Background Changes in pharmacy models of care, services and funding have been occurring internationally, moving away from the traditional dispensing role to more extended patient-facing roles utilising pharmacists’ clinical skills. This study aimed to identify the extended services offered by community pharmacy in Aotearoa New Zealand and the barriers and facilitators to extended services provision. The study is unique in that it includes intern (pre-registration) pharmacists. Methods An online survey, conducted in 2018, of all pharmacists and intern (pre-registration) pharmacists working in a community pharmacy. Data were analysed using descriptive statistics and regression analyses. Results The results are based on replies from 553 community pharmacists and 59 intern pharmacists (response rate: 19 and 26% respectively). Both pharmacists (83%) and interns (85%) want to work at the top of their scope of practice. Wide variation exists in the specific services individual pharmacists offer. Most pharmacists were accredited to supply the emergency contraceptive pill (95%), sildenafil for erectile dysfunction (86%) and trimethoprim for uncomplicated urinary tract infection (85%). Fewer were able to immunise (34%) or to supply selected oral contraceptives (44%). Just under a quarter could provide a Medicines Use Review (MUR) or Community Pharmacy Anticoagulation Management Service (CPAMS). Of the pharmacists not already accredited, 85% intended to gain accreditation to supply selected oral contraceptives, 40% to become vaccinators, 37% to offer CPAMS and 30% MUR. Interns expressed strong interest in becoming accredited for all extended services. Poisson regression analyses showed key factors supporting the likelihood of providing extended services were owner and management support and appropriate space and equipment. Being excited about the opportunities in community pharmacy, having employer funding and time for training and sufficient support staff were also statistically significant. Conclusions Pharmacists need time and a supportive management structure to enable them to deliver extended services. Health policy with a greater strategic emphasis on funding services and pharmacist training, and developing technician support roles, will help to minimise or eliminate some of the barriers to role expansion both in Aotearoa New Zealand and internationally.

BackgroundNew Zealand rates of obesity and overweight have increased since the 1980s, particularly among indigenous Māori people, Pacific people and those living in areas of high deprivation. New Zealand's response to the obesity epidemic has been The Healthy Eating-Healthy Action: Oranga Kai - Oranga Pumau (HEHA) Strategy ('the Strategy'), launched in 2003. Because the HEHA Strategy explicitly recognises the importance of evaluation and the need to create an evidence base to support future initiatives, the Ministry of Health has commissioned a Consortium of researchers to evaluate the Strategy as a whole.MethodsThis paper discusses the Consortium's approach to evaluating the HEHA Strategy. It includes an outline of the conceptual framework underpinning the evaluation, and describes the critical components of the evaluation which are: judging to what extent stakeholders were engaged in the process of the strategy implementation and to what extent their feedback was incorporated in to future iterations of the Strategy (continuous improvement), to what extent the programmes, policies, and initiatives implemented span the target populations and priority areas, whether there have been any population changes in nutrition and/or physical activity outcomes or behaviours relating to those outcomes, and to what extent HEHA Strategy and spending can be considered value for money.DiscussionThis paper outlines our approach to evaluating a complex national health promotion strategy. Not only does the Evaluation have the potential to identify interventions that could be adopted internationally, but also the development of the Evaluation design can inform other complex evaluations.

Late antenatal care attendance could be linked to Pacific women having higher rates of perinatal mortality, premature delivery and birth complications ( Perinatal and Maternal Mortality Review Committee (PMMRC), 2010 ). Aim: To explore, in depth, the attitudes of Samoan women towards antenatal and midwifery care. Methods: A qualitative study, where individual face-to-face audio-recorded interviews were conducted in either English or Samoan with 40 Samoan women and 10 key informants from professional organisations and midwifery practice. Results: Most women in this study did not have complications with their pregnancies and attended their first antenatal appointment in their first trimester of pregnancy. Fewer women attended antenatal care later in their pregnancies (15th week of pregnancy or after), but this group did not experience pregnancy complications either. The Samoan women viewed pregnancy as wellness and very few of them had planned their pregnancy. Although most participants did not relate to the content of mainstream antenatal classes because they were not culturally appropriate, they were satisfied with their midwifery care. Conclusions: While it is generally assumed that early attendance at antenatal care services is related to good pregnancy outcomes, this research tends to suggest that this is not always the case. Most of the Samoan women in the study had not planned their pregnancy and pregnancy was not considered to be an ‘illness’. Because they felt well during pregnancy, these women did not see the need to attend antenatal classes and did not necessarily register with antenatal services early in their pregnancy. Regardless of when they first accessed antenatal care services, most of the women had healthy pregnancies and were happy with the service provided by their midwives.

From 2010, a not-for-profit community services’ provider has delivered a Pacific cancer navigation patient facilitation and support service (hereafter ‘the Service’) for Pacific peoples residing in an area of West Auckland, New Zealand. The Service was evaluated in 2013. As part of the evaluation, both group and individual interviews were held with sixteen cancer patients, eight family members and seven key informants; in conjunction, observations and informal discussions were held with two navigators. Service personnel were closely involved from the inception of the evaluation, and this practice will be discussed as part of building an evaluation culture in the organisation. There was general agreement that the implementation of the facilitation and support Service had proceeded well, this was characterised by effective engagement with health professionals; the establishment of a support group; the provision of transport; assistance in dealings with Work and Income New Zealand (WINZ); and the provision of timely and accurate information to assist patients and their families. From this common consensus, suggestions were made around increasing and ensuring ongoing funding to sustain the supporting roles of navigators and the services offered. Other invaluable features of the Service included the ability of navigators to translate from English to Samoan, and from medical to lay language, as well as the provision of the Service beyond central metro areas.

Background. New Zealand rates of obesity and overweight have increased since the 1980s, particularly among indigenous Mori people, Pacific people and those living in areas of high deprivation. New Zealand's response to the obesity epidemic has been The Healthy Eating-Healthy Action: Oranga Kai - Oranga Pumau (HEHA) Strategy ('the Strategy'), launched in 2003. Because the HEHA Strategy explicitly recognises the importance of evaluation and the need to create an evidence base to support future initiatives, the Ministry of Health has commissioned a Consortium of researchers to evaluate the Strategy as a whole. Methods. This paper discusses the Consortium's approach to evaluating the HEHA Strategy. It includes an outline of the conceptual framework underpinning the evaluation, and describes the critical components of the evaluation which are: judging to what extent stakeholders were engaged in the process of the strategy implementation and to what extent their feedback was incorporated in to future iterations of the Strategy (continuous improvement), to what extent the programmes, policies, and initiatives implemented span the target populations and priority areas, whether there have been any population changes in nutrition and/or physical activity outcomes or behaviours relating to those outcomes, and to what extent HEHA Strategy and spending can be considered value for money. Discussion. This paper outlines our approach to evaluating a complex national health promotion strategy. Not only does the Evaluation have the potential to identify interventions that could be adopted internationally, but also the development of the Evaluation design can inform other complex evaluations. © 2009 McLean et al; licensee BioMed Central Ltd.

Objective The aim of the present study was to evaluate the short-term outcomes of two health science academies established by a district health board in South Auckland, New Zealand, to create a health workforce pipeline for local Māori and Pasifika students.Methods A mixed-methods approach was used, involving background discussions with key informants to generate an initial logic model of how the academies work, followed by secondary analysis of students’ records relating to retention and academic achievement, a survey of senior academy students’ interest in particular health careers and face-to-face interviews and focus groups with students, families and teachers.Results Academy students are collectively achieving better academic results than their contemporaries, although selection decisions are likely to contribute to these results. Academies are retaining students, with over 70% of students transitioning from Year 11 to Years 12 and 13. Senior students are expressing long-term ambitions to work in the health sector.Conclusions Health science academies show promise as an innovative approach to supporting Māori and Pasifika students prepare for a career in the health professions. Evaluating the long-term outcomes of the academies is required to determine their contribution to addressing inequities in the local health workforce.What is known about the topic? Despite progress in health workforce participation for underrepresented indigenous and ethnic minority groups in New Zealand, significant disparities persist. Within this context, a workforce development pipeline that targets preparation of secondary school students is recommended to address identified barriers in the pursuit of health careers.What does this paper add? We provide an evaluation of an innovative district health board initiative supporting high school students that is designed to ensure their future workforce is responsive to the needs of the local community.What are the implications for practitioners? The findings have implications for decision makers in health workforce planning regarding the benefits of investing at an early stage of the workforce development pipeline in order to build an equitable and diverse health professions workforce.

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Objective The aim of the present study was to evaluate the short-term outcomes of two health science academies established by a district health board in South Auckland, New Zealand, to create a health workforce pipeline for local Māori and Pasifika students. Methods A mixed-methods approach was used, involving background discussions with key informants to generate an initial logic model of how the academies work, followed by secondary analysis of students’ records relating to retention and academic achievement, a survey of senior academy students’ interest in particular health careers and face-to-face interviews and focus groups with students, families and teachers. Results Academy students are collectively achieving better academic results than their contemporaries, although selection decisions are likely to contribute to these results. Academies are retaining students, with over 70% of students transitioning from Year 11 to Years 12 and 13. Senior students are expressing long-term ambitions to work in the health sector. Conclusions Health science academies show promise as an innovative approach to supporting Māori and Pasifika students prepare for a career in the health professions. Evaluating the long-term outcomes of the academies is required to determine their contribution to addressing inequities in the local health workforce. What is known about the topic? Despite progress in health workforce participation for underrepresented indigenous and ethnic minority groups in New Zealand, significant disparities persist. Within this context, a workforce development pipeline that targets preparation of secondary school students is recommended to address identified barriers in the pursuit of health careers. What does this paper add? We provide an evaluation of an innovative district health board initiative supporting high school students that is designed to ensure their future workforce is responsive to the needs of the local community. What are the implications for practitioners? The findings have implications for decision makers in health workforce planning regarding the benefits of investing at an early stage of the workforce development pipeline in order to build an equitable and diverse health professions workforce.