Suzanne G Pitama

University of Otago

Introduction Clinical assessment in emergency departments (EDs) for possible acute myocardial infarction (AMI) requires at least one cardiac troponin (cTn) blood test. The turn-around time from blood draw to posting results in the clinical portal for central laboratory analysers is ~1–2 hours. New generation, high-sensitivity, point-of-care cardiac...

Bipolar disorder (BD) is a serious mental health condition that is clinically complex to monitor and manage. While best practice guidelines exist, they vary internationally lacking consensus. Indigenous peoples, including Māori in New Zealand, experience higher community rates of BD. While New Zealand practice guidelines recommend providing cultura...

Background Chronic obstructive pulmonary disease (COPD) is a progressive and disabling lung condition with a high mortality. Our research has shown that health care for end-of-life COPD is poorly integrated. The aim of this study was to involve people with end-of-life COPD, their support people and health professionals in the design of healthcare s...

Background New Zealand's older Indigenous Māori people experience poorer health and reduced access to healthcare than their older non‐Māori counterparts. Organisational factors (such as leadership or workforce) may influence the attitudes and perceptions of older Māori and their family (whānau) to use aged residential care services. Currently, ther...

Background Meaningful engagement with stakeholders in the provision of healthcare and services is recommended by the World Health Organisation. Culturally specific evaluation may enable deeper exploration of the critical views of people living with advanced long-term conditions, their support people, and healthcare providers. Aim and design This a...

Background Eating disorders are as common in Māori, the Indigenous people of Aotearoa-New Zealand, as they are in non-Māori; however, research has focused on the experiences of non-Māori. This paper will describe explanatory factors, treatment experiences and what helps with recovery for Māori. Methods Kaupapa Māori research methodology informed t...

Purpose Aotearoa New Zealand’s Research, Science and Innovation (RSI) system is undergoing a ‘once in a generation’ reform known as Te Ara Paerangi Future Pathways (TAP). One of TAP’s four high-level goals is to embed Te Tiriti o Waitangi across the RSI system. Using the analogy of bridge-making, we draw on insights from Māori submissions to TAP to...

Background: There is evidence of Indigenous and ethnic minority inequities in the incidence and outcomes of early psychosis. Racism has been implicated as having an important role. Aim: To use Indigenous experiences to develop a more detailed understanding of how racism operates to impact early psychosis outcomes. Methods: Critical Race Theory...

In the field of mental health and addictions, there is a lack of research that acknowledges or considers Indigenous needs, preferences, and approaches to the design, development and maintenance of collaborative health and social initiatives in rural communities. This study presents a Kaupapa Māori (Indigenous Māori research approach) qualitative ca...

Introduction: Delivery of end-of-life care for severe chronic obstructive pulmonary disease (COPD) has been hampered by an unpredictable disease trajectory and poor integration of health care and social services. Objective: To critically explore the perspectives, values, and experiences of stakeholders in COPD end-of-life healthcare services in...

Enabling patients to consent to or decline involvement of medical students in their care is an essential aspect of ethically sound, patient-centred, mana-enhancing healthcare. It is required by Aotearoa New Zealand law and Te Kaunihera Rata o Aotearoa Medical Council of New Zealand policy. This requirement was affirmed and explored in a 2015 Consen...

Background: Epidemiological studies on acute aortic syndrome (AAS) have relied largely on unverified administrative coding, leading to wide-ranging estimates of incidence. This study aimed to evaluate the incidence, management, and outcomes of AAS in Aotearoa New Zealand. Methods: This was a national population-based retrospective study of patie...

Background: People with end-of-life chronic obstructive pulmonary disease (COPD) experience debilitating physical limitations, with a high mortality rate. Our research has shown health system design and delivery leads to inequitable outcomes. Enabling people with end-of-life COPD, their support people, and health professionals to partner in settin...

Background: Chronic obstructive pulmonary disease (COPD) is a progressive and disabling lung condition with a high mortality. Our research has shown that health care for end-of-life COPD is poorly integrated. Involving people with end-of-life COPD, their support people and health professionals in the design of healthcare services may improve the de...

Purpose Open-source automated insulin delivery (AID) is used by thousands of people with type 1 diabetes (T1D), but has unknown generalisability to marginalised ethnic groups. This study explored experiences of Indigenous Māori participants in the CREATE trial with use of an open-source AID system to identify enablers/barriers to health equity. Me...

there is evidence of indigenous and ethnic minority inequities in the incidence and outcomes of early psychosis. Racism has an important role. this study aimed to use indigenous experiences to develop a more detailed understanding of how racism operates to impact early psychosis. critical Race theory informed the methods used. twenty-three indigeno...

Background Health, illness, and the body are conceptualized within the cultural context of a society. The values and belief systems of a society, including media portrayals, shape how health and illness present. Traditionally, Western portrayals of eating disorders have been prioritized over and above Indigenous realities. This paper explores the l...

Aim: To understand what healthcare staff perceive contributes to the quality of patient and family/whānau experiences of dying and death on a hospital inpatient ward. Method: A survey was created, piloted and sent to all staff members who had cared for a deceased patient within two working days of their death, at Christchurch Hospital (CH), New...

Aim: To compare the use of smoking cessation aids across different ethnic groups and age groups within a large New Zealand cohort and to assess the uptake and effectiveness of e-cigarettes for smoking cessation via a "vape to quit" initiative. Methods: Retrospective analysis of Te Hā - Waitaha smoking cessation service, including a telephone int...

Background There is evidence of disparities between non-Indigenous and Indigenous incidence of psychotic disorders. Despite these disparities being a clear signpost of the impact of structural racism, there remains a lack of evidence to target institutional factors. We aimed to investigate non-Indigenous and Indigenous differences in government ser...

Indigenous experiences of hospitalisation may contribute to maintenance of Indigenous health inequities. We undertook a qualitative systematic review of Māori experiences of hospital care within New Zealand. We performed electronic database searches and used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to assist...

The objective of this systematic literature review is to identify patients’, carers’ and health professionals’ reported perspectives of end-of-life care services for severe chronic obstructive pulmonary diseases (COPD) and explore whether services are person-centred and integrated according to WHO definitions. The systematic review was qualitative...

Aims: The validity of diagnostic classification in early psychosis has important implications for early intervention; however, it is unknown if previously found disparities between Māori (Indigenous people of New Zealand) and non-Māori in first episode diagnoses persist over time, or how these differences impact service use. Methods: We used ano...

There are differences between research that is performed in an Indigenous setting using Western methodologies and research performed using Indigenous methodologies. Kaupapa Māori research provides opportunities for Māori, the Indigenous people of New Zealand, to participate in and influence research agendas and processes while providing a platform...

Objectives: This paper identifies barriers to equity and proposes changes to improve the organisation of healthcare in New Zealand for Māori with bipolar disorder (BD) and their families. Design: A qualitative Kaupapa Māori methodology was used. Twenty-four semi-structured interviews were completed with Māori with BD and members of their family....

Objectives: This paper synthesises critique from Māori patients with Bipolar Disorder (BD) and their whānau to identify barriers and propose changes to improve the structure and function of the New Zealand mental health system. Design: A qualitative Kaupapa Māori Research methodology was used. Twenty-four semi-structured interviews were complete...

The required adjustments precipitated by the coronavirus disease 2019 crisis have been challenging, but also represent a critical opportunity for the evolution and potential disruptive and constructive change of medical education. Given that the format of medical education is not fixed, but malleable and in fact must be adaptable to societal needs...

Background To summarise the evidentiary basis related to causes of inequities in chronic kidney disease among Indigenous Peoples. Methods We conducted a Kaupapa Māori meta-synthesis evaluating the epidemiology of chronic kidney diseases in Indigenous Peoples. Systematic searching of MEDLINE, Google Scholar, OVID Nursing, CENTRAL and Embase was con...

Objective Research designed to increase knowledge about Māori with bipolar disorder is required to understand how health services support wellbeing and respond to identified levels of community need. This paper synthesises the expert critique of Māori patients with bipolar disorder and their whānau regarding the nuances of cultural competence and s...

Although the demand for aged residential care increases, low use of aged residential care by Indigenous people raises questions about unrecognised barriers to health care. The objectives of this systematic literature review are to (a) examine current scientific literature that reports older Indigenous people’s experiences in aged residential care a...

Indigenous peoples experience well documented health inequities compared to majority ethnic groups. More research into serious conditions like Bipolar Disorder (BD) is needed. A systematic review of published original research involving Indigenous peoples with BD was completed to identify areas of consistency, contradiction and gaps in available li...

Background Despite evidence of gender differences in bipolar disorder characteristics and comorbidity, there is little research on the differences in treatment and service use between men and women with bipolar disorder. Aims To use routine data to describe specialist mental health service contact for bipolar disorder, including in-patient, commun...

Effectively conceptualising impaired wellness for physicians requires review of the roles and responsibilities of teams, health service leadership and the health system as a whole.

Aims: There is very little empirical evidence about the relationship between severe mental illness and the physical health of Indigenous peoples. This paper aims to compare the physical health of Māori and non-Māori with a diagnosis of bipolar disorder in contact with NZ mental health services. Methods: A cohort of Māori and non-Māori with a cur...

Introduction: First episode psychosis (FEP) disproportionately affects rangatahi (young) Māori, the Indigenous people of New Zealand, but little is known about factors contributing to this inequity. This study describes a cohort of rangatahi Māori and young non-Māori with FEP, and explores ethnic differences in incidence rates, and the contributio...

This article presents a description of a specific Indigenous research methodology, Kaupapa Māori Research (KMR), followed by a discussion of the potential contribution that KMR and other Indigenous frameworks make toward understanding and addressing widespread mental health inequities affecting the world’s Indigenous peoples. The contribution of ex...

Objective Lifetime prevalence rates in Te Rau Hinengaro (The New Zealand Mental Health Survey) suggest eating disorders are at least as common in the Māori population as the non‐Māori population, yet little is known at a population level about those accessing specialist mental health treatment for eating disorders in New Zealand. The aim of this st...

Research on collaboration between health and social service organisations and professions often views collaboration from the narrow perspective of being between practitioners from different professions at a set point in time. This is often also focused on issues of efficacy and does not address the role of identity, values, and practices, or “cultu...

The New Zealand Mental Health Survey, Te Rau Hinengaro, indicated that eating disorders are at least as common in Māori as non-Māori, which is consistent with international findings that eating disorders exist in other indigenous and ethnic minority groups. Specific factors may be relevant to the development and treatment of eating disorders in the...

Purpose Advanced pancreatic cancer has a universally poor survival rate. Patients frequently develop malabsorption that requires pancreatic enzyme replacement therapy (PERT). This study explores the experience of patient engagement with PERT and how the medication is taken and tolerated. Methods Participants with advanced pancreatic cancer requiri...

Background: Persistent inequities in health experiences and outcomes are observed for Māori compared to non-Māori in Aotearoa New Zealand. We conceptualised factors associated with Māori consumer experiences of health programs and services and characterise how the recommendations arising from qualitative research inform strategies to address inequ...

Medical education provides a locus to apply the principles of social justice to advocate for indigenous health inequities. Within the education field, social accountability measures have been used to increase equity. This study uses a social accountability lens to explore the perspectives and experiences of academic and clinical leaders, students,...

Background:Research reporting guidelines are increasingly commonplace and shown to improve the quality of published health research and health outcomes. Despite severe health inequities among Indigenous Peoples and the potential for research to address the causes, there is an extended legacy of health research exploitingIndigenous Peoples. This pap...

Objectives: Schizophrenia is a serious and chronic mental illness known to have broad ranging impacts for individuals across the lifespan, yet research on the disease in older adults is sparse. This study provides a profile of the sociodemographic, environmental and diagnostic characteristics of older community residents with schizophrenia using a...

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...

Infant weight gain has long-term implications for the establishment of overall health. We examined whether socioeconomic position (SEP), the use of pressure as a feeding practice, and picky eating relate to changes infant in weight-for-length (WFL). A modified developmental design was used to examine whether current levels of child picky eating, pa...

INTRODUCTION: Gout is a common form of arthritis that is typically managed in primary care. Gout management guidelines emphasise patient education for successful treatment outcomes, but there is limited literature about the educational experiences of people living with gout in New Zealand, particularly for Māori, who have higher gout prevalence and...

Context The effectiveness of cultural competency education in improving health practitioner proficiency and addressing health inequities for minoritised patient groups is uncertain. Identification of institutional factors that shape or constrain development of indigenous health curricula may provide insights into the impact of these factors on the...

Since 2006 the Australian Medical Council (AMC) accreditation standards have required medical schools to comprehensively address issues related to the health of Aboriginal and Torres Strait Islander peoples in Australia, and Māori in New Zealand. This has spanned areas of staff expertise, staff and student recruitment, curriculum and institutional...

There has been a steady increase in cultural competency training in medical education programmes worldwide. To provide high-quality culturally competent care and reduce health disparities between Māori and non-Māori in New Zealand, several health models have been devised. The Indigenous Health Framework (IHF), currently taught at the University of...

Background In Aotearoa/New Zealand, Māori, as the indigenous people, experience chronic kidney disease at three times the rate of non-Māori, non-Pacific New Zealanders. Māori commence dialysis treatment for end-stage kidney disease at three times the rate of New Zealand European adults. To examine for evidence of inequity in dialysis-related incide...

Patients with severe chronic obstructive pulmonary disease (COPD) have a chaotic trajectory towards death. Research has focused on identifying a “transition point” that would allow identification of those patients who may benefit from a palliative approach to their care, or referral to a specialist palliative care service. This article aims to outl...

This paper documents a joint initiative of clinical practice educators from four tertiary institutions and their engagement in the design and development of a proposed Hauora Māori Clinical Guide for Psychologists, which outlines how to apply the Hui Process and Meihana Model to applied psychology. It describes the ability for this proposed Hauora...

Background Indigenous health programs are seen as a curriculum response to addressing health disparities and social accountability. Several interrelated teaching approaches to cultural competency curricula have been recommended, however evidence of the impact of these on learner outcomes including engagement and self-reported competencies is limite...

Objectives: Socio-economic status (SES) and ethnicity have been reported as markers influencing the likelihood of increased mortality. The aim of this study was to investigate how SES and ethnicity impacted patient survival after abdominal aortic aneurysm (AAA) repair. Methods: Consecutive patients undergoing open and endovascular AAA repair dur...

Objectives: Gout typically responds well to medications but adherence might be improved by education that meets individuals' needs in a way that is inclusive of their ethnicity and rurality. The aim of this study was to compare educational preferences of: 1) Māori and New Zealand European (NZEuropean) individuals with gout; and 2) those living in...

Background: There is no accepted best practice for optimizing tertiary student knowledge, perceptions, and skills to care for sexual and gender diverse groups. The objective of this research was to synthesize the relevant literature regarding effective curricular initiatives designed to enhance tertiary level student knowledge, perceptions, and sk...

Objectives Non-invasive ventilation (NIV) is widely used as a lifesaving treatment in acute exacerbations of chronic obstructive pulmonary disease; however, little is known about the patients' experience of this treatment. This study was designed to investigate the experiences and perceptions of participants using NIV. The study interprets the part...

Chronic obstructive pulmonary disease (COPD) is a slowly disabling illness, with functional limitations and a high burden of symptoms. Palliative care services focus on quality of life for those facing life-limiting illness. Patients with COPD often see their illness as a 'way of life', not as a life-threatening illness, which makes the interface d...

The incidence rates and risk factors of SUDI (inclusive of SIDS) have over the years been explored and discussed within the New Zealand Medical Journal. Moreover, the acknowledgement of Māori health disparities within SUDI has been the focus of many articles over the past 5 years. In 2010, Tipene-Leach, Hutchison, Tangiora, Rea, White, Stewart and...

Objectives: Cardiovascular disease (CVD) is the leading cause of mortality in New Zealand with a disproportionate burden of disease in the Māori population. The Hauora Manawa Project investigated the prevalence of cardiovascular risk factors and CVD in randomly selected Māori and non-Māori participants. This paper reports the prevalence of structu...

Health professionals play an important role in addressing indigenous health inequalities. This paper describes the further development and a new conceptualisation of the Meihana model (2007) and the Hui process (2011), which together have formed the indigenous health framework in the University of Otago, Christchurch undergraduate medical education...

Substantial health disparities exist between Māori-the indigenous people of Aotearoa New Zealand-and non-Māori New Zealanders. This article explores the experience and impact of racism on Māori registered nurses within the New Zealand health system. The narratives of 15 Māori registered nurses were analyzed to identify the effects of racism. This M...

The impact of alcohol and other drug problems for Māori is well documented. Substance use has been implicated in a range of physical and mental health problems, and a variety of negative social statistics such as high rates of imprisonment. To date there has been little systematic documentation of treatment practices, and limited operationalisation...

The concept of academic networks as a means for promoting knowledge creation and exchange in the field of Indigenous health has emerged over the past decade, although the efficacy of such networks has not been explicitly described in the literature. Net- works offer benefits such as pooled resources, improved communications, development of competen...

Cardiovascular disease (CVD) is the leading cause of death worldwide. Many indigenous populations are overrepresented among these global statistics. National mortality and morbidity data illustrate that Māori, the indigenous population of New Zealand (NZ), have higher rates of CVD mortality and morbidity than non-Māori, and life expectancy for Māor...

There are few current data on the prevalence of hyperuricaemia and gout in New Zealand, particularly among the indigenous Māori population. To determine the prevalence of gout and hyperuricaemia in rural and urban Māori and non-Māori community samples and describe the treatment and comorbidities of participants with gout. Participants aged 20–64 ye...

To explore Maori health worker perspectives on colorectal screening and identify factors that may influence Maori participation in a colorectal screening programme. Thirty Maori health workers were interviewed to explore their experience with screening programmes, knowledge of colorectal cancer and their perspective on a potential colorectal screen...

To understand health disparities in cardiovascular disease (CVD) in the indigenous Māori of New Zealand, diagnosed and undiagnosed CVD risk factors were compared in rural Māori in an area remote from health services with urban Māori and non-Māori in a city well served with health services. Prospective cohort study. Hauora Manawa is a cohort study o...

To describe a method of integrating cultural competency practice, specific to Māori, in the doctor-patient relationship. The Hauora Māori curriculum at University of Otago, Christchurch has developed the 'Hui Process', a framework to guide clinical interaction with Māori derived from engagement and relationship building principles of Te Ao Māori. T...

To document levels of cardiovascular disease (CVD), diagnosed and undiagnosed risk factors and clinical management of CVD risk in rural Māori. Participants (aged 20-64 years), of Māori descent and self-report, were randomly sampled to be representative of age and gender profiles of the community. Screening clinics included health questionnaires, fa...

The influence of indigeneity is widely recognised as a health determinant; however the impact of the utilisation of the indigenous language on health care has not been closely examined. To explore the Maori language (te reo) as a determinant of health from a Maori patient's perspective. Maori patients were recruited through Maori health networks an...

To report the processes and protocols that were developed in the design and implementation of the Hauora Manawa Project, a cohort study of heart disease in New Zealand and to report the participation at baseline. This study utilised application of a Kaupapa Māori Methodology in gaining tribal and health community engagement, design of the project a...

Introduction: Simulated patient programs are an accepted teaching method within medical education. This paper explores patient simulation as a sustainable and meaningful approach to Indigenous health teaching and learning in medical education.

Medical education in Aotearoa/New Zealand has a critical role to play in producing a health professional workforce that is prepared to meet the challenge of addressing Māori health. While cultural competence is an important aspect of this, we argue that Māori health is an educational domain in its own right with distinct learning objectives and edu...

The Peabody Picture Vocabulary Test (PPVT-III) is a test which is currently used in New Zealand to measure receptive vocabulary skills (Stockman, 2000). This research investigated the suitability of the PPVT-III with 46 Māori children from three different age groups (5-11 years). Results revealed that the PPVT-III appeared to be suitable for use wi...