Sally B. Rose

Introduction: Access to effective vaccination is an important way to protect against infectious diseases. The Aotearoa–New Zealand immunisation handbook on safe and effective vaccination practice recommends a 38-mm needle length for intramuscular deltoid injections in very large individuals, using clinical judgment to ensure needle length is appropriate to reach muscle. It is not clear how vaccinators implement this guidance in practice. Aim: This study aimed to explore vaccinators’ needle-length selection practice for big-bodied people and their views on a prototype arm circumference tool to guide needle choice. Method: Vaccinators working with Māori and Pacific communities were recruited via researchers’ networks to take part in one of six in-person focus groups in the Wellington region, Horowhenua district, and Tairāwhiti region (August–October 2025). Data were analysed qualitatively using a reflexive thematic approach. Results: Twenty-five primary care-based vaccinators with varied roles and experience participated. Themes identified in the discussion included prioritisation of patient-centred care, influences on decision making (familiarity with guidance, training, workflow and equipment), and strengthening practice in these areas. The prototype tool was viewed positively, with discussion highlighting its potential to improve familiarity with arm size and needle-length criteria. Practical, workflow, and patient-centred considerations were raised, with particular focus on the importance of communicating use of the tool in a sensitive manner. Discussion: Ensuring adequate supply and availability of 38-mm needles, along with clear guidance and education, are essential to support vaccinators’ clinical judgement and effective vaccine delivery to big-bodied people. Use of an arm circumference assessment tool could strengthen vaccinators’ decision making and help standardise needle length.

Introduction: Data from Aotearoa–New Zealand’s 2021 COVID-19 mass vaccination programme revealed underutilisation of longer 38 mm needles, which are recommended for big-bodied people. This raises health equity concerns because correct needle length is necessary to achieve intramuscular vaccine delivery. Aim: This study aimed to explore vaccinators’ awareness and implementation of needle-length guidance, and to identify barriers and enablers to use of long needles for big-bodied people in New Zealand. Method: Between August and October 2025, an anonymous online survey was distributed to vaccinators in New Zealand through professional organisations with links to vaccinator health professionals. Data collection included demographics, education received on needle-length guidance, barriers and enablers to use of 38 mm long needles, and opportunities to support future practice. Data were summarised using descriptive statistics, and comments summarised using a qualitative descriptive approach. Results: Of 196 respondents, 70% were aware of needle-length guidance and 48.5% recalled receipt of specific information or education about using longer needles. In total, 60% had ever used a 38 mm needle, but only 26% had used a longer needle for at least half of those they thought eligible in the past 12 months. Key barriers to long needle use included supply of vaccines with shorter needle lengths attached, information gaps and uncertainty in determining eligibility for a 38 mm long needle. A total of 62% saw a need for strategies to strengthen their implementation of needle-length guidance. Discussion: A range of strategies need to be implemented across multiple levels (from vaccinators through to policy makers) to overcome these barriers and to support safe and effective vaccine delivery to big-bodied people.

Introduction In 2023, Aotearoa New Zealand’s National Cervical Screening Programme introduced human papillomavirus (HPV) primary screening with the universal option to self-test. This change was informed by a primary care implementation study involving 3308 people due or overdue for cervical screening. Methods A cross-sectional survey conducted in 2023 sought implementation study participants’ perspectives on their experience of HPV primary screening, with separate analysis of responses from indigenous Māori participants - a group historically underserved by the screening programme. Data collection included: information provision, choice of test, receipt of results, screening experience, understanding of HPV testing, future preferences and suggested improvements. Survey data were analysed using descriptive statistics and inductive thematic analysis. Results In total, 176 of 921 survey respondents self-identified as Māori ethnicity (aged 24–70 years) so were included in analyses. Most chose to self-test (94%) for comfort, privacy and convenience and because it supports mana motuhake (self-determination). Good communication and support from the health professional had a positive impact on screening experience. Many felt well informed, but key facts about HPV primary screening were later incorrectly recalled. A minority of participants experienced issues related to implementation, including inadequate education, information or instructions. Future screening intent was high (91.8%), with nearly half (48.2%) wanting to self-test at home. Conclusion HPV self-testing was an acceptable screening method for Māori survey participants. Findings highlight the need for clear, repeated communication and education to improve awareness and understanding of HPV screening. Reducing current inequities in screening and related outcomes will require providers to effectively engage, educate and support Māori into screening.

Introduction: In 2022–2023, a multi-region implementation study (‘Let’s test for HPV’) was undertaken in New Zealand primary care to inform the National Cervical Screening Programme shift to human papillomavirus (HPV) primary screening in September 2023. Aim: This study aimed to describe ‘Let’s test for HPV study participants’ experiences with HPV primary screening. Method: Implementation study participants were invited to complete an anonymous online survey in September 2023. Survey data were summarised using descriptive statistics. Free text comments were analysed using inductive thematic analysis. Results: Forty-two percent of those invited began a survey (969/2302) and 921 were included in analyses. Respondents were aged 24–71, represented each of the three regions of New Zealand and different ethnic groups and included never and under-screened participants. Most people chose to self-test for comfort, convenience and privacy. Gaps were identified in participant understanding about HPV, how HPV testing differs from cervical cytology and the implications of HPV test results. Key topics requiring further explanation were identified by participants. Around 8% did not find self-testing easy or comfortable. Intent to screen again was high (92.4%), with greater preference for self-testing at home (48.2%) over the GP practice (33.5%). Discussion: HPV primary screening incorporating the option to self-test was highly acceptable to primary care-based study participants. Despite having participated in the new pathway, knowledge gaps were evident. Clear communication from screen-takers will be key to support participant knowledge, understanding and confidence in the efficacy of HPV primary screening. Ongoing programme evaluation, including patients’ perspectives, will be essential in the pursuit of equity and progress towards cervical cancer elimination.

Background: Human papillomavirus (HPV) testing became the primary cervical screening modality in Aotearoa New Zealand in September 2023. To inform the national roll‐out of HPV primary screening, a multiregion implementation study (‘Let's Test for HPV’) was undertaken in primary care in 2022–2023.Aims: To explore participant perspectives and information needs following receipt of an HPV detected result.Materials and methods: An online survey completed in 2023 by 921 Let's Test for HPV participants included 95 people with an HPV detected result (10.3%). Data collection included: adequacy of information provision, receipt of results, emotional response, views on HPV primary screening and needing cervical cytology and/or colposcopy, and intent to screen again.Results: Receipt of an HPV detected result was worrying for most people and many had unanswered questions about HPV, how HPV testing fits with cytology, implications for follow‐up and outcomes. Knowledge gaps and uncertainty appeared to be linked with feeling anxious about possible outcomes and fear of a cancer diagnosis. All survey participants received recommended follow‐up (cytology and/or colposcopy). Having a choice of screening test and the ability to self‐test were welcomed and the majority (88%) expressed intent to screen again.Conclusions: These survey findings highlight the importance of giving clear information about potential outcomes at the time of screening and again when sharing results. Sensitive delivery of results, providing reassurance and answering questions are also important to mitigate fear and worry. Population‐level education would help improve understanding of key messages about HPV testing and the changes to cervical screening.

Introduction: Aotearoa New Zealand’s National Screening Unit (NSU) moved to use of human papillomavirus (HPV) primary screening in November 2023. Aims: This study aimed to evaluate participants’ views on favourable and unfavourable elements of HPV primary screening and to seek suggestions for potential improvements. Method: Primary care participants in a multi-region HPV primary screening implementation study were invited to complete an online follow-up survey in September 2023. This paper reports on qualitatively analysed responses to open-ended questions asking participants what they liked, disliked or thought could be improved for future screening participants. Results: Of 2361 invitations sent, 2302 were delivered, 969 people consented to participate and 921 were included in analyses (40%, 921/2302). Respondents were 24–71 years of age, from three regions, different ethnic groups and included under-screened participants. Most had chosen to self-test (92%) and 28.9% self-tested at home. Three quarters shared comments about what they liked, with themes related to ability to self-test, avoiding cervical tests, choice, communication and support. Twenty percent described unfavourable aspects, with themes related to inadequate information, self-testing issues, inappropriate physical space and process and programme-related factors. Seven key recommendations were identified from suggestions about potential improvements for future screening participants. Conclusion: Survey participants’ experience of HPV primary screening was overwhelmingly positive, with choice of a self-test a clear benefit for most. Inadequate information or communication contributed to suboptimal experiences for some. Participant recommendations highlight practical steps screen-takers (and the NSU) could take to ensure screening participants receive a well-informed, affirming experience that supports ongoing participation in cervical screening.

Background: Māori and Pacific young people are disproportionately impacted by sexually transmitted infections (STIs). Access to STI screening is important to reduce transmission and reproductive health complications. Methods: Between November 2022 and May 2023, we held four wānanga (workshops) with Māori and Pacific participants (15–24 years old) to find out what barriers they encounter to STI testing, and hear their ideas about how to overcome these. Participants were recruited via youth-focused community organisations in the Wellington region of Aotearoa New Zealand. Inductive thematic analysis was used to understand data generated from discussions, drawing on Māori and Pacific models of wellbeing to frame themes. Results: Thirty-eight participants were involved in the wānanga. Barriers to STI testing related to five themes: (1) differences in cultural values and expression; (2) family/friends; (3) educational gaps; (4) psychological factors; and (5) structural obstacles. Suggested strategies to improve access to sexual health care included the need for free, flexible services, education and health promotion activities to reach young people in their spaces (e.g. church, marae, social media). Participants stressed the need for approaches to be community-based, delivered by trusted individuals using culturally appropriate messages, and saw participation in STI testing as beneficial for whānau/family and communities. Conclusions: To improve access to STI testing, participants described the need for free services, together with education and health promotion to improve inter-generational sexual health knowledge. Reframing messages around STIs to align with Māori and Pacific models of wellbeing was identified as a way to normalise conversations, in turn reducing the stigma surrounding STI testing.

Introduction: Gender affirming hormone therapy (GAHT) is an important aspect of health care for many transgender and non-binary (TNB) people, but little is known about the long-term outcomes for TNB people in Aotearoa New Zealand (NZ). Pathways to access GAHT are shifting from secondary care towards primary care, so this is an opportune time to commence local research on long-term health and wellbeing outcomes for people initiating GAHT. Aim: This paper aims to report on the key findings from four meetings held to inform the design of a prospective cohort study to follow the journey of people initiating GAHT in primary and secondary care settings in NZ. Methods: We worked with a community advisory group of six TNB young people and sought input from 14 health care providers involved in the care of TNB people initiating GAHT (GPs, secondary care doctors, and mental health providers). Semi-structured interview schedules were used to guide discussions. Template analysis was used to initially code data based on themes identified from the interview schedule and new themes from discussions were added. Results: Participants shared ideas about recruitment and data collection priorities for baseline and follow-up surveys. These included understanding the journey to starting hormone therapy (information-seeking, decision-making), access to services for GAHT initiation, appropriateness of information provision, receipt of the first prescription, goals for and experience of GAHT, and the unique needs of non-binary people. Discussion: Input from a TNB advisory group and health care professionals has informed the development of a survey that will be used to understand the experience of, and outcomes for, people starting GAHT in NZ. Findings from this planned prospective cohort study have the potential to improve access to GAHT for TNB people who wish to pursue this option.

Introduction: International research suggests free online postal self-sampling for sexually transmitted infection (STI) testing is an acceptable alternative to clinic-based testing. A user-pays online STI testing service exists in Aotearoa New Zealand, but acceptability among priority populations is unknown. Aim: To explore Māori and Pacific young people’s perspectives on online postal self-sampling for STI testing (as prospective service users). Methods: Four wānanga (knowledge-sharing forum) were held between November 2022 and May 2023 with Māori and Pacific participants aged 15–24 years who were recruited via youth-focused community organisations. Three facilitators guided discussions about STI testing and use of an online service. Inductive thematic analysis was used to analyse data generated from audio-recorded discussions, group work notes and facilitator field notes. Results: None of the 38 participants were aware of online STI testing and all considered it cost-prohibitive. Perceptions of online testing were mixed, and discussion about concerns outweighed perceived benefits. Three themes were identified: (i) potential to support autonomy (perceived benefits and positive features of self-sample collection kits); (ii) barriers and process-related concerns; and (iii) tailoring online STI testing to young people’s needs (facilitating engagement with online testing). Discussion: For online STI testing to be an accessible alternative to clinic-based testing for priority populations, cost, low awareness and other barriers in the testing pathway need to be addressed. Clinician follow-up on positive results and free treatment would be critical to ensure the cycle of best practice care is completed. Regardless of where testing is accessed, investment is needed to support young people’s knowledge of when, why and how to access a sexual health check.

Background: Rainbow young people (RYP; people of diverse genders, sexualities, and variations in sex characteristics) face barriers accessing primary care, often report negative experiences and the need to educate clinicians on rainbow-specific issues. This study explores general practice staff views and experiences of providing care to RYP. Methods: Three focus groups were held with staff from 5 general practices in an urban area of Aotearoa New Zealand (25 participants in total). Practices were purposively selected to include some known to be more “rainbow-friendly” seeing larger numbers of RYP and some with no particular focus on RYP. All members of each practice were invited to participate, including administration and reception staff. Focus groups were audio-recorded, transcribed, and analysed in NVivo using inductive thematic analysis. Results: Four main themes were identified: (i) Practice experience, (ii) Feeling awkward, (iii) Knowledge and training, and (iv) Structural barriers. Differences were apparent in health provider knowledge, comfort, and experience in providing care to RYP. Participants identified a lack of knowledge and training and wanted more resources and education. Systems limitations were common (e.g. with IT systems for recording gender) and often contributed to awkward clinical encounters. Conclusions: Participants recognized shortcomings in their training, knowledge, and level of confidence providing care to RYP and expressed a desire to improve their competency. Further work is needed to identify and trial practical strategies that help improve communication skills, knowledge, and the delivery of more equitable healthcare to RYP.