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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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.
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).
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