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
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Date
2019
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Massey University
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Abstract
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.
Description
The following Figures were removed for copyright reasons but may be accessed via their sources: Fig 3 (=Harfield et al., 2018 Fig 2) & Fig 4 (=Ministry of Health graphic work not licensed under the Creative Commons Attribution 4.0 International Licence).
Keywords
Heart, Diseases, Patients, New Zealand, Australia, Maori (New Zealand people), Aboriginal Australians, Men, Medical care, Health and hygiene, Attitudes, Mate manawa, Tūroro, Tāne, Iwi taketake, Tāngata whenua, Hauora, Māori Doctoral Thesis