Disrupted mana and systemic abdication: Māori qualitative experiences accessing healthcare in the 12 years post-injury

Abstract

Background Māori have been found to experience marked health inequities compared to non-Māori, including for injury. Accessing healthcare services post-injury can improve outcomes; however, longer-term experiences of healthcare access for injured Māori are unknown. This paper reports on data from the longitudinal Prospective Outcomes of Injury Study – 10 year follow up (POIS-10) Māori study in Aotearoa/New Zealand (NZ), to qualitatively understand Māori experiences of accessing injury-related healthcare services long-term. Methods Follow-up telephone interviews were conducted with 305 POIS-10 Māori participants, who were injured and recruited 12-years earlier, experiencing a range of injury types and severities. Free text responses about trouble accessing injury-related health services were thematically analysed. Results Sixty-one participants (20%) reported trouble accessing injury-related health services and provided free text responses. Three related themes describing participants’ experiences were connected by the overarching concept that participants were engaging with a system that was not operating in a way it was intended to work: 1) Competing responsibilities and commitments encapsulates practical barriers to accessing services, such as a lack of time and having to prioritise other responsibilities such as work or whānau (family); 2) Disrupted mana refers to the feelings of personal disempowerment through, for example, receiving limited support, care or information tailored to participants’ circumstances and is a consequence of patients contending with the practical barriers to accessing services; and 3) Systemic abdication highlights systemic barriers including conflicting information regarding diagnoses and treatment plans, and healthcare provider distrust of participants. Conclusions Twelve years post-injury, a considerable proportion of Māori reported experiencing barriers to accessing healthcare services. To restore a sense of manaakitanga and improve Māori access to healthcare, Māori-specific supports are required and systemic barriers must be addressed and removed.

Are patients with type 2 diabetes in the Waikato District provided with adequate education and support in primary care to self-manage their condition? A qualitative study

“…44,45 Previous studies have stated Māori have less access to health services such as GPs 46 and a sense of whakamā (shame/feeling of blame) may result from the racism they experience. 47 Therefore, healthcare practitioners and a health service that is culturally safe is needed, along with a clear understanding of Te Tiriti and its obligations (New Zealand's founding document and partnership with Māori and the Crown). 48 It is important to note, however, that one patient who experienced such stigma was able to find a healthcare practitioner who was Māori, and was able to develop trust and empathy.…”

Association of ethnicity with unintentional injury‐related hospitalisation and mortality among older people residing in two regions of Aotearoa New Zealand

“…13 These outcomes have occurred in the context of Māori having inequitable access to timely, high-quality, culturally appropriate healthcare in NZ, including lower access to ACC-funded prevention, injury health care and injury rehabilitation services. [14][15][16] Inequities in access to the determinants of health result in Māori being more likely to develop chronic comorbidities at younger ages. 10,17 The effect of earlier co-morbidities, exacerbated by prescription medication use, can lead to functional impairment and thus increased risk of falls.…”

“…Māori also have higher rates of unintentional injury‐related hospitalisation 12 and an increased risk of disability compared to non‐Māori 12‐month postinjury after controlling for preinjury and injury‐related factors 13 . These outcomes have occurred in the context of Māori having inequitable access to timely, high‐quality, culturally appropriate healthcare in NZ, including lower access to ACC‐funded prevention, injury health care and injury rehabilitation services 14–16 …”