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    What are the effects of Ngā Kōti Rangatahi on the health and wellbeing of rangatahi and their whānau who enter this system? : a thesis submitted for the degree of Doctor of Philosophy at Massey University, Palmerston North, New Zealand
    (Massey University, 2024-07-28) Findlay, Eru
    In the last two decades, Aotearoa New Zealand has established a judicial system in Māori communities. These establishments are termed Ngā Kōti Rangatahi (NKR), also known as Marae Youth Courts. The primary role of the establishment is to arrest the increase in crime by creating an environment that leads to a decrease in Māori youth reoffending nationally (The Justice and Electoral Committee, 2017). Rangatahi, youth aged 14 to 16 years of Māori ethnicity, are currently appearing in the New Zealand justice system more than any other ethnic group – and this is increasing (Ministry of Justice, 2017). There are many reasons why this is occurring, and the reasons can be broad and range from the individual experience to social conditions, or universal trends. The objective of this research was to investigate the effectiveness of NKR on the health and well-being of rangatahi and their whānau (families that take care of the wellbeing of Māori youth). This research also explored the relationship between youth offending and contemporary Māori socialization processes to identify customary approaches in Te Ao Māori and their relevance to contemporary views on what counts as justice for Māori. It looked at the theoretical perspectives which underpin NKR and examined the involved processes and their effects on rangatahi and their whānau. In doing so, this research assessed the potential of NKR to impact wellbeing as an alternative to the mainstream youth court system via the implementation of Durie's (1984) Te Whare Tapa Whā model as a holistic approach to NKR. Drawing on a mixed methods qualitative approach this study was conducted with NKR professionals, NKR youth, and their whānau. The research found that rangatahi and their whānau experienced health outcomes that corresponded with the four dimensions of Te Whare Tapa Whā model; physical, psychological, spiritual, and familial.
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    He Hauora! He Hauoro! : the use of taonga pūoro in hauora Māori : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Palmerston North, New Zealand
    (Massey University, 2023-11-05) Solly, Ruby
    Taonga pūoro, often referred to as the traditional musical instruments of the Māori, hold a deeper significance beyond their musicality. Before colonisation, taonga pūoro were integral to Māori wellbeing and health practices. However, during the period of the Tohunga Suppression Act from 1907 to 1962, taonga pūoro were banned and forced underground. The 1980s saw a revival of taonga pūoro, marking the beginning of a renaissance phase. This resurgence has increased their use by clinicians without whakapapa Māori or those with limited experience in their use. This research aims to explore these factors in greater depth, recognising the dangers associated with the professionalisation of taonga pūoro in the context of hauora. A kaupapa Māori approach was used to examine the uses, philosophies, histories, and practitioners of taonga pūoro within hauora to create a framework of models for Māori hauora practitioners and relevant groups. This qualitative design utilised mātauranga Māori as epistemology and whakapapa as ontology, acknowledging the interconnected nature of te ao Māori and the discipline. The first study, ‘Ngā Pou o Pūoro,’ involved interviews with important figures within taonga pūoro ki hauora. Key themes from this study were te taiao (the environment), pūoro as a means of communication, the role of wāhine as kaitiaki pūoro, and the significance of tīpuna and whakapapa. The findings from this study were translated into the ‘He Hauora! He Hauoro!’ framework for taonga pūoro ki hauora. This framework consists of five models, each focusing on different knowledge areas within taonga pūoro ki hauora, such as practitioner safety, mana wāhine, environment, and experimentation. The framework was then applied in the second study, ‘Taonga Pūoro ki Waihao,’ within a marae-based community context during a wānanga series for whānau. Themes of mana wāhine and wāhine as kaitiaki of taonga pūoro were found to be crucial, along with the relationship with the environment and Indigenous joy. Implications of this research include the use of the ‘He Hauora! He Hauoro!’ framework by Māori and Māori health organisations, including the inclusion of taonga pūoro ki hauora practitioners within hospitals and other public health services as part of the integration of rongoā Māori into healthcare. Recommendations include further research to explore how taonga pūoro can support those with specific health conditions and better enhance overall hauora needs. The research also advocates for increased measures to safeguard taonga pūoro practices for Māori. It is suggested that a form of school or kura be developed to assist with disseminating this knowledge for all Māori, focusing on wāhine, and assisting practitioner development.
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    Kaumātua Mana Motuhake Pōi: a study protocol for enhancing wellbeing, social connectedness and cultural identity for Māori elders.
    (BioMed Central, 2020-10-02) Hokowhitu B; Oetzel JG; Simpson ML; Nock S; Reddy R; Meha P; Johnston K; Jackson A-M; Erueti B; Rewi P; Warbrick I; Cameron MP; Zhang Y; Ruru S
    BACKGROUND: The Aotearoa New Zealand population is ageing accompanied by health and social challenges including significant inequities that exist between Māori and non-Māori around poor ageing and health. Although historically kaumātua (elder Māori) faced a dominant society that failed to realise their full potential as they age, Māori culture has remained steadfast in upholding elders as cultural/community anchors. Yet, many of today's kaumātua have experienced 'cultural dissonance' as the result of a hegemonic dominant culture subjugating an Indigenous culture, leading to generations of Indigenous peoples compelled or forced to dissociate with their culture. The present research project, Kaumātua Mana Motuhake Pōī (KMMP) comprises two interrelated projects that foreground dimensions of wellbeing within a holistic Te Ao Māori (Māori epistemology) view of wellbeing. Project 1 involves a tuakana-teina/peer educator model approach focused on increasing service access and utilisation to support kaumātua with the greatest health and social needs. Project 2 focuses on physical activity and cultural knowledge exchange (including te reo Māori--Māori language) through intergenerational models of learning. METHODS: Both projects have a consistent research design and common set of methods that coalesce around the emphasis on kaupapa kaumatua; research projects led by kaumātua and kaumātua providers that advance better life outcomes for kaumātua and their communities. The research design for each project is a mixed-methods, pre-test and two post-test, staggered design with 2-3 providers receiving the approach first and then 2-3 receiving it on a delayed basis. A pre-test (baseline) of all participants will be completed. The approach will then be implemented with the first providers. There will then be a follow-up data collection for all participants (post-test 1). The second providers will then implement the approach, which will be followed by a final data collection for all participants (post-test 2). DISCUSSION: Two specific outcomes are anticipated from this research; firstly, it is hoped that the research methodology provides a framework for how government agencies, researchers and relevant sector stakeholders can work with Māori communities. Secondly, the two individual projects will each produce a tangible approach that, it is anticipated, will be cost effective in enhancing kaumātua hauora and mana motuhake. TRIAL REGISTRATION: Australia New Zealand Clinical Trial Registry ( ACTRN12620000316909 ). Registered 6 March 2020.
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    Theorising Māori health and wellbeing in a whakapapa paradigm : voices from the margins : a thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy in Communication and Journalism at Massey University, Te Kunenga ki Pūrehuroa, Center for Culture-Centered Approach to Research and Evaluation (CARE)
    (Massey University, 2022) Elers, Christine
    This thesis explores communication infrastructures at the margins of Indigeneity to understand Māori health and wellbeing meanings, challenges, strategies and solutions, articulated by whānau whose voices have been ignored, or not sought. Māori health and wellbeing understandings, forged amidst ongoing colonial processes of socioeconomic and health inequities, are best articulated by Māori with these lived experiences. The communication platforms established by the settler colonial state are infused with power dynamics that determine the communication rules including who can speak, what can be said and how that should be delivered. The privileging of communicative spaces to experts, leaders, and community champions, shaped by the underlying ideology of whiteness that organises the settler colonial state, forecloses the space to those not fitting these categories. Māori health and wellbeing meanings emphasise the totality of Whakapapa as a basis for communicating health and wellbeing. Kaupapa Māori theory, and Whakapapa as a super-connector of relationships both in the spiritual and physical domains, anchored the research. Rooted in Māori epistemology, the enduring intergenerational relationship between health and land formed the basis for the participants’ understandings of health and wellbeing. Positioned also in dialogue with the Culture-Centered Approach (CCA), we foreground whānau voices through the co-creation of voice infrastructures at the margins of Indigeneity, with whānau members candidly sharing lived experiences navigating health and wellbeing through the establishment of the Feilding advisory group. The interplay of land, rivers and health is a dominant theme. Strategies for improving health and wellbeing include co-creating communicative infrastructures, such as platforms for voices to emerge at the margins of Indigeneity. The campaigns documented buttress the importance of regaining stolen land, (re)connecting to land through the collective establishment of māra kai with the advisory group. Indigenous communication infrastructures disrupt hegemonic, top-down configurations of health and wellbeing campaigns, providing the impetus for localised strategies to emerge into mainstream communicative spaces. Voice and the right for the “margins of the margins” to be listened to by the Crown are also included as taonga in article two, Te Tiriti o Waitangi. The co-creation, resource sharing and decision-making about communicative infrastructures can be harnessed to drive health equity.
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    Measuring Māori identity and health : the cultural cohort approach : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Palmerston North, Aotearoa New Zealand
    (Massey University, 2023) Stevenson, Brendan
    Current statistical methods of disaggregating populations by ethnic or cultural identity wrongly assume cultural invariance within an ethnic population over time and place. Calculating risk factors between ethno-cultural populations also wrongly assumes homogeneity of risk, obscuring what may be distinct sub-populations with very different demographics, risk profiles, and health outcomes. The Cultural Cohort Approach (CCA) proposes a novel method for understanding within-ethnic population difference, whereby cultural identity is framed as the enduring membership of multiple related cultural cohorts, rather than the contextual and unstable measure of ethnic group affiliation currently used. It predicts that multiple cultural cohorts exist inside an ethno-cultural population, that these cultural cohorts are resilient and culturally distinct, exist over generations, and can divide at pre-existing social or economic stratifications in response to powerful external forces. The cultural cohort approach unites history, extant identity theories and research to identify and describe these within-ethnic cultural cohorts. The measurement of a Māori cultural cohort joins existing Māori identity research, historical documents, and personal accounts to enumerate distinct Māori cultural cohorts, describe relationships between cultural cohorts, and exclude unrelated cultural cohorts. Across three distinct components of this thesis the Cultural Cohort Approach (CCA) is first described and a worked example of its use in identifying Māori cultural cohorts given. Second, these hypothesised cultural cohorts were mapped to a cross-sectional data collection wave of Māori participants (n=3287, born between 1941 and 1955) from Massey University’s longitudinal Health, Work and Retirement (HWR) study in a test of the CCA’s predictive accuracy using latent class analysis. Third, longitudinal HWR study data for Māori participants (n=1252, born between 1941 and 1955) was used in a second worked example to test the stability of the predicted cultural cohorts using latent transition analyses and further refine the CCA. The Māori cultural cohorts identified using the CCA had clear narratives, shared cultural characteristics, and identifiable cultural differences that persisted across time as predicted. The CCA will allow researchers to better represent the diverse lived realities of ethno-cultural populations and support more nuanced analytical insights into how health and well-being is patterned between distinct cultural cohorts.
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    Mā te whiritahi, ka whakatutuki ai ngā pūmanawa ā tāngata = Together weaving the realisation of potential : exploring the social, cultural and health benefits of whānau-centred initiatives : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Health Science at Te Kunenga ki Pūrehuroa (Massey University), Manawatū, Aotearoa New Zealand
    (Massey University, 2022) Reweti, Angelique
    The persistence of Māori health inequities, exacerbated by deficit narratives, underscores the importance of conducting research on the strengths and capabilities whānau possess and use in their daily lives in order to actively rethink and redesign health promotion practice in Aotearoa New Zealand in a way that will be beneficial for whānau. Focusing on health promotion within an Indigenous context, this thesis synthesises results from three case studies about whānau-centred initiatives where Māori (Indigenous to New Zealand) values and practices are foundational. A kaupapa whānau research framework, developed in collaboration with whānau, draws on mātauranga (Māori epistemologies/ways of knowing) expressed in pūrākau (epistemological narratives), tikanga (cultural principles), te reo (Māori language), and lived experience, which serve as the foundation for the methodology employed in this research. The findings illustrate the diversity and potential capabilities of whānau-centred initiatives in addressing Māori health inequities, emphasising the critical role of whānau in improving Māori health and wellbeing. A conceptual framework, Tū Kahikatea, is developed to present findings demonstrating the connection between the values underpinning the initiatives and their outcomes. Furthermore, the framework emphasises how whānau-centred initiatives can aid whānau in achieving mana motuhake (mana achieved through collective self-determination and control over one’s own destiny). Consistent with an Indigenous approach to health promotion, this research indicates that health promotion activities that take into account Māori worldviews and values, as well as those generated within Māori communities, will have a greater influence on Māori health outcomes than programmes that take a top-down, single issue approach to health promotion. As part of a global movement for more inclusive healthcare that prioritises Indigenous voices and knowledge systems, this research bridges the gap between academia and local flax roots community action. With new opportunities created by recent changes to Aotearoa New Zealand's health system, findings highlight the diversity and potential of whānau-centred initiatives, and advocate for the continuation of current strengths-based whānau ora practices as a strategy to attain mana motuhake within whānau and thus improve whānau health outcomes.
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    Māori cultural identity : a determinant of wellbeing for older Māori : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Psychology at Massey University, Manawatū, Aotearoa New Zealand
    (Massey University, 2020) Apiti, Ariana Rutawa Rose
    Kaumātua is a term used to describe older Māori in Aotearoa New Zealand. Encompassing both males and females, the term serves a functional purpose that reflects a sense of leadership within given communities. With various researchers making contributions to strategies and focusing on how older adults navigate this phase of life, it is important to ensure the voices of kaumātua are accounted for in ageing discourse. When exploring determinants of health for older Māori, an emphasis on Māori cultural identity (MCI) as a determinant of wellbeing specifically, may provide a more empowering perspective towards the ageing process. The research aim for this thesis is to explore the relationship between Māori cultural identity and well-being for older Māori adults. The research objectives are outlined below: 1. To examine the different levels of MCI present in this sample of older Māori adults. 2. To examine the relationship between each level of MCI and the four dimensions of well-being, as encompassed by Te Whare Tapa Whā. 3. To examine the relationship between demographic variables and well-being for older Māori adults. The data for the present study was collected as secondary data, sourced from the 2018 Health, Work and Retirement (HWR) study survey. A total of 970 participants who self identified as Māori, aged 55 years and over and provided answers to all MCI items were included in the sample. The data was analysed using Kruskal-Wallis ANOVA, Mann Whitney U tests and multiple linear regression. Main findings from the present study indicate that Māori cultural identity plays a role in shaping wellbeing for older Māori adults. Older Māori adults who reported a secure MCI also reported experiencing a greater sense of overall wellbeing, supporting MCI as a significant determinant of wellbeing, for older Māori adults.
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    Heart to heart - He ngākau māhaki : a thesis presented in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Public Health, Massey University, Wellington, New Zealand
    (Massey University, 2019) Hoerara, Roy
    This research investigates the patient experiences of Indigenous men from Australia and New Zealand who have accessed specialist treatment for heart disease. Using mixed methods – qualitative interviews and a quantitative survey – this research aims to understand the relationship between their patient experience and their patient journey. Twenty men - 10 Indigenous Australian and 10 Māori (Indigenous people of Aotearoa New Zealand) were recruited through health services. A series of semi-structured interviews was used to generate a grounded theory which describes their patient engagement and on- going patient journey. Ethical review in two countries was a particular challenge. Each country required both mainstream and Indigenous reviews, as well as locality assessments in each of the health services. Through this research I extrapolated a theory that Indigenous men co- construct their patient journey. They rely on others (clinicians, partners, family/whānau) to recall events and comprehend health information for their journey going forward. Underpinning the theory of co-construction were themes which demonstrate both similarites and differences for the cohorts. Demographics, health status, socio-economic status and historically poor access to heart healthcare were factors in common. Healthcare systems within each country explained many of the differences. The Australian cohort was based within a large city, whereas the New Zealand cohort resided in a smaller province, dependant upon more distant services. There was strong evidence of positive behavioural change, growing trust and confidence with clinicans, effective support from community groups and improving health literacy. An innovative feature of this study is a comparative Indigenous analysis which seeks to explain the findings. The main limitations of this research is related to the setting. All respondents were male, and they were recruited by the health agencies they engaged with, which will have resulted in some biases. The sample size was relatively small, especially for the survey – however this aspect was intended to be more exploratory. Future research is needed to develop Indigenous-specific patient experience measurement tools.
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    Exploring the meaning of cardiovascular disease with Māori men : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Health Psychology at Massey University, Albany, New Zealand
    (Massey University, 2019) Lisipeki, Samantha
    Ethnic disparities in health outcomes are an ongoing concern in Aotearoa/New Zealand. These disparities are particularly pronounced between Māori and non-Māori, and are especially apparent for cardiovascular disease (CVD). Despite these well-known disparities, research into how the social determinants of health manifest in the context of Māori people’s everyday lives and experiences of CVD is limited. Using a narrative approach, this research documents Māori male patients’ experiences of CVD within the context of everyday life. Four Māori males who have experienced cardiovascular care were recruited through the Waikato District Health Board secondary prevention service. The patients and their whānau (family) who wished to participate were engaged in three separate semi-structured interviews which explored topics involving their CVD diagnosis, experiences of CVD, their steps to accessing care and experiences of care. Overall, the cases revealed three key findings. First, various factors work in concert to influence participant access to cardiac care, which extend beyond individual decision making (such as structures of everyday life and resources). Second, there is considerable diversity in participant life circumstances, which are related to their experiences of care and its outcomes. Third, CVD impacted the lives of my participants differently and contributed to varying levels of illness disruption to their life narratives. This study contributes to a growing body of knowledge for addressing disparities in health outcomes between Māori and non-Māori.
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    Social determinants of preschoolers' sleep health in Aotearoa/New Zealand : a mixed methods study : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Wellington, New Zealand
    (Massey University, 2019) Muller, Diane Patricia
    Sleep is important for young children’s health and wellbeing. In Aotearoa/New Zealand ethnic and socioeconomic inequities exist in adult sleep, however little is known about the social determinants of young children’s sleep and whether sleep inequities exist in early childhood. A mixed methods study was conducted to address this gap in knowledge. Kaupapa Māori epidemiological principles informed the study design and sleep was viewed through a social determinants of health and complementary socioecological theoretical lens. Sleep and sociodemographic questionnaire data from 340 Māori and 570 non-Māori preschoolers in the Moe Kura: Mother and Child, Sleep and Wellbeing in Aotearoa/New Zealand study (Moe Kura) were analysed. Log-binomial regression models investigated independent associations between ethnicity, socioeconomic position (SEP) and preschoolers’ sleep duration, timing and problems. Ethnicity and socioeconomic deprivation were independently associated with short sleep duration (<10hrs), week/weekend sleep duration difference >1hr, later bedtimes and sleep problems based on a number of maternal-report measures. A sub-sample of Moe Kura mothers (15 Māori and 16 non-Māori with low and high SEP) participated in face-to-face interviews about their preschooler’s sleep. Results from thematic analysis identified four themes relating to mothers’ perceptions of preschooler sleep: ‘child happiness and health’, ‘maternal wellbeing’, ‘comfort and connection’ and ‘family functioning and harmony’. Four additional themes centred around facilitators and barriers to preschoolers sleeping well: ‘health, activity and diet’, ‘sleep promoting physical environments’, ‘consistency’ and ‘doing it our way’. Mothers valued their preschooler having good sleep health, however societal factors influenced the degree of autonomy they had over implementing sleep supporting strategies. Integrated mixed methods findings indicate that ethnic and socioeconomic inequities in preschooler sleep health exist in Aotearoa/New Zealand and that social determinants of preschoolers’ sleep include institutional racism, material and financial resources, employment, housing, social support, early childhood education services and child health services. Results indicate that a victim-blaming approach which does not take into account the broader societal context and places blame and burden on mothers not ‘managing’ their child’s sleep ‘properly’ must be rejected. Action is required to address the socio-political drivers that lead to the inequitable distribution of social determinants of preschoolers’ sleep health.