“A tikanga based approach to cardiac rehabilitation for participants in Aotearoa" : a thesis presented in partial fulfilment of the requirements for the degree of Master of Public Health at Massey University, New Zealand
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Date
2024
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Massey University
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Iwi Māori (the indigenous people) of New Zealand (NZ) have a disproportionately high prevalence of cardiovascular disease (CVD) compared to their non-indigenous counterparts. NZ Māori are hospitalised 1.5 more times than non-indigenous New Zealanders for CVD. A recognised secondary prevention method for CVD, post-heart event such as acute coronary syndrome, is cardiac rehabilitation (CR). This service offers opportunities for patients after a heart event to improve their quality of life, extend overall survival, return function, learn successful techniques to modify risk-factors and reduce the occurrence of further cardiac events. An audit of regional NZ CR services found that while 85% of Māori patients were referred to CR, only 37% took up (attended at least one session) and completed (attended at least four face to face sessions) outpatient phase two CR (Kira et al., 2016). Barriers to CR included; lack of recommendations by, and interaction with Health Professionals (HP), misconceptions about CR, difficulty and cost associated with transport, inconvenient timing of CR session, lack of perceived need, and understanding some or all of the information provided while in hospital. The aim of this study sought to overcome these barriers to CR particularly for Māori. This was through the utilisation of a tikanga based approach in a mainstream CR programme to help increase the uptake and maintain retention. However, there was a no-show for Māori patients into the study, primarily because hospital referrals did not reach the primary health organisation (PHO). The study’s gaze then shifted to interviewing non-Māori patients to gain their insights and experiences of the offering of the CR sessions with the tikanga approach. There was also the addition of interviewing relevant Kaupapa Māori CR (KMCR) services to understand their services and approaches on how they differ from mainstream CR services. A Māori-centric qualitative study design was applied and semi-structured interviews were conducted with seven non-Māori participants of the CR programme and four kaupapa Māori CR services. The data collected was transcribed and analysed using an inductive tikanga thematic approach. The resulting themes demonstrated the acceptability of the tikanga-based approach for non-Māori. The study also found that the nature of clinical relationships had an impact on the service to Māori. The marginalisation of Māori in the healthcare system was evident along with the role communication had within the CR referral processes from hospital staff through to the programme itself. Recommendations were highlighted that the need for cultural competency training, system changes, and improvements in the referral and communication processes were critical to such a programme. There is a need for continued research in this area, particularly exploring automated referrals and strategies in encouraging Māori to attend CR. Systemic issues in the health system including the impacts of colonial history and racism need to be addressed to reduce inequities and increase the uptake of CR.
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Māori Masters Thesis