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Evidence Base 2: STI Service Providers

STI testing and treatment services take place across a range of primary care organisations1, some of which are specialised STI services, and others, like GP medical centres, which offer STI testing and treatment as part of a range of primary health services. In the greater Hamilton region, free STI testing and treatment services are available at Hamilton Sexual Health Services, while Family Planning, Hamilton offers free testing for young people up to 22 years of age. Meantime, the cost of an appointment at any of the GP medical centres that are part of the Midland Health Network and the Hauraki PHO varies depending upon the medical centre, the person’s age, whether the person is enrolled, and whether the medical centre is part of a PHO.

1. Organisational Health Literacy Strategy with Priority Population Identified

Health professionals and organisations have a key role in building the health literacy of Māori communities as part of their efforts towards achieving health equity (Signal, Martin, Cram & Robson, 2008) . However, in order to improve the health literacy of priority populations such as rangatahi NEET and takataapui, health organisations must improve their own health literacy. Although sexual health organisations may have a strategic plan that prioritises eliminating inequities and delivering services in areas of greatest need, they should also have a strategy that prioritises organisational health literacy so as to engage rangatahi NEET and takataapui.

I think the major barrier is people navigating services; having the health literacy to self-care, but then also how to access care when you actually need help. And we had lots of great ideas and they looked at it all and said, ‘There is no money for sexual health.’

I couldn’t find anything for [organisational health literacy]. . . We’ve got various position statements . . . [but] we don’t have one for health literacy.


Signal L, Martin J, Cram F and Robson B. (2008). The Health Equity Assessment Tool: A user’s guide. Wellington: Ministry of Health.

2. Professional Development Advances Organisational Health Literacy

Research shows that health professionals have a limited understanding of health literacy, and of the consequences of low health literacy, particularly for high priority groups (Lambert et al., 2014). Very few health professionals report having received any training in health literacy approaches (Jones et al., 2015), including the development of information resources that match group needs (Witt & Barnett, 2012). In order to improve their health literacy, health professionals require training that includes cultural competency,  reducing systemic barriers, and developing accessible information resources that are tailored to patients with high health literacy needs.

Last year, [XX] did a health literacy for clinicians, a ‘train the trainers’ `session . . .Sometimes the training’s been done with the health promoters, helping with the facilitation skills, because . . . our senior doctors and nurses . . . may not be particularly good facilitators. And so that’s another thing, we need to make sure that they have some facilitation training.

In terms of the public facing information, we haven’t followed that up as well. And trying to wean people away from providing reams of knowledge at a person, I’m finding really hard. And some people then, if they do cut it down, somebody says, ‘Oh why didn’t you talk to them about that?’


Jones B., Ingham T. R., Reid S., Davies C., Levack W. and Robson B. (2015). He māramatanga huangō: Asthma health literacy for Māori children in New Zealand. Dunedin, NZ: University of Otago. Available from

Lambert, M., Luke, J., Downey, B., Crengle, S., Kelaher, M., Reid S., & Smylie, J. (2014). Health literacy: Health professionals’ understandings and their perceptions of barriers that Indigenous patients encounter. BMC Public Health, 14(614). Retrieved from

Witt, M., & Barnett, P. (2012). Assessing the capacity of New Zealand health promoters to develop programs that meet the health literacy needs of both consumers and government. Health Promotion Journal of Australia, 23, 117-121. Available from

3.  Information Resources That Match The Health Literacy of Rangatahi NEET and takataapui

Health literacy is an important contributor to knowledge, self-management, and health outcomes (Crengle, Smylie, Kelaher, Lambert, Reid, Luke, Anderson, Harré, Hindmarsh & Harwood, 2014). A critical aspect of improving organisational health literacy is developing accessible information resources that are tailored to the the health literacy needs of the priority population (Cram, 2014; Lambert et al., 2014). Recent research shows that rangatahi  NEET and takataapui respond to resources that provide succinct information about STI testing, treatment and where to find those services, ideally in an audio-visual format, rather than extensive text-based resources (Waiti & Green, 2014). Incorporating rangatahi NEET and takataapui perspectives into the planning and development of website narratives and information resources increases the likelihood of information uptake (Waiti & Green, 2014).

We have got a hand-out . . . it’s not specifically about them, but it talks about the significance of a partner. It’s pretty high literacy at the moment, and that’s another of our projects we haven’t got very far with yet, which is lowering the literacy level so that it’s a bit easier for some people.

We’ve been doing quite a bit of health literacy training lately, and one of the things that I have been most struck with was the idea that there should be 3 to 5 key messages and no more than that. And I strongly believe that [our organisation] has become so keen that we know everything about whatever, that people lose the wood for the trees. And so that’s the thing that we want to work out, what are your key messages when you’ve got chlamydia.

If they come to a drop-in . . . near the end of the time, when there just won’t be time to see them, then we’re hoping that we will be able to . . . get them to answer a questionnaire, which we tried really hard to keep simple, and we’ve tried it with some clients to see, as to whether they’ve got symptoms or not, and then they’re going to be given instructions on how to do the test.


Cram, F. (2014). Improving Māori access to health care: Research report. Auckland: Katoa Ltd.

Crengle, S., Smylie, J., Kelaher, M., Lambert, M., Reid, S., Luke, J., Anderson, I., Harré Hindmarsh, J., & Harwood, M. (2014). Cardiovascular disease medication health literacy among Indigenous peoples: design and protocol of an intervention trial in Indigenous primary care services. BMC Public Health, 14(714).

Lambert, M., Luke, J., Downey, B., Crengle, S., Kelaher, M., Reid S., & Smylie, J. (2014). Health literacy: Health professionals’ understandings and their perceptions of barriers that Indigenous patients encounter. BMC Public Health, 14(614). Retrieved from

Lawton, B., Makowharemahihi, C., Cram, F., Robson, B., & Ngata, T. (2016). E Hine: access to contraception for indigenous Māori teenage mothers. Journal of Primary Health Care, 8(1), 52-59. Available from

Waiti, J. & Green, J. (2014). Planning a national STI website that appeals to young Māori. Available at:

4. IT Resources Should Reduce, Not Increase Inequities

The health sector is currently trialing new or ‘non-traditional’ models of care. These include IT tools in the form of smart phone apps, online consultations and information portals. Rangatahi have identified audio visual resources as a preferred medium for accessing information, however it is imperative that IT resources are accessible to rangatahi NEET and takataapui and are effective in reducing rather than increasing inequalities. A report for Waikato District Health Board identified 33% of Māori households as having no internet access and 13% having no mobile phone (Robson et al, 2015).

You know, the technology is there, [but] . . .the clinicians aren’t up to speed with it yet and the population certainly isn’t. So I think . . . it’ll be a lot of change coming up. There are definitely opportunities [with IT resources] for us to look at how we better deliver services, but I think we have to be really, really careful that it’s not the people who already have advantage that get even more advantage. And I think that’s a real risk.

So we’ve been asked to work with the tools that we have. This is why I have concern about whether what is current health literacy amongst this priority group, and the ability to use the [IT] tools that [the organisation] is saying are simple enough, are ‘simple, easy and exactly what people want’. So, will people feel comfortable with the app? Do people have smart phones? Do people have broadband access? And enough data? And, and, and


Robson, B., Purdie, G., Simmonds, S., Waa, A., Brownlee, G., Rameka, R. (2015). Waikato District Health Board  Māori Health Profile 2015. Wellington: Te Rōpū Hauora a Eru Pomare.

  1. Hamilton Sexual Health Services, Family Planning clinics, Midland PHO, and Hauraki PHO