Transcript Kia Piki Te Mauriora Maori MAORI ENGAGEMENT STRATEGY

Kia Piki Te Mauriora Māori
MĀORI ENGAGEMENT STRATEGY
Mr Tuwhakairiora Williams
Dr Tristram Ingham
NZ Respiratory Conference
9-10 October 2014
Wellington
Acknowledgements
Māori Reference Group
The Asthma Foundation Board
Angela Francis (Chief Executive)
Janice Kuka (Board Member/ MRG Chair)
Sharon Cavanagh (Māori Health Manager)
Pania Lee (Project Researcher)
Background
Our Vision:
Better respiratory health for all New Zealanders
Our Goal:
Reduce hospital admissions caused by asthma
and other respiratory conditions by 25%, by 2025
Respiratory Hospitalisations
(Hospitalisations, All DHB’s, 2006-2011)
Non-Māori
Māori
Standardised Relative Rate
(Māori vs Non-Māori)
6
5.1
5
4.64
4
3
2.55
2.48
2.09
2
1.37
1
0
Asthma
Upper
Respiratory Tract
Infection
Data: Asthma Foundation/ University of Otago 2013
Influenza &
Pneumonia
Other Lower
Respiratory Tract
Infection
COPD
Lung Cancer
Burden of Respiratory Disease
(Hospitalisations, All DHB’s, 2006-2011)
ASTHMA
Māori
35%
Māori
26%
nonMāori
65%
OTHER LRTI
Māori
39%
URTI
nonMāori
61%
Data: Asthma Foundation/ University of Otago 2013
INFLUENZA/PNEUMONIA
Māori
27%
nonMāori
73%
nonMāori
74%
COPD
Māori
34%
LUNG CANCER
Māori
30%
nonMāori
66%
nonMāori
70%
Strategy Aims
Explore ways in which the Asthma Foundation
can collaborate with Māori health provider
networks & communities to improve Māori
respiratory health
Inform the Asthma Foundation’s strategic
direction & responsiveness to Māori policies
Desired Outcomes
To enable the Asthma Foundation to
establish stronger working relationships
with Whānau Ora collectives and Māori
health providers to:
– enable closer, more meaningful
collaborations at local and regional levels
– contribute to improving the access of
whānau to services, information and support
– reduce the burden of respiratory illnesses for
Māori.
Phased Approach
Phase 1:
– Scoping & Needs Assessment
Phase 2:
– Collaboration & Intervention Development
Phase 3:
– National Deployment
PROJECT PHASE 1
SCOPING & NEEDS ASSESSMENT
Phase 1 Objectives
1. Meeting the collectives to introduce the Foundation and what it does
2. Outlining its commitment to improving Māori respiratory health
conditions
3. Outlining how it intends to carry out that commitment
4. Finding out what collectives are doing in respiratory health,
especially for Māori
5. Identifying the gaps and what is working
6. Identifying other areas the Foundation can help with their work in
respiratory care
Kia Piki Te Mauriora Māori
This was the cultural plan used to guide the engagement strategy with Whānau Ora
collectives
Kia Piki Te Mauriora Māori adopts Te Ira Atua, Te Ira Whenua, and Te Ira Tangata as
the core to engagement and Te Whare Tapa Whā as the practice model.
Tapu and noa permeate the model which incorporates whakawhanaungatanga,
whakamanawa and mauri as the essential concepts of engagement. The model is
holistic and focuses on:
Oranga Wairua
Spiritual wellbeing
Oranga Tinana
Physical wellbeing
Oranga Hinengaro
Mental wellbeing
Oranganui o te reo me nga
tikanga Māori
The overall wellbeing of the language
and upholding Māori values
Oranga Taiao
Environmental wellbeing
Oranga Whānau
Family wellbeing
Kia Piki Te Mauriora Māori
From: Kia Piki Te Mauriora Māori, Tu Williams, 2014
Whānau Ora Collectives
Kotahitanga
(South Auckland)
• Papakura Marae
• Te Kaha o Te Rangataki Trust
• Turuki Healthcare Trust
Heretaunga Providers
(Hawkes Bay)
Takiri Mai Te Ata
(Lower Hutt)
•
•
•
•
•
•
•
Kokiri Marae Keriana Olsen Trust
Kokiri Marae Maori Women’s Refuge
Mana Wahine
Naku Enei Tamariki
Tu Kotahi Maori Asthma Trust
Wainuiomata Marae
Whai Oranga o Te Iwi Health Centre
•
•
•
•
Te Kupenga Hauora – Ahuriri
Te Taiwhenua o Heretaunga
Choices Kahungunu Health Services
Central Health
Methodology
Methods:
–
Qualitative research design using ‘hui method’ underpinned by
Kaupapa Māori Research (KMR) framework
Sampling Framework:
–
–
Health professionals and staff from three Whānau Ora collectives and
affiliated Māori Health Providers
Collectives purposively selected (asthma experience, convenience)
Focus Groups:
–
Kanohi ki te kanohi, semi-structured, open-ended Discussion, English
& Te Reo Māori
Analysis:
–
Audio-taped & transcribed. Thematic analysis (grounded theory),
results validated through review by collectives & external peer-review
Participants:
–
–
23 staff participated (6 males, 17 females)
Auckland (n=9), Hawkes Bay (n=3), Hutt Valley (n=11)
Focus Group Questions
What does your provider/collective do for Māori respiratory health?
What are some of the gaps in supporting Māori respiratory health?
What does your provider/collective do well for Māori respiratory
health
How can the Foundation assist or support your provider/collective?
Do providers/collectives want a relationship with the Asthma
foundation and if so how? And what does that look like?
Strengths & Limitations
Strengths
- Kaupapa Māori Methodology
- Established networks
- Team complimentary skills
Limitations
- Aimed only to be an initial engagement
- Limited number of providers
- Limited time engaging with key informants
- Staff, not patients
- Tight timeframes
Asthma Foundation Awareness
“I don’t even know who they are…Which one’s that? Oh, is that the
one with the balloons?” (Hawkes Bay)
“I didn’t know that there was a Asthma Foundation, my asthma
foundation is Tu Kotahi […] that’s where we refer them [our
patients]” (Takiri Mai)
The Asthma Foundation Balloon Day
Successes
1. Holistic Approach to Health
Wrap-around Services
“…mother and pēpi contract which we support a
mother from as soon as they find out they’re
pregnant to babies born, and right through to 2
years old if necessary. So from there they have
a kaiawhina and you know that helps them get a
midwife, anything that needs to be done for
them, if they have no transport getting them to
those appointments like your scans, stuff like
that as they go through there’s appointments
with WINZ, getting them to the curtain bank, any
needs that they need” (Heretaunga)
Feathers and pounamu: unknown Rotorua woman - oil
Artist: Lindsay Mitchell
Going beyond the biomedical model
“GP’s: It’s asthma, it’s a virus, here’s the pamol” (Kotahitanga)
Promoting the role of, and strengthening the evidence base for,
complimentary therapies:
• Exercise (promoting the role in respiratory health)
• Mirimiri (massage)
• Rongoā (traditional medicines)
Ngā Kaitiaki o Te Puna Rongoā o Aotearoa –
The Māori Pharmacists’ Association Inc.
2. ‘Hard to Reach’ whānau vs. ‘Hard to Reach’
services
Kahohi Kitea (The seen face)
“So we have Māori and Pacific here. I say when they ask now
what’s your hard reach I say 60% yeah. And often they’re not,
they’re not hard to reach for us ‘cause we know the communities
and hard to reach maybe for hospitals and places like that ‘cause
they don’t go out into the community” (Takiri Mai)
Innovative Approaches to Engagement
• Asthma Camps
• Māori Traditional Games
• Promotion and modelling of healthy lifestyles
• Community events
Challenges
1. Best Practice:
Consistency of Messages
“…when you talk about education and best practice, obviously you
know, when whānau go to the doctors, they get information from
one doctor - how to use their nebulisers, how to use the spacers,
then they’ll go to the nurse. They’ll be shown a different way to do
it, then they’ll go to the hospital and they’re shown a different way
again” (Kotahitanga).
Care Pathways
“…they need to have like some kind of plan or pathway so if you
come in several other times or they can go straight to the children’s
ward or they are referred automatically to organisations like Tu
Kotahi” (Takiri Mai)
Medication Challenges
• Medication sharing
• Lack of warning when running low
• Dispensed individually (monthly, repeats expire)
• Need multiple (school, home, other whānau houses)
• Cost (prioritisation vs other expenses)
• Better explanations regarding value
Equipment Funding/ Point of Care Testing:
“…ideally we’ve got the spirometry machine in the boot, when we
identify someone in the home or wherever it is, we can complete
the spirometry, but the Māori providers have got no funding”
(Heretaunga)
2. Resources
Culturally Appropriate Resources:
Need for resources that are culturally relevant, accessible &
appropriate, i.e. anatomical cartoon maps, resources with whānau
experience, a media strategy, improved health literacy training
“…the stuff that’s for Māori: so for Māori means we’ll stick some
Māori words in there […] then we’ll stick a few pictures of brown
people on and we’ll stick a few Māori words on the titles and
things, then we’ve got the Māori version…” (Heretaunga)
What Maui Learnt About Asthma
Written by Waka Cookson.
3. Workforce Development, Training & Education
Workforce Development
“I think Māori health providers definitely need support along those
sort of lines of that training, like I say the spirometry … but support
around all those training needs definitely, because obviously we
want to be delivering an excellent service, a better service than
they were receiving in mainstream, and to achieve that we’ve got to
put in that workforce, the development, the ongoing training and
support” (Heretaunga)
School-based Programmes
“…we’ll provide […] an asthma kit for them at school so that they
can go and access an inhaler. Also provide education to them
about a 10 and 15 minute session at a visit at school with them.
We also offer education to the staff and sometimes we end up with
about 20 staff in the staffroom” (Tu Kotahi)
4. Accessing the Community & Health Promotion
Events
“…a presence you know like how we have those festivals[…] a day
you’re going to get all the whānau out […] you’re going to get them
at the […] festival, having a presence there, those are the places
you’re going to get, we’re all going to roll out then, Waitangi Day
we’re all going to go to those things, and it doesn’t matter it’s
having a presence there” (Heretaunga)
Smoking Cessation
“Yes, so certainly smoking cessation is a key health promotion of
education situation that’s under threat at the moment, actually”
(Kotahitanga)
5. Policies and Funding
Funding
“Unless it’s a target they won’t focus, or they [government] won’t put
resources to it. So providers won’t get those resources so it has to be
a health target”. (Kotahitanga)
“For any successful strategy the government
wants at the end of the day, has to
have…action. Do talk to whānau and be able
to talk to them about a particular issue,
whether it’s clinical, whether it’s going into
their homes. I think those are the important
face-to-face stuff that you’ll get some
change” (Kotahitanga)
Prime Minister visits Asthma Foundation, February 2014
Social Determinants of Health
“What good is the clinical best practice by itself unless you’ve got
the social drivers, like damp houses and all that?”(Kotahitanga)
Equal Access to Health
“…is the criteria really working for those that really need it, or is it
just because they know how to get it, these people […] our families
that don’t know aren’t getting it, so is it really going to where it
should be going?” (Heretaunga)
Living rough: Home for Cora Coleman is a damp Housing NZ
property that the Tenancy Tribunal has ruled is not fit to live in.
Photo: Nicholas Boyack. Stuff (Aug 2012)
Recommendations
Recommendation One:
Continue to build the Asthma
Foundation’s relationship with Māori
(through whānau ora collectives) to better
understand their specific needs; to raise
their awareness of the foundation and to
collaboratively co-develop a Māori
respiratory strategy
Recommendation Two:
Investigate and explore innovative
resources i.e. multimedia that will be of
more relevance to Māori communities.
Recommendation Three:
Collaboratively develop a Māori
respiratory research agenda resulting in
improved respiratory health outcomes for
Māori. For example research to improve
health literacy; understanding of
complimentary methods of respiratory
wellness and reduced health disparities,
and innovative service delivery models.
Recommendation Four:
Collaboratively develop best practice
support structures that are responsive and
relevant to Māori to support practitioners
working with Māori whānau
Recommendation Five:
Understand specific needs of whānau ora
collectives around workforce training and
development and to use these
recommendations to broaden and revise
the existing Asthma Foundation training
programmes.
PROJECT PHASE 2
COLLABORATION &
INTERVENTION DEVELOPMENT
Bernadette Jones with Cheryl Davies and whānau
Aims
To continue to engage with three Whānau
Ora collectives
To collaboratively develop and pilot a
‘best-practice support’ package for Māori
providers (using tamariki asthma as a
development model)
Methodology
Kaupapa Māori methodology
Participatory Action Research (PAR)
Three Plan-Do-Study-Act cycles
Embedded capacity
Possible actions, to develop:
–
–
–
–
–
Practise audit tool
Service specification template
Staff development training programme
Asthma resource training tool
Community education programme
Act
Plan
Study
Do
Conclusion: Future Engagements
Engagements with Whānau Ora Collectives have the potential to inform
the Foundation’s future strategic planning in:
Health Sector Positioning and Stakeholder Relationships: Organisational
responsiveness to Māori; as a model for engaging with both Māori and mainstream
providers
Research: Health Literacy; service delivery models; & complimentary therapies
Education: Resources and staff development to meet the needs of Māori
Media: improved community awareness; health promotion activities; and targeted
dissemination (e.g. community events, iwi radio, and Māori Television)
Kia Piki Te Mauriora Māori
MĀORI ENGAGEMENT STRATEGY
Asthma Foundation Māori Engagement Strategy Team: Tuwhakairiora Williams, Tristram Ingham, Pania Lee