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BACKGROUND: The Royal Australasian College of Surgeons (RACS) Te Rautaki Maori cites the need for more research dedicated to health equity in surgery for Maori. However, the gaps in research for Maori in surgery have not yet been highlighted. This review is the first in a series of reviews named Te Ara Pokanga that seeks to identify these gaps over all nine surgical specialties. The aim of this study was to assess neurosurgical disease incidence and perioperative outcomes for Maori at any point from referral through to the postoperative period. METHODS: A systematic review of Maori neurosurgical disease and care for Maori in NZ was performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement assisted study selection and reporting. Kaupapa Maori (Maori-centred) research methodology and the Maori Framework were utilized to evaluate Maori research responsiveness. RESULTS: Nine studies were included in this review. All studies were retrospective cohort studies and only two studies had at least one Maori clinical or academic expert named on their research team. Therefore, only one study was deemed responsive to Maori. Studies assessing long-term outcomes from the management of neurosurgical disease for Maori and patient and whanau experiences of neurosurgical care are lacking. CONCLUSION: This study indicates the limited scope of research conducted for Maori in neurosurgery. The broader clinical implications of this review highlight the need for good quality research to investigate access to and long-term outcomes from the management of neurosurgical disease for Maori.

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BACKGROUND: The Royal Australasian College of Surgeons (RACS) recently instituted cultural safety and cultural competency as its 10th competency with formalized cultural safety training yet to be instituted. Wananga are Indigenous Maori teaching institutions that can be used contemporarily for cultural safety training. METHODS: In 2022, surgical registrars based at Taranaki Base Hospital (TBH) held in-hospital wananga ranging from 1 to 3 h focussed on cultural safety, professionalism and wellbeing. This study explores the perspectives of these registrars who attended wananga using a Kaupapa Maori aligned methodological stance and interpretive phenomenological analysis. RESULTS: Twenty-six wananga were held from March 22nd 2022 to January 30th 2023. Six registrars provided their perspectives with four major themes emerging from their stories including: cultural safety; unity; time, place and person; and a new era. Registrars valued the wananga which was scheduled for Friday afternoons after daily clinical duties. Wananga facilitated unity and understanding with registrars being able to reflect on the context within which they are practicing - describing it as a new era of surgical training. 'Time' was the biggest barrier to attend wananga however, the number of wananga held was testament to the commitment of the registrars. CONCLUSIONS: Regular wananga set up by, and for, surgical registrars cultural safety development is feasible and well subscribed in a rural or provincial NZ setting. We present one coalface method of regular cultural safety training and development for surgical registrars and trainees in NZ.

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INTRODUCTION: Maori continue to experience inequitable healthcare and health outcomes compared with other New Zealanders. A narrative review conducted in 2016 described disparities in access to and through the surgical care pathway for Maori from a limited pool of small retrospective cohort studies. This review only targeted studies that specifically investigated surgical care for Maori; however, many other studies have performed subanalyses for Maori as part of bigger ethnographic epidemiological studies and Indigenous health has become more topical in Australasia since this review was conducted. Health disparities and inequities in surgical care for Maori are still not well understood. This scoping review aims to report the nature and extent of disparities in surgical disease and care for Maori. METHODS AND ANALYSIS: A scoping review will be performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist. This study will be informed by Kaupapa Maori research methodology. Electronic searches of PubMed, MEDLINE, Embase and Cumulative Index to Nursing and Allied Health Literature Plus will be performed between 19 February and 19 March 2022. Two authors will independently identify and retrieve relevant texts in an iterative manner and examine how responsive each of the included studies are to Maori using the recently described Maori framework-a framework designed to guide researcher responsiveness to Maori. ETHICS AND DISSEMINATION: Ethical approval has not been sought as our review will only include published and publicly accessible data. We will publish the review in an open access peer-reviewed surgical journal. This protocol has been registered in Open Science Framework (10.17605/OSF.IO/NP4H3).

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BACKGROUND: Health equity is a fundamental right afforded to all regardless of ethnicity. However, in New Zealand (NZ), health inequities are most compelling for Indigenous Maori who experience inadequate access to services, poorer quality of care and poor health outcomes as a result. Bariatric surgery is the most effective intervention for weight loss and remission of obesity-related disease where all other interventions have been exhausted. This Kaupapa Maori qualitative study presents Maori perspectives of bariatric surgery from the largest public bariatric centre in NZ and offers solutions for enhancing bariatric service responsiveness to Maori. METHODS: This qualitative study was informed by Kaupapa Maori methodology and involved a general inductive thematic analysis of 31 semi-structured interviews with Maori patients who had bariatric surgery at Counties Manukau Health in South Auckland, NZ. RESULTS: Four key themes were identified following analysis: (i) Kaupapa Maori standards of health; (ii) bariatric mentors; (iii) bariatric psychologists; and (iv) community-integrated support. These themes offer four tangible solutions for optimizing bariatric pathways for Maori from the perspectives of Maori bariatric patients. CONCLUSION: Kaupapa Maori, community-centred and greater non-surgeon aspects of bariatric supportive mechanisms comprise key areas of opportunity for public bariatric pathways in NZ. Surgical leadership is required to advance health equity and service responsiveness to Maori.

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INTRODUCTION: Bariatric surgery is the most effective intervention for alleviating obesity and its complications. Indigenous people worldwide experience higher rates of obesity and obesity disease burden. However, few studies exploring bariatric surgery among Indigenous peoples are published. In this study we aimed to explore the motivation of Maori women in coming forward for bariatric surgery. METHODS: Maori women who had bariatric surgery prior to December 31, 2014, were invited to participate in semi-structured interpersonal interviews. Kaupapa Maori research, an Indigenous Maori research methodology, informed this study. Interviews were recorded, transcribed and subject to inductive thematic analysis. RESULTS: Twenty-nine Maori women participated in semi-structured interpersonal interviews. The majority of women reported that the presence of obesity-related disease alongside the desire for a better quality of life served as the greatest sources of motivation for having bariatric surgery. Whanau (family) were key for participants achieving the preoperative milestones needed to be accepted for bariatric surgery. Interpersonal experiences of fat-shaming and yo-yo dieting also impacted their choice to have surgery. CONCLUSION: This study is one of the first to describe the motivations of Indigenous Maori women to have bariatric surgery. Our study conveys the importance of health, a desire to have a better quality of life and whanau in motivating Maori women to come forward for bariatric surgery.

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INTRODUCTION: Indigenous peoples suffer high rates of obesity and obesity-related disease worldwide. Currently, bariatric surgery is the most effective intervention for severe obesity and obesity-related disease. The role bariatric surgery plays in alleviating the obesity burden amongst Indigenous peoples is unknown. We aimed to collate studies investigating bariatric surgery in Indigenous peoples and to provide a simple framework to use in future research surrounding this important issue. MATERIALS AND METHODS: We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies that investigated outcomes for Indigenous peoples at any point along the bariatric surgery journey were included. RESULTS: Six articles were included in this review. Three studies investigated access to bariatric surgery and the remaining three studies investigated short to long-term outcomes following bariatric surgery. A narrative review was performed given study heterogeneity and quality of included studies. Indigenous peoples had lower access to bariatric surgery and in one study had greater weight loss in comparison to non-Indigenous peoples. CONCLUSION: Despite a paucity of studies, it appears that there is emerging interest in investigating bariatric surgery among Indigenous peoples. We encourage those who seek to investigate this important issue at any point along the bariatric surgery journey, to do so using an equity-based approach.

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