Kaumātua Mana Motuhake: A study protocol for a peer education intervention to help Māori elders work through later-stage life transitions

Abstract

BackgroundThe Aotearoa/New Zealand population is ageing and numerous studies demonstrate with this phenomenon comes increases in non-communicable diseases, injuries and healthcare costs among other issues. Further, significant inequities exist between Māori (Indigenous peoples of Aotearoa/New Zealand) and non-Māori around poor ageing and health. Most research addressing these issues is deficit oriented; however, the current research project takes a strengths-based approach that highlights the potential of kaumātua (elders) by asserting mana motuhake (autonomy, identity and self-actualisation). We believe that the esteem of elders in Māori culture signals transformative potential. Specifically, this project utilises a ‘tuakana-teina’ (older sibling/younger sibling) peer-educator model, where kaumātua work with other kaumātua in relation to health and wellbeing. The objectives of the project are (a) to develop the capacity of kaumātua as peer educators, whilst having positive impacts on their sense of purpose, health and wellbeing; and (b) to enhance the social and health outcomes for kaumātua receiving the intervention.MethodsThe research is grounded in principles of Kaupapa Māori and community-based participatory research, and brings together an Indigenous community of kaumātua, community health researchers, and academic researchers working with two advisory boards. The project intervention involves an orientation programme for tuakana peer educators for other kaumātua (teina). The research design is a pre- and post-test, clustered staggered design. All participants will complete a baseline assessment of health and wellbeing consistent with Māori worldviews (i.e., holistic model). The tuakana and teina participants will be divided into two groups with the first group completing the intervention during the first half of the project and the second group during the second half of the project. All participants will complete post-test assessments following both interventions allowing comparison of the two groups along with repeated measures over time.DiscussionThe findings will provide an evidence base for the importance and relevancy of kaumātua knowledge to create contextually based and culturally safe age-friendly environments that facilitate engagement and participation by kaumātua for kaumātua. If the model is effective, we will seek to facilitate the dissemination and scalability of the intervention.Trial registrationAustralia New Zealand Clinical Trial Registry (ACTRN12617001396314); Date Registered: 3 October 2017 (retrospectively registered).Electronic supplementary materialThe online version of this article (10.1186/s12877-019-1041-2) contains supplementary material, which is available to authorized users.

Kaumātua Mana Motuhake Pōi: a study protocol for enhancing wellbeing, social connectedness and cultural identity for Māori elders

“…The sample size was determined by a balance of resources and power to determine the optimal design and confirmed with the od.exe software [121]. Twenty tuakana and 120 teina will be recruited in total from the five providers; with all tuakana retained/replaced and 67% of teina retention as occurred in a previous iteration of this model [36] it is expected that at least 20 tuakana and 80 teina will be retained. With the assumption of p = .05 and intra-class correlation = .01 (from our previous study) [36], there will be sufficient power (=.80) to identify a medium effect (d = .5) in change over time and a group X time interaction.…”

“…Twenty tuakana and 120 teina will be recruited in total from the five providers; with all tuakana retained/replaced and 67% of teina retention as occurred in a previous iteration of this model [36] it is expected that at least 20 tuakana and 80 teina will be retained. With the assumption of p = .05 and intra-class correlation = .01 (from our previous study) [36], there will be sufficient power (=.80) to identify a medium effect (d = .5) in change over time and a group X time interaction. A medium effect size was chosen given prior research on the impact of elder peer educators on self-rated health and related wellbeing outcomes [122,123] and our previous research [36].…”

“…2 Planned CONSORT Flow Diagram and Data Collection for Tuakana-Teina Project. Note: Participants not allocated to intervention, lost to follow up and excluded from analysis will be calculated at the conclusion of the intervention For specific measures, this project will use a measure of elder abuse adapted from a previous scale [124], housing (two items created for the study; one adapted from the Māori Social Survey) [102], and three items on service use and satisfaction (two created for this study and one from our previous project) [36]. See Additional file 1 for the items created for this study.…”

“…The sample size of 90 kaumātua and 90 whānau members across six providers (n = 15 pairs each) was determined by a balance of resources and power to determine the optimal design and confirmed with NCSS-PASS software [134]. Sixty participant dyads are expected to be retained given the 67% retention rate in our previous research [36]. This sample size is sufficient to detect a small to medium effect size (d = .2, power = .80, p = .05) in time from pre-test to final post-test and a small to medium effect (d = .3, power = .80, p = .05) for group X time interaction.…”

The case of a change in meaning and its impact

“…It can mean either that all elderly have special status in the whānau or, that there are specific elderly who have special status. The former seems to be the general meaning in use nowadays (McNeill 2005;Oetzel et al 2019) and it is commonly acknowledged that elderly Māori occupies a special space of respect. However that meaning, as mentioned earlier, causes some consternation among some Kaumātua who believe not all elderly Māori deserve to be called Kaumātua.…”