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Item Enabled at last? : a study of the development of three Maori health providers from 1994 - 2001 : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Social Policy at Massey University(Massey University, 2007) Barcham, Joan May RangioueThis thesis is a study of the experiences of three Maori health providers in the Heretaunga (Hawkes Bay) region, New Zealand. Focusing on the first six to seven years of their existence this study examines how government policies of devolution and the associated creation of appropriate health care organisations for Maori affected the operation of these organisations. The following topics were utilised throughout the thesis as a structure for analysis: the contracting model used, the reporting required by the funders, inadequate funding, professional intolerance, competition for resources, and health system restructuring resulting in short term policies. Looking at the issue of tino rangatiratanga this thesis draws on these topics to determine whether or not this new policy environment has actually led to increased tino rangatiratanga for Maori - specifically Maori working in Maori health providers. The evidence provided in this thesis shows that in many respects this has not been the case. While increased tino rangatiratanga has been an outcome of the devolution process, the process has not delivered the extent of tino rangatiratanga that some hoped would be delivered through the devolution of service delivery to Maori. However, despite the relatively bleak picture that this thesis has painted of the experiences of these Maori health providers, their experiences should still be seen as an example of success. The changes in government policy which led to the creation of Maori service providers as discussed in this thesis have led to the creation of an environment in which a greater degree of Maori control over Maori health issues has been achieved. This thesis shows that unfortunately this change has not been to the extent that the women interviewed for this thesis hoped it would be when they first set up their organisations. The problem is that the policies, structures and processes, which they as Maori health practitioners and workers in Maori health provider organisations have had to work through, have at points, seemed to impede the operation of their organisations. However, despite these problems, shifts in government policy combined with their ongoing efforts have created a space in which they are able to assert their tino rangatiratanga through the practice of their mana wahine.Item Conceptualising mind, body, spirit interconnections : perspectives of Māori and non-Māori healers : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Health Psychology(Massey University, 2008) Mark, Glenis TabethaThis study into the nature of the mind, body, and spirit aimed to enhance psychological understandings of the holistic nature of human beings. There is a focus in mainstream psychology on the biomedical model, which has a limited view of people, of health and illness. The biopsychosocial and biopsychosocialspiritual models of health and illness, and the Whare Tapa Wha and Te Wheke Māori cultural models encompass holism but there is little literature or research specifically on MBS interconnections. Due to the difficulty of studying the mind, body, spirit according to scientific assumptions and methods, the interconnections between these three elements were explored through spiritual healers' understandings of spiritual healing practices. There were twelve participants, six indigenous Māori and six non-indigenous spiritual healers who participated in semi-structured interviews. The data was analysed using interpretative phenomenological analysis techniques. Three specific questions about mind, body, and spirit interconnections conceptualisations were studied. The first research question focused on how spiritual healers conceptualise mind, body, spirit interconnections. The second research question considered how mind, body, spirit interconnections are understood by spiritual healers practices of spiritual healing. The last research question examined how a Māori cultural worldview influences spiritual healers' understandings of interconnections between the mind, body, and spirit. The diversity of mind, body, spirit interconnections broadened and expanded on the sparse definitions in the literature by showing the use of the mind, body, spirit as both separate and combined elements. There were illustrations of the theoretical and practical use of mind, body, spirit interconnections in healing and in life. Cultural perspectives influenced and impacted on views of the mind, body, spirit with the addition of whānau and whenua to the mind, body, spirit concept that was considered culturally appropriate. The results provided a much broader picture than traditional models of health and illness, and showed further definitions and understandings of MBS interconnections. It is concluded that it is important that Māori cultural meanings of health and illness are included in the New Zealand health system.Item Hauora : a socio-cultural perspective : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University(Massey University, 1993) Olson, Charles SmithThe present study investigates the role that socio-cultural factors have had on the health of Maori. To date most explanations for observed health disparities between Maori and non-Maori have been found to be inadequate and may actually be due to socio-cultural factors. Supporting this suggestion are health differences between younger and older Maori since the urbanisation of the 1950's and the similarities Maori have with other ethnic minorities globally. Measures of Maoritanga were created in the present study and completed by 128 subjects. These were used to divide the sample into acculturated, partially acculturated and enculturated Maori. Groups differing in enculturation, and gender, were compared on a number of health issues. Health was assessed in terms of subjective wellbeing, general distress, physical symptoms, and chronic illness. Utilisation of Pakeha and Maori health systems were also examined as well as five health behaviours that have been found to differ between Maori and non-Maori. Although the Maoritanga measure appeared to be highly reliable, it failed to find any health differences between levels of enculturation. However, females with low self-reported Maoritanga were found to exhibit significantly more physical symptoms and general distress than females with high self-reported Maoritanga. For the five health behaviours, differences were found between males and females but not between levels of enculturation. There were some differences in the way that different Maori utilised Pakeha and Maori health systems. It appears that culture does have an important role in the health of Maori consequently more indepth investigation is required.Item Matua te reo, matua te tangata : speaker community : visions, approaches, outcomes : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Palmerston North, New Zealand(Massey University, 2013) Hond, RuakereIt is a well-documented fact that, globally, the number of languages spoken is diminishing. Māori is a threatened language. While much effort has gone into language revitalisation efforts to reverse language shift for Māori, in the past few decades it has focused on state as opposed to community mechanisms and community capacity has reduced. This is at odds with international evidence of the critical nature of intergenerational language transmission, a community-based strategy, in the achievement of language vitality. This research is about Māori language revitalisation and investigates how it facilitates intergenerationally sustainable health outcomes. It explores three main areas: the characteristics of Māori language revitalisation, the form of community development approaches used, and the Māori health outcomes that arise from language revitalisation practice. The research was located within a constructivist paradigm, took a qualitative approach, and applied a case study research strategy. Three case study groups that displayed features of language revitalisation participated in the research. They were: Te Ataarangi – nationally based; Te Reo o Whanganui – regionally based; and, Te Kōpae Piripono – locally based. The primary source of data was in-depth open-ended interviews carried out with knowledgable group representatives. This study has proposed a new term, speaker community, which signals a shift in understanding the process by which restoring vitality to a threatened language is achieved. First, language vitality is viewed as a state of language strength arising from the restoration of conditions that enable language use among a community of speakers where another language is dominant. Second, that language revitalisation is a community-level endeavour that provides a means to achieve language vitality. This research has also explained the role of language revitalisation in the achievement of positive Māori health outcomes. The framework ‘Matua te Reo’ describes the relationship between the core activities of speaker communities and the achievement of positive Māori health outcomes. The identified health outcomes underpin a secure Māori identity and are community defined. It is further argued that the sustainability of outcomes can be enhanced by encouraging a key language revitalisation approach based on the re-engagement of natural intergenerational transmission of language, culture and identity.Item Conceptualisation and measurement of iwi wellbeing : a thesis presented in partial fulfilment of the requirements for the degree of Master of Public Health at Massey University, Wellington, New Zealand(Massey University, 2013) Porter, JodiMeasures used in the New Zealand health sector to gauge the state of Māori health and the effectiveness of health services are poorly aligned to Māori understandings of wellbeing and iwi and Māori community aspirations. This thesis explores the conceptualisation and measurement of wellbeing from an iwi perspective and is therefore distinct in that it is localised within an iwicentred Māori inquiry paradigm that privileges iwi worldviews. The study has been informed by a qualitative methodology and a multi-methods approach that included a literature review, three Ngai Tai marae-based wānanga and 14 key informant interviews. The term iwi vitality was identified in this research as best capturing iwi aspirations for wellbeing. Central to the concept of iwi vitality is the notion that iwi are able to actively determine what matters to them from a local perspective and how best to monitor progress towards the achievement of iwi vitality. Iwi vitality is both ecologically localised and context specific, and is best expressed through the following seven iwi vitality outcomes that have been derived from this study - a secure iwi identity, intergenerational sustainability, collective cohesion, environmental stewardship, self-determination, economic prosperity and whānau health and wellbeing. In combination these outcomes reflect what constitutes iwi vitality. Progress towards the achievement of iwi vitality can be measured in a way that is consistent with iwi values and aspirations, through the application of the Iwi Vitality Outcomes Framework described in this thesis. The framework is based on iwi values, and therefore is located within an iwi paradigm. Application of the framework provides a mechanism through which iwi are able to align their efforts to iwi vitality outcomes, effectively monitor what matters to them and plan for the future towards the realisation of iwi vitality.Item What really does it have to do with osteopathy anyway? : New Zealand osteopath practitioners talk about rural Māori health : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Health Science in Māori mental health at Massey University, Palmerston North, New Zealand(Massey University, 2011) Awatere, Sharon ArohaThis thesis reports findings from a qualitative research project, investigating how New Zealand osteopath practitioners talk about rural Māori health. The primary research question asked, How can osteopath practitioners contribute to rural Māori well-being (with a specific focus on the knowledge, attitudes and behaviours of osteopath practitioners practicing in New Zealand)? Secondary aims were to ascertain the sources of information used and accessibility of osteopathy health care, the prevalence of musculo-skeletal disorders among rural Māori, as well as identifying the tensions and factors associated with rural osteopathy practice. The data was collected from semi-structured interviews with eight osteopath practitioners working in Hawke’s Bay on the topic of rural Māori health, and subjected to detailed qualitative narrative analysis. This analysis identified critical patterning of particular topics, revealed by practitioners in their interviews, bringing to light themes. The research findings showed that osteopath practitioners viewed engagement and effective relationship building as vital to their clinical practice with rural Māori. They also exhibited a willingness to acknowledge culture and recognise the Treaty of Waitangi in their daily practice, but often sought clarity on how this could be achieved. The potential for collaboration between Māori health perspectives and the osteopathy scientific tradition was high as they were shown to share a number of philosophical positions.Item Obstructive sleep apnoea in Aotearoa/New Zealand : an objective and questionnaire-based approach to population prevalence and clinical screening : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Wellington Campus, New Zealand(Massey University, 2004) Mihaere, KaraThe goals of this thesis were to objectively assess the prevalence of obstructive sleep apnoea syndrome (OSAS) among Māori and non-Māori adults in a community-based sample, and to develop a questionnaire-based multivariate predictive tool for OSAS, to help improve referral of patients to specialist sleep services, and prioritise waiting lists. This research was situated within the wider scope of ethnic inequalities in health between Māori and non-Māori, and was conducted within a Kaupapa Māori Research (KMR) framework. Between August 1999 and June 2001 letters and information were progressively sent out to 1200 (600 Māori, 600 non-Māori) Wellington residents aged 30-60 years selected randomly from the electoral rolls. Participants were asked to wear a small sleep monitoring device (MESAM4) for one night in their own homes and to fill out a sleep questionnaire. Contemporaneously, sleep and questionnaire data were collected from 510 consecutive patients aged 30-60 years, who were referred to the regional sleep clinic for suspected OSAS. In the community sample, OSA was found to be more prevalent among Māori. Among men, 21.98% of Māori had OSA (RDI≥ 5) compared with 11.37% of non-Māori. Among women, 6.28% of Māori and 3.02% of non-Māori respectively had OSA (RDI≥ 5). The higher risk among Māori appeared to be due to well-recognised risk factors such as higher body mass index (BMI) and larger neck circumference, rather than ethnicity per se. Using the combined data from the community and clinical samples, two clinical prediction models were developed using logistic regression modelling. One model (Model 1a) included age, sex, observed apnoeas, self-reported habitual snoring, subjective excessive daytime sleepiness, and BMI. The second model (Model 2a) included neck circumference instead of BMI. Model 1a correctly classified 82.50% of participants (sensitivity 72%, specificity 87%). Model 2a correctly classified 81.10% of participants (sensitivity 80%, specificity 82%). This research indicates that OSA is a common problem among New Zealand adults and that ethnic disparities exist. The results provide important guidance for planning to meet population needs, by identifying differential needs of specific groups. The prediction models provided reliable estimates of a priori probability of OSA, and therefore may be useful tools for screening patients for OSAS.Item Hei aha nga whakaaro o Ngati Ruanui mo te Whanau Ora? : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy (Nursing) at Massey University, Palmerston North, New Zealand(Massey University, 2012) Campbell-Knowles, Te MoanaIn Aotearoa New Zealand poorer health outcomes for Māori have been well documented. There is growing evidence that limited contact between whānau members has a potential negative impact on the health and wellbeing within the whānau. The term Whānau Ora has been widely used and variously defined by Māori over many years however there is no single shared definition of Whānau Ora, and little understanding about how it can be implemented by Māori health providers as a service delivery framework. This research expands on existing knowledge of Whānau Ora by identifying definitions, gathering data about Whānau Ora values and concepts, cultural beliefs and practices. This research is informed by the worldview of healthcare for Māori. A number of hui (meetings) were held where Ngāti Ruanui iwi members were consulted and ten Ngāti Ruanui participants were interviewed. These participants identified meanings of Whānau Ora that included ‘being Māori’ and who they are (whakapapa) and how this translates to ‘how they live’ (Matauranga Māori), ‘self-definition’ (tino-rangatiranga) and how Whānau Ora is the ‘way forward’ to address past and present issues such as colonisation and inequalities. This research employed a Māori-centred qualitative methodology which allowed Māori and Western belief systems their own integrity whilst working side by side, utilizing the energy of the two systems. Localising the research to Ngāti Ruanui Iwi members was intentional, to understand what members considered important. As the integrity of the participants was a central concern in the research, a methodology was adopted that was respectful and valued the participant’s worldview. Participants regarded Whānau Ora as a mechanism to assist whānau to “move on”, and advance as Māori. Whānau Ora was also regarded as an important future model of health that has the potential ‘do away’ with disparities and assist Māori in their efforts to strive for good health. The research concluded that Māori health outcomes will be much improved when they are delivered in ways that meet the cultural needs of Māori. The roles and responsibilities of the Crown must ensure that these changes develop and are done in collaboration with Māori organisations themselves which will ensure that any changes reflect the philosophies of Whānau Ora: optimal wellbeing.Item Tuku iho, he tapu te upoko = From our ancestors, the head is sacred : Indigenous theory building and therapeutic framework development for Māori children and adolescents with traumatic brain injury : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health, Massey University, Wellington, New Zealand(Massey University, 2012) Elder, HinemoaInternational research shows „minority‟ culture and indigeneity are risk factors for traumatic brain injury (TBI) and for differential responses by rehabilitation services. New Zealand epidemiological studies align with those findings showing that Māori tamariki (children) and taiohi (adolescents) are significantly over represented in TBI populations with poorer outcomes, including higher mortality rates. This study asked two questions. Firstly, what do Māori people say about tamariki and taiohi TBI in the context of the Māori cultural belief that the head is the most sacred part of the body? Secondly, how could this information be used to build theory and inform a framework to address the rehabilitation needs of this group? Eighteen marae wānanga (culture specific fora in traditional meeting houses) were held in urban, rural and remote locations. Participation in these marae wānanga established an overt collective Māori cultural orientation at the entry point of the study. This collective view meant that marae themselves were considered as respondents. Data were analysed using Rangahau Kaupapa Māori (Māori indigenous research methods) and informed by elements of grounded theory. The central aspect of the theory proposes that TBI not only injures anatomical structures and physiology but also injures wairua. Wairua is defined here as a uniquely Māori dimension of wellbeing characterised by profound connection with all elements of the universe. The wairua injury means culturally determined interventions are both indicated and expected. The cultural knowledge required to address the wairua injury is housed within whakapapa (genealogy). This knowledge is activated by a cascade of events. The wairua theory in mokopuna TBI thereby provides a guide to intervention. The interventional framework underpinned by this theoretical position is called Te Waka Oranga. This framework uses the metaphor of a waka, a traditional Māori sailing vessel, preparing for journeys, in the process of moving across the ocean and finally arriving at it‟s destination. In this way this framework provides a Māori space where both Māori and clinical world views and their respective interventions can co-exist and be jointly monitored. This framework is therefore a practical tool that clarifies the interface where the two world views of the whānau and clinicians meet, suggesting opportunity for improved outcomes. This is the first study to propose and operationalise an indigenous theoretical construct for Māori child and adolescent TBI rehabilitation. Methods including noho puku, whanaungatanga, kaitiakitanga and centrifugal thinking were employed in novel ways. Future application of this work includes non-accidental traumatic brain injury, youth forensic populations, incarcerated groups and virtual rehabilitation.Item A life transformed : the lived experiences of Māori with chronic pain : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Science in Health Psychology at Massey University, Wellington, New Zealand(Massey University, 2011) McGavock, Zoe CarolineDue to its subjective nature, pain can be a complex and difficult health issue to address; pain and pain experiences need to be better understood in order for improvements to be made in how it is responded to and managed. Although there is some international research exploring cultural issues in pain, very little research of this kind has been conducted in Aotearoa, where significant health disparities exist between Māori and non-Māori. Furthermore, there is a lack of research with a specific focus on the chronic pain experiences of Māori in Aotearoa. The aim of the present research was to fill this gap in the literature, by addressing the following research question: how do Māori talk about their lived experiences of chronic pain? The methodology used for this research included a Kaupapa Māori approach along with Interpretative Phenomenological Analysis. In-depth semi-structured interviews were conducted with seven Māori adults who were experiencing chronic pain or a chronic painful health condition. Analysis of the interview transcripts resulted in identification of four superordinate themes and thirteen subthemes. These were ‘A life transformed by the experience of chronic pain’ (four subthemes), ‘Experiences of chronic pain as Māori’ (four subthemes), ‘Evaluating treatment experiences’ (three subthemes), and ‘Negative perceptions, negative experiences’ (two subthemes). The major implications drawn from these results are a clear need to incorporate greater cultural consideration into consultations and treatment with Māori who have chronic pain, as well as a broader need to improve the treatment and care of people who have chronic pain. These needs are both informed and driven by commitments to Te Tiriti and health equity in Aotearoa.