Maori elders' perspectives of end-of-life family care: whanau carers as knowledge holders, weavers, and navigators.

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

Reflecting and learning: A grounded theory on reframing deficit views of young indigenous women and safety.

Often young indigenous women are framed in ways that problematize and pathologize them, which overlooks their strengths. We interviewed 16 young Indigenous Maori women aged 14 to 18 years about their understandings of safety, being safe, and how they kept themselves and their friends safe. Reflecting and Learning, aided by progressing age and maturity, is the process that mediated their feeling unsafe and keeping safe and resulted in being safe. Young Maori women's reflecting and learning facilitates relatively mature levels of resourcefulness for navigating being safe, including situations they encountered appear unsafe.

A cultural analysis of New Zealand palliative care brochures.

Low utilization of palliative care services by Maori remains despite increases in services designed to meet Maori needs. The purpose of this study is to explore palliative care information brochures in the context of Maori principles of well-being and communication protocols, and health literacy. We examined 99 brochures from palliative care services in New Zealand and held two focus groups with 12 Maori elders (kaumatua) and extended family (whanau) members. Taking a cultural-discursive approach incorporating Maori worldviews, we analysed textual and conceptual features of the brochures. The findings centred on cultural connection and disconnection within the brochures and serve as a critique of the prominent messages currently presented in these brochures. The findings raise questions about the capacity of agencies to convey culturally resonant messages to kaumatua and their whanau. We identify implications of palliative care brochures for health literacy of provider organizations as well as kaumatua and whanau.

Managing communication tensions and challenges during the end-of-life journey: perspectives of Maori kaumatua and their whanau.

The purpose of this study is to explore the cultural practices and communication tensions perceived among Maori kaumatua (elders) and their whanaunga (extended family) during the end-of-life journey. Further, the study aims to explore the manner in which the tensions are managed. The study was framed by relational dialectics theory and included interviews with 21 kaumatua and focus groups with 39 whanau members. The study identified three cultural practices (dying at home, prayer, and song) that helped to build connection among the family members and also helped to connect the dying person to the spiritual world. Further, four communication tensions were noted: (a) autonomy and connection; (b) conflict and connection; (c) isolation and connection; and (d) balancing the needs of self and other. To manage these tensions, the following strategies were used: (a) coordination conversations; (b) inclusion in decision-making conversations; (c) emotional support within the whanau; and (d) passing on lessons to the next generation.

Reducing disease burden and health inequalities arising from chronic disease among indigenous children: an early childhood caries intervention in Aotearoa/New Zealand.

BACKGROUND: Maaori are the Indigenous people of New Zealand and do not enjoy the same oral health status as the non-Indigenous majority. To overcome oral health disparities, the life course approach affords a valid foundation on which to develop a process that will contribute to the protection of the oral health of young infants. The key to this process is the support that could be provided to the parents or care givers of Maaori infants during the pregnancy of the mother and the early years of the child. This study seeks to determine whether implementing a kaupapa Maaori (Maaori philosophical viewpoint) in an early childhood caries (ECC) intervention reduces dental disease burden among Maaori children. The intervention consists of four approaches to prevent early childhood caries: dental care provided during pregnancy, fluoride varnish application to the teeth of children, motivational interviewing, and anticipatory guidance. METHODS/DESIGN: The participants are Maaori women who are expecting a child and who reside within the Maaori tribal area of Waikato-Tainui.This randomised-control trial will be undertaken utilising the principles of kaupapa Maaori research, which encompasses Maaori leadership, Maaori relationships, Maaori customary practices, etiquette and protocol. Participants will be monitored through clinical and self-reported information collected throughout the ECC intervention. Self-report information will be collected in a baseline questionnaire during pregnancy and when children are aged 24 and 36 months. Clinical oral health data will be collected during standardised examinations at ages 24 and 36 months by calibrated dental professionals. All participants receive the ECC intervention benefits, with the intervention delayed by 24 months for participants who are randomised to the control-delayed arm. DISCUSSION: The development and evaluation of oral health interventions may produce evidence that supports the application of the principles of kaupapa Maaori research in the research processes. This study will assess an ECC intervention which could provide a meaningful approach for Maaori for the protection and maintenance of oral health for Maaori children and their family, thus reducing oral health disparities. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12611000111976.