Data application form

Section 1: Your research

Research title

Researchers/investigators

Please enter the details of the lead researcher.

Name:

Role:

Responsibility:

Please enter the name, role and responsibilities of each research team member. If this is a supervised study, include the names and qualifications of supervisors.

List your employer and, if this project is related to study, your host institution:

Research question(s):

Proposed start date:

Proposed finish date:

Abstract (max 200 words).

*Study protocol (upload your study protocol here [max 10 pages]).

Prioritisation

*Please reference He Puna Whakatau (see page 10 of the guide) in your responses to the following questions.

Why did you decide to research this area?*

Why should this proposed research be an area of interest to the He Mutunga Kore | National Mortality Review Committee?*

Knowledge generation. Describe what is already known, where the topic area is a known area of variation/inequity and the opportunities for impact.*

Interrogation. Describe where the known inequities lie, how the system works better for certain groups and the related underlying mechanism driving the inequity.*

Decision-making. How will your research team contribute to the identified area of interest, including practical and policy opportunities?*

Section 2: The data

Data required

Describe specifically the data you are requesting. A complete list of data fields is not required here. However, you should only request data that can be related directly to addressing the research question(s) and adequately justify their selection.*

Please clearly specify the following requirements and tick the boxes to indicate the data you require.

Type of mortality/subject area:

Year range:

Age range:

International Classification of Diseases (ICD)/Perinatal Society of Australia and New Zealand (PSANZ) codes (perinatal mortality only)

Ethnicity data

Prioritised ethnicity

Ethnicity data

In the second question, you will need to refer to these mandatory Health New Zealand |Te Whatu Ora health sector protocols.

Describe how you will report ethnicity data.

Describe how the mandatory Health New Zealand| Te Whatu Ora health sector protocols for outputting ethnicity data will be followed.

Section 3: Data governance

Researchers must consider Māori data governance and its implications for their research. Māori data governance pou will be considered by the national mortality review function management group when assessing applications. Please reference Te Pou – Māori responsive rubric when answering the following question.

Indicate the degree to which the study can contribute to Māori health outcomes.

*Provide evidence on organisational processes around data governance, including Māori data governance and oversight, as follows. If you are not working with Māori data, please enter ‘NA’ so you can progress through the form.

Rangatiratanga | authority

Control: provide information on researcher processes around data governance, including Māori data governance and oversight.*

Jurisdiction: provide information on where data is stored and who the provider is.*

Whakapapa | relationships

Context: provide information about where NMRC data will be used in conjunction with other data.*

Data disaggregation: provide information about how ethnicity data will be disaggregated in any analysis or reporting.*

Whanaungatanga | obligations

Accountability: detail your accountability mechanisms to Māori.*

Sign-off: agree to provide findings/results to the national mortality review function management group for sign-off prior to dissemination or publication.*

Kotahitanga | collective benefit

Benefit: provide information about the benefit for Māori from use of Māori data and how any potential data harms will be mitigated.*

Build capacity: provide information about Māori involvement as researchers or advisors in any research or monitoring applications.*

Manaakitanga | reciprocity

Respect: provide information about how research will be presented in a way that does not enhance negative stereotypes or stigmatise individuals, whānau or communities and is respectful of those whose data is being used.*

Consent: provide information in any research or monitoring applications about consent received for any Māori data being used in conjunction with NMRC data.*

Section 4: Ethics, conflicts of interest and data storage

*Please indicate the status of your ethics application.

Please attach a copy of your letter of approval.

Please explain the process you intend to follow, including the authorising agent and anticipated timeframe

Conflicts of interest and management plan

Please specify any actual or potential conflicts of interest regarding your research and this application and describe how this conflict of interest will be managed.*

Data storage

*Describe how you will comply with the 5 safes framework.

Safe people:*

Safe projects:*

Safe settings:*

Safe data:*

Safe output:*

Other information

List any external funders or other individuals/organisations associated with this research.*

Policy and procedure requirements

Confirm you are aware of each of the following requirements.

Acknowledgement of requirements

All named investigators must sign this form to acknowledge they have read, understood and will meet the requirements outlined in the associated data access policy and application guide. Please print, sign and upload it below.

The new harm (adverse) event submission portal is now live

The new harm (adverse) event submission portal is now live

Data application form

Section 1: Your research

Researchers/investigators

Prioritisation

Section 2: The data

Data required

Ethnicity data

Section 3: Data governance

Rangatiratanga | authority

Whakapapa | relationships

Whanaungatanga | obligations

Kotahitanga | collective benefit

Manaakitanga | reciprocity

Section 4: Ethics, conflicts of interest and data storage

Conflicts of interest and management plan

Data storage

Other information

Policy and procedure requirements

Acknowledgement of requirements