RESUMO
BACKGROUND: Health inequities experienced by kaumatua (older Maori) 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 Maori to new communities. METHODS: The study was grounded in an Indigenous methodology (Kaupapa Maori) 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: Kaumatua mana motuhake (kaumatua independence and autonomy) where community researchers centred the needs of kaumatua in co-designing the programme with researchers; Whanaungatanga (relationships and connectedness) which illustrated how community researchers' existing and emerging relationships with kaumatua, 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.
RESUMO
Background: Maori kaumatua (elders) face stark health and social inequities compared to non-Maori New Zealanders. The tuakana-teina (older sibling-younger sibling) peer education programme is a strengths-based approach to enhance well-being and social connectedness. The purpose of this study is to present the baseline data from this programme and identify correlates of well-being outcomes. Method: Participants included 128 kaumatua who completed a self-report survey about health-related quality of life, spirituality, social connection and loneliness, life satisfaction, cultural identity and connection, elder abuse, health service utilisation and demographics. Findings: Multiple regression models illustrated the following correlates of outcomes: (a) self-rated health: needing more help with daily tasks (ß = -0.36) and housing problems (ß = -0.17); (b) health-related quality of life: needing more help with daily tasks (ß = -0.31), housing problems (ß = -0.21), and perceived autonomy (ß = 0.19); (c) spiritual well-being: understanding of tikanga (cultural protocols) (ß = 0.32) and perceived autonomy (ß = 0.23); (d) life satisfaction: social support (ß = 0.23), sense of purpose (ß = 0.23), cultural identity (ß = 0.24), trouble paying bills (ß = -0.16), and housing problems (ß = -0.16); (e) loneliness: elder abuse (ß = 0.27), social support (ß = -0.21), and missing pleasure of being with whanau (extended family) (ß = 0.19). Conclusions: Key correlates for outcomes centred on social support, housing problems, cultural connection and perceived autonomy. These correlates are largely addressed through the programme where tuakana/peer educators provide support and links to social and health services to teina/peer recipients in need. This study illustrates needs and challenges for kaumatua, whilst the larger programme represents a strengths-based and culturally-centred approach to address health issues related to ageing in an Indigenous population.