Project Updates Archive

Hospital Transfers – Whānau Involvement in the healing equation

Whakauae Research Services, the University of Auckland and Waikato University have partnered to undertake research looking at hospital transfers for Māori. The project is funded through Ngā Pae o te Māramatangā and is titled: Hospital Transfers, whānau involvement in the healing equation. The project has four distinct phases.

1. Description:

Phase one is to gain a comprehensive understanding of patterns of hospital transfers and experiences of whānau who wish to stay actively engaged in care. Three pieces of work are currently being completed; Statistical Analysis, Whānau interviews and an Environmental Scan.

The statistical analysis is well underway with work undertaken by Dr Arama Rata (NIDEA) and Waikato University Biostatistician Ms Lyn Hunt. Utilising publicly available (e.g. from DHB reports), the analysis provides important information on specific patterns of Māori ‘away from home’ hospital care. The analysis will include hospital transfers and flows of patients between facilities and identify patterns in these flows for Māori at national and regional levels.

Twenty-two whānau interviews, focusing on the whānau experiences of hospital transfers and hospitalisations ‘away from home’ have been completed. Whānau recruitment occurred through researcher networks as well as the community “kumara vine”. The circulation of an artistically tailored poster caught the eye of many whānau.  Whānau replied by text highlighting their willingness to be involved in the project. Each interview has been transcribed, cleaned and summarised ready to be given back to participants. Participants will receive a summary on a template incorporating the art used in the recruitment poster. Analysis of interviews has commenced with the team coming together to undertake a mahi-a-roopu analysis (analysis as a team) in mid-August.

The environmental scan will assist the team to gain a deeper understanding of the current environment within which whānau who wish to remain actively engaged in care operate. The scan focuses on publicly available data on current policies, programmes or interventions associated with hospital transfers and hospitalisation ‘away from home’. We are just starting this phase of data collection.

2. Engagement:

This phase includes engagement of stakeholders, partnering activities (agreements, terms of reference) and progressing proposals for funding. Gaining stakeholder buy-in will assist the research team better understand how the hospital system and broader policy contexts facilitate or hinder active whānau involvement.  Current engagement has included: Waikato DHB clinicians; research-active clinicians at the University of Auckland; the Ministry of Health through the development of specifications for the National Minimum Data Set; and a range of experts who comprise the Health Experts Advisory Group.  A Terms of Reference document has been confirmed and engagement has been agreed with relevant parties. Proposals for additional funding are in progress. Two proposals for interns have been successful as well as proposals to attend and present at national and international conferences.

3. Uptake:

The uptake phase incorporates mapping and identifying strategies or environments that promote active whānau participation in care. It is a work in progress and reliant on data from the earlier phases.

4. Dissemination:

This phase involves discussion, debate and generating awareness of the impacts of hospital transfers on both sides of the healing equation by making sure research findings continue to be distributed through multiple forums.

Dissemination has occurred through different avenues. Research team members have presented at both local event (research symposiums, meetings and community hui) as well as at international fora such as the Race, Whiteness and Indigeneity International Conference on the Gold Coast, Australia; the International Indigenous Research Conference,  Auckland; and He Manawa Whenua, Waikato. 

Te Puawai o te Ahi Kaa

In 2014, the three-year Te Puawai o Te Ahi (TPoTAK) project was awarded funding through the MoH Māori Innovations Fund. A collaboration between Raetihi Pah and Te Oranganui Trust, the project aim was to strengthen the health and wellbeing of those whānau who maintain the Ahi Kaa to ensure the future sustainability of the paepae and marae. Whakauae was commissioned to complete the evaluation component of the innovation project.   A general process and outcomes approach to the evaluation was taken underpinned by Kaupapa Māori methodology. The use of a Kaupapa Māori methodology reflects Whakauae’s commitment, as an iwi-owned research centre, to working with Māori communities in a way that resonates with Māori beliefs and traditions maintaining a focus on transparency, building purposeful and respectful relationships, recognising strengths and contributing to positive social change.

 Outcomes / Achievements

The evaluation identified that TPoTAK has contributed to empowering whānau to be proactive about understanding and managing their own health and that of their whānau. Whānau valued the time and effort that the project kaimahi had put into building social capital in the Raetihi Pah community. There is no doubt that the whakapapa links of the kaimahi, and their membership of the Raetihi community, were instrumental in the their successfully gaining community ‘buy in’ for the TPoTAK innovation. The Advisory Group, established to guide the project, proved to be indispensable. The Group sealed the working relationship between Raetihi Pah and Te Oranganui Trust, provided cultural oversight for the project and involved whānau in a role that would help prepare them for future involvement in service delivery contracting arrangements.

Increased positive health behaviours among whānau, highlighted by the evaluation, included participation in physical and nutrition related activities such as Tri-Māori, Zumba, boot-camps and the development of maara kai. In addition, networking by the project kaimahi produced valuable collaborations with other service providers. These collaborations have supported the delivery of health and wider social services to the Raetihi Pah community that better meet their needs in terms of both cultural relevance and accessibility.

Capability building was possible through the Health Research Council Independent Research Organisation Funding and was an important component of this project for both the whānau and the kaimahi. Increasing capability in the Māori health services workforce was demonstrated at many points throughout the project from workshops at whānau hui to upskilling and formal training sessions. In addition, kaimahi were supported to attend evaluation conferences and evaluation training workshops. In June 2017, funding for the project ceased however TPoTAK has supported Raetihi Pah whānau to develop further knowledge and skills to enhance their health and wellbeing.

Whānau members from TPOTAK project participating in a Mystery Bus Tour to Huka Falls.

Whaia Te Ahi Kaa: Ahi Kaa and its role in Hauora 

Dr Heather Gifford was approached by Kiri Parata and her iwi, Te Atiawa ki Waikanae to assist in the development of an HRC application to the Ngā Kanohi Kitea fund. The application was successful and Dr Gifford supported Ms Parata as she led this project for her whānau. The study aimed to explore the impact of active participation in marae and iwi activities on the health, wellbeing and sense of connectedness of iwi members. 

Outcomes / Achievements

There have been a number of distinct research outcomes from the research. First, the results from the research are directly informing the longer-term oranga strategy for the iwi. Researchers and iwi leaders are using the images and voices of the participants to clearly communicate positive messages to iwi members about maintaining their hauora. Secondly, as a consequence of the opportunity to participate in the research, members of the iwi now have increased confidence about undertaking future research. Third, the research provided two opportunities to directly mentor emerging researchers. Ms Parata was able to undertake her first research project as a principal investigator (with close support by Dr Heather Gifford) and in turn she mentored a research assistant who gained skills in a number of research areas. Finally iwi members have participated fully in the research and, through very skilled dissemination activities by the lead researcher, have experienced positive messages about themselves. 

Maternity Quality and Safety Programme Evaluation 

Whakauae was subcontracted by Allan and Clarke to contribute to the evaluation of the progress and effectiveness of the Ministry of Health’s Maternity Quality and Safety Programme (MQSP). The MQSP programme has been operating in each DHB since 2012, with initial funding provided until 30 June 2015, after which time DHBs were expected to operate MQSPs as business as usual. The Ministry of Health sought an evaluation which would inform decisions regarding continued funding of the programme, and improvements to the programme. The evaluation particularly focused on what has worked at a local (District Health Board) level to improve the safety and quality of maternity services. 

Outcomes / Achievements

The Ministry of Health has been provided with a final report containing a number of recommendations to inform future development for the MQSP programme. Members of the research team presented the final report at the four yearly Maternity Conference where it was officially launched by Minister Dunn. As Allen and Clarke have noted on their website: the evaluation evidence showed that the programme had considerable merit, and in time, would likely provide significant returns. The programme had started to deliver meaningful improvements and there was significant value in continued Ministry of Health investment and support. A full copy of the report is available on the Ministry of Health website.

Smokefree Wellington 

This project aimed to: 

1) Identify potential benefits and challenges of smokefree outdoor policies,

2) Propose relevant policy options and recommendations for smokefree outdoor areas in public spaces, using Wellington City as a case study.

Outcomes / Achievements

In 2015 we used data from documents, in-depth interviews, small workshops and a symposium to develop options and recommendations for extending smokefree outdoor areas in Wellington. Our research participants represented a mix of sectors including the business (particularly hospitality and retail); local government (politicians and staff); iwi; union; and health sectors. Policymaker workshops were conducted in 2015 to further explore the results from the research and discuss a mix of policy options. Results are intended to be used by Wellington City Council to inform smokefree bylaws for the city in 2016. 

Enjoy Nicotine Replacement Therapy 

The University of Otago led this project, which was successful in being awarded funding for the study from the Ministry of Health Innovation Fund. The project tested the latest advanced, rapid-acting, nicotine replacement therapies (NRT), taking these direct to smokers in localities such as shopping malls. As part of the study Whakauae provided advice on engagement with Māori and relevant research methods and analysis. 

Outcomes / Achievements

The results of this study suggest that more effective and more attractive NRTs, and more effective methods of encouraging smokers to use NRT are required. Current NRTs, with their medicalised packaging, and highly restrictive rules around their provision and use, are not sufficiently attractive to smokers. It is possible that smoking cessation staff, who are very well connected to their community, may have better success in encouraging smokers to use NRT and continue to engage in quitting behaviour. The methods used to engage with smokers in the present trial were successful in reaching a large number of smokers, many of whom were Māori, almost half of whom had neutral or no motivation to quit smoking in the short-term and were therefore unlikely to enrol in a conventional smoking cessation service. This method of reaching smokers in high priority populations, if combined with access to a wider range of more effective and free-of-charge NRTs, is likely to help New Zealand achieve the SmokeFree2025 Vision.

Smoking an Informed Choice 

Whakauae has been subcontracted by the University of Otago to lead the Māori stream of this three-year project. The overall aim of the research is to determine how young adult smokers and social smokers define “informed choice”, and to develop and evaluate methods of estimating “informed choice”. 

Outcomes / Achievements

Data collection is complete for this project and results have been disseminated widely. The research has adapted existing informed choice frameworks to better recognise the wider social and behavioural context of smoking. Tobacco control policy makers will be invited to a symposium in 2016 to share and discuss final results. 

Evaluation of the Early Pregnancy Assessment Approach 

We carried out an intensive process and short-term outcomes evaluation of the Whanganui Regional Health Network’s locally developed Early Pregnancy Assessment Approach (EPAA) in the first half of 2015. This evaluation was commissioned by the Health Promotion Agency (HPA), a Crown entity established under the New Zealand Public Health and Disability Amendment Act 2012. The evaluation aimed to determine how the EPAA ‘works’, who it works for and why in order to support both the Regional Health Network’s refinement of the intervention and the HPA’s critical assessment of EPAA potential for implementation by other primary health care providers nationally. Key informant interviews with service users informed the evaluation results along with interviews with the Regional Health Network’s staff and service delivery partners. Document review was also carried out. 

Outcomes / Achievements

A detailed service model description was developed in the early stages of the evaluation. That description provides a template for other primary health care providers looking to put an EPAA in place in their own areas of the country. The final evaluation report includes practical recommendations for further refinement of the EPPA locally, which have been taken into account by the Regional Health Network as it continues to fine-tune the intervention. The HPA has made the evaluation material available on its website. 

Tapuhi Tū Toa: a Kaupapa Māori Tobacco Cessation Intervention 

This work builds on results from a previous Whakauae research project, Māori Nurses and Smoking; Exploring the opportunities for change. In this new project we are piloting an intervention in four nursing schools which is aimed at ensuring all Māori nurses who graduate are smokefree. The intervention uses a supportive wānanga approach to bring smokers together to discuss tensions, evidence for quit and link participants with a range of services and support systems. 

Outcomes / Achievements

A significant amount of background work took place in 2015 in preparation for the intervention rolling out in 2016 including; engaging support from the wider nursing sector, ethics approval, engaging the sites and establishing a new advisory team. In addition an evaluation team has been established to test effectiveness of the intervention. It is intended that the pilot will be in the field in the first half of 2016. 

Mana Tamariki Mokopuna Mana Whānau Project Evaluation 

Mana Tamariki Mokopuna Mana Whānau (MTMMW) is an intervention that represents a new model of service delivery. It focuses on addressing the needs of vulnerable young Māori women, their pēpi, tamariki and whānau who reside on the West Coast of the South Island. In 2014, Poutini Waiora engaged Whakauae to develop and implement a process and outcomes evaluation of the intervention. 

Outcomes / Achievements

During 2015 the evaluator worked alongside the provider as the intervention developed and unfolded. Evaluation activities included finalising an evaluation plan including a project logic model. The evaluator also provided feedback on project activities such as action plans and data collection tools. During this phase a focus group interview of kaimahi was completed and initial data analysis completed. The evaluation has contributed to building community capacity, which in turn, has strengthened understanding of the project and subsequent implementation. 

Te Puawai o te Ahi Kaa Project Evaluation 

Te Puawai o Te Ahi Kaa (TPoTAK) Project is being collaboratively undertaken by Raetihi Pah and Te Oranganui Iwi Health Authority. This innovative Kaupapa Māori initiative is based on the role of the marae as the house of the hapū; the place of cultural sustenance and vitality for whānau. It recognises that the health and wellbeing of those whānau who maintain the ahi kaa is critical to the sustainability of the paepae and marae. The project commenced in mid-2014 and shortly afterwards Whakauae Research Services was engaged to evaluate it. The evaluation design is based on a participatory research approach to “evaluate with” rather than carry out an “evaluation of ” Te Puawai o Te Ahi Kaa. Whilst the design uses methods described in Western research literature it draws primarily on qualitative approaches using a Māori worldview. 

Outcomes / Achievements

At the beginning of 2015 Phase Two of the evaluation commenced. Evaluation activities included development of rubrics tables as a tool to help make evaluation assessments (regarding project activities and outcomes) transparent. A focus group interview, a survey of project participants, kaimahi recording of photo narratives and muralling methods were used. In the initial data analysis phase key findings and themes were identified. The evaluators shared these results with whānau in a data ‘sense-making’ process which was part of the December 2015 whānau day held at the marae. The day provided an opportunity for the evaluators to meet face to face with the wider whānau. 

Taranaki Māmā Pēpē Hauora Programme Evaluation 

We carried out a process and short – medium term outcomes evaluation of the Taranaki Māmā Pēpē Hauora (MPH) Programme, which we completed in the second half of 2015. The MPH Programme was initiated in mid-2013 following a successful response by the Taranaki District Health Board, and its strategic partners, to a Ministry of Health request for proposals. The Programme seeks to improve the health and wellbeing of mothers and their children through better nutrition, including breastfeeding, and regular physical activity. Tui Ora Ltd, based in New Plymouth, is delivering the Programme that focuses on priority Taranaki communities. The evaluation aimed to determine how effective the Programme was in reaching priority audiences. It also assessed positive changes in participant awareness, understanding and behaviour with respect to nutrition and physical activity. 

Outcomes / Achievements

An MPH Programme Interim Evaluation Report was completed in March 2015 using data collected from programme participants, kaimahi and governance group members along with the review of key programme documentation. The findings and recommendations made in that report were used by the evaluation commissioner, and the provider, to refine the second phase of the Programme rollout which began in July 2015. 

Using further data collected in the first half of 2015, a Final MPH Programme Evaluation Report was completed in September 2015. Results and recommendations included in the Final Evaluation Report have since been used to further inform the fine-tuning of phase two of the MPH Programme which is scheduled to conclude in mid-2016.

Huarahi rongoā ki a ngāi tātou: Māori views on rongoā Māori and primary health (Postdoctoral Research) 

In this project, the views of Māori were explored in relation to health, experience of rongoā Māori, experience of primary health services and the integration of rongoā Māori with primary health care. Two groups of Māori health services consumers, one which used rongoā in addition to primary health treatment and one which only used primary health treatment, were interviewed. Consumers also participated in the use of a methodology termed “Māori-voice” by Dr Mark; giving expression to Māori worldviews of hauora through photographs. In undertaking the research, it was hoped to establish the ways in which Māori beliefs about health and illness contribute to health treatment choices along with how the health treatment experiences of participants can be used to inform integration of rongoā and primary health services for the benefit of Māori. 

Outcomes / Achievements

Dr Glenis Mark completed her postdoctoral studies in February 2015. A key achievement was the production of a booklet for her research participants, based on the photographs they took as part of the study. The booklet, Huarahi rongoā ki a ngāi tātou: Māori views on rongoā Māori and primary health - Results of research conducted with Māori patients of rongoā and primary health, was presented to participants and Project Advisory Group members at a research dissemination hui in November 2014. An important component of Dr Mark’s postdoctoral work was the production of academic journal articles and, in addition to the research she undertook, she was successful in having two articles accepted for publication in 2015, with a further two currently under review. 

Preventing Chronic Conditions: Learnings from Participatory Research with Māori 

In this 42-month study, we are examining how the primary and secondary prevention of chronic conditions is being modelled, practiced and measured in three case study sites; to define what short term outcomes are being achieved; and enable naturalistic generalisation to be made to inform wider health service development. A collective case study design, utilising qualitative and evaluation-based research methods, will examine the three case studies. Data will be interrogated across three levels, policy (government), practice (provider) and whānau (community). 

Outcomes / Achievements

Phase One of the study was completed at the close of 2015. The three case study sites are each implementing models of care to improve Māori health outcomes for chronic conditions. All have similar principles: cross sector collaboration; integrated health services; improved health service access; emphasis on health outcomes; increased responsiveness to Māori; and whānau-centred services. 

The early results from this project will be presented to Tumu Whakarae, the National Reference Group of Māori Strategy Managers within DHBs, in early 2016. 

HRC Writing Workshops 

The HRC Writing Workshops have been run by Whakauae since 2009, in a variety of formats and locations, but always with the same primary objective, namely to increase the number and quality of applications made by Māori researchers to the HRC’s various funding rounds. In 2015, two workshops were held; one at the offices of Te Whānau o Waipereira Trust in Auckland and a second at Te Pūtahi ā Toi, Massey University, Palmerston North. A workshop specifically focused on applying for the Ngā Kanohi Kitea (NKK) round of community-led research grants was held in Whanganui, after a number of requests from the local community. This workshop was held in conjunction with, and hosted by, Te Atawhai o te Ao. 

Outcomes / Achievements

All workshops were well attended with the rise in interest amongst community and iwi members in both research funding and the work of the HRC, being particularly noticeable. This community interest in the activity of “research” is heartening and can be put down in large part to the success of the HRC’s Ngā Kanohi Kitea grant round. The NKK Investigator Briefing Meeting (IBM) was well attended and participants remained very engaged throughout the day. From the feedback we receive through our formal evaluation forms, and un-solicited comments, we know that community members who attend the writing workshops get real value from their attendance. We have noticed greater interest on the part of community members participating in, and eventually leading their own research projects for their own people. In addition, the presentation on Career Development Awards (CDA) is always well received, and we are aware that this interest has translated directly into a growth in CDA applications to the HRC over the years we have been conducting the workshops. 

Supporting Traditional Rongoā Practice in Contemporary Health Care Settings 

In this three-year project, we sought to identify the health service arrangements that best support traditional rongoā Māori practice in a contemporary setting. Using a Māori-centred approach, and a mix of qualitative and quantitative methods, the research aimed to identify the features of health service arrangements that are both consistent with principles of rongoā practice and that ensure cultural integrity. The project represented a collaboration between researchers from Whakauae and two different universities (Canterbury and Waikato) as well as the involvement of the Chair of Te Kāhui Rongoā as a researcher on the project. Te Kāhui Rongoā, the national body for rongoā Māori practitioners, played an active role in the project. As well as acting in an advisory capacity for the project team, Te Kāhui Rongoā assisted the research team to make sense of the findings before they were released to the wider sector. 

Outcomes / Achievements

The results of our research have shown a number of significant issues must be addressed by the rongoā sector to ensure rongoā Māori continues as a vital part of Te Ao Māori. Key amongst these issues include how to ensure the sustainability of an ageing workforce; that this workforce is receiving the training it requires; and that the sector has access to the raw materials and mātauranga it requires to be effective. To date, the research team has produced two peer-reviewed journal articles on these and other issues, and further articles are being prepared for publication. We have also been able to share our findings with the sector through peer reviewed conference papers; six separate oral conference papers and presentations to local communities. Local presentations have culminated in a keynote address on the importance of the rongoā sector driving its own research agenda at the National Rongoā Symposium and Expo, held in Whanganui in October 2015.

The Rangitīkei Iwi of Ngāti Apa and Mōkai Pātea identified a collective need to access good quality information about their individual iwi populations. Te Kete Tū Ātea Phase 2 study builds on previous HRC funded research that developed an information framework for each iwi, namely, Te Kete Tū Ātea. Whakauae has funded Phase 2 implementation of the framework testing utility and impact of the framework using data from the economic domain. The intended outcome will be iwi leaders and governors utilising information to achieve evidence-informed decisions.

This research is conducted with iwi participating as active research partners and uses a mixed methods approach of both qualitative in-depth interviews and quantitative statistical data.   The aim is to:

1. Determine how economic information is able to be accessed, analysed and disseminated to iwi leaders in a meaningful and efficient manner,
2. To observe and discuss how economic information is received and can be used to exercise Kaitiakitanga, and
3. To analyse how, or if, information results in decision-making that future-proofs iwi.

It is intended that this research provide evidence to inform the future progression of the framework across all five domains for the Collective.

Outcomes / Achievements

The project is progressing well and in particular is seen as a flagship for other iwi when it comes to collecting, analysing and utilising quantitative data at an iwi level. There are a number of data initiatives happening across government, coinciding with the timing of this project. As a result, the team were asked to present at the Iwi/Māori data hui initiated by the Minister of Finance, and facilitated by Treasury and Statistics New Zealand in September 2015. Kirikowhai Mikaere was also invited to an Advisory Group Hui (following the first Iwi/Māori data hui of the Minister of Finance), to provide further advice and guidance as to next steps for Treasury and Statistics New Zealand. Because of these meetings, the NZ Data Futures project, and the creation of an Integrated Data Infrastructure, or IDI, an independent Māori Data Sovereignty network has been initiated. A first hui on the topic of Māori Data Sovereignty was held in Hopuhopu in October 2015 and attracted some 30 Māori with interests in this kaupapa. Kirikowhai Mikaere and Dr Tahu Kukutai are the interim co-leaders of the network.

Iwi Information + Iwi Analysis = Better Iwi Futures

Care and Protection of our Māori Children, our Future: A Whānau Perspective

Māori overrepresentation in care and protection of tamariki/mokopuna is continuing to rise, increasing the risk of incidents of child abuse and removal of mokopuna from whānau. However, resources for the care and protection of mokopuna have tended to overlook the contribution of positive change models initiated by Māori parents and grandparents. The aim of this research is to ascertain and articulate the positive contribution that can be made by Māori parents and grandparents to the care and protection of their tamariki/mokopuna. The qualitative research design used a narrative inquiry in semi-structured kanohi-ki-te-kanohi interviews to elicit stories from 10 Māori whānau parents and grandparents. Preliminary findings from the analysis indicate that there are a number of ways in which Māori parents and grandparents can better be supported to meet the needs of their children, once they have come to the attention of Child, Youth & Family Services (CYFS) and the Justice system. Preliminary findings also indicate that further training of the iwi/community social service sector, who work with parents and grandparents at the time of first contact and subsequently is required.

Outcomes / Achievements

The research provided valuable insight into the positive contribution made by Māori parents and grandparents to the care and protection of tamariki/mokopuna. Subsequently, the research has used the stories gathered from whānau to set up a pilot study offering navigator services for whānau. The pilot, Mokopuna Ora, is a partnership between Waikato-Tainui and CYFS and seeks to address some of the key issues identified by whānau including the lack of information, knowledge and communication when interacting with the CYFS/Family Court system. Research results will be disseminated at a Research Hui in Whanganui early in 2016.

Te Puawai o Te Ahi Kaa: a MoH Innovation Project

At Raetihi Pah, local hapū members are leading a four-year Ministry of Health funded Innovation project; Te Puawai o Te Ahi Kaa (TPoTAK). This project is in partnership with Te Oranganui Iwi Health Authority and Whakauae Research (as evaluation support). TPoTAK seeks to enhance the wellbeing of whānau who have remained living locally by mapping the historical wellbeing of whānau as well as identifying the current health and wellbeing status of members. To date, the team has completed a health needs assessment and developed a whānau-informed programme of action. The aim of this is to increase health literacy and positively change health behaviours to enhance whānau well-being. Now in the final year of the project, the team is working on implementation of these strategies with the ultimate aspiration of strengthening Ahi Kaa and keeping the paepae strong.

Whakauae is committed to working collaboratively with project kaimahi and the wider community and seeks to build the evaluation skills of kaimahi throughout the project. Examples of this have included:

• kaimahi administration and collection of evaluation data;
• kaimahi generated photo narratives that provide project activities a voice; and
• support with applications to the Australasian Evaluation Society conference support grant fund.

In December 2015, evaluators attended a whānau day so they could share initial data analysis and key findings with the community. Results show that the project is providing members with a vehicle to better understand the health issues within their whānau and the community.  This greater understanding has resulted in a plan of action whereby health information is being shared, services are better integrated with the community and community members are upskilled in issues such as chronic conditions self-management and caring for vulnerable children. During the whānau day, participants were encouraged to take part in sessions where ‘muralling’ techniques were used to make sense of data. Whānau enjoyed the interactive whānau-friendly sessions and are keen to utilise some of these in their workplace. The day provided an opportunity for the evaluators to meet face to face with the wider whānau and other community groups. 

Preventing Chronic Conditions:  Learnings from Participatory Research with Māori

In this 42-month, HRC-funded study, we are examining how the primary and secondary prevention of chronic conditions is being modelled, practiced and measured in three case study sites.  Read on for the latest update on this project.

Why is this work important now?

Extensive work is underway in the health sector to manage chronic conditions including service and workforce redesign, and clinical guideline development. Key health service approaches include quality management, primary and secondary care integration, care coordination and multidisciplinary teamwork. For those with chronic conditions, emphasis is often placed on self-management as an outcome of interventions, education and support. These approaches however contribute little to the prevention of chronic conditions and commonly inadequately address the needs of Māori, under-utilise broader whānau engagement in prevention and struggle to achieve and maintain cross sector collaboration.

Our research aims to:

• Examine how the prevention (both primary and secondary) of chronic conditions is being modelled, practiced and measured in three unique iwi health provider sites (Poutini Waiora, Westcoast); Te Oranganui Iwi Health Authority, Whanganui; and Tui Ora Ltd, Taranaki);
• Define what short term outcomes are being achieved; and to,
• Enable naturalistic generalisations to be made to inform wider health service development.

Under the umbrella of a Māori-centred approach a collective case study design, utilising qualitative and evaluation-based research methods, is being used to examine a chronic condition prevention case study in each of the health provider sites. Data is being interrogated across three levels, policy (government), practice (provider) and whānau (community). Multilevel, comparative exploration will produce results that demonstrate the diversity in perspectives, priority setting, and intervention practices and experiences between key actors.

Phase One of the study was completed at the close of 2015. That Phase included identifying and defining each chronic condition prevention case along with addressing research questions about how prevention is modelled and priorities are defined. 

What have we found out so far?

Our three research sites are each implementing models of care to improve Māori health outcomes for chronic conditions. All have similar principles: cross sector collaboration; integrated health services; improved health service access; emphasis on health outcomes; increased responsiveness to Māori; and whānau-centred services.

Data collected from the three sites and analysed in Phase One highlights the following:

• Providers are taking opportunities to meet the needs of their communities;
• Achieving long-term wellbeing, through health service delivery, is complex especially if you want a programme to be sustainable; and,
• The broader national policy environment is not necessarily conducive to local level implementation.

Providers know their communities in-depth and have some degree of flexibility to be able to re-orient themselves to better meet those needs. That provider responsiveness however, demands a mix of staff and skills that may not necessarily be readily available.  Negotiating constant flux, exacerbated by ongoing changes in organisational funding and contracting, contributes to some lack of clarity with regard to organisational vision, roles and responsibilities. Ongoing organisational change therefore has impacts that can undermine the momentum to keep moving forward.

Commitment to working at whānau level is being articulated, but is not readily facilitated by the wider national policy environment which conditions funding and contracting. For example, whilst key players may identify multi-sector collaboration as being integral to delivery of services which promote wellness much of the existing wider policy environment remains tuned to delivery ‘in silos’. Such delivery is directed towards separately addressing each of an individual’s specific medical conditions in isolation.      

There are a range of impediments to achieving wellbeing through health service delivery. The dominant individualistic, medical conditions focused discourse noted above is a driver of service delivery norms. There are examples of shifts in organisational structure, skill mix focus and delivery configurations that demonstrate that these norms are being challenged and reframed, in some form, by the providers. Early indications are that promising whānau focussed, integrated models of care are being developed and implemented by providers though significant hurdles exist.

Where to from here?

Phase Two (15 months) of the study is exploring how the chronic condition prevention cases identified in Phase One are being implemented in each site. In this Phase, we will also determine the outcome frameworks being utilised. Phase Three (late 2017 to January 2018) will then identify short term outcomes achieved, with respect to the implementation of each of the case study  interventions, over the period of the research. Using the results and knowledge gained from each phase, Phase Three will inform broader health service development.

In the long-term this research has the potential to reduce chronic conditions for Māori through a number of interlinked pathways including the modelling of effective prevention along with using a combination of evidence and Māori models of practice. It will also contribute to Indigenous models of chronic condition prevention globally. 

Health Promotion Evaluation 

During 2014, Whakauae was commissioned by jigsaw whanganui to carry out an evaluation of the agency’s White Water Years Parenting Programme. The evaluation was largely funded through a Lotteries Board grant with the final report being completed in November 2014.

A collaborative approach was taken to carrying out the evaluation mahi. Whakauae worked alongside jigsaw whanganui staff to clarify Programme intent, to determine how Programme quality and success would be judged and to collect and ‘make sense’ of evaluation data. jigsaw whanganui has already taken on board evaluation recommendations and is working towards further strengthening the already well rated White Water Years Parenting Programme. Programme developments influenced by the evaluation were outlined at a luncheon hosted by jigsaw whanganui to mark the completion of the evaluation.

Whakauae evaluators, Gill Potaka-Osborne and Lynley Cvitanovic joined jigsaw whanganui’s staff at the luncheon on 03 February 2015.

Whakauae & jigsaw whanganui staff celebrate completion of the White Water Years Parenting Programme evaluation.

Whakauae evaluators with jigsaw whanganui programme facilitators, 03 February 2015.

Health Promotion Evaluation

Whakauae Research staff belong to evaluation professional associations and take part in regular evaluation professional development activities. Gill Potaka-Osborne and Lynley Cvitanovic are both members of the Aotearoa New Zealand Evaluation Association (ANZEA), Dr Heather Gifford is an American Evaluation Association (AEA) member and Dr Amohia Boulton is an Australasian Evaluation Society (AES) member as well as being a member of the AES Board.

Evaluation which Whakauae is currently carrying out, or which has been completed this year, includes that of:   

• Te Oranganui Iwi Health Authority (Whanganui) and the Raetihi Pa’s collaborative project, Te Puawai o Te Ahi Kaa with evaluation commissioned by the Ministry of Health through Te Ao Auahatanga Hauora Māori – Māori Health Innovations Fund 2013-2017;
• Poutini Waiora’s (West Coast) Mana Tamariki Mokopuna, Mana Whānau o Te Tai o Poutini project commissioned by the Ministry of Health through Te Ao Auahatanga Hauora Māori – Māori Health Innovations Fund 2013-2017;
• The Māmā Pēpē Hauora Programme 2013-2015 delivered by Tui Ora in Taranaki with evaluation commissioned by the Taranaki District Health Board;
• The Early Pregnancy Assessment Approach developed and being delivered by the Whanganui Regional Health Network with evaluation commissioned by the national Health Promotion Agency (HPA);
• The national Maternity and Quality Safety Programme. We have been sub-contracted by Allan and Clarke to contribute to this programme evaluation commissioned by the Ministry of Health.

As well as carrying out health promotion programme evaluation research locally, regionally and nationally, Whakauae has developed resource material to support community level practitioners to evaluate their own health promotion project work. This self-directed learning material, Building Evaluation Competence: Workbooks One, Two and Three is available on the Publications page of this website under the heading Technical Reports.