Creating an Indigenous Māori‐centred model of relational health: A literature review of Māori models of health

Abstract

Aims and objectives: Identify the key concepts, principles and values embedded within Indigenous Māori models of health and wellbeing; and determine how these could inform the development of a Māori-centred relational model of care.Background: Improving health equity for Māori, similar to other colonised Indigenous peoples globally, requires urgent attention. Improving the quality of health practitioners' engagement with Indigenous Māori accessing health services is one area that could support improving Māori health equity. While the Fundamentals of Care framework offers a promising relational approach, it lacks consideration of culture, whānau or family, and spirituality, important for Indigenous health and wellbeing. Design and methods:A qualitative literature review on Māori models of health and wellbeing yielded nine models to inform a Māori-centred relational model of care. We followed the PRISMA guidelines for reporting literature reviews.Results: Four overarching themes were identified that included dimensions of health and wellbeing; whanaungatanga (connectedness); whakawhanaungatanga (building relationships); and socio-political health context (colonisation, urbanisation, racism, and marginalisation). Health and wellbeing for Māori is a holistic and relational concept. Building relationships that include whānau (extended family) is a cultural imperative. Conclusions:This study highlights the importance and relevance of relational approaches to engaging Māori and their whānau accessing health services. It signals the necessary foundations for health practitioners to build trust-based relationships with Māori. Key elements for a Māori-centred model of relational care include whakawhanaungatanga (the process of building relationships) using tikanga (cultural protocols and processes) informed by cultural values of aroha (compassion and empathy), manaakitanga (kindness and hospitality), mauri (binding energy), wairua (importance of spiritual wellbeing).

He Tamariki Kokoti Tau: Families of Indigenous Infants Talk about Their Experiences of Preterm Birth and Neonatal Intensive Care

“…Parents and their whānau do not wish to be perceived as isolated individuals, but rather as situated within complex social networks. Health services taking the time to build relationships with these wider whānau networks is, for Māori, "a cultural imperative" (p. 2) [57], and is completely necessary, as they are the ones who will take their infant/s home.…”

“…Ultimately, culturally safe care is best evidence care [38,57,65,66]. Challenging the NICU to ensure this is a fundamental right and upskilling staff to ensure this occurs always, with all care, should be mandated, such as from the national Newborn Clinical Network (clinical leadership for newborn services).…”

Climate anxiety. When it's good to be worried

“…These include reconnection to a more value-based way of living including connecting with communities to mitigate climate change through environmentally sustainable practices. Indigenous models of health focus on the inter-dependence of our personal, whanau (family) and community well-being and on the well-being of our environment (Wilson et al, 2021). Climate change is a geopolitical issue, the effects of which are socially distributed and influenced by social determinants such as poverty, discrimination and marginalization that are known to contribute to health disparities.…”

“…These include reconnection to a more value‐based way of living including connecting with communities to mitigate climate change through environmentally sustainable practices. Indigenous models of health focus on the inter‐dependence of our personal, whanau (family) and community well‐being and on the well‐being of our environment (Wilson et al, 2021).…”

Steadfast is the rock: Primary health care Māori nurse leaders discuss tensions, resistance, and their contributions to prioritise communities and whānau during COVID-19

“…Socio-economic deprivation, compromised living conditions, existing poorer health status and age, and poor health literacy all increase risk for Māori for hospitalisation and death from COVID-19 (Dawes et al, 2021;Steyn et al, 2021). Across the health system, Māori are more likely to have negative experiences, including encountering racism, discrimination, and marginalisation at an interpersonal level as well as through institutional structures and processes (Cormack et al, 2018;Wilson et al, 2021).…”