Fifty-eight studies were included, which addressed a wide array of health outcomes and risk behaviors. The review examined the effects of four types of strategies or interventions: community system-level change strategies; broad health and social care system-level strategies; interventions using lay community health outreach workers or group-based health education led by professional staff; and group-based health education.

The authors found that "... interventions led by community coalitions may connect health and human service providers with ethnic and racial minority communities in ways that benefit individual health outcomes and behaviors, as well as care delivery systems". However, they go on to say that "... because information on characteristics of the coalitions themselves is insufficient, evidence does not provide an explanation for the underlying mechanisms of beneficial effects".

This article is available to read in free full text at:  http://dx.doi.org/10.1002/14651858.CD009905.pub2

Anderson LM, Adeney KL, Shinn C, Safranek S, Buckner-Brown J, Krause LK. (2015). Community coalition-driven interventions to reduce health disparities among racial and ethnic minority populations. Cochrane Database of Systematic Reviews, 6, CD009905.

Designed with young people in mind, the JUST THE FACTS website aims to dispel myths and provide simple, up-to-date information about Sexually Transmitted Infections (STIs) and related issues to target those at most risk. Research indicates that Maori and Pasifica aged under 25 years have a disproportionate burden of STIs within the NZ population.

To read the full media release, go to:  http://www.scoop.co.nz/stories/GE1506/S00049/new-sexual-health-website-to-reach-at-risk-nz-youth.htm

For more information, visit JUST THE FACTS website.

The South Island Alliance’s Health of Older Peoples group (HOPSLA) has announced the recent appointment of two new part-time Primary Care Dementia Education Co-ordinator roles, a move which looks set to support improved diagnosis and quality of life for dementia patients living in the South Island.

The new roles are in response to the fact that many people with dementia are receiving a diagnosis late in their illness as Jenny Keightley, Chair of HOPSLA explains, “helping GPs to make an early diagnosis of dementia and providing links to support services can make a real difference to the patient and their family. It can reduce stigma and enable people with dementia to understand their condition, access treatments that could help relieve their symptoms and improve their quality of life. It can also give them time to plan for the future. The new positions are an exciting development as they will specifically focus on primary care settings, looking at the education resources and the implementation of a dementia education programme across the South Island, so that we can help promote better, earlier diagnosis of dementia and continuity of care.”

One of the new appointees is Carole Kerr, a registered psychiatric nurse with an extensive career related to older people, in particular mental health services for older people, people with disabilities, and Planning and Funding.  Carole is currently the Walking in Another’s Shoes Dementia Educator for Nelson Marlborough DHB. Carole will be on secondment from 18 May 2015.

Carole will share her role with Rebecca Winsor, a registered nurse who works as a Clinical Nurse Specialist (CNS) for Older Person’s Health and NetP Nurse Educator for the Princess Margaret Hospital, Canterbury DHB.  Rebecca’s post graduate diploma study has focussed on patients with dementia or delirium, or patients with depression. Rebecca will commence on 11 May 2015 and will be based at the South Island Alliance Programme Office.

The work programme is being led by HOPSLA and positions are fixed-term until 30 June 2016. “We are delighted to have such excellent, experienced new recruits to join our team and look forward very much to working with them in the future,” says Keightley.

Fourteen trials (n = 4872) were included. "There is moderate- to high-quality evidence that patient education increases reassurance more than usual care/control education in the short term ... and long term ... Interventions delivered by physicians were significantly more reassuring than those delivered by other primary care practitioners (eg, physiotherapist or nurse). There is moderate-quality evidence that patient education reduces LBP-related primary care visits more than usual care/control education".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1001/jamainternmed.2015.0217 or contact your DHB library, or organisational or local library for assistance.

Traeger, A.C., et al. (2015). Effect of primary care–based education on reassurance in patients with acute low back pain: Systematic review and meta-analysis. JAMA Internal Medicine, 175(5), 733-743

Fifteen studies met the inclusion criteria: one randomized controlled trial, two time series analyses, three controlled before and after studies, five uncontrolled before and after studies, two retrospective observational studies, and two prospective observational studies. Studies were heterogeneous in quality; thus, meta-analysis was not feasible.

Thirteen studies examined prehospital delay, with ten studies reporting a significant reduction in delay times, with a varied magnitude of effect. Eight studies examined thrombolysis rates, with only three studies reporting a statistically significant increase in thrombolysis administration. Five studies examined ambulance usage, and four reported a statistically significant increase in ambulance transports following the intervention. Three studies examining ED presentations reported significantly increased ED presentations following intervention.

Public educational interventions varied widely on type, duration, and content, with description of intervention development largely absent from studies, limiting the potential replication of successful interventions.

The authors conclude that positive intervention effects were reported in the majority of studies; however, methodological weaknesses evident in a number of studies limited the generalisability of the observed effects. Reporting of specific intervention design was suboptimal and impeded the identification of key intervention components for reducing patient delay. They go on to say that studies incorporating a rigorous study design are required to strengthen the evidence for public interventions to reduce patient delay in stroke. 

This is an open access article and can be read in free full text at:  http://dx.doi.org/10.2147/PROM.S54087

Mellon, L., et al. (2015). Stroke warning campaigns: Delivering better patient outcomes? A systematic review. Patient Related Outcome Measures, 6, 61-73.

The National Stroke Foundation of Australia has run 12 public awareness campaigns since 2004. The aim of this study was to measure the effect of campaigns on calls to ambulance for stroke across Australia in exposed regions.

Studies in this issue (attached below):

In the intervention units, individualised education was based on principles of changes in health behaviour from a trained health professional, in addition to usual care. Information was provided about patients' goals, feedback about the ward environment, and perceived barriers to engagement in falls-prevention strategies to staff who were trained to support the uptake of strategies by patients. 

The authors conclude from the results that "individualised patient education programmes combined with training and feedback to staff added to usual care reduces the rates of falls and injurious falls in older patients in rehabilitation hospital-units".

To read the full abstract, and for information on how to access the full text, go to: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61945-0/fulltext or contact your DHB library, or organisational or local library for assistance.

Hill, A-M., et al. (2015). Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: A pragmatic, stepped-wedge, cluster-randomised controlled trial. The Lancet, 9 April [Epub before print]

Forty randomised controlled trials (RCTs) of self-management support interventions in men, and 20 eligible RCTs where an analysis by sex was reported, were included in the review. Meta-analysis suggested that physical activity, education, and peer support-based interventions have a positive impact on quality of life in men. However, there is currently insufficient evidence to make strong statements about whether self-management support interventions show larger, similar or smaller effects in men compared with women and mixed-sex groups.

The authors conclude that clinicians may wish to consider whether certain types of self-management support (eg, physical activity, education, peer support) are particularly effective in men, although more research is needed to fully determine and explore this.

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1136/bmjopen-2014-006620

Galdas, P., et al. (2015). The effectiveness of self-management support interventions for men with long-term conditions: A systematic review and meta-analysis. BMJ Open, 5:e006620.

Nineteen in-depth interviews were conducted with men and women (aged 45–59). Participants were given two types of colorectal screening information to read: factual and narrative. Participants gave their views on both types of information. Data were analysed using Framework Analysis.

The most frequent responses to the narrative information were that they were reassuring, made colorectal screening more vivid, participants could relate to the people in the stories and they liked the range of narratives presented. Despite the narrative information being seen as more persuasive by some, this was not regarded as manipulative or negative. Both types of information were seen as equally credible. Participants felt a combination of facts and narratives would be useful when considering an offer of colorectal cancer screening.

The authors conclude that, overall, participants were positive about the addition of narrative information to the currently provided factual information about colorectal cancer screening. Supplementing existing factual information with narrative information may provide participants with a more complete understanding of participation in colorectal cancer screening when considering an offer to be screened.

This is an open access article and can be read in free full text at:  http://dx.doi.org/10.1111/hex.12357

Bennett, K. F., von Wagner, C. and Robb, K. A. (2015). Supplementing factual information with patient narratives in the cancer screening context: A qualitative study of acceptability and preferences. Health Expectations, 1 March [Epub before print]

The program will bring together national and international experts to promote the exchange of the latest clinical practices and cutting edge research in diabetes. 

For further information about this event, go to:  http://www.ads-adea.org.au/

A mixed methods qualitative evaluation was undertaken to understand self-management service provision to culturally diverse communities (i.e. how components such as lay workers, group-based design, and culturally-appropriate educational material are intended to encourage behavioural change). The authors interviewed lay educators delivering the Chronic Disease Educator programme along with attendees, whilst observing workshops. Data were thematically analysed using a content-based constant comparison approach through a number of interpretative analytical stages.

Lay educators felt part of the local community, relating to attendees from different races and ethnicities. However, lay educators faced challenges when addressing health beliefs and changing lifestyle practices. Culturally-tailored components aided communication, with educator’s cultural awareness leading to close relationships with attendees, while the group-based design facilitated discussions of the emotional impact of illness.

The authors conclude that lay educators bring with them a number of nuanced skills and knowledge when delivering self-management education. The development and training required for this role is inhibited by financial constraints at policy-level. The interpretation of being from the ‘community’ links with the identity and status of the lay role, overlapping notions of race, ethnicity, and language.

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1186/s12913-015-0712-8

Sidhu, M.S., et al. (2015). A critique of the design, implementation, and delivery of a culturally-tailored self-management education intervention: a qualitative evaluation. BMC Health Services Research, 15:54

To download or order hard copies of Ministry of Health resources, go to the HealthEd website: https://www.healthed.govt.nz

Semistructured interviews were conducted with a sample of 56 adults age 50 years old and over. Six higher-level general concerns emerged: (1) limitations in own ability, (2) credibility/limitations of online information, (3) anxiety, (4) time consumption, (5) conflict, and (6) non-physical harm. The most prevalent concern raised by participants who communicated with a doctor about their online health information seeking related to the credibility or limitations in online information. Participants who had never communicated with a doctor about their online health information seeking most commonly reported concerns about non-physical harm. Four barriers to communication emerged: (1) concerns about embarrassment, (2) concerns that the doctor doesn’t want to hear about it, (3) belief that there is no need to bring it up, and (4) forgetting to bring it up. Facilitators of communication included: (1) having a family member present at doctor visits, (2) doctor-initiated inquiries, and (3) encountering an advertisement that suggested talking with a doctor.

The authors conclued that, overall, participants displayed awareness of potential problems related to online health information seeking. Findings from this study point to a set of barriers as well as facilitators of communication about online health information seeking between patients and doctors. This study highlights the need for enhanced patient communication skills, eHealth literacy assessments that are accompanied by targeted resources pointing individuals to high-quality credible online health information, and the need to remind patients of the importance of consulting a medical professional when they use online health resources to diagnose and treat a health issue.

This is an open access article and is available to read in free full text at:  http://doi.org/10.2196/jmir.3588

Silver, M.P (2015). Patient Perspectives on Online Health Information and Communication With Doctors: A Qualitative Study of Patients 50 Years Old and Over. Journal of Medical Internet Research, 17(1),.

Patients presenting to an academic ED with a primary complaint of back pain had their consultations recorded. Coders reviewed each transcript to determine whether smoking was discussed and to build a corpus of smoking-related discussions. They developed coding categories to characterise how providers responded when patients endorsed smoking behavior.

Of 52 patient-provider encounters during which smoking was discussed, two-thirds of patients indicated that they were smokers. Providers missed opportunities for smoking cessation counseling 70% of the time. Eleven encounters contained teachable moments for smoking cessation. The authors identified four primary strategies for creating teachable moments: 1) positive reinforcement, 2) encouragement, 3) assessing readiness, and 4) offering concrete motivating reasons.

The authors conclude that most providers missed opportunities to offer teachable moments for smoking cessation. In encounters that contained teachable moments, providers employed multiple strategies, combining general advice with motivation tailored to the patient's particular circumstances. Creating motivational links to enhance smoking cessation efforts may be possible with a minimal investment of ED resources.

This is  an open access article and can be read in free full text at:  http://dx.doi.org/10.1186/s12913-014-0651-9

Buchbinder, M., et al. (2014). Teachable moments and missed opportunities for smoking cessation counseling in a Hospital Emergency Department: A mixed-methods study of patient-provider communication. BMC Health Services Research, 14:651

To evaluate the campaign's impact, data were analysed for various metrics covering public awareness of symptoms and process measures, through to diagnosis, staging, treatment and 1-year survival (available for regional pilot only).

Compared with the same time in the previous year, there were significant increases in metrics including: public awareness of persistent cough as a lung cancer symptom; urgent GP referrals for suspected lung cancer; and lung cancers diagnosed. Most encouragingly, there was a 3.1 percentage point increase (P<0.001) in proportion of non-small cell lung cancer diagnosed at stage I and a 2.3 percentage point increase (P<0.001) in resections for patients seen during the national campaign, with no evidence these proportions changed during the control period (P=0.404, 0.425).

The authors note that, to their knowledge, the data are the first to suggest a shift in stage distribution following an awareness campaign for lung cancer. It is possible a sustained increase in resections may lead to improved long-term survival.

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1038/bjc.2014.596

Ironmonger, L., et al. (2015). An evaluation of the impact of large-scale interventions to raise public awareness of a lung cancer symptom. British Journal of Cancer, 112, 207–216.

Eligible participants were 18 years of age or older, from a neurology or orthopaedic ward and had been admitted to hospital at least 24 hours prior to enrolment in the study. A questionnaire including fixed and open-ended responses was administered by researchers to 51 participants (mean age of 65 years; three quarters were orthopaedic surgical patients).

Eighty-six per cent of participants understood the concept of pressure injury and 80% agreed that patients have a role in PIP. Participants nominated the following PIP strategies that could be undertaken by patients: Keep skin healthy; Listen to your body and Looking after the inside. Strategies required for patient participation in PIP were represented by three themes: Manage pain and discomfort; Work together; Ongoing PI education.

The authors conclude that, to ensure successful participation in PIP, patients require education throughout admission, management of pain and discomfort and a supportive and collaborative relationship with health care staff. Health professionals should identify patient ability and motivation to prevent pressure injury (PI), work in partnership with patients to adhere to PIP, and ensure that PIP actions are facilitated with appropriate pain relief.

This is an open access article and is available to download and read in free full text at:  http://dx.doi.org/10.1186/s12912-014-0041-y

McInnes, E., et al. (2014). The role of patients in pressure injury prevention: A survey of acute care patients. BMC Nursing, 13:41.

Nine studies were included. "Physical ability, perceived importance, patient knowledge, provision of education, social integration, risk status, and patient-provider communication were identified as key barriers and enablers of foot self-care. Participants at high risk of foot complications were found to perceive themselves at greater risk of complications, receive more education, and engage in better overall foot self-care practices compared to those at low risk of foot complications".

The authors conclude that foot self-care practices appear to be underutilised as "... primary prevention measures by older adults and are instead adopted only once complications have already occurred. Likewise, facilitators of foot self-care practices, such as education, appear to be reserved for individuals who have already developed foot complications".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1177/0145721714560441 or contact your DHB library, or organisational or local library for assistance.

Matricciani, L. & Jones, S. (2015). Who cares about foot care? Barriers and enablers of foot self-care practices among non-institutionalized older adults diagnosed with diabetes: An integrative review. The Diabetes Educator, 41(1), 106-117.

This is one of two reviews on communication interventions for childhood vaccination. The companion review focuses on face-to-face interventions for informing or educating parents.

"The review found two studies. The first study took place in India. Here, families, teachers, children and village leaders were encouraged to attend information meetings where they were given information about childhood vaccination and could ask questions. Posters and leaflets were also distributed in the community. The second study was from Pakistan. Here, people who were considered to be trusted in the community were invited to meetings where they discussed the current rates of vaccine coverage in their community and the costs and benefits of childhood vaccination. They were also asked to develop local action plans, to share the information they had been given and continue the discussions with households in their communities".

The authors conclude that there is "... limited evidence that interventions aimed at communities to inform and educate about early childhood vaccination may improve attitudes towards vaccination and probably increase vaccination uptake under some circumstances. However, some of these interventions may be resource intensive when implemented on a large scale and further rigorous evaluations are needed. These interventions may achieve most benefit when targeted to areas or groups that have low childhood vaccination rates.’"

This article is available to dowwnload and read in free full text at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010232.pub2/full

Saeterdal I., Lewin S., Austvoll-Dahlgren A., Glenton C., Munabi-Babigumira S. (2014). Interventions aimed at communities to inform and/or educate about early childhood vaccination. Cochrane Database of Systematic Reviews, 11, CD010232.

The review is based on results which are derived from a total of at least 5,500 individuals residing in the six participating countries. It indicates a policy shift towards patient-centred self-management of diabetes in a primary care context. The professional role of diabetes specialist nurses, the need for multidisciplinary approaches and a focus on patient education emerge as fundamental principles in the design of relevant programmes. Socio-economic circumstances are relevant to the capacity to self-manage and suggest that any gains and progress will be hard to maintain during economic austerity. The authors note that this realist review should be interpreted within the wider context of a whole systems approach regarding self-care support and chronic illness management.

This is an open access article and can be downloaded and read in free full text at: http://dx.doi.org/10.1186/1472-6963-14-453

Kousoulis, A.A., et al. (2014). Diabetes self-management arrangements in Europe: A realist review to facilitate a project implemented in six countries. BMC Health Services Research, 14:453.

The website has been developed by Diabetes NZ, the NZ Society of the Study of Diabetes, the Aotearoa College of Diabetes Nurses, and the Refract Group.

Over the next three years, the Ministry of Health will support action in nine key areas to improve the quality of life for people with dementia. These action areas are to:

• implement a nationally consistent approach to dementia care
• increase dementia awareness
• reduce the risk of dementia
• increase access to a timely diagnosis of dementia
• provide navigation of services and increase the quality of information and education
• increase the ability of people with dementia to remain living at home
• increase the quality of information and education for the workforce
• develop dementia-friendly health and social support services
• provide respectful and supportive end-of-life care.

The publication is available to download in full text at: http://www.health.govt.nz/publication/improving-lives-people-dementia

We have now met with around fifty-five individuals across six different focus groups and the dialogue from these  is now beginning to shape our approach to diabetes support and services.

Below is a summary of each focus group discussion, outlining the flow of conversation, along with the key findings and some of the recommendations that emerged as a result.

We'll provide more information about the next steps from here shortly.

Thanks again to all those who were kind enough to share their stories and experiences with us, and also to the various health workers and local practices that helped co-ordinate the focus group invitations.

We look forward to keeping in touch.

Focus Group Summaries

Coastal Focus Group - discussion with participants living in a coastal region

Type 1 Young Adults Focus Group - discussion with a number of tertiary students living with Type 1 diabetes

Urban Focus Group - discussion with patients living in an urban city environment

Low Literacy, High-Needs focus group - participants from one of Wellington's lower income communities

Rural Focus Group - discussion with people from one of the more rural North Island towns

Indo-Asian Focus Group - participants from Auckland's Indian and South-East Asian communnities

In August 2013, the authors searched Facebook and three top Internet search engines using smoking cessation keywords to identify relevant Facebook apps. Resultant apps were screened for eligibility (smoking cessation-related, English language, and functioning). Eligible apps were reviewed by 2 independent coders using a standardized coding scheme. Coding included content features (interactive, informational, and social) and adherence to an established 20-item index (possible score 0-40) derived from the US Public Health Service’s Clinical Practice Guidelines for Treating Tobacco Use and Dependence.

Twenty-two apps were screened for eligibility. Of these, 12 underwent full coding. Only 9 apps were available on Facebook. Facebook apps fell into three broad categories: public pledge to quit (n=3), quit-date–based calculator/tracker (n=4), or a multicomponent quit smoking program (n=2). All apps incorporated interactive, informational, and social features except for two quit-date–based calculator/trackers apps (lacked informational component). All apps allowed app-related posting within Facebook (ie, on self/other Facebook profile), and four had a within-app “community” feature to enable app users to communicate with each other. Adherence index summary scores among Facebook apps were low overall (mean 15.1, SD 7.8, range 7-30), with multicomponent apps scoring the highest.

The authors conclude that there are few smoking cessation apps available within Facebook. Among those available, adherence to cessation treatment guidelines was low. Smoking cessation interventions provided via the Facebook platform are a unique and as yet untapped treatment strategy that can harness existing social support and social networks for quitting. Research is needed to examine whether apps that adhere to clinical practice guidelines for tobacco dependence treatment are more effective in promoting cessation than those that do not.

This is an open access article and is available to read in full text at: http://dx.doi.org/10.2196/jmir.3491

Jacobs, M.A., et al. (2014). Facebook apps for smoking cessation: A review of content and adherence to evidence-based guidelines. Journal of Medical Internet Research, 16(9), e205.

Most of the caravan’s stops will be in towns that don’t have easy access to breast health services.

“We want women everywhere to know all the signs and symptoms of breast cancer, to understand their family and lifestyle risk factors, and to know what to do if they have any worries. We’re inviting women – and men – to pop into the Pink Caravan with their questions,” said Nurse Janice Wood.

The nurses will answer women’s questions about breast cancer and will use a new bioimpedance machine to help women who’ve had breast cancer monitor their risk of lymphoedema (a painful and debilitating condition that can occur many years after breast cancer surgery). In some locations, there will be opportunities for public seminars and training for GPs and practice nurses. A breast surgeon will be on board the caravan in several towns.

To read the full media release from the NZ Breast Cancer Foundation, go to: http://www.scoop.co.nz/stories/GE1409/S00045/kiwis-invited-to-pop-into-the-pink-caravan.htm

You can now access HealthEd anywhere, anytime as the site has been made responsive, meaning you can view it across various mobile devices, eg, Smartphones, tablets, iPads.

To ensure HealthEd is accessible to all New Zealanders, the site is now providing a range of resources in New Zealand Sign Language (NZSL) for the Deaf community. These resources are a pilot to test the uptake for further evaluation.

For further detail ablout these changes, go to:  https://www.healthed.govt.nz/article/refreshed-healthed-website

A total of 33 randomised controlled trials (RCTs)  (including 11 from the original 2008 review) involving 7453 participants were included. The interventions were very different from one study to another but most were based on recognisable theoretical models.

Based on their analysis, the authors conclude that "culturally appropriate health education has short- to medium-term effects on glycaemic control and on knowledge of diabetes and healthy lifestyles ... None of these studies were long-term trials, and so clinically important long-term outcomes could not be studied. No studies included an economic analysis. The heterogeneity of the studies made subgroup comparisons difficult to interpret with confidence". 

This article is available to read in full text at:  http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006424.pub3/full

Attridge, M., Creamer, J., Ramsden, M., Cannings-John, R., Hawthorne, K. (2014). Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews, 9, CD006424.

This focus group was made up of 14 participants who all had Type 2 diabetes, with a number of the group having had the disease for over 20 years. All of the participants were of South Asian ethnicity and either in their later working years or their retirement.

The most common themes in this group included the lack of information appropriate to the Indian diet and exercise, the cultural barriers faced regarding accepting and managing their diabetes and the types of support received and services available in their area.

One participant described, “Even saying ‘Eat less carbohydrates’ means absolutely nothing to an 80 year old Indian woman. What are carbohydrates? Why not tell her to just eat half her roti instead?’”

Another member added, “The medical system here has no understanding of Indian culture at all. The advice they give just doesn’t work for us. It’s about acknowledging that we eat rice and japarti. Just being told ‘don’t’ doesn’t help. We need to be told what we can eat or how we can observe our traditions and culture in a healthy way.”

Indian cooking is also done collectively. “One downside of that is it feels like it’s too much trouble to cook something separate for yourself so you end up thinking ‘oh well, I’ll just have a little…,’” added another partipant.

Nutritional advice that has been specifically referenced in Indian culture would be very helpful. “We need to have advice about how to manage diabetes even though our culture eats rice. Something similar to the Ministry’s plate portions and other nutritional advice – how do you translate that into an Indian context?” asked one of the participants.

There were also cultural barriers including encouraging diabetics to exercise. Many Indians feel embarrassed to go to a gym or swimming pool. “Indian people are never going to go - we wear saris. There should be an exercise programme especially for Indian people.”

The change in culture from Indian to New Zealand is also a challenge. “Back home a lot of us came from farms so our exercise was a lot more regular. Here we just tend to stay in our homes. We don’t walk and our jobs aren’t active,” added another participant.

Other cultural barriers faced included the influence of family. “You can tell people anything they need to know but they will go home and do nothing if it means conflicting with their family. It is very much a collective decision, not an individual one. You need to reach the whole family.”

Another participant agreed, “Family plays a huge role in the life of the South Asian. It is a huge influence that can be both positive and negative.”

Some of the group also mentioned that because so many people have got diabetes it is almost normalised in their culture and viewed as inevitable. It becomes a barrier to prevention when people they think there is nothing they can do. It’s hard to even get them to try.

Some logistical barriers they faced were the availability of support services in their area. Diabetes NZ is based in Mt Eden and one of the participants said, “Indian people are not comfortable going there. It’s intimidating for us. If there was something more local or it was in Hindu or Punjabi, that would be better.”

Gaining access to services like the diabetes clinic was also a challenge depending on your health status. “Why is it that you have to wait until things get really bad before you can access the useful support?” asked one participant. “If we could get that earlier that would help prevent things better.”

One of the health workers who helped host the group, a nurse that worked in Greenlane, said, “I am the only Indian nurse available who speaks Hindi. Auckland DHB provides ethnic programmes but they need to be offered in other areas where there are high Indian populations. It should be standardised.”

Another participant added that they needed more help than just from their GP. “Just giving us medication and a prescription doesn’t help – they are not diabetes specialists. Plus there isn’t enough time to talk to them.”

Another participant added, “There are asthma nurses that see patients regularly on a one-to-one basis but there is nothing like that for diabetes.”

“When people are diagnosed with a chronic disease, their next appointment after the GP should be with a specialist for their condition. Chronic conditions need separate monitoring rather than just with the GP.”

One of the participants was himself a doctor and he admitted that he previously had poor notions of what a good diet was. “When I attended the programme run by a Diabetes Educator and Nutritionist who is also Indian, it made much more sense.”

Other cultural issues also come into play. “In our culture we put it on the doctor – we treat our doctors and priests like gods and put everything on them. But this is our diabetes! We need to take control.”

There is also a perception that insulin is very bad. “If you are on insulin, it is seen that your diabetes in deteriorating and you will die. There is also an anxiety about hypos – people fear dying in their sleep.”

Another participant added “People think once you are on insulin it becomes addictive and you are hooked like with morphine.”

The session was concluded with a discussion about some of the volunteer workers who give their time and support to the community for free. There are a number of very willing volunteers who just need some additional support. It was suggested this is something that could be utilised, supported and recognised much more actively.

Key recommendations based on this focus group include:

• Providing support services and education for patients and their families in Hindi or Punjabi
• Nutritional advice that has been specifically referenced in Indian culture for both health professionals and diabetics, especially with regard to their food
• Support to identify and implement ways to engage in physical activity that are appropriate to their culture in terms of dress code, environment, location, collective vs individual in nature etc.
• Support to change the misinterpretation of insulin
• Approaches to health information and advice that incorporate the entire family and address the perceived inevitability (and therefore apathy) towards diabetes

This focus group was made up of six adults of Pacific Island descent and one Māori participant. The patients were all experiencing Type 2 diabetes, although one person had initially developed gestational diabetes and another participant was in the pre-diabetes stage. The group were mostly male.

This focus group were very appreciative of the opportunity for a shared discussion and expressed a lot of gratitude for members of the health system taking the time to hear their stories. They provided some excellent feedback on how to make information more meaningful and accessible to others like them.

They suggested making information more personally relevant to the patient and providing the information in easily understood and culturally appropriate ways – either face to face or in their own language.

One participant was diagnosed and referred to a dietician but “I saw about five different people before I listened. They all said ‘don’t do this, don’t do that’ which I found very negative. There was little guidance about what I could do,” he added.

The other participants agreed with this positive approach and also suggested personalising the information. “There is plenty of information out there but it’s either written in a language that’s difficult to understand or it’s presented in neutral, general terms - and because it’s not personal it’s easy to ignore,” the participant added.

There was a strong desire for people who can deliver the information in their language as ‘most of it is too clinical’ and ‘some of it is not culturally appropriate.’

“You need to get the Church Pastors and Ministers involved. If they promote it, the people listen,” one participant added.

Another commented that they had heard a Cook Islands doctor on Radio NZ talking about diabetes in his own language and “this really helped me understand - it finally sunk in”.

The participants indicated there were a number of nurses that attended church themselves and they were particularly helpful. They do heart and diabetes checks onsite and take people’s bloods. For most of the group, they found the follow up conversations with the nurses is what helped them keep on track.

“Diabetes is a lifestyle change. You need to support people with that. If they don’t look after it, it has an impact on other organs in their bodies and most people don’t realise that. It’s the silent killer – you don’t see it until it’s too late,” one of the participants added.

In their experience, they had either not received sufficient information about diabetes or had not found the information they had received very accessible. Consequently, low levels of understanding and awareness about diabetes was a common theme amongst the group despite the fact that for most of the participants they were at least second generation diabetics.

Most of the group had diabetes in their families but some didn’t see the significance of this until later as it wasn’t really talked about and the general understanding of the disease within the family was quite low. Perhaps as a result, several participants didn’t see the relevance of medication (one person described taking medication only while they experienced specific symptoms and then discontinuing it until the symptoms reappeared). Others were more comfortable with traditional remedies from home (especially the Noni fruit, which is well known for it’s curative properties for those with diabetes).

One of the participants suggested a pamphlet that focussed the motivation to look after yourself on the patient’s kids or grandkids because that is one motivation they all seemed to have in common that finally got through to a lot of them.

Another participant mentioned the economic barriers people faced to eating well and the ease of denial of diabetes, “Because it isn’t visible like smoking, alcohol or obesity, people tend to ignore it until something happens and then it is too late.”

The key recommendations based on this focus group include:

• Exploration of some form of translation app that translates medical advice, explanations and instructions into Pacific languages so people can ‘hear’ the information in a language they understand
• Exploring other ways to provide personalised information and explanation to Pacific patients – if in English it needs to be in person or orally, if in writing it needs to be in their language
• Visual diagrams or illustrations that explain diabetes in visual terms so that people can ‘see’ it and understand the concept more easily
• Exploring ways to work more directly with patient families to increase understanding of diabetes and support inter-generational health outcomes.

The authors analysed monthly cross-sectional surveys to investigate the effects of tobacco control television advertisements with positive and negative emotional content on adult smoking prevalence and cigarette consumption. Participants were 60 000 adults aged 18 years or over living in England and interviewed in the Opinions and Lifestyle Survey from 2004 to 2010.

After several months of gestation, health professionals and educators up and down the coast would like to announce the birth of the West Coast maternity services web pages.

Organised through the West Coast District Health Board, the web pages deliver information including: How to find and register with a midwife; what women can do to help themselves and baby during pregnancy; what to take with them for a hospital birth; car seat hire; and links to support groups and services.

West Coast DHB Quality Coordinator, Hospital Services, Vicki Piner has been working closely with West Coast and Canterbury DHB Maternity Quality and Safety Programme Coordinator Lesa Freeman to collate information that is now available on a one stop online shop, www.westcoastdhb.health.nz/maternity.

“We wanted to make it simple for newly pregnant women to get information all in the one place.  Having this information online means it can be updated at any time, so it stays relevant and timely,” Ms Piner says.

Business card-sized “purse pack” cards will be distributed around the coast, so women can easily find the web address and understand what the web pages contain.

A celebration to launch the pages was held today (Wednesday 9 July) at the Grey Base Hospital, Buller and South Westland DHB facilities.

Click here to download the toolkit

See other HHNZ guidance resources at: http://www.handhygiene.org.nz/index.php?option=com_content&view=article&id=13&Itemid=115

https://www.healthed.govt.nz/resource/well-child-tamariki-ora-my-health-book

The authors identified 74 randomised trials of smoking cessation with follow-up of at least six months, where at least one arm tested a print-based self-help intervention. Based on the results of their analysis, they conclude that "standard, print-based self-help materials increase quit rates compared to no intervention, but the effect is likely to be small". They found no evidence of an additional benefit when they were used alongside other interventions such as advice from a healthcare professional. They do note that "materials that are tailored for individual smokers are more effective than non-tailored materials, although the absolute size of effect is still small".

This review is available to download and read in free full text at: http://dx.doi.org/10.1002/14651858.CD001118.pub3

Hartmann-Boyce J, Lancaster T, Stead LF. Print-based self-help interventions for smoking cessation. Cochrane Database of Systematic Reviews, 6, CD001118.

Based on the results, they conclude that "low literacy is associated with less diabetes-related knowledge and may be related to other important health outcomes. Further studies are needed to better elucidate pathways by which literacy skills affect health outcomes. Promising interventions are available to improve diabetes outcomes for patients with low literacy; more research is needed to determine their effectiveness outside of research settings".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1177/0145721714540220 or contact your DHB library, or organisational or local library for assistance.

Bailey, S.C., et al. (2014). Update on health literacy and diabetes. The Diabetes Educator, 40(5), 581-604.

UK study of 939 patients that examined the impact of structured education promoting flexible intensive insulin therapy on rates of diabetic ketoacidosis, and the costs associated with emergency treatment for severe hypoglycaemia and ketoacidosis in adults with Type 1 diabetes.

MidCentral District Health Board, in partnership with BNZ Levin and Horowhenua College, launched the Smoke or Save (SOS) initiative last night.

Targeted at Rangatahi (Māori youth), the initiative is being piloted at Horowhenua College, with plans to roll it out to all Horowhenua schools. The latest ASH survey shows Māori youth have double the percentage of regular smokers compared to the general population

SOS will comprise of two segments. The first was introduced by MDHB Māori Health Advisor Doug Edwards at the presentation last night, and will encourage Rangatahi to stay smoke-free, or quit if they currently smoke. This will be a student-led operation where the Rangatahi set up a leadership group to run programmes and events aimed at promoting a smoke-free message. Ongoing support will be provided to this team by MDHB.

In addition, a competition will be run for those participating in the SOS initiative, which will involve the design of a resource to help spread the smoke-free message. These resources can include anything from a poster to a song, or even an app for the technologically minded. An iPhone will be awarded to the best entry.

Mr Edwards is excited about the potential of SOS. He said: “I’m excited to be bringing this message to the Rangatahi and their Whānau. This new initiative will empower them to take control of their future, and realise that using their hard earned money to feed an addiction is not the way to go.”

The second part of the initiative was introduced by BNZ Levin Manager Lesley Forward, who spoke on the ‘Save’ aspect. Ms Forward gave examples on how the youth could be saving for their future and the money they would save by not smoking. In addition, she introduced a new incentive package created by BNZ Levin for the SOS initiative. This package will see those students participating in the SOS project, and signed up with BNZ, receive incentives for saving certain amounts of money.

At the presentation, Mr Edwards and Ms Forward asked Rangatahi and Whānau to set their goals for both the health and saving components of SOS. These goals will be used to monitor progress and help determine what support is needed to help the Rangatahi achieve these.

By combining the smoke-free message with a real incentive to save money, the Rangatahi will be empowered to make positive lifestyle choices, and see real benefits for their physical and financial wellbeing.

Of course, everyone is encouraged to quit smoking. Support can be found at Quitline (0800 778 778), the Smoke-free website, or with the Quit Coaches at Te Auhi Kore Mutunga. Quit coaches can be accessed through your General Practice team.

Statistics show over a third of pregnant Pacific mothers in Auckland were not attended to by a midwife during their pregnancy in 2010 and less than one percent of all Pacific people participate in childbirth education programmes.

‘Tapuaki’ is a new website and Smartphone app that allows Pacific mothers and other members of the family to find information leading up to, during and after pregnancy. The features provide accessible information on how to search for a midwife in Auckland, find advice about their pregnancy, and tips on caring for their baby.

The tools were developed by TAHA - Well Pacific Mother & Infant Service in conjunction with the National Institute of Health Innovation, which are both based at the University of Auckland, Zest Media and the Ministry of Health’s Pacific Innovation Fund.

TAHA Director, Dr Teuila Percival says research shows Pacific people have the highest rates of neonatal deaths, a high rate of stillbirths and the second highest rate of SUDI in New Zealand so it’s important to provide the right information about pregnancy to Pacific women.

“Our vision is for all Pacific children to have the best possible start to life. We are so proud of this new application because it’s a convenient way of learning about oneself and the development of baby as you both grow and develop together.

More and more Pacific people are accessing the internet and Smartphone technology so having the Smartphone app and website just makes it easier for women to have the right information at their fingertips, especially knowing where to access a midwife.”

Dr Percival says the ‘Tapuaki’ website is user-friendly with the main point of difference being that it specifically caters to the Pacific communities by having the website translated into four Pacific languages – Samoan, Tongan, Niuean and Cook Islands.

“I think this is a first for any Pacific website which is very exciting. Just being able to provide the information in the four main Pacific languages means we can explain things in a way that all our women can relate to.”

The website and mobile app are also aimed at Pacific dads and the important role they play in the family.

Young Pacific mum to be Natasha Gasu from West Auckland says the website and Smartphone app have already helped her with finding out more information about services available to her.

“I am quite shy and didn’t really know what to do or where to go. Someone suggested I look at the website and I loved seeing pictures of our people and being able to use my language to find out what I should do.”

I didn’t know I could find a midwife online or that we had a Pacific liaison advisor in our area. I really like the vibrancy of the pictures – I will share it with my family” says Ms Gasu.

Hilda Fa’asalele, Chief Advisor Pacific at the Ministry of Health believes that innovation is key when looking to improve health outcomes for Pacific pregnant women and infants.

“The average age group of Pacific women giving birth is 25-29 years which is younger than the mainstream average of 30-34 years, so initiatives such as these acknowledge the need to have a range of approaches to maternal care and education.”

The website and Smartphone app will be launched at 10am on Tuesday, 13 May in Henderson with the help of a Pacific mothers’ group.

The Tapuaki application is available on both iPhone and Android phones.

To access website: www.tapuaki.org.nz

Please note – The ‘search your midwife’ function in Smartphone app is available only for Auckland suburbs (will include rest of NZ suburbs by July 2014)

Studies presented at the World Heart Federation’s World Congress of Cardiology on 5 May 2014 showcase new research on best practices in the design and development of healthcare mobile applications, in order to optimize usability and maximise impact in different populations across the world.

Around 75% of the world’s inhabitants now have access to a mobile phone.  Out of the estimated 6 billion phone subscriptions worldwide, 5 billion are in developing countries.  Figures show there were over 30 billion app downloads worldwide in 2012 , including a surge in the uptake of apps focused on education and information rather than entertainment.

This wide access to mobile applications provides enormous opportunities to improve the reach and effectiveness of health self-management programmes and enhance communication between patients and healthcare professionals, particularly in the field of cardiovascular disease (CVD). In order to ensure that apps are responsive to the needs of patients and healthcare professionals, experts say the development of best practices in the field is a priority.

National examples presented here at the World Congress of Cardiology illustrate how effective e-health strategies can be designed to educate and improve health outcomes in the prevention and treatment of CVD in two very different healthcare settings.

Australia: using e-health to support lifestyle changes and prevent CVD
E-health programmes can be very useful in the prevention of CVD, in particular to support lifestyle changes in patients at high risk of CVD or who have already experienced a cardiac event.  In this study, led by The George Institute for Global Health, Australian academics reviewed how web and mobile apps could be best designed for effective CVD risk reduction and found that the use of personas and journey maps are valuable tools to create effective e-health tools.

To reach this conclusion, a multi-disciplinary team of researchers ran a workshop with the purpose of mapping a journey framework, actually reconstructing the steps of a CVD patient from life before their cardiac event to post-hospital care.  Interviews, photo-diaries and a workshop involving CVD patients and those at high CVD risk were held, to capture personal experiences and refine the journey.  Following this, four “personas” of patients were created, each of them representing different risk profiles across a range of demographics, including needs, backgrounds and ages.

Using these personas and mapping, the team identified the main touch points where e-health tools could provide additional support to respond to specific patient’s needs, such as ‘help me understand my risk of CVD’ or ‘help motivate me’. 

“E-Health is reshaping healthcare delivery across the globe. It provides new opportunities to improve healthcare for patients and optimise lifestyle-related changes for cardiovascular disease prevention. User-centred tools like the CVD journey maps and personas help us to understand people’s needs in relation to their lifestyles, motivations and choices and can aid in the development of successful, supportive and relevant mobile applications for all,” commented Associate Professor David Peiris, Program Head Primary Health Care Research, The George Institute for Global Health, University of Sydney, Australia.

Apps for all: best practice in developing mobile apps in a low resource setting in India
A study undertaken by Dr Dhruv Kazi and colleagues studied the role of an m-health intervention to reduce death and disability from stroke among low-literacy patients on blood thinning treatments.  This study, based in Bangalore, India, tested a number of prototypes with stakeholders in the healthcare system, including patients, nurses, physicians, administrators, information technology staff, engineers, and software developers in hospital and community-based settings in Mysore and Bangalore. The results showed that:
• Patients  and providers were enthusiastic about mobile technology-based solutions for healthcare, but less than 50% had used a healthcare app prior to the interview
• Despite the higher costs, patients preferred voice-based solutions to text- based solutions because of limited literacy and numeracy
• Use of drop-down menus and syntax clarification significantly reduced user-error and improved efficiency, particularly among low-literacy users,  e.g., dates (MM/DD/YYYY vs. DD/MM/YYYY), phone numbers (e.g., with or without preceding area code) and laboratory results involving decimal points
• Patients and providers requested versatile apps that could be accessed from a variety of devices (e.g., desktops, tablets, and android phones)
• Role-based passwords and data encryption were feasible mechanisms for data security even in low-resource settings.

“These overarching principles can guide entrepreneurs, software developers, public health experts, and governments as they develop locally-relevant mobile solutions to address the ongoing epidemic of cardiovascular disease.  We found that agile development practices – including rapid, iterative prototyping and early, frequent engagement of patients and providers – yielded invaluable insights that greatly enhanced the usability and acceptability of the final product.  Well-designed and validated mobile applications can revolutionize the delivery of affordable, high quality healthcare in low-resource settings, but only if they are sensitive to the needs of the end-user.  Applied correctly, m-health has the potential to alleviate the burden of cardiovascular disease in the most vulnerable sections of society,” explained Dhruv Kazi, Division of Cardiology, University of California, San Francisco, USA.

To access the original media release, go to: http://www.world-heart-federation.org/press/releases/detail/article/ehealth-the-dawn-of-a-new-era-in-cardiovascular-disease-prevention-and-management/

To read the full abstract, and for information on how to access the full text, go to: http://ejhp.bmj.com/content/21/4/238.abstract or contact your DHB library, local or organisational library for assistance.

Jala, Z. S., et al. (2014). Pharmacy care and adherence to primary and secondary prevention cardiovascular medication: A systematic review of studies. European Journal of Hospital Pharmacy, 21, 238-244.

Strategies that appear to improve medicines use include self-monitoring and self-management programmes, simplified dosing regimens and directly involving pharmacists in medicines management. Other strategies, such as delayed antibiotic prescriptions, practical management tools (eg. reminders, packaging), education or information combined with other strategies (eg. self-management skills training, counselling), and financial incentives, may also have some positive effects, but their effects are less consistent.

To read this Cochrane Review in full text, go to: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007768.pub3/full

Ryan, R., et al. (2014). Interventions to improve safe and effective medicines use by consumers: An overview of systematic reviews. Cochrane Database of Systematic Reviews, 4, doi: 10.1002/14651858.CD007768.pub3.

Four out of ten people who took part in the Stroke Foundation’s annual blood pressure awareness campaign say they are taking action to control their blood pressure as a result. That is the startling finding of a follow up survey of participants who had their blood pressure tested in the October 2013 event.

“Normally it’s quite difficult for most health promotion campaigns to produce behaviour change,” said Stroke Foundation Health Promotion Manager Julia Rout on publishing the campaign evaluation report. “Improvements in people’s understanding or knowledge are common, but getting people to take action to improve their health is the Holy Grail of health promotion. Even if we can’t be certain everyone is really making changes this survey certainly shows that the messages about blood pressure and stroke are getting through to a high proportion of participants in our campaign.”

Nearly 20,000 shoppers had their blood pressure tested on 5 October 2013 at 168 different sites, mostly New World or PAK’nSAVE supermarkets. The tests were carried out by St John volunteers, assisted by Rotary. Wellington Free Ambulance volunteers also took part in the Wellington region for the first time.

A random sample of 367 shoppers who had their blood pressure tested were contacted nine weeks later and quizzed about the campaign. They were asked “Are you taking any action as a result of your blood pressure reading, or the information you received?” Forty per cent said they were.

The number of people who could recall their last blood pressure reading, or at least whether it was high or low, also increased for the third year in succession, rising from just 13 per cent in 2011 to 28 per cent in 2013.

“It’s really encouraging to see that the campaign is making an impact,” continued Julia Rout. “The aim is to encourage people to check their blood pressure regularly, know what their reading is, and understand the relationship between high blood pressure and stroke. More than 8 out of 10 participants said they understood that high blood pressure was a major risk factor for stroke. Even if we are cautious about what people say about their behaviour, taken together with the findings on recall of last test it still shows just how worthwhile this activity is.”

Invitations are being sent to all Foodstuffs supermarkets this week to participate in the 2014 campaign scheduled for Saturday 4 October.

Notes:

The Stroke Foundation of New Zealand, in partnership with St John, Wellington Free Ambulance, Rotary NZ and Foodstuffs, held its fifth national blood pressure awareness campaign on Saturday 5 October, 2013.

A full list of the results from each of the 168 venues is attached.

The aim of the campaign was to raise awareness amongst shoppers at Foodstuffs supermarkets (New World and PAK’nSAVE), and the general public visiting non-supermarket sites, about blood pressure, its relationship to stroke, and the importance of having regular blood pressure checks. Information packs and free blood pressure checks were offered to all participants between 10am and 2pm on the day. Data was collected to help inform the Stroke Foundation’s future activities.

Key results
• 40% of respondents in a follow-up survey indicated they were taking action as a result of their blood pressure reading or due to information received on campaign day.
• Over 80% of respondents in the same follow-up survey were able to identify ways to reduce their risk of stroke.
• More people had some idea of what their last blood pressure reading was when compared to previous years (28% recall in 2013 vs 20% in 2012 and 13% in 2011)
• 168 blood pressure testing sites participated on campaign day
• At least 20,000 shoppers visited the test sites
• The proportion of participants with blood pressure falling in the ‘normal’ and ‘raised’ ranges was similar to previous years.
• 13% of participants that took part on campaign were referred to a GP due to high readings
• 20% of participants indicated they were on blood pressure medication

Blood pressure readings
• Raised readings were those with 140 mm Hg systolic and/or 90 mm Hg diastolic; 8,102 participants (47%) had raised blood pressure readings, similar to 2012 (46.9%).
• 691 participants (4%) fell into the severe hypertension range (180 systolic and/or 100 diastolic).
• The average reading was 134/82, exactly the same as 2012.The highest systolic reading recorded was 231/133; the highest diastolic reading was 218/180.

Referrals to a GP or nurse
• 2,268 participants (13%) were referred to a GP or nurse as a result of a high blood pressure reading (to ensure proper medical assessment of apparently high readings).

Recall of information on campaign day
• 28% of participants indicated they could either recall or had some knowledge (e.g. high, normal, approximate) of what their last blood pressure reading was. This compares to 20% in 2012 and just 13% in 2011.
• Recall of when a participant’s blood pressure was last measured was similar to previous years (between 63 – 66% could say how long ago they last had a test).
• Over 80% of participants had a strong awareness of blood pressure being the major risk factor for stroke.

Gender
• 59.5% of participants were female; 39.5% were male
Ages
• 32% were aged between 20-49
• 66% were aged 50 and above

Ethnicity
• European 77.8%
• Maori 9.0%
• Pacifica 3.9%
• Asian 4.2%
• Indian 2.9%
• Other 1.8%

A full evaluation report on the 2013 campaign can be downloaded from http://www.stroke.org.nz/stroke-blood-pressure-campaign

To read the full abstract, and for access to a free full text version of the article, go to: http://www.biomedcentral.com/1472-6963/14/183/abstract

Hamrosi, K. K., Raynor, D. K., & Aslani, P. (2014). Enhancing provision of written medicine information in Australia: Pharmacist, general practitioner and consumer perceptions of the barriers and facilitators. BMC Health Services Research, 14, 183.

To read the full abstract, and for information on how to access the full text, go to: http://www.ajicjournal.org/article/S0196-6553%2813%2901323-0/abstract or contact your DHB library, or local or organisational library for assistance.

Sopirala, M. M., Et al. (2014). Infection Control Link Nurse Program: An interdisciplinary approach in targeting health care-acquired infection. AJIC: American Journal of Infection Control, 42 (4), 353-359.

The kit contains the rationale for using the World Health Organizations’ ‘5 Moments’ approach to hand hygiene, information about encouraging a frontline ownership approach to improve hand hygiene, education materials on glove use, and a list of journal articles for further reading.

Click here to access the resource kit.

See other HHNZ guidance resources at: http://www.handhygiene.org.nz/index.php?option=com_content&view=article&id=13&Itemid=115

The presenters include:

• Chris Walsh on the what, why and how of consumer engagement in health services and SSI
• Kelly Vince on raising the profile of consumer engagement among clinicians and the benefits of working with patients to reduce the risk of infection
• Owen Ashwell on opportunities to engage with patients during their perioperative experience
• a panel discussion on the opportunities to be part of reducing your own risk of SSI
• working with consumers to develop patient information – ‘Preventing Surgical Site Infection’
• Kula Alapaki on the information Pacific peoples need before surgery on reducing the risk of a SSI
• Geoff Cardwell on involvement as a consumer representative – what do consumers bring to the table

To view the full recording of the webinar, go to: http://open.hqsc.govt.nz/infections/publications-and-resources/publication/1438/

• Asian health service development in Aotearoa
  
• Experience of life-limiting illness among South-Asian Sikhs and Muslims
  
• Advance care planning for Māori, Pacific and Asian people
  
• “Like Minds, Like Mine” anti-stigma and discrimination campaign
• Interpreter use in Canterbury general practice
  
• Deconstructing consumer choice in health communication
  
• Smokeless tobacco use in South-Asian Sydney
  
• Effective interventions in racism and health
  
• A social movement to transform institutional racism
• Health and wellbeing of secondary school students.

To subscribe to the Asian Health Research Review, go to: http://www.researchreview.co.nz/

Wendy Donaldson, Midlands Network Development Facilitator, says the increased focus on health literacy began with the adoption of the Midland Health Network Strategy in 2012, and a vision of making health literacy “everyone’s business”. As the Network wants to become a health literacy promoting organisation, the first phase of the health literacy project involved training and planning to ensure all staff were familiar with health literacy themselves. “We are now moving into phase two of the project, which involves providing health literacy training and resources for clinicians and practice nurses throughout the region,” says Wendy.

According to the education and training resources developed for the Health Quality & Safety Commission by Workbase, health literacy can be improved by practicing three simple steps.

• Find out what people know: sometimes people will have incorrect knowledge or beliefs about their health condition.
• Build people’s health literacy to meet their needs: give information in logical steps, give information in chunks to help the patient understand, and ask questions.
• Check you were clear: clinicians should check they were clear by getting feedback from the patient about how effective you were at communicating.

The education sessions for clinicians will include a powerpoint presentation on the importance of health literacy and what clinicians can do to support their patients. A diagram from the Commission’s Three steps to better health literacy brochure will be used to explain how to apply health literacy in a simple way.

To read the full news story on the HQSC website, go to: http://www.hqsc.govt.nz/our-programmes/consumer-engagement/news-and-events/news-2/news/1429/

Five types of special events were identified: health fairs, parties, cultural events, special days, and plays. Many focused on breast cancer only, or in combination with other cancers. For cancer screening as an outcome of the events, mammography screening rates ranged from 4.8% to 88%, Pap testing was 3.9%, and clinical breast exams ranged from 9.1% to 100%. For colorectal screening, FOBT ranged from 29.4% to 76%, and sigmoidoscopy was 100% at one event. Outcome measures included intentions to get screened, scheduled appointments, uptake of clinical exams, and participation in cancer screening.

The authors conclude that some special events can lead to increases in cancer screening, especially if they provide onsite screening services. However, there is insufficient evidence to demonstrate that special events are effective in increasing cancer screening.

This is an open access article and is available to read in free full text at: http://www.biomedcentral.com/1471-2458/14/274/abstract

Escoffery, C., et al. (2014). A systematic review of special events to promote breast, cervical and colorectal cancer screening in the United States. BMC Public Health, 14, 274.

However, the authors note that whether patient-reported outcome measures (PROMs) comprehensively cover these dimensions remains unexplored. This systematic review examined whether PROMs designed to assess the quality of patient-centred cancer care addressed all six IOM dimensions of patient-centred care and the psychometric properties of these measures.

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1186/1471-2407-14-41

Tzelepis, F., et al. (2014). Are we missing the Institute of Medicine’s mark? A systematic review of patient-reported outcome measures assessing quality of patient-centred cancer care. BMC Cancer, 14:41.

‘I’m not a nurse; I come in as a parent,’ Michaela says. ‘I have three children, so I’ve been through the system. I know how busy we all are as parents, and I know how it feels to bring your children in for vaccination.’

Michaela’s role was created two years ago in response to low immunisation rates in the area. There are similar lay advocates in other countries who work to increase immunisation rates in their local communities.

To read the full case study, go to:  http://www.ssc.govt.nz/bps-result3-cs5

Associate Health Minister Jo Goodhew says frontline health services, including travel clinics and emergency departments (EDs), are being encouraged to help counter any spread of measles with new resources.

“There have now been 33 cases of measles recorded since the end of 2013, with seven people needing hospitalisation,” says Mrs Goodhew.

“All these people either caught the disease overseas, or were in contact with someone who had recently done so.

“This highlights the need for people to check they have been immunised against measles before heading abroad.

“The public health units have been working intensively whenever a case occurs to trace those who have been in contact with them.”

To help raise awareness of the current measles cases resources are being distributed to primary care, travel clinics, and EDs. The material includes flyers which highlight symptoms, explains what a person should do if they think they have measles and reminds travellers to get immunised before they fly.

“Anyone who suspects they may have measles should call their GP, or Healthline on 0800 611 116, as soon as possible. It’s important to call before visiting a GP surgery or emergency department, so that staff can take steps to prevent measles being spread to people in the waiting room,” says Mrs Goodhew.

You can find out more at the Ministry of Health measles pages at www.health.govt.nz/measles 

Based on the results of their analysis, they conclude that "... approximately 1 in 8 never-smoking youth worldwide was found to be susceptible to smoking. A comprehensive approach involving parental and peer education, smoke-free policies, ban on tobacco advertising and promotions, and antismoking education in schools should be developed ... to protect never-smoking youth from being susceptible to smoking and transforming into future regular smokers".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1016/j.jadohealth.2013.07.036 or contact your DHB library, or organisational or local library for assistance.

Veeranki, S.P., et al. (2014). Worldwide never-smoking youth susceptibility to smoking. Journal of Adolescent Health, 54(2), 144-150. 

The authors project the effect of five hypothetical prevention policies on future US diabetes rates through 2030: 1) no diabetes prevention strategy; 2) a “high-risk” strategy, wherein adults with both impaired fasting glucose and impaired glucose tolerance receive structured lifestyle intervention; 3) a “moderate-risk” strategy, wherein only adults with impaired fasting glucose are offered structured lifestyle intervention; 4) a “population-wide” strategy, in which the entire population is exposed to broad risk reduction policies; and 5) a “combined” strategy, involving both the moderate-risk and population-wide strategies.

They report the results and note that, although implementation of appropriate diabetes prevention strategies may slow the rate of increase of the prevalence of diabetes among US adults through 2030, the US diabetes prevalence rate is likely to increase dramatically over the next 20 years. 

This is an open access article and is available to read in free full text at:  http://www.pophealthmetrics.com/content/11/1/18

Gregg, E.W., et al. (2013). Modeling the impact of prevention policies on future diabetes prevalence in the United States: 2010–2030. Population Health Metrics, 11:18

The authors included twenty-nine studies (6,753 participants) that compared self-management education programmes to attention control (five studies), usual care (17 studies), information alone (four studies) or another intervention (seven studies).

They found that "low to moderate quality evidence indicates that self-management education programmes result in no or small benefits in people with osteoarthritis but are unlikely to cause harm".

Available to read in free full text at:  http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008963.pub2/full

Kroon FPB, van der Burg LRA, Buchbinder R, Osborne RH, Johnston RV, Pitt V. (2014). Self-management education programmes for osteoarthritis. Cochrane Database of Systematic Reviews, 1. Art. No.: CD008963. 

• Structured Education and Diabetes
• UK Guidelines
• Evidence for the effectiveness of structured education programmes
• Current trials
• Commissioning tools
• References

Go to: http://www.nice.org.uk/guidance/qualitystandards/diabetesinadults/structurededucation.jsp

A new NPS MedicineWise health professional educational program launched today looks at the complex issues that contribute to the disproportionate number of medicine-related adverse events and hospital admissions experienced by older Australians.

NPS MedicineWise clinical adviser Dr Philippa Binns says the program will provide effective strategies to assist GPs manage polypharmacy and prevent medicine-related problems in patients aged 75 and over.

"The proportion of older Australians aged 75 years or more taking multiple medicines is double that of those aged 50-64 years. Of course this reflects the increasing number and complexity of comorbidities that occur with age, but by taking more medicines older people also have a higher risk of adverse events," says Dr Binns.

To read the full media release on the NZ Doctor website, go to: http://www.nzdoctor.co.nz/un-doctored/2013/september-2013/03/older,-wiser-and-safer-reducing-adverse-medicine-events-in-older-people.aspx

For more information about this program Older and wiser: Promoting safe use of medicines in older people, visit: http://www.nps.org.au/medicines-in-older-people/

This systematic review and meta-analysis investigated the effects of patient education on mortality, morbidity, health-related quality of life, and healthcare costs in people with coronary heart disease.

A University of Canterbury researcher has worked with the Māori community in a bid to fight Type 2 diabetes which is a serious health problem for Māori.

UC PhD student Alison Farmer has produced a documentary, to be launched next month, which will be distributed among the Māori community to highlight the seriousness of the disease.

Type 2 diabetes is almost three times more common in Māori than non-Māori who are diagnosed younger and are two to three times more likely to develop complications such as eye disease, kidney failure, strokes and heart disease.

Mortality rates for Māori with Type 2 diabetes are seven times higher than for non-Māori. The Ministry of Health estimates that diabetes increased by 78 per cent between 1996 and 2011.

Farmer is an Emmy-award winning documentary producer/director and her DVD has the support of Māori health workers and is the result of two years of collaboration with Māori health professionals and the community. The DVD - https://vimeo.com/68196701 - will be launched on 5 July.

"The DVD has been produced as a result of extensive consultation and research with the Māori community and health organisations, reflected in part by the endorsement from Ngai Tahu chairman Sir Mark Solomon who features in the DVD, titled I Want to Walk with my Moko: Preventing Type 2 Diabetes.

"If the low levels of knowledge of diabetes can be attributed in part to the failure to reflect Maori cultural practices, this study tests whether community cased participatory research is an effective approach to address and overcome this problem.

"My research approach has not been implemented or tested before in any health education campaigns with Māori. Academics suggest that this type of research is a particularly fitting method but there is no existing research to demonstrate whether it can be effective with Maori public health programmes.

"Evaluation and results of the DVD documentary in the Māori community will begin in six months and will seek to confirm if the target audience found the DVD approach helpful.

"Type 2 diabetes is an increasingly significant health issue with many health professionals predicting a diabetes epidemic in New Zealand. Several studies of Maori health identify the need for new approaches to diabetes education in order to reduce the current gap between Māori and non-Māori disease rates."

Research suggests that the reported low level of diabetes knowledge in the Māori community is due to a lack of culturally appropriate media that reflects Māori beliefs and cultural practices.

Farmer’s research, supervised by Associate Professor Ray Kirk and health sciences senior lecturer Jeff Gage (Health Sciences), focuses on what Māori want to see in a media resource about diabetes prevention.

• Gastric bypass vs. intensive medical management
• Pre-eclampsia as a diabetes risk factor
• Food insecurity and glycaemia changes during an educational intervention
• Behavioural interventions in older adults
• Type 2 diabetes and cognitive change
• Precipitating events of diabetes-related amputations
• Diabetes and impaired glucose metabolism in young ‘at risk’ adults
• Enteric-coated pellets lower glycaemia in type 2 diabetes
• Work hours and weight gain in middle-aged women
• Treadmill desks reduce workers’ sedentary time

To subscribe to the research review, go to: http://researchreview.co.nz

The review investigated six randomised controlled trials and one cluster randomised controlled trial. The studies involved a total of 2978 participants, with three studies conducted in low- or middle-income countries and four in high-income countries.

The authors conclude that there is limited evidence and it is of a low quality. The available evidence suggests that "... face to face interventions to inform or educate parents about childhood vaccination have little to no impact on immunisation status, or knowledge or understanding of vaccination".

The authors go on to say that "... given the apparently limited effect of such interventions, it may be feasible and appropriate to incorporate communication about vaccination into a healthcare encounter, rather than conduct it as a separate activity".

This review is available to read in full text at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010038.pub2/full

Kaufman, J., Synnot, A., Ryan, R., Hill, S., Horey, D., Willis, N., Lin, V. & Robinson, P.  (2013). Face to face interventions for informing or educating parents about early childhood vaccination. Cochrane Database of Systematic Reviews, 5. Art. No.: CD010038. DOI: 10.1002/14651858.CD010038.pub2.

In this paper, the authors present an overview of systematic reviews evaluating the impact of interventions to improve the quality of diabetes care.

To read the full abstract, and for access to a free full text version of the article, go to: http://www.systematicreviewsjournal.com/content/2/1/26/abstract

Worswick, J. (2013). Improving quality of care for persons with diabetes: An overview of systematic reviews - what does the evidence tell us? Systematic Reviews, 2:26.

After conducting an experimental study with 325 smokers and non-smokers ages 18–30 years, the authors found that most of the proposed labels enhanced fear-related reactions about health consequences of smoking and reduced motivations to smoke relative to text-only labels, although some had larger effects than others. All but one of the nine warning labels recently adopted by the FDA enhanced fear-related reactions and reduced smoking motivations.

To read the full abstract, and for information on how to access the full text, go to: http://tobaccocontrol.bmj.com/content/early/2013/04/25/tobaccocontrol-2012-050645.short or contact your DHB library, or organisational or local library for assistance.

Cameron, L. D., et al. (2013). Responses of young adults to graphic warning labels for cigarette packages. Tobacco Control, epublished 26 April 2013.

A total of 1,381 patients aged ≥40 years and newly diagnosed with type 2 diabetes were followed for 19 years.  The original 6 year intervention involved structured personal care (compared with usual care).

Among the findings of the study were that, during the 19 years of the study, all-cause mortality was not different between the groups, but a lower risk emerged for fatal and non-fatal myocardial infarction and any diabetes-related endpoint. 

To view the full abstract and for information on how to access the full text, go to:
http://link.springer.com/article/10.1007/s00125-013-2893-1 or contact your DHB library, or organisational or local library for assistance.

Hansen, L. J., et al. (2013). Structured personal care of type 2 diabetes: a 19 year follow-up of the study Diabetes Care in General Practice (DCGP). Diabetologia, 56(6), 1243-1253.

They found that, although professionals were aware of patients' needs for information, provision of such information was the exception rather than the rule, despite the information being available for all medicines. 

Participants were concerned about its impact on the patient-provider relationship. The authors suggest appproaches to improving the provision of written medicine information to patients.

To view the full abstract and for information on how to access the full text, go to: http://www.rsap.org/article/S1551-7411(13)00042-9/abstract or contact your DHB library, or organisational or local library for assistance.

Hamrosi, K. K., et al. (2013). Pharmacist and general practitioner ambivalence about providing written medicine information to patients—A qualitative study. Research in Social and Administrative Pharmacy, 9(5), 517-530.

TDE publishes original articles on patient care and education, clinical practice and/or research, and the multidisciplinary profession of diabetes education as represented by nurses, dietitians, physicians, pharmacists, mental health professionals, podiatrists, and exercise physiologists.

The patient workbook uses evidence-based techniques to support individuals (and their whānau) at high cardiovascular risk to build skills in health literacy and self-management. The easy-to-use booklet is designed to facilitate risk awareness, goal setting and self-management through a semi-structured interaction between a health care provider and patient. 

The booklet can be downloaded, or ordered at: http://www.heartfoundation.org.nz/resources/taking-control-my-plan-for-heart-health-booklet/

In 2009, a smoking cessation programme offered a weekly financial incentive of £12.50 over a 12-week period. However, a significant proportion of participants dropped out, with some not even collecting the financial reward they were owed.

The authors interview 14 participants to explore the reasons for disengagement and failure to re-engage within this group.

To read the full abstract, and for information on how to access the full text, go to: http://jhsrp.rsmjournals.com/content/17/4/212.abstract or contact your local, DHB or organisational library for assistance.

Allan, C., et al. (2012). Paying the price for an incentive: An exploratory study of smokers' reasons for failing to complete an incentive based smoking cessation scheme. Journal of Health Services Research & Policy, 17(4), 212-218

This is an update of a Cochrane review first published in 2009.

The review is available to read in full text at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007146.pub3/full

Gillespie, L.D., Robertson, M.C., Gillespie, W.J., Sherrington, C., Gates, S., Clemson, L.M., Lamb, S.E. Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 9. doi: 10.1002/14651858.CD007146.pub3.

The quitline-based counseling intervention included up to 4 proactive telephone counseling sessions, while those in the self-help group received only mailed cessation materials.

To read the full abstract, and for information on how to access the full text, go to: http://ntr.oxfordjournals.org/content/15/5/932 or contact your local, DHB or organisational library for assistance.

Sims, T.H., et al. (2013). Quitline cessation counseling for young adult smokers: A randomized clinical trial. Nicotine & Tobacco Research, 15(5), 932-941.

A total of 24 original studies met the authors' criteria, seven of which focused on vaccination, eleven on screening aimed at early detection of disease, and six on screening aimed at identifying high risk of a disease, targeting a variety of diseases and conditions. Lack of personal relevance of the program, younger age, higher social deprivation and former non-participation were related to actual non-participation. No differences were found in non-participation levels or factors related to non-participation between the three program types. The large variation in non-participation levels within the program types may be partly due to differences in recruitment strategies, with more active, personalized strategies resulting in higher participation levels compared to an invitation letter.

The authors conclude that theere is still much to be gained by tailoring strategies to improve participation in those who are less likely to do so, namely younger individuals, those living in a deprived area and former non-participants. Participation may increase by applying more active recruitment strategies.

This is an open access article and is available to read in full text at: http://www.biomedcentral.com/1471-2458/12/856/abstract

Koopmans, B., et al. (2012). Non-participation in population-based disease prevention programs in general practice. BMC Public Health, 12: 856

The authors conclude that more methodologically rigorous trials are needed. However, they note that  emergency department–initiated tobacco control, combining motivational interviewing and booster phone calls, "... showed a trend toward increased episodically measured tobacco abstinence up to 12 months".

To read the full abstract, and for information on how to access the full text, go to: http://ntr.oxfordjournals.org/content/15/3/643.abstract or contact your local, DHB or organisational library for assistance.

 Rabe, G.L., et al. (2013). Efficacy of emergency department–initiated tobacco control - systematic review and meta-analysis of randomized controlled trials. Nicotine & Tobacco Research, 15(3), 643-655.