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

Abstract

International 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.