Reported Māori consumer experiences of health systems and programs in qualitative research: a systematic review with meta-synthesis

Abstract

Background: Persistent inequities in health experiences and outcomes are observed for Māori compared to non-Māori in Aotearoa New Zealand. We conceptualised factors associated with Māori consumer experiences of health programs and services and characterise how the recommendations arising from qualitative research inform strategies to address inequities. Methods: In this systematic review, electronic literature searching was conducted in February 2018. Qualitative studies reporting Māori consumer experiences of health services and programs in Aotearoa New Zealand were eligible. Māori consumer experiences of health services were mapped to the WHO Commission of Social Determinants of Health (CSDH) conceptual framework on health inequities as related to: (i) the socioeconomic and political context; (ii) socioeconomic positioning; or (iii) intermediary factors that increase exposure to health-compromising conditions. Recommendations to improve consumer experiences were mapped to the CSDH framework for tackling social determinants of health inequities as policy directions on: (i) unequal consequences of illness (individual interaction); (ii) risks of exposure to health-damaging factors (community); (iii) exposures to health-damaging factors (public policies); and (iv) mitigating effects of socioeconomic and political stratification (environment). Results: Fifty-four studies were included. Māori consumer experiences mapped to social determinants of health inequities were most frequently related to direct interactions with health services and programs, particularly patient-clinician interactions (communication, relationships) and cultural competencies of clinicians and the system. Key recommendations by researchers mapped to potential strategies to address inequity were identified at all levels of the political, social and health system from individual interactions, community change, and broader public and system-level strategies. Recommendations were predominantly focused on actions to reduce risks of exposure to health-damaging factors including health literacy interventions, increased resources in cultural competencies and Māori capacity in health service development and workforce. Conclusions: Māori consumer experiences of health services and programs are an important informer of variables that impact health inequity. Strategies to tackle health inequities informed by Māori consumer experiences can be drawn from existing empirical research. Future qualitative exploration of how socioeconomic, political and public policies influence Māori consumer experiences of health services and programs could inform a broader range of structural policies to address health inequities.

The Transformative Potential of Kaupapa Māori Research and Indigenous Methodologies: Positioning Māori Patient Experiences of Mental Health Services

“…This additional Phase 3 step privileges the voices and expertise of Māori patients and whānau, and challenges those involved in the design and delivery of services to identify the barriers and enablers to transforming health care and the clinical, structural and organizational changes required to achieve health equity for Māori. This response was critical as systematic review findings have shown that capturing Māori voices in research alone has been insufficient to invoke the systemic changes needed to address the causes of longstanding health inequities (Palmer et al, 2019). Indigenous knowledges, and the methodologies that simultaneously contribute to and derive from them, have long been utilized to conduct safe, ethical, and useful research practices by, with, and for the benefit of Indigenous peoples (Chilisa, 2012;Cochran et al, 2008;Curtis, 2016;Drawson et al, 2017;Greenwood et al, 2018;Jones et al, 2006;Pihama et al, 2002;Smith, 2012;Smith et al, 2016).…”

“…To date KMR employing qualitative methods has provided valuable insights into how health services can be adapted to achieve health equity for Māori (Palmer et al, 2019). Recommendations have included the need to change the ways that clinical staff interact with and relate to Māori patients and their whānau, and other health service-specific adaptations (Awatere-Walker, 2015; Boulton, 2005;Drawson et al, 2017;Dyall, 2003;Eade, 2007Eade, , 2014Elder, 2008Elder, , 2013Harris, 2014;Hughes, 2007;Johnson, 2009;Lambert, 2015;Ngata, 2014;Palmer et al, 2019;Pere, 2006;Pihama et al, 2002;Staps et al, 2019;Sweetman, 2017;Taitimu et al, 2018;Tricklebank, 2017;Wakaiti, 2007;Walsh-Mooney, 2009;Watkins, 2007;Wharewera-Mika, 2012;Wilson & Baker, 2012). Some have also recognized that health services need to become more holistic in their view of wellbeing, and in their approaches to service delivery when working with Māori (Boulton, 2005;Dyall, 2003;Eade, 2007;Elder, 2013;Harris, 2014;Johnson, 2009;Ngata, 2014;Palmer et al, 2019;Staps et al, 2019;Sweetman, 2017;Taitimu et al, 2018;Tricklebank, 2017;Walsh-Mooney, 2009;…”

“…Coding notes were developed from the Betancourt et al (2003) framework to ensure a consistent approach was applied across each of the 24 interviews (see Table 1 above). This approach to coding was chosen to ensure attention was given to participants' reported experiences of the impact of systemic factors on hauora, as well as the more commonly considered individual, clinical or service-specific factors (Palmer et al, 2019). In addition, the use of the Betancourt et al (2003) framework required adherence to a structure that ensured participant voices remained privileged in their expert critique of all aspects of the health system, mitigating the risk of defaulting to an interpretation of transcripts based on the research team's training in Western institutions.…”

“…The MBDRP was led by a Māori principal investigator, and Phase 2 was exclusively undertaken by a Māori research team. Domain 2-Research Prioritization: The MBDRP was developed by an experienced Māori research team, and Phase 2 aims and priorities were informed by two systematic reviews completed during the study period (Haitana, 2017;Haitana et al, 2018;Palmer et al, 2019). Domain 3-Research Relationships: This paper details the approach taken to adhere to Māori ethical guidelines, and the involvement of Māori stakeholders in the research process.…”

Clinical and cost-effectiveness of an online-delivered group-based pain management programme in improving pain-related disability for people with persistent pain—protocol for a non-inferiority randomised controlled trial (iSelf-help trial)

“…17 Barriers to accessing specialist pain services include a shortage of skilled healthcare providers 17 ; long waiting times for referral 18 ; limited community-based health services; and geographic barriers and transport costs. For Māori, they include a sense of stigma and stoicism, experiences of institutional racism 19 and restricted access to healthcare. 20 These barriers highlight the need for culturally appropriate, innovative approaches to delivering pain management services.…”