Randomised Controlled Trial of a holistic needs assessment to enable equity in Aotearoa New Zealand

Abstract Background Large and persistent health inequities exist between Māori (Indigenous) tamariki (children) and non-Māori in Aotearoa New Zealand, stemming from systems failure, unequal access to determinants (e.g. socioeconomic), and siloed, low-quality, unresponsive services. Holistic screening and support during hospital stays may improve outcomes and equity. To determine this, a co-designed Māori-centred holistic programme, Harti Hauora Tamariki (HHT), was developed to promote wellbeing through culturally safe engagement, needs assessment, and service navigation. Methods A randomised controlled trial (RCT) assessed HHT's impact. Primary outcomes were 30-day, 6-month, and 12-month hospital readmissions. Secondary outcomes included care satisfaction and service access within 30 days of discharge: immunisation, primary care enrolment, oral health, referrals for housing support, and smoking cessation. Results The 965 children recruited (485 in the intervention, 480 control) included 56% Māori. No significant difference in 30-day readmission was observed - intervention: 57 (11.7%), control: 56 (11.7%); risk difference +0.04% (-4.02-4.09%), X²=0.00, p = 0.99; adjusted OR 0.99 (0.66-1.49). However, significant gains occurred in secondary outcomes: housing and smoking support, oral health enrolment, unmet need documentation, and overall care satisfaction. Conclusions A robust whānau-centred RCT is feasible in tertiary settings with continuous improvement and adaptation. Although readmission rates did not change, HHT yielded meaningful system-level benefits, access to health determinants and enhanced clinical pathways. Culturally safe, racism-free whānau engagement improved care quality and engagement. HHT delivered equity gains across individual, whānau, and system levels, optimising limited resources for better outcomes. Key messages • Despite complexity within tertiary paediatric health care, a robust and holistic RCT is possible to evaluate interventions and maximise health outcomes and health equity. • Holistic assessment and support systems can enable systems-level improvement, particularly if co-designed with community-level experts and delivered through culturally-safe engagement.