Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, PO Box 56, Dunedin, Aotearoa, New Zealand, 9054.
Te Whatu Ora Waitematā and Te Toka Tumai Auckland, Auckland, Aotearoa, New Zealand.
Int J Equity Health. 2024 Jan 27;23(1):15. doi: 10.1186/s12939-023-02087-y.
Health intervention implementation in Aotearoa New Zealand (NZ), as in many countries globally, usually varies by ethnicity. Māori (the Indigenous peoples of Aotearoa) and Pacific peoples are less likely to receive interventions than other ethnic groups, despite experiencing persistent health inequities. This study aimed to develop an equity-focused implementation framework, appropriate for the Aotearoa NZ context, to support the planning and delivery of equitable implementation pathways for health interventions, with the intention of achieving equitable outcomes for Māori, as well as people originating from the Pacific Islands.
A scoping review of the literature to identify existing equity-focused implementation theories, models and frameworks was undertaken. One of these, the Equity-based framework for Implementation Research (EquIR), was selected for adaptation. The adaptation process was undertaken in collaboration with the project's Māori and consumer advisory groups and informed by the expertise of local health equity researchers and stakeholders, as well as the international implementation science literature.
The adapted framework's foundation is the principles of Te Tiriti o Waitangi (the written agreement between Māori rangatira (chiefs) and the British Crown), and its focus is whānau (extended family)-centred implementation that meets the health and wellbeing aspirations, priorities and needs of whānau. The implementation pathway comprises four main steps: implementation planning, pathway design, monitoring, and outcomes and evaluation, all with an equity focus. The pathway is underpinned by the core constructs of equitable implementation in Aotearoa NZ: collaborative design, anti-racism, Māori and priority population expertise, cultural safety and values-based. Additionally, the contextual factors impacting implementation, i.e. the social, economic, commercial and political determinants of health, are included.
The framework presented in this study is the first equity-focused process-type implementation framework to be adapted for the Aotearoa NZ context. This framework is intended to support and facilitate equity-focused implementation research and health intervention implementation by mainstream health services.
与许多全球国家一样，新西兰（Aotearoa New Zealand）的健康干预措施的实施通常因族裔而异。毛利人（Aotearoa 的土著人民）和太平洋岛民比其他族裔群体更不可能接受干预措施，尽管他们一直存在健康不平等问题。这项研究旨在制定一个注重公平的实施框架，适用于新西兰的背景，以支持规划和提供公平的健康干预措施实施途径，旨在为毛利人以及来自太平洋岛屿的人实现公平的结果。
对文献进行了范围广泛的审查，以确定现有的注重公平的实施理论、模型和框架。其中一个，即实施研究的基于公平的框架（EquIR），被选中进行改编。改编过程是与项目的毛利和消费者咨询小组合作进行的，并借鉴了当地健康公平研究人员和利益相关者的专业知识，以及国际实施科学文献。
改编框架的基础是《怀唐伊条约》（毛利酋长与英国王室之间的书面协议）的原则，其重点是家庭为中心的实施，满足家庭的健康和幸福愿望、优先事项和需求。实施途径包括四个主要步骤：实施规划、途径设计、监测以及结果和评估，所有这些都注重公平。该途径以新西兰的公平实施核心要素为支撑：协作设计、反种族主义、毛利人和优先人群的专业知识、文化安全和基于价值观。此外，还包括影响实施的背景因素，即健康的社会、经济、商业和政治决定因素。
本研究提出的框架是第一个为新西兰背景改编的注重公平的过程型实施框架。该框架旨在支持和促进主流卫生服务的注重公平的实施研究和健康干预措施的实施。
