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      Addressing indigenous health workforce inequities: A literature review exploring 'best' practice for recruitment into tertiary health programmes

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          Abstract

          Introduction

          Addressing the underrepresentation of indigenous health professionals is recognised internationally as being integral to overcoming indigenous health inequities. This literature review aims to identify 'best practice' for recruitment of indigenous secondary school students into tertiary health programmes with particular relevance to recruitment of Māori within a New Zealand context.

          Methodology/methods

          A Kaupapa Māori Research (KMR) methodological approach was utilised to review literature and categorise content via: country; population group; health profession ffocus; research methods; evidence of effectiveness; and discussion of barriers. Recruitment activities are described within five broad contexts associated with the recruitment pipeline: Early Exposure, Transitioning, Retention/Completion, Professional Workforce Development, and Across the total pipeline.

          Results

          A total of 70 articles were included. There is a lack of published literature specific to Māori recruitment and a limited, but growing, body of literature focused on other indigenous and underrepresented minority populations.

          The literature is primarily descriptive in nature with few articles providing evidence of effectiveness. However, the literature clearly frames recruitment activity as occurring across a pipeline that extends from secondary through to tertiary education contexts and in some instances vocational (post-graduate) training. Early exposure activities encourage students to achieve success in appropriate school subjects, address deficiencies in careers advice and offer tertiary enrichment opportunities. Support for students to transition into and within health professional programmes is required including bridging/foundation programmes, admission policies/quotas and institutional mission statements demonstrating a commitment to achieving equity. Retention/completion support includes academic and pastoral interventions and institutional changes to ensure safer environments for indigenous students. Overall, recruitment should reflect a comprehensive, integrated pipeline approach that includes secondary, tertiary, community and workforce stakeholders.

          Conclusions

          Although the current literature is less able to identify 'best practice', six broad principles to achieve success for indigenous health workforce development include: 1) Framing initiatives within indigenous worldviews 2) Demonstrating a tangible institutional commitment to equity 3) Framing interventions to address barriers to indigenous health workforce development 4) Incorporating a comprehensive pipeline model 5) Increasing family and community engagement and 6) Incorporating quality data tracking and evaluation. Achieving equity in health workforce representation should remain both a political and ethical priority.

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          Most cited references 56

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          "Not a university type": focus group study of social class, ethnic, and sex differences in school pupils' perceptions about medical school.

          To investigate what going to medical school means to academically able 14-16 year olds from different ethnic and socioeconomic backgrounds in order to understand the wide socioeconomic variation in applications to medical school. Focus group study. Six London secondary schools. 68 academically able and scientifically oriented pupils aged 14-16 years from a wide range of social and ethnic backgrounds. Pupils' perceptions of medical school, motivation to apply, confidence in ability to stay the course, expectations of medicine as a career, and perceived sources of information and support. There were few differences by sex or ethnicity, but striking differences by socioeconomic status. Pupils from lower socioeconomic groups held stereotyped and superficial perceptions of doctors, saw medical school as culturally alien and geared towards "posh" students, and greatly underestimated their own chances of gaining a place and staying the course. They saw medicine as having extrinsic rewards (money) but requiring prohibitive personal sacrifices. Pupils from affluent backgrounds saw medicine as one of a menu of challenging career options with intrinsic rewards (fulfillment, achievement). All pupils had concerns about the costs of study, but only those from poor backgrounds saw costs as constraining their choices. Underachievement by able pupils from poor backgrounds may be more to do with identity, motivation, and the cultural framing of career choices than with low levels of factual knowledge. Policies to widen participation in medical education must go beyond a knowledge deficit model and address the complex social and cultural environment within which individual life choices are embedded.
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            Disparities in indigenous health: a cross-country comparison between New Zealand and the United States.

            We compared the health statuses of the indigenous populations of New Zealand and the United States with those of the numerically dominant populations of these countries. Health indicators compared included health outcome measures, preventive care measures, modifiable risk factor prevalence, and treatment measures. In the case of nearly every health status indicator assessed, disparities (both absolute and relative) were more pronounced for Maoris than for American Indians/Alaska Natives. Both indigenous populations suffered from disparities across a range of health indicators. However, no disparities were observed for American Indians/Alaska Natives in regard to immunization coverage. Ethnic health disparities appear to be more pronounced in New Zealand than in the United States. These disparities are not necessarily intractable. Although differences in national health sector responses exist, New Zealand may be well placed in the future to evaluate the effectiveness of new strategies to reduce these disparities given the extent and quality of Maori-specific health information available.
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              The association of doctor-patient race concordance with health services utilization.

              We examined a national sample of African-American, white, Hispanic, and Asian-American respondents to test the hypothesis that when patients are race concordant with their physicians, they are more likely to utilize health services. The analysis used the 1994 Commonwealth Fund Minority Health Survey to construct a series of multivariate models. Using three dimensions of health services utilization, we found support for the hypothesis. Compared to patients whose regular doctors are of a different race, patients who are of the same racial or ethnic group as their physicians were more likely to use needed health services (OR=.62; 95% CI .46, .81); were less likely to postpone or delay seeking care (OR=.78; 95% CI .65, .94); and reported a higher volume of use of health services (OR=2.68; 95% CI 2.07, 3.45). Analysis within race-specific sub-samples found this pattern to be most consistent among white and African-Americans and less prevalent among Hispanic and Asian-Americans. Adjusting the models for health status and a variety of other known predictors of health care utilization did not substantially affect the relationship between doctor-patient race concordance and health services use.
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                Author and article information

                Journal
                Int J Equity Health
                Int J Equity Health
                International Journal for Equity in Health
                BioMed Central
                1475-9276
                2012
                15 March 2012
                : 11
                : 13
                Affiliations
                [1 ]Te Kupenga Hauora Māori (Department of Māori Health), Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
                Article
                1475-9276-11-13
                10.1186/1475-9276-11-13
                3402985
                22416784
                Copyright ©2012 Curtis et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Research

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