Whakawhirinakitanga ahua : exploring a Māori model of health service delivery : a thesis submitted for the degree of Doctor of Philosophy in Public Health (Māori Health) Massey University

Abstract

Māori health service delivery is underpinned by Māori tikanga, philosophies, values and processes; and Māori providers have consistently developed and delivered tikanga-based services to meet the needs of Māori and whānau. This thesis explored a Māori model of health service delivery, Whakawhirinakitanga Ahua, developed by an iwi health provider, Best Care (Whakapai Hauora) Charitable Trust. It aimed to uncover if health service delivery was reflective of the model, and if it addressed the health needs of Māori accessing services at Whakapai Hauora. This research was undertaken within the interpretivist paradigm using qualitative methods aligned to Māori-centred research. It drew upon the experiences, attitudes and beliefs of 50 key informants; health professionals (Māori and non-Māori) who delivered services and Māori who accessed services at Whakapai Hauora. The primary focus is on collaborative processes involved in the delivery of integrated health care. Findings in this research indicated how Māori and non-Māori work together in a Māori health environment, how they work with clients and whānau, and also at the interface with mainstream services. It demonstrated how Māori utilise tikanga-based service delivery in the provision of care to individuals and whānau; and how non-Māori working at Whakapai Hauora utilise significant aspects of tikanga-based and Treaty principles in service delivery, in response to Māori health interests within the context of Government health priorities and social policy. This thesis draws a distinction between client-centred care and whānau focused care. While client-centred practice has been a widely accepted philosophy in holistic approaches to care, whānau focused care places whānau central to all service delivery processes. It challenges health professionals to reconsider the way in which they engage with Māori and whānau, shifting mindsets from working with individuals to whānau as a collective. It challenges health professionals to acknowledge the wider environment and the determinants that impact on health and wellbeing. This thesis also acknowledges the expertise and strengths from both Te Ao Māori and Te Ao Pākehā, and highlights the significance of health professionals having to walk in both worlds in order to facilitate better outcomes for Māori.