Mary Simpson

As the population of Aotearoa New Zealand ages, informal family carers will play an increasingly important role in caring for older adults at home. Multi-generational living arrangements are a growing trend, particularly among Māori communities, where caring for older relatives within the family home is widespread. This article uses in-depth, semi-structured interviews with Māori whānau (extended family members) caring for kaumātua (older family members) at home to explore how carers experienced care coordination in the broader care collective. The findings centred on three interconnected factors that described the collective organisation of care: (1) whānau care as normal; (2) whānau care as collective coordination; and (3) whānau carer knowledge and needs as unseen. The findings show that although whānau care of kaumātua is highly valued, ‘structural holes’ within care systems contribute to challenges in care coordination. Despite extensive whānau support for kaumātua, primary carers often felt that their knowledge, preferences and self-care needs remained unseen and not translatable to those outside the everyday care situation. Rather than assuming an artificial binary difference between ‘collective’ and ‘individually oriented’ care contexts and cultures, analysing the cultural norms surrounding whānau care-giving confirms that collective care system members face similar and different challenges to carers with smaller caring capacities.

Safe, secure, suitable housing is often an unattainable reality for kaumātua (older Māori aged 55 years and over in this study) in Aotearoa New Zealand. Kaumātua, unfortunately, are at the forefront of the housing crisis, and struggle to find housing which meets their most basic needs. Therefore, many organisations are considering the development of urban papakāinga to meet their needs. The purpose of this study is to assess the needs of kaumātua currently in temporary, emergency or state housing situations to understand their perspectives about what factors enable successful urban papakāinga. The research design and methodology in this article apply a multi‐method observational approach, guided by the He Pikinga Waiora (HPW) Implementation Framework. The main findings in this study include five cultural characteristics necessary within urban papakāinga developments; whanaungatanga (connections); kaitiakitanga (environmental care/ guardianship); manaakitanga (care for others); rangatiratanga (leadership, autonomy, or control); and haumarutanga (safety/security). In addition, key correlates of wellbeing indicators included housing suitability, community connection and a safe neighbourhood. These key needs and perspectives have important theoretical and practical implications for kaumātua wellbeing, and successful housing developments for Māori. Glossary of Kupu Māori words: Aotearoa: Māori name of New Zealand; haumarutanga: security, safety, or peace of mind; kaitiakitanga: environmental care, guardianship, or stewardship; kaumātua: older Māori aged 55 years and over; kaupapa Māori: Māori approach; koroua: older male; kuia: older female; manaakitanga: generosity, cherish, respect, care and hospitality; Māori: Indigenous people of Aotearoa‐NZ; papakāinga: traditional Māori housing/community complex; Papatūānuku: Earth Mother; rangatiratanga: leadership, self‐determination, autonomy, or control; Te Puāwaitanga o Ngā Waka: The Blossoming of Aspirations for All; tikanga: correct custom, procedure, or protocol; tūrangawaewae: a place of strength, belonging, connection, a place to stand; urban papakāinga: modern Māori housing/urban intergenerational village; wairuatanga: spirituality; whakapapa: decent, lineage, ancestor, or genealogy; whānau: family or closely connected kin group; whanaungatanga: connectedness, kinship, or relationships

Background: Health inequities experienced by kaumātua (older Māori) in Aotearoa, New Zealand, are well documented. Examples of translating and adapting research into practice that identifies ways to help address such inequities are less evident. The study used the He Pikinga Waiora (HPW) implementation framework and the Consolidated Framework for Implementation Research (CFIR) to explore promising co-design and implementation practices in translating an evidence-based peer-education programme for older Māori to new communities. Methods: The study was grounded in an Indigenous methodology (Kaupapa Māori) and a participatory research approach. Data were collected from research documentation, community meeting and briefing notes, and interviews with community researchers. Results: The data analysis resulted in several key promising practices: Kaumātua mana motuhake (kaumātua independence and autonomy) where community researchers centred the needs of kaumātua in co-designing the programme with researchers; Whanaungatanga (relationships and connectedness) which illustrated how community researchers’ existing and emerging relationships with kaumātua, research partners, and each other facilitated the implementation process; and Whakaoti Rapanga (problem-solving) which centred on the joint problem-solving undertaken by the community and university researchers, particularly around safety issues. These results illustrate content, process, and relationship issues associated with implementation effectiveness. Conclusions: This study showed that relational factors are central to the co-design process and also offers an example of a braided river, or He Awa Whiria, approach to implementation. The study offers a valuable case study in how to translate, adapt, and implement a research-based health programme to Indigenous community settings through co-design processes. Trial registration: The project was registered on 6 March 2020 with the Australia New Zealand Clinical Trial Registry: ACTRN12620000316909. Prospectively registered.

Background: There is growing interest in palliative care within Indigenous communities, and within Aotearoa New Zealand, of the significant role that Māori (Indigenous people) families play in caring for older relatives. This study explored the centrality of culture in how Māori extended families ( whānau) in Aotearoa New Zealand interpret and enact family-based care roles within the Māori world ( Te Ao Māori). Methods: Applying Māori-centered and community-based participatory research principles, we examined 17 interviews with older Māori who shared experiences of palliative care for a partner or family member. The thematic analysis used a cultural-discursive framework incorporating Māori principles of wellbeing and values expressed within the care relationship. Results: The findings centered on three whānau roles in palliative care: whānau as (1) Holders and protectors of Māori knowledge; (2) Weavers of spiritual connection; and (3) Navigators in different worlds. Conclusion: The study problematizes the notion of a single ‘primary caregiver’, privileges whānau as an inter-woven relational, dynamic care network, and encourages health professionals to recognize the cultural embeddedness of dominant approaches to palliative care.

This study examined a Māori (Indigenous people of Aotearoa New Zealand) age-friendly housing development. Two Māori community groups worked with multiple stakeholders to codesign a culture-centered, kaumātua (older adults) urban housing community. The purpose was to identify codesign and culture-centered principles in the development. Kaupapa Māori (Māori-centered) and participatory research methodologies guided the culture-centered research design. Data collection included 27 interviews with 19 residents and 12 organizational stakeholders; three focus groups with residents’ families, service providers, and nonresident kaumātua (n = 16); and project documents. Data analysis used the framework method. Three codesign process themes emerged: (a) Kaumātua-centered vision; (b) realizing the vision; and (c) living the shared vision. Accounting for cultural practices in codesigning age-friendly and culture-centered housing for and with Indigenous older adults helps meet their cultural, social, health, and economic needs. The research offers a practical pathway to developing age-friendly housing environments for Māori kaumātua, their communities, wider society, and other Indigenous people.

The majority of Indigenous health models do not directly acknowledge that health is a contested political space. Providing a Foucauldian analysis, this article suggests a function of biopower is to naturalise discourses such as the poor Māori health statistic to appear based on factual evidence and thus are apolitical. Employing Foucault’s triad of power—sovereign, disciplinary and biopower—to understand the genealogy of Māori health, this article proffers mana motuhake (Māori political self-governance) as an appropriate health analytic because it, first, identifies Indigenous health as political and, second, because it recognises the disempowering role that colonialism has played in relation to Māori biopolitical self-governance. Hence, we suggest Māori health will be enhanced by mana motuhake and that research underpinned by Indigenous agency and self-governance resists biopower. The article references two Ageing Well National Science Challenge–funded research projects because they innovatively fundamentalise mana motuhake and politics to Indigenous health.

The literature regarding implementation science of evidence-based health interventions in Māori communities is limited, and there is a push for new and innovative delivery methods of health interventions in New Zealand. The purpose of the study was to identify the facilitators and barriers in implementing a health intervention designed by others and was framed by the Consolidated Framework for Implementation Research (CFIR). This study explored general perceptions of the implementation process and also included a case study, the Kaumātua Mana Motuhake (older people’s autonomy and self-actualization) project; a codesigned peer education intervention for older Māori. Semistructured interviews (N = 17) were conducted via face-to-face, phone, or Zoom with health and social service professionals with experience working with Māori communities. Thematic analysis was used to analyze the data. The facilitators included community engagement, program structure, program adaptability and creators’ experience. The barriers consisted of funding access, funding constraints and organizational constraints. The findings support key elements within the CFIR, highlighting the importance of community engagement and adaptability. Additionally, this study identified nuanced aspects of funding and resources that constrain organisations in employing health interventions designed by others.

Seeing Chronic Inequities – A Health Communication Call to ActionCommunication is central to perceptions of and meanings given to health and wellbeing, delivery of health care and health promotion ...

Background: The Aotearoa New Zealand population is ageing accompanied by health and social challenges including significant inequities that exist between Māori and non-Māori around poor ageing and health. Although historically kaumātua (elder Māori) faced a dominant society that failed to realise their full potential as they age, Māori culture has remained steadfast in upholding elders as cultural/community anchors. Yet, many of today’s kaumātua have experienced ‘cultural dissonance’ as the result of a hegemonic dominant culture subjugating an Indigenous culture, leading to generations of Indigenous peoples compelled or forced to dissociate with their culture. The present research project, Kaumātua Mana Motuhake Pōī (KMMP) comprises two interrelated projects that foreground dimensions of wellbeing within a holistic Te Ao Māori (Māori epistemology) view of wellbeing. Project 1 involves a tuakana-teina/peer educator model approach focused on increasing service access and utilisation to support kaumātua with the greatest health and social needs. Project 2 focuses on physical activity and cultural knowledge exchange (including te reo Māori--Māori language) through intergenerational models of learning.Methods: Both projects have a consistent research design and common set of methods that coalesce around the emphasis on kaupapa kaumatua; research projects led by kaumātua and kaumātua providers that advance better life outcomes for kaumātua and their communities. The research design for each project is a mixed-methods, pre-test and two post-test, staggered design with 2–3 providers receiving the approach first and then 2–3 receiving it on a delayed basis. A pre-test (baseline) of all participants will be completed. The approach will then be implemented with the first providers. There will then be a follow-up data collection for all participants (post-test 1). The second providers will then implement the approach, which will be followed by a final data collection for all participants (post-test 2).Discussion: Two specific outcomes are anticipated from this research; firstly, it is hoped that the research methodology provides a framework for how government agencies, researchers and relevant sector stakeholders can work with Māori communities. Secondly, the two individual projects will each produce a tangible approach that, it is anticipated, will be cost effective in enhancing kaumātua hauora and mana motuhake.Trial registration: Australia New Zealand Clinical Trial Registry (ACTRN12620000316909).Registered6 March 2020.