sought to examine ethnic bias (Māori (ind...

Excellent health research is essential for good health outcomes, services and systems. Health research should also build towards equity and in doing so ensure that no one is left behind. As recipients of government funding, researchers are increasingly required to demonstrate an understanding of their delegated responsibilities to undertake researc...

Objective To determine associations between admission markers of socioeconomic status, transitioning, bridging programme attendance and prior academic preparation on academic outcomes for indigenous Māori, Pacific and rural students admitted into medicine under access pathways designed to widen participation. Findings were compared with students ad...

Aim: To determine whether implementation of a national health target called Shorter Stays in Emergency Departments impacted on clinical markers of quality of care. Method: A retrospective pre- and post-intervention study from 2006 to 2012 examined quality of care metrics for five different indicators at different sites in relation to the impleme...

Aim: The impact of national targets for emergency department (ED) length of stay (LOS) on patient care is unclear. This study aimed to determine the effect of New Zealand's six-hour time target (95% of ED patients discharged or admitted to hospital within six hours) on a range of quality indicators. Methods: A nationwide observational study from...

Tertiary institutions internationally aim to increase student diversity, however are struggling to achieve equitable academic outcomes for indigenous and ethnic minority students and detailed exploration of factors that impact on success is required. This study explored the predictive effect of admission variables on academic outcomes for health pr...

Aim: Timely access to computerised tomography (CT) for acute traumatic brain injuries (TBIs) facilitates rapid diagnosis and surgical intervention. In 2009, New Zealand introduced a mandatory target for emergency department (ED) stay such that 95% of patients should leave ED within 6 h of arrival. This study investigated whether this target influe...

Accepted for publication

Understanding how to undertake Kaupapa Maori research can be a challenge for emerging health researchers. Unless emerging researchers have exposure to Kaupapa Maori theory or senior Maori health research expertise, the challenge of undertaking Kaupapa Maori research within health research contexts can seem daunting, and for some, too difficult to a...

This is a conceptual inquiry into the nature of the role of learning designer from mainstream cultural groups working within culturally-grounded digital design settings. This paper stems from the co-design of an online transition-to-study resource developed specifically for Māori and Pacific students about to begin postgraduate study at the Univers...

This is a conceptual inquiry into the nature of the role of learning designer from mainstream cultural groups working within culturally-grounded digital design settings. This paper stems from the co-design of an online transition-to-study resource developed specificall for Maori and Pacific students about to begin postgraduate study at the Universi...

Background: Tertiary institutions are struggling to ensure equitable academic outcomes for indigenous and ethnic minority students in health professional study. This demonstrates disadvantaging of ethnic minority student groups (whereby Indigenous and ethnic minority students consistently achieve academic outcomes at a lower level when compared to...

Background Health provider racial/ethnic bias and its relationship to clinical decision-making is an emerging area of research focus in understanding and addressing ethnic health inequities. Examining potential racial/ethnic bias among medical students may provide important information to inform medical education and training. This paper describes...

Objective Time targets for ED stays are used as a policy instrument to reduce ED crowding. There is debate whether such policies are helpful or harmful, as focus on a process target may divert attention from clinical care. The objective of this study is to investigate whether the Shorter Stays in Emergency Departments target in New Zealand was asso...

Objective: There is debate whether targets for ED length of stay introduced to reduce ED overcrowding are helpful or harmful, as focus on a process target may divert attention from clinical care. Our objective was to investigate the effect of a national ED target in Aotearoa New Zealand on the recommended care for acute asthma as this is known to...

Introduction Achieving health equity for indigenous and ethnic minority populations requires the development of an ethnically diverse health workforce. This study explores a tertiary admission programme targeting Māori and Pacific applicants to nursing, pharmacy and health sciences (a precursor to medicine) at the University of Auckland (UoA), Aote...

Background Universities should provide flexible and inclusive selection and admission policies to increase equity in access and outcomes for indigenous and ethnic minority students. This study investigates an equity-targeted admissions process, involving a Multiple Mini Interview and objective testing, advising Māori and Pacific students on their b...

Bridging/foundation programmes are often provided by tertiary institutions to increase equity in access and academic performance of students from under-served communities. Little empirical evidence exists to measure the effectiveness of these bridging/foundation programmes on undergraduate academic outcomes. This research identifies the predictive...

Tertiary institutions aim to provide high quality teaching and learning that meet the academic needs for an increasingly diverse student body including indigenous students. Tātou Tātou is a qualitative research project utilising Kaupapa Māori research methodology and the Critical Incident Technique interview method to investigate the teaching and l...

Indigenous health workforce development has been identified as a key strategy to improve Indigenous health and reduce ethnic inequities in health outcomes. Likewise, development of a culturally safe and culturally competent non-Indigenous health workforce must also occur if the elimination of health inequities is to be fully realised. Tertiary educ...

Background: There are significant health workforce inequities that exist internationally. The shortage of indigenous health professionals within Australia and New Zealand requires action across multiple sectors, including health and education. This article outlines the successes and challenges of the University of Auckland's Vision 20:20 programme...

This study investigates what teaching practices in the ‘non-lecture context of a foundation programme’ help or hinder Māori and Pasifika students’ success in a New Zealand university. This two-year qualitative project used Kaupapa Māori and Pasifika Research (KM/PR) methodologies conducted in three phases: (1) needs analysis, (2) intervention and (...

Despite the spread of time targets for ED lengths of stay around the world, there have been few studies exploring the effects of such policies on quality of ED care. The Shorter Stays in Emergency Departments (SSED) National Research Project seeks to address this. The purpose of this paper was to describe how the indicators for the SSED study in Ne...

Addressing the underrepresentation of indigenous health professionals is recognised internationally as being integral to overcoming indigenous health inequities. This literature review aims to identify 'best practice' for recruitment of indigenous secondary school students into tertiary health programmes with particular relevance to recruitment of...

In May 2009, the New Zealand government announced a new policy aimed at improving the quality of Emergency Department care and whole hospital performance. Governments have increasingly looked to time targets as a mechanism for improving hospital performance and from a whole system perspective, using the Emergency Department waiting time as a perfor...

Survey of Initiatives Made and Resources Used to Help Meet the Shorter Stays in Emergency Departments Target (Stream One).

Interview Schedule for Qualitative Interviews (Stream Three).

Data Dictionary for Quantitative Outcomes (Stream Two).

The ability of universities to teach in ways that support the success of diverse students is a matter of focused action in many nations, especially those where demographic trends suggest an increasing prevalence of students from groups under-represented in universities. This paper describes findings from research involving three Faculties and a ser...

Ischaemic Heart Disease (IHD) is a leading cause of death in New Zealand and the burden falls disproportionately on Māori, the indigenous population of Aotearoa New Zealand. Data for Māori:non-Māori disparities in risk factors, hospitalisation, procedure receipt and mortality for IHD are analysed. Age-adjusted rates of IHD mortality (2000-2004) and...

To determine vaccination coverage, by ethnicity, for the routine publicly funded vaccinations for 11 year olds, from school-based vaccination data in South Auckland, New Zealand. De-identified aggregate data were obtained with permission from the Counties Manukau District Health Board (CMDHB) Public Health Nurses Database on the 11-year-old tetanus...

The reasons for race/ethnicity (R/E) differences in breast cancer survival have been difficult to disentangle. Surveillance, Epidemiology, and End Results (SEER)-Medicare data were used to identify 41,020 women aged > or =68 years with incident breast cancer between 1994-1999 including African American (2479), Hispanic (1172), Asian/Pacific Island...

To investigate the relationship between caesarean section (CS), deprivation, and ethnicity; and to examine Māori/non-Māori differences in CS after controlling for possible confounding factors. Total, acute, and elective CS rates (as proportions of women giving birth in New Zealand hospitals) during 1997-2001 were examined by ethnicity and area depr...

This paper presents a summary of the aims and delivery of Hikitia Te Ora – the Certificate in Health Sciences (CertHSc) programme of Te Kupenga Hauora Māori, The University of Auckland. CertHSc is a one-year bridging programme for Māori and Pacific Island students interested in pursuing health-related careers but who lack the necessary educational...

To describe the epidemiology of breast cancer in Maori and non-Maori women in New Zealand, and to identify the implications for breast cancer screening and treatment policy and practice. New Zealand Census Mortality Study (NZCMS)-adjusted age-specific incidence and mortality rates for breast cancer in total and sole Maori and non-Maori women were c...

To describe the methods used to estimate breast cancer incidence and mortality in Maori and non-Maori women using multiple adjustors to assign ethnicity. Age-specific incidence and mortality rates for breast cancer in Maori and non-Maori were calculated using registration and deaths data obtained from New Zealand Health Information Service (NZHIS)...