Implementation framework for chronic disease intervention effectiveness in Māori and other indigenous communities

Abstract

Background: About 40% of all health burden in New Zealand is due to cancer, cardiovascular disease, and type 2 diabetes/obesity. Outcomes for Māori (indigenous people) are significantly worse than non-Maori; these inequities mirror those found in indigenous communities elsewhere. Evidence-based interventions with established efficacy may not be effective in indigenous communities without addressing specific implementation challenges. We present an implementation framework for interventions to prevent and treat chronic conditions for Māori and other indigenous communities. Theoretical framework: The He Pikinga Waiora Implementation Framework has indigenous self-determination at its core and consists of four elements: cultural-centeredness, community engagement, systems thinking, and integrated knowledge translation. All elements have conceptual fit with Kaupapa Māori aspirations (i.e., indigenous knowledge creation, theorizing, and methodology) and all have demonstrated evidence of positive implementation outcomes.

What protects against pre-diabetes progressing to diabetes? Observational study of integrated health and social data

“…The aim of this study was to first, examine the incidence of diabetes in an ethnicallydiverse primary care population with newly diagnosed pre-diabetes; and second, to quantify the factors that protect against progression to diabetes, with an emphasis on non-clinical as well as clinical factors. The question posed in this paper was developed in response to issues raised as part of an Indigenous community co-design project that used the He Pikinga Waiora Implementation Framework [19]. The framework is a participatory approach to developing and implementing interventions that places Māori knowledge and self-determination at the center and then integrates systems thinking to enhance effectiveness, sustainability and improve health equity.…”

He aha te mea nui o te ao? He tāngata! (What is the most important thing in the world? It is people!)

“…Activate collaborations between Indigenous researchers, community partners and services providers is a key pathway to support the development of culturally appropriate, high-quality health services for under-served populations (Simmons and Voyle 2003;Korn and Ryser 2006;Dutta 2007;Wallerstein et al 2008;Walters et al 2011;Michener et al 2012;Stellefson et al 2013;Cyril et al 2015). HPW comprises a collaboration of academic researchers, public health physicians and systems analysts who aim to reduce health inequities through a better understanding of the science of implementation (Oetzel et al 2017). In this paper, we describe our work alongside two M aori community health providers: Te K ohao Health 1 in the Waikato region and Poutiri Charitable Trust 2 in the Bay of Plenty region.…”

Re-Contextualizing Medical Pluralism in South Africa: a Research Schema for Indigenous Decision Making

“…The Mauri Model decision making framework represents the process through which an indigenous concept became officially endorsed as a goal within a government-led strategy to mitigate the impact of a national environmental disaster (Faaui et al 2017). The negotiated process represents a first in New Zealand's history and the concept has subsequently been re-used in other action-oriented projects (for one example relating to chronic disease mitigation, see Oetzel et al 2017).…”