An indigenous approach to explore health-related experiences among Māori parents: the Pukapuka Hauora asthma study

Abstract

BackgroundThe prevalence of asthma for Indigenous New Zealand Māori is amongst the highest in the world. Recent evidence shows ethnic differences in asthma symptom prevalence in New Zealand have widened, with asthma symptoms and hospitalisation rates consistently higher for Māori across all age-groups, especially children and adolescents. This paper: outlines our qualitative, longitudinal research exploring the practical issues Māori children and their families face trying to achieve optimum asthma outcomes; details the research methods used within this study; and discusses the process evaluation findings of the features that made this approach successful in engaging and retaining participants in the study.MethodsThirty-two Māori families were recruited using a Kaupapa Māori (Māori way) Research approach. Each participated in a series of four in-depth interviews that were carried out at seasonal intervals over the course of one year. Families also took part in an interviewer-administered questionnaire and participated in a Photovoice exercise. All interviews were digitally recorded, transcribed verbatim and independently coded by two researchers. The research team then conducted the analysis and theme development. The questionnaires were analysed separately, with explanations for findings explored within the qualitative data.ResultsThe methodology produced a 100 percent retention rate of the participating families over the course of the follow-up. This was attributed to the research collaboration, the respectful research relationships established with families, and the families’ judgement that the methods used enabled them to tell their stories. The acceptability of the methodology will add to the validity and trustworthiness of the findings.ConclusionGiven the extent and persistence of ethnic disparities in childhood asthma management, it is imperative that an indigenous approach be taken to understanding the core issues facing Māori families. By conducting community-partnership research underpinned by an indigenous methodology, and employing a range of appropriate methods, we have successfully recruited and retained a cohort of Māori families with experiences of childhood asthma. We aim to make their voices heard in order to develop a series of culturally relevant interventions aimed at remediating these disparities.

Indigenous Research Methods: A Systematic Review

“…This involvement in the data collection process also promotes a sense of ownership over the data, which is important in research with Indigenous Peoples and particularly CBPR (Castleden et al, 2008). Jones, Ingham, Cram, Dean, and Davies (2013) also indicated that photovoice is useful in traversing the divide that is presented between researchers and the Indigenous Peoples with whom they collaborate.…”

Mālama nā makua i nā keiki me ka hānō: Native Hawaiian parents caring for their children with asthma

“…It is similarly found in other cultures such as Latino (la familia; Desai et al, 2016), Mexican (familismo; Arcoleo et al, 2015), and Māori (whānau; Jones, Ingham, Cram, Dean, & Davies, 2013). In these cultures, the family is the primary source of social relationships and assistance crucial to one's sense of identity and self-worth (Desai et al, 2016;Jones et al, 2013). Family support (Scheckner, Arcoleo, & Feldman, 2015) and higher levels of family connectedness and stronger ethnic identity appear to be protective factors against asthma-related limitations (Koinis-Mitchell et al, 2012).…”

“…It is similarly found in other cultures such as Latino (la familia; Desai et al, 2016), Mexican (familismo; Arcoleo et al, 2015), and Māori (whānau; Jones, Ingham, Cram, Dean, & Davies, 2013). In these cultures, the family is the primary source of social relationships and assistance crucial to one's sense of identity and self-worth (Desai et al, 2016;Jones et al, 2013).…”

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“…Distinctive challenges related to geographic barriers contribute to the uncertainty experience for native Hawaiian parents living on rural islands. Aboriginal peoples (First Nations, Inuit, and Métis) of Canada (Watson et al, 2012), indigenous New Zealand Māori (Jones, Ingham, Cram, Dean, & Davies, 2013), and Aborginal and Torres Strait Islander people of Australia (Giarola et al, 2014) live in remote areas and encounter similar geographic barriers to hospitals and spirometry testing (Castleden et al, 2016), social and health services (Ely & Gorman, 2010), specialty medical services (Chang et al, 2000), and asthma education and support (Watson et al, 2012).…”