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Science to help our tamariki's health and wellbeing so they can thrive

Whiriwhiria, kia ora ai te tamaiti: Building health, wellbeing and learning success for tamariki and rangatahi through and Māturangi Māori and systems science approach to evaluate, integrate and reorient systems, learning and movement initiatives in Hawke's Bay.

A Better Start funded the project managed by Eastern Institute of Technology and Te Pūkenga.

The research objectives are:
1. To evaluate the effectiveness of current food, learning and movement initiatives in Hawke’s Bay with particular regard to outcomes for tamariki Māori;

2. To explore how Māaurangi Māori can inform the development of a comprehensive systems dynamics science approach and reorient food systems in Hawke’s Bay;

3. To create an indigenous informed and inspired food systems approach to improve health, wellbeing, resilience and educational outcomes for tamariki, rangatahi and whānau.

Researchers hope this will provide an exemplar of success for integrating strategies to improve healthy weight, learning and movement outcomes within a high need area and one that can demonstration for other regions across the country.

Theme: Healthy Weight
Researchers: Co-led by Professor Boyd Swinburn and Professor David Tipene-Leach

Moemoeā - Sleep Programme

Moemoeā aims to look to traditional knowledge in Māori and Pasifika communities around centeredness or connection, to create a pou (pillar) for whānau to use to improve outcomes for their tamariki/mokopuna based around the potential of sleep to improve well-being.

We aim to develop a sleep tool-kit that is a) appropriate, engaging, useful and easy to use, b) tailored for Māori and Pasifika families, c) supports communication and connectedness between children and caregivers, d) incorporates relevant cultural values and traditions, e) improves sleep outcomes and reduces excessive weight gain in young tamariki (0-2 years) and f) improves wellbeing among tamariki and caregivers. In Phase 1, we will explore Māori and Pasifika expertise on sleep, nurture and identity to determine the acceptability, challenges for implementation, best delivery methods, and perceived feasibility for changing sleep behaviour of up to 10 different toolkit “components”.

In Phase 2, the research team, stakeholders, and advisory groups will select up to 4 components that will be tested using an innovative experimental design called MOST in around 600 participants recruited through Plunket and Māori provider(s) to determine the effect on wellbeing, weight, and mental health as deemed appropriate in phase 1.

Theme: Healthy Weight

Researchers: Professor Rachael Taylor, Justine Camp

Big Data for A Better Start (Simulation Modelling Project)

This project aims to calculate the cost effectiveness of interventions that the wider research teams at A Better Start has of evidence showing improved health and success of Aotearoa New Zealand children. The purpose of this research project is to demonstrate the value of implementing these interventions to a large population of NZ children.

This valuable project will use simulation modeling to quantify the impact of three key interventions for our tamariki: (i) the Better Start Literacy Approach on successful transition from school into either the labour market or further training; (ii) interventions to change trajectories of early weight gain; and (iii) digital tools on adolescent mental health.

The hypothesis to be tested is that interventions targeting literacy, early growth and mental wellbeing will be cost effective for improving child, adolescent, and early adult outcomes. Additionally, that these will be cost-effective interventions that differentially improve outcomes for Māori and Pasifika children, and so improve equity.

The research team who are currently successfully leading two A Better Start strategic projects: Big Data for A Better Start and Lifecourse. The project team has three Māori co-investigators: Andrew Sporle (Ngati Apa, Rangitane, Te Rarawa) will contribute expertise in Māori data sovereignty issues and in guiding the selection of scenarios to model; Professor Gail Gillon (Ngai Tahu) (also Deputy Director of A Better Start), will guide the modelling relating to literacy development among Māori children; and Dr Tania Cargo (Ngāti Manu, Ngāti Maru, Ngāpuhi) (also ABS Resilient Teens theme leader) will guide the modelling relating to mental resilience among Māori adolescents.

Partners: University of Otago, University of Canterbury, Ministry for Pacific Peoples, University of Auckland HABITs team

Theme: Big Data

Researchers: Associate Professor Director of COMPASS Barry Taylor, Department of Women’s and Children’s Health, University of Otago, Dr Lisa Daniels, Dr Nick Bowden, Dr Jesse Kokaua, Dr Sheree Gibb, Dr Stephanie D’Souza

HABITS: Health Advances through Behavioural Intervention Technologies

This is a digital mental health project incorporating an online platform for screening for mental health problems in young people, delivering effective treatments and monitoring outcomes.

HABITs is a safe and secure digital space that students can access on mobile phones or digital devices. HABITs hosts a range of digital tools for wellbeing, monitoring their usage, tracking changes and providing data for future upgrades.

Currently, the platform hosts digital tools for young people that target emotional wellbeing, including Quest – Te Whitianga, Headstrong, 21-day Stress Detox, Aroha, Tune In and SPARX.

HABITs also includes the ability to screen and identify users who could benefit from digital wellbeing tools and contains a digital testing centre to run online clinical trials. The project has a particular focus on engaging Māori and Pacific youth and their communities to ensure that our interventions are acceptable and helpful.

Theme: Resilient Teens

Researchers: Dr Tanya Cargo, Dr Karolina Stasiak

Other resources/websites: www.headstrong.org.nz

HABITs | The Centre for Infant, Child and Adolescent Mental Health (tearaharo.ac.nz)

Raranga, Raranga, Raranga, taku takpau: hapū ora for tamariki

The study addresses the crucial need for new research to inform future policies and practices that contribute to better outcomes for Māori mothers and their babies, particularly where mothers are experiencing higher levels of stress and mental wellbeing challenges.

It takes a co-design approach with whānau, hapū, iwi and community providers to understand how Māori communities support maternal wellbeing within a mātauranga Māori worldview.

Work has been carried out over four different sites in the North Island (Tāmaki Makaurau, Te Whare Pora at Flaxmere, Rāhui Pokeka, and Ngāti Haua) with researchers holding more than 40 hui and interviewing around 100 women and whānau members since the project began in 2020.

A wide range of stakeholders have been involved from the beginning, including Māori midwives, Raukawa Charitable Trust, Tamaki Hapū Wānanga, Perinatal Anxiety and Depression Aotearoa (Whaiora Wahine), Whānau Āwhina Plunket, Birth Trauma Aotearoa, and Waikato Home Birth Association Māori hui.

Project has significant value for the future of maternal health and wellbeing services for Māori women.

The most important theme that has come through is the need for Māori maternity spaces and places to be rich with wairua, history, cultural knowledge and practices that can transform birthing experiences. The qualitative approach has enabled rich stories to emerge that reflect the experiences of whānau and kaimahi in the hapūtanga space. The depth and breadth of findings reflect this, covering experiences of running wānanga, to what it means to whānau as they engage in Māori spaces of wellbeing and learning.

Other preliminary key findings vital for improving Māori maternity models include:

Improved resources for rural communities, who are particularly underserved – which impacts on birth and maternity outcomes
Physical spaces that are culturally safe for wāhine – such as weaving wānanga, which enable wāhine Māori to reconnect, reclaim and reinstate what it looks and feels like to be Māori hapū wāhine and māmā
Tāne and wāhine being part of the pre and postnatal experence – and the need for them to be included in care and support services
Reclaiming cultural practices such as taonga pūoro in haputanga which supports the connection between the spiritual and physical for hapū wāhine and whānau.

These findings will contribute to the newly formed Māori Health Authority’s goals of pae ora through researchers’ relationships with iwi providers and via the MHA’s iwi advisory group.

There is already direct engagement between the research project team and end-users with project co-lead Dr Naomi Simmonds working with the Raukawa Charitable Trust to support development of their hapū ora programme and delivery for whānau. Dr Simmonds is an advisory member on the programme.

One of the project’s collaborating sites – Te Whare Pora – is a research, service delivery space, and place that supports engagement with hapū wāhine. At the project’s Tamaki site, taonga pūoro knowledges and learnings are already being shared directly with hapū wānanga.

While the dissemination plan is broad and includes papers and a range of media, a strong focus to date has been on wānanga with practitioners and communities to support their aspirations for whānau. This has enabled learnings to be shared with those who are at the flax roots of change. Given the connectedness to communities that all research sites have, the ability to continue to share knowledge and findings from the Raranga study with those involved in Māori maternal care will be easily achievable.

Several future kaupapa have also been identified, including maternity and birthing spaces to consider the place of Whare Kohanga, learning through whare tangata (traditional practices in the womb), and birth trauma and healing. The team has been active in writing submissions for the Pae Ora (Healthy Futures) Bill and for the ACC Maternal Birth Injury Amendment Bill.

Theme:

Researchers: Dr Warekaremoana Waitoki, Dr Naomi Simmonds, Professor Helen Moewaka Barnes, Dr Cheryl Stephens, Professor David Tipene-Leach, Dr Fiona Cram, Dr Teah Carlson, Ms Te Pora Thompson-Evans, Ms Korina Burne-Vaughn, Ms Beverly T Huia

Other resources/websites:

Raranga, raranga taku takapau: hapū ora for tamariki

https://www.teaomaori.news/maori-maternal-health-inequity-research-receives-almost-1m-funding

Life-course impact of chronic health conditions Investigating the impact of chronic disease on families and whānau at different life stages

There is a lot of research evidence about the impact of chronic conditions, such as cancer, cardiovascular disease, diabetes, obesity and mental health disorders, on individuals in middle and later life. However, the indirect effects on the whānau of those with chronic conditions have been less well-studied, and these are likely to have impacts across the entire life-course.

This project aims to understand how living with a person who has a chronic condition affects their whānau – children, partners, carers, elders and household members. It will specifically investigate what helps some New Zealand communities to thrive despite high rates of chronic conditions.

This research is intended to inform health policymakers about the wider benefits of chronic disease prevention and ways of improving the lives of whānau who live with people with chronic conditions. It will also develop novel kaupapa Māori resources to enhance future life-course research.

Approach,

The First Project is a large cohort of individuals and families followed over time, using big and linked data sets. The study will compare outcomes for those who live in families which contain a member suffering from a chronic disease or mental health disorder, and those who don’t. A wide range of outcomes will be assessed at different stages of the life-course. Our research will enable us to quantify the impact on the wider whānau for a range of chronic conditions and provide a more solid basis for future burden and therefore costing efforts.
The second project focuses on the strengths and resilience in the Tokelauan community, and will have the potential to impact the livelihood of Pacific peoples who are affected by long term chronic conditions at a higher prevalence and at younger ages than other ethnic groups in New Zealand, and the livelihood of their families and communities who carry the bulk of the burden of their care.

Using our findings, we will work with the knowledge translation experts in our team (Prof Jen Curtin, Dr Suzanne Woodward), as well as in consultation with the Tokelauan communities, to design intervention ‘products’ and community engagement activities to be implemented. Also, we will leverage current findings from Pacific family caring studies led by Dewes and the impact on carers, families, and their communities.

The research will identify expressed needs of Pacific families living with a chronic condition and how these needs may be effectively and efficiently met to enhance access to culturally appropriate services at home and/or in the community.

The Second Project is focused on having impact in NZ and leveraging this to have impact in Tokelau and the Pacific region. It will also focus on increasing/improving policies, practices and systems towards effective and efficient health promotion and service delivery, as well as empowering impact partners to increase people’s ability to pursue their aspirations and better access to health, social and economic development services, and support.

Impact will be measured in the medium term following this research: whole population datasets will be analysed to assess whether there are fewer negative consequences of being in a family with a chronic conditions sufferer among groups receiving the intervention vs a suitable (e.g., matched) control group. In the shorter-term impact will be assessed by the extent to which communities have received the intervention.

Two further pieces of work will build on previous research to make novel Māori theoretical frameworks for life-course and intergenerational research available for use by others:

The third project, focussing on a methodology for undertaking a kaupapa Māori early life and whānau programme, will publish and disseminate new knowledge about the theoretical and practical processes of applying research methods at the interface between mātauranga Māori and Western science for intergenerational gains in health and wellbeing. This knowledge can be applied in future research that enables effective intervention that improves the health and wellbeing of Māori and through all stages of life.
The fourth project, focussing on inter-generational research with whānau, hapu and iwi, will provide crucial information to assist other Māori collectives to assemble and control their own whakapapa databases that make such iwi and hapu driven intergenerational research possible; and will also document the impact of the research process itself on Māori intergenerational wellbeing.

This research will contribute to improved health and support for Māori whānau, through the chronic research project and through the development of novel kaupapa Māori informed approaches for researching life-course and inter-generational research in projects 3 and 4. These projects are focussed on creating ways for local communities to do kaupapa Māori life-course and intergenerational research. They are both community driven and will create methods and resources for other Māori collectives to use in future research. They are led by some of the senior Māori researchers in the country (Sporle, Kukutai, Edwards, Ratima), and built on existing successful research projects. An advisory group comprising senior Tokelauan community leaders has also been established.

Our research will identify how family members are impacted by being in a family with a chronic condition, and the strengths that different family and whanau draw on to protect against negative outcomes.

We will measure and report on positive life-changing experiences; informed and empowered community leaders and families who can serve as advocates and role models if the intervention is scaled up across NZ and the region; generation of a novel approach to life course research that is co-created and culturally centred, owned and delivered by the community and key stakeholders.

This Project Is Co-Funded By: A Better Start, Healthier Lives, and Ageing Well National Science Challenges.

Theme: Big Data
Researchers: Associate Professor Barry Milne

Word Learning: Languages and it's Impact on Building Resilience in our Young Tamariki

The project aimed focussed on oral language development in the preschool years as it is the foundation for communication, learning, and social interaction. Preschoolers with strong oral language are more likely to perform well in reading, writing, and other academic subjects later on. They are also more likely to have positive social interactions with peers and adults, which can lead to better mental health and well-being. In New Zealand, there are unacceptable inequities in children’s literacy, learning and wellbeing outcomes. This project developed and evaluated a culturally responsive approach to enhance young children’s oral language in the early childhood education setting in Aotearoa as a core strategy to ensure more equitable learning and literacy outcomes for our tamariki. A core aim of this programme of work was to improve the literacy and learning of tamariki Māori and Pasifika children.

The project team partnered with Kidsfirst Kindergartens and co-constructed an approach to support oral language in the early childhood context called Words Can Pop! The approach was rolled out across 24 centres in the Canterbury region and the progress of 486 tamariki in response to the initiative was tracked. The approach included teaching mentoring and professional learning, resource development (for kaiako and home) and whānau workshops. Following implementation of the approach for all tamariki (i.e, centre wide) 86 children were identified who could benefit from extra support with their oral language and/or self-regulation. These children entered Tier 2 support. In the Tier 2 study, a controlled intervention design was used to compare the effectiveness of different delivery models to support children with language and/or self-regulation needs: small group teaching led by a Speech-Language Therapist (n=36), well-resourced coaching for teachers (n=30) and a waiting comparison group (n=20).

The team conducted case study work to evaluate the effectiveness of approaches to support children’s foundational literacy knowledge in the early school years in reo rua (bilingual), rumaki (Māori immersion) and in Samoan. As part of this work, te reo Māori assessments in phonological awareness and oral language were developed and trialled. Further, a phonological awareness assessment in Samoan was developed in trialled.

The early childhood project showed that children’s oral language, self-regulation and emergent literacy development is strongly related from ages 3 to 5. The Words Can Pop approach enhanced the oral language, letter-sound knowledge and cognitive flexibility (a measure of self-regulation) for children. The controlled Tier 2 trial showed that the coaching and mentoring condition was more effective at enhancing the self regulation and oral language needs of children who were identified as benefitting from more support. This approach was also more accepted by teachers and whānau. Te reo Māori assessment measures have been incorporated into the Better Start Literacy Approach Assessment Website.

Further, a version of the BSLA appropriate for tamariki in reo rua settings who are learning to read in English has been developed and shown to be successful at building children’s early literacy knowledge. An approach to supporting phonological awareness development in Samoan was successfully trialled with 5 Samoan speaking children.

Independent analysis from ImpactLab showed that the social return on investment for the WordsCanPop Approach returned $8.38 for every dollar spent on the implementation of the approach.

The early childhood work has also led to an invitation from the MOE to develop progress and practice monitoring tools for oral language (with the aim they will be used across the motu).

Theme: Literacy
Researchers: Professor Gail Gillon (and Deputy Director of A Better Start), Professor Brigid McNeill

Other resources/websites: www.betterstartapproach.com

Big Data for A Better Start

This valuable project will use simulation modelling to quantify the impact of three key interventions for our tamariki: (i) the Better Start Literacy Approach on successful transition from school into either the labour market or further training; (ii) interventions to change trajectories of early weight gain; and (iii) digital tools on adolescent mental health.

The project will be managed by Associate Professor Barry Milne and the research team who are currently successfully leading two A Better Start strategic projects: Big Data for A Better Start and Lifecourse. The project team has three Māori co-investigators: Andrew Sporle (Ngati Apa, Rangitane, Te Rarawa) will contribute expertise in Māori data sovereignty issues and in guiding the selection of scenarios to model; Professor Gail Gillon (Ngai Tahu) (also Deputy Director of A Better Start), will guide the modelling relating to literacy development among Māori children; and Dr Tania Cargo (Ngāti Manu, Ngāti Maru, Ngāpuhi) (also ABS Resilient Teens theme leader) will guide the modelling relating to mental resilience among Māori adolescents. The project is set to run from 1 January – 31 December 2023.