Mainstream approaches to chronic condition management and prevention inadequately address the needs of Māori, the Indigenous people of New Zealand. Māori health service providers (MHSPs) are uniquely placed to address the critical gap in the prevention of chronic conditions. In this paper, we report qualitative research findings investigating how prevention was being modelled, practiced and measured in selected MHSP settings. Results indicate barriers to achieving wellbeing through health service delivery. The dominant individualistic, medical conditions-focused discourse, along with responding to acute need, is a driver of service delivery norms.There are examples of shifts in organisational structure and delivery configurations that demonstrate that these norms are being challenged and reframed, in some form, by MHSPs. Consolidation of these approaches requires significant work and increased resources as well as a broader systems-level response that prioritises prevention.
ARTICLE HISTORY
Background: In recent decades, financial investment has been made in health-related programs and services to overcome inequities and improve Indigenous people's wellbeing in Australia and New Zealand. Despite policies aiming to 'close the gap', limited evaluation evidence has informed evidence-based policy and practice. Indigenous leaders have called for evaluation stakeholders to align their practices with Indigenous approaches. Methods: This study aimed to strengthen culturally safe evaluation practice in Indigenous settings by engaging evaluation stakeholders, in both countries, in a participatory concept mapping study. Concept maps for each country were generated from multi-dimensional scaling and hierarchical cluster analysis.
ObjectiveHigh smoking prevalence rates, combined with a steep tax on tobacco and lower household income, mean that 5% of Māori (indigenous) whānau (family unit) expenditure in New Zealand is on tobacco. This paper outlines whānau perceptions of, and behavioural responses to, increasing tobacco tax.MethodsThis qualitative study was informed by the Kaupapa Māori theory and used a simplified interpretive phenomenological analysis thematic hybrid methodology. A semistructured, open-ended interview guide was designed and used in one-off focus group interviews.Setting and participantsInterviews were separately conducted with each of 15 whānau units. A total of 72 participants, most of whom were smokers, took part in the interviews carried out in two geographical regions: one rural/provincial and one urban.ResultsWhānau were concerned about the rising cost of tobacco. However, this concern had not generally translated into quit attempts. Whānau had instead developed innovative tobacco-related practices. Working collectively within their whānau, they were able to continue to smoke, although in a modified fashion, despite the rising costs of tobacco. Whānau thereby resisted the intended outcome of the government’s tobacco tax which is to reduce rates of smoking prevalence.ConclusionIn the face of significant government disinvestment in New Zealand tobacco control over the last 10 years, hypothecated taxes should be used to scale up Māori-specific cessation and uptake prevention programmes, supporting authentic Māori partnerships for endgame solutions including restricting the availability and appeal of tobacco.
This article explores the service delivery experience of Mäori health service providers within the context of contracting. It draws on selected findings from a three-year Health Research Councilfunded study and discusses how Mäori health service providers are evidencing that their service delivery is contributing to positive outcomes for whänau. Although generally outcomes contracting appears to be fraught for providers, the foundations of a policy platform for effective outcomes contracting ‘by Mäori for Mäori’ has been established through the Whänau Ora policy,\.
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