Tuakana-teina peer education programme to help Maori elders enhance wellbeing and social connectedness.

BACKGROUND: There are significant inequities between Maori (Indigenous people) and non-Maori in ageing outcomes. This study used a strengths-based approach based on the key cultural concept of mana motuhake (autonomy and self-actualisation) to develop a tuakana-teina (literally older sibling-younger sibling) peer education programme to assist kaumatua (elders) in addressing health and social needs. The purpose of this study was to test the impact on those receiving the programme. Three aims identify the impact on outcomes, resources received and the cost effectiveness of the programme. METHODS: Five Kaupapa Maori (research and services guided by Maori worldviews) iwi (tribe) and community providers implemented the project using a partnership approach. Tuakana (peer educators) had up to six conversations each with up to six teina (peer learners) and shared information related to social and health services. A pre- and post-test, clustered staggered design was the research design. Participants completed a baseline and post-programme assessment of health and mana motuhake measures consistent with Maori worldviews. Open-ended questions on the assessments, five focus groups, and four individual interviews were used for qualitative evaluation. FINDINGS: A total of 113 kaumatua were recruited, and 86 completed the programme. The analysis revealed improvements in health-related quality of life, needing more help with daily tasks, life satisfaction, paying bills and housing problems. Qualitative results supported impacts of the programme on mana motuhake and hauora (holistic health) through providing intangible and tangible resources. Cost-effectiveness analysis showed that the intervention is cost effective, with a cost per QALY of less than the conventional threshold of three times GDP per capita. CONCLUSIONS: A culturally-resonant, strengths-based programme developed through a participatory approach can significantly improve health and social outcomes in a cost-effective way. TRIAL REGISTRY: Clinical trial registry: Trial registration: (ACTRN12620000316909). Prospectively registered 06/03/2020, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379302&isClinicalTrial=False .

Enhancing health outcomes for Maori elders through an intergenerational cultural exchange and physical activity programme: a cross-sectional baseline study.

Background: The study offers baseline data for a strengths-based approach emphasizing intergenerational cultural knowledge exchange and physical activity developed through a partnership with kaumatua (Maori elders) and kaumatua service providers. The study aims to identify the baseline characteristics, along with correlates of five key outcomes. Methods: The study design is a cross-sectional survey. A total of 75 kaumatua from six providers completed two physical functioning tests and a survey that included dependent variables based in a holistic model of health: health-related quality of life (HRQOL), self-rated health, spirituality, life satisfaction, and loneliness. Results: The findings indicate that there was good reliability and moderate scores on most variables. Specific correlates included the following: (a) HRQOL: emotional support (ß = 0.31), and frequent interaction with a co-participant (ß = 0.25); (b) self-rated health: frequency of moderate exercise (ß = 0.32) and sense of purpose (ß = 0.27); (c) spirituality: sense of purpose (ß = 0.46), not needing additional help with daily tasks (ß = 0.28), and level of confidence with cultural practices (ß = 0.20); (d) life satisfaction: sense of purpose (ß = 0.57), frequency of interaction with a co-participant (ß = -0.30), emotional support (ß = 0.25), and quality of relationship with a co-participant (ß = 0.16); and (e) lower loneliness: emotional support (ß = 0.27), enjoyment interacting with a co-participant (ß = 0.25), sense of purpose (ß = 0.24), not needing additional help with daily tasks (ß = 0.28), and frequency of moderate exercise (ß = 0.18). Conclusion: This study provides the baseline scores and correlates of important social and health outcomes for the He Huarahi Tautoko (Avenue of Support) programme, a strengths-based approach for enhancing cultural connection and physical activity.

Adaptation and implementation processes of a culture-centred community-based peer-education programme for older Maori.

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.

Enhancing Well-Being and Social Connectedness for Maori Elders Through a Peer Education (Tuakana-Teina) Programme: A Cross-Sectional Baseline Study.

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.

Ha Ora: secondary care barriers and enablers to early diagnosis of lung cancer for Maori communities.

BACKGROUND: Lung Cancer is the leading cause of cancer deaths in Aotearoa New Zealand. Maori communities in particular have higher incidence and mortality rates from Lung Cancer. Diagnosis of lung cancer at an early stage can allow for curative treatment. This project aimed to document the barriers to early diagnosis and treatment of lung cancer in secondary care for Maori communities. METHODS: This project used a kaupapa Maori approach. Nine community hui (focus groups) and nine primary healthcare provider hui were carried out in five rural localities in the Midland region. Community hui included cancer patients, whanau (families), and other community members. Healthcare provider hui comprised staff members at the local primary healthcare centre, including General Practitioners and nurses. Hui data were thematically analysed. RESULTS: Barriers and enablers to early diagnosis of lung cancer were categorised into two broad themes: Specialist services and treatment, and whanau journey. The barriers and enablers that participants experienced in specialist services and treatment related to access to care, engagement with specialists, communication with specialist services and cultural values and respect, whereas barriers and enablers relating to the whanau journey focused on agency and the impact on whanau. CONCLUSIONS: The study highlighted the need to improve communication within and across healthcare services, the importance of understanding the cultural needs of patients and whanau and a health system strategy that meets these needs. Findings also demonstrated the resilience of Maori and the active efforts of whanau as carers to foster health literacy in future generations.

Indigenous perspectives on breaking bad news: ethical considerations for healthcare providers.

Most healthcare providers (HCPs) work from ethical principles based on a Western model of practice that may not adhere to the cultural values intrinsic to Indigenous peoples. Breaking bad news (BBN) is an important topic of ethical concern in health research. While much has been documented on BBN globally, the ethical implications of receiving bad news, from an Indigenous patient perspective in particular, is an area that requires further inquiry. This article discusses the experiences of Maori (Indigenous peoples of New Zealand) lung cancer patients and their families, in order to investigate the ethical implications of receiving bad news. Data collection occurred through 23 semistructured interviews and nine focus groups with Maori lung cancer patients and their families in four districts in the Midland Region of New Zealand: Waikato, Bay of Plenty, Lakes and Tairawhiti. The findings of this study were categorised into two key themes: communication and context. Avenues for best practice include understanding the centrality of the HCP-patient relationship and family ties in the healthcare journey, and providing patients with the full range of viable treatment options including hope, clear advice and guidance when the situation calls for it. Overall, the findings of this study hold implications for providing culturally safe and humanistic cancer care when BBN to Maori and Indigenous patients.

Maori Becoming Peer Educators in Later Life: Impacts on Identity, Well-being, and Social Connectedness.

OBJECTIVE: The aim of this study was to examine ways that older Maori (New Zealand's Indigenous people) enhanced their ability to be peer educators and how this role impacted on their sense of purpose and well-being in later life. METHOD: Kaupapa Maori and community-based participatory research principles guided the peer intervention involving 26 Maori kaumatua (older people 55 years and older) as peer educators (tuakana) for 121 other kaumatua (teina) facing transitions in later life. Each pair held up to 3 conversations; independent coders rated tuakana communication skills. We used mixed methods in a pre- and post-test, clustered staggered design. Participants completed baseline and post-intervention assessments of health and well-being consistent with Maori worldviews. 5 focus groups involving 22 teina and 1 with 5 tuakana were held. RESULTS: Tuakana communication skills were rated as high by teina and independent coders. Qualitative analysis supported the importance of Maori communication processes for the role. Further, three measures increased significantly from the baseline to the final period for tuakana accounting for about 15% of the variance in these variables: sense of purpose (p = .07), self-rated health (p = .05), and health-related quality of life (p = .04). The qualitative analysis supported the benefits of the peer educator role for older Maori including enhanced sense of identity, well-being, and social connectedness. DISCUSSION: The results demonstrated that kaumatua had strong communication in the peer educator role and that the intervention has positive impacts for them. The study contributes to peer intervention research that may help to improve experiences ofIndigenous and other older people.

Ha Ora: Barriers and enablers to early diagnosis of lung cancer in primary healthcare for Maori communities.

OBJECTIVE: The objective of this research was to document the barriers to early presentation and diagnosis of lung cancer within primary healthcare, identified by Maori whanau (families) and primary healthcare providers in the Midland region of Aotearoa New Zealand. METHODS: This project used a kaupapa Maori approach. Nine community hui (focus groups) and nine primary healthcare provider hui were carried out in five rural localities in the Midland region. Each community hui included cancer patients, whanau, and other community members. Each healthcare provider hui comprised staff members at the local primary healthcare centre, including General Practitioners and nurses. Hui data were thematically analysed. RESULTS: Barriers and enablers to early diagnosis of lung cancer were categorised into three key themes: GP relationship and position in the community, health literacy and pathways to diagnosis. CONCLUSION: This study demonstrates that culturally responsive, patient-centred healthcare, and positive GP-patient relationships are significant factors for Maori patients and whanau serving as barriers and enablers to early diagnosis of lung cancer.

Kaumatua Mana Motuhake Poi: a study protocol for enhancing wellbeing, social connectedness and cultural identity for Maori elders.

BACKGROUND: The Aotearoa New Zealand population is ageing accompanied by health and social challenges including significant inequities that exist between Maori and non-Maori around poor ageing and health. Although historically kaumatua (elder Maori) faced a dominant society that failed to realise their full potential as they age, Maori culture has remained steadfast in upholding elders as cultural/community anchors. Yet, many of today's kaumatua 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, Kaumatua Mana Motuhake Poi (KMMP) comprises two interrelated projects that foreground dimensions of wellbeing within a holistic Te Ao Maori (Maori epistemology) view of wellbeing. Project 1 involves a tuakana-teina/peer educator model approach focused on increasing service access and utilisation to support kaumatua with the greatest health and social needs. Project 2 focuses on physical activity and cultural knowledge exchange (including te reo Maori--Maori 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 kaumatua and kaumatua providers that advance better life outcomes for kaumatua 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 Maori communities. Secondly, the two individual projects will each produce a tangible approach that, it is anticipated, will be cost effective in enhancing kaumatua hauora and mana motuhake. TRIAL REGISTRATION: Australia New Zealand Clinical Trial Registry ( ACTRN12620000316909 ). Registered 6 March 2020.

Kaumatua Mana Motuhake: peer education intervention to help Maori elders during later-stage life transitions.

BACKGROUND: Aotearoa/New Zealand has a population that is ageing and there are challenges to health and social outcomes related to related to key life transitions (e.g., retirement, change in health conditions, loss of spouse). Further, there are significant inequities between Maori (Indigenous people) and non-Maori in ageing outcomes. The purpose of this study was to test the impacts and cost effectiveness of a tuakana/teina (peer education) intervention on kaumatua (elders) receiving the intervention. This study was framed by a strengths-based approach based on the key cultural concept of mana motuhake (autonomy and self-actualisation). METHODS: This study was grounded in principles of Kaupapa Maori and community-based participatory research to bring together a diverse group of stakeholders to co-develop and co-evaluate the intervention. The intervention had tuakana (peer educators) having conversations with up to six teina (recipients) and providing information related to health and social services. The research design was a pre- and post-test, clustered staggered design. Participants completed a baseline assessment of health and mana motuhake measures consistent with Maori worldviews along with two follow-up assessments (one after the first intervention group completed its activities and a second after the second intervention group completed its activities). Additionally, five focus groups and open-ended questions on the assessments were used to provide qualitative evaluation. FINDINGS: A total of 180 kaumatua were recruited to the intervention with 121 completing it. The analysis revealed improvements over time in the expected direction on most of the variables. However, only three of the variables had statistically significant intervention effects: received support, tribal identity, and trouble paying bills. Qualitative results supported impacts of the intervention on mana motuhake, social connectedness, and tangible/information support related to services. Cost-effectiveness analysis showed that the intervention is cost effective, with a cost per QALY of less than the conventional threshold of three times gross domestic product per capita. CONCLUSIONS: The findings support the relevancy and importance of kaumatua knowledge to create a strengths-based approach to improve health and social outcomes. This study demonstrates that a contextually based and culturally safe age-friendly environments can facilitate engagement and participation by kaumatua for kaumatua. TRIAL REGISTRY: Australia New Zealand Clinical Trial Registry (ACTRN12617001396314); Date Registered: 3 October 2017 (retrospectively registered); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373733&isClinicalTrial=False.

Correlates of Health-Related Quality of Life for Maori Elders Involved in a Peer Education Intervention.

The purpose of this study was to identify social determinant and communication correlates of health-related quality of life for kaumatua (Maori elders) in New Zealand. A total of 209 kaumatua completed a self-report survey of self-rated health, physical/mental quality of life, spirituality, and a series of questions about social determinants (e.g., factors related to income) and communication variables (e.g., loneliness, social support, cultural identity, and perceived burden/benefit). The survey was baseline data for a peer education intervention to help kaumatua work through life transitions in older age. The main findings of this study were that social determinants, particularly difficulty paying bills, accounted for a small amount of variance in physical/mental quality of life and self-rated health. Further, the communication correlates of loneliness, perceived burden, and desired support accounted for about three times as much variance in these two outcomes all with negative associations. Strength of tribal identity, importance of whanau (extended family), and knowledge of tikanga (customs and protocols) accounted for a moderate amount variance in spirituality with positive associations. These findings have important theoretical and practical implications for positive aging.

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

BACKGROUND: The 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 Maori (Indigenous peoples of Aotearoa/New Zealand) and non-Maori 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 kaumatua (elders) by asserting mana motuhake (autonomy, identity and self-actualisation). We believe that the esteem of elders in Maori culture signals transformative potential. Specifically, this project utilises a 'tuakana-teina' (older sibling/younger sibling) peer-educator model, where kaumatua work with other kaumatua in relation to health and wellbeing. The objectives of the project are (a) to develop the capacity of kaumatua 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 kaumatua receiving the intervention. METHODS: The research is grounded in principles of Kaupapa Maori and community-based participatory research, and brings together an Indigenous community of kaumatua, community health researchers, and academic researchers working with two advisory boards. The project intervention involves an orientation programme for tuakana peer educators for other kaumatua (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 Maori 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. DISCUSSION: The findings will provide an evidence base for the importance and relevancy of kaumatua knowledge to create contextually based and culturally safe age-friendly environments that facilitate engagement and participation by kaumatua for kaumatua. If the model is effective, we will seek to facilitate the dissemination and scalability of the intervention. TRIAL REGISTRATION: Australia New Zealand Clinical Trial Registry ( ACTRN12617001396314 ); Date Registered: 3 October 2017 (retrospectively registered).

Injury severity and 3-month outcomes among Maori: results from a New Zealand prospective cohort study.

AIMS: To examine the prevalence of health and social outcomes pre- and 3 months post-injury, and the association between New Injury Severity Scores (NISS) and 3-month outcomes, for the Maori cohort of the Prospective Outcomes of Injury Study. METHODS: New Zealand residents were recruited from the Accident Compensation Corporation's entitlement claims register and participants interviewed at 3 months post-injury. Those who reported Maori ethnicity (n=566) were included in the Maori cohort. RESULTS: States indicative of favourable health were less prevalent among the cohort post-injury than pre-injury for all measures examined. Approximately half the cohort were experiencing difficulties walking 3 months after their injury, over two-thirds a level of pain or discomfort, and more than half a level of psychological distress. The prevalence of disability was 49%. The prevalence of some adverse outcomes increased with increasing NISS but a high level of problems were still experienced by those classified as having a 'minor' injury. Nonetheless, a majority of the cohort were satisfied with life and they considered themselves to be of good to excellent overall health. CONCLUSIONS: Findings emphasise the importance of injury prevention and appropriate post-injury care to reduce the burden experienced by Maori due to injury.

Indigenous injury outcomes: life satisfaction among injured Maori in New Zealand three months after injury.

BACKGROUND: Maori, the indigenous population of New Zealand, experience numerous and consistent health disparities when compared to non-Maori. Injury is no exception, yet there is a paucity of published literature that examines outcomes following a wide variety of injury types and severities for this population. This paper aims to identify pre-injury and injury-related predictors of life satisfaction three months after injury for a group of injured Maori. METHODS: The Maori sample (n = 566) were all participants in the Prospective Outcomes of Injury Study (POIS). POIS is a longitudinal study of 2856 injured New Zealanders aged 18-64 years who were on an injury entitlement claims' register with New Zealand's no-fault compensation insurer. The well-known Te Whare Tapa Wha model of overall health and well-being was used to help inform the selection of post-injury life satisfaction predictor variables. Multivariable analyses were used to examine the relationships between potential predictors and life satisfaction. RESULTS: Of the 566 Maori participants, post-injury life satisfaction data was available for 563 (99%) participants. Of these, 71% reported satisfaction with life three months after injury (compared to 93% pre-injury). Those with a higher injury severity score, not satisfied with pre-injury social relationships or poor self-efficacy pre-injury were less likely to be satisfied with life three months after injury. CONCLUSIONS: The large majority of Maori participants reported being satisfied with life three months after injury; however, nearly a third did not. This suggests that further research investigating outcomes after injury for Maori, and predictors of these, is necessary. Results show that healthcare providers could perhaps put greater effort into working alongside injured Maori who have more severe injuries, report poor self-efficacy and were not satisfied with their pre-injury social relationships to ensure increased likelihood of satisfaction with life soon after injury.

Factors associated with non-participation in one or two follow-up phases in a cohort study of injured adults.

OBJECTIVE: To identify factors associated with non-participation at the 12-month and 24-month follow-up phases of a prospective cohort study of injury outcomes. METHODS: Associations between non-participation at follow-up phases and a range of sociodemographic, injury, health, outcome and administrative factors were examined. RESULTS: An individual's non-participation at 12 months did not necessarily mean non-participation at 24 months. Sociodemographic factors were the most salient for non-participation, regardless of the number of follow-up phases or specific phase considered. CONCLUSIONS: Retention rates in prospective cohort studies of injury outcome may be improved by follow-up of everyone irrespective of previous non-participation, focusing resources to retain men, young adults, indigenous people and those living with people other than family members, and by ensuring that multiple alternative participant contacts are obtained. There is sufficient evidence to be concerned about potential bias given that several of the factors we, and others, have identified as associated with non-participation are also associated with various functional and disability outcomes following injury. This suggests detailed investigations are warranted into the effect non-participation may be having on the estimates for various outcomes.

Seres físicos: estereótipos, esporte e a educação física dos Maori na nova Zelândia / Physical beings: Stereotypes, sport and physical education of Maori in New Zealand

Este trabalho examina como o esporte, a educação pública e a educação física têm contribuído para a supressão dos indígenas Maori da Nova Zelândia pela promoção de estereótipos desse povo como seres físicos e pouco inteligentes. O artigo começa por fornecer uma genealogia histórica do estereótipo físico e selvagem Maori. Em seguida, apresenta-se como este estereótipo é usado para justificar um sistema de educação racista que canalizou os Maori a atividades manuais, em oposição a áreas acadêmicas. Mais tarde, foi oferecida inclusão à cultura Maori somente dentro de domínios não ameaçadores, como a educação física e os desportos. As ramificações da Educação Física se tornaram a primeira a oferecer aberturas aos Maori. Finalmente, eu sugiro que a naturalização dos Maori como esportistas contribui para o processo de assimilação Maori numa área que destaca sua supostamente inerente fisicalidade.

This essay examines how sport, State education and physical education have contributed to the suppression of the indigenous New Zealand Maori by promulgating their stereotype as a physical and unintelligent people. It begins by providing an historical genealogy of the savage physical Maori stereotype. Next, this stereotypeis shown to have justified a racist education system that channelled Maori into manual, as opposed to academic, areas. Later, Maori culture and Maori successes were afforded inclusion only within nonthreatening domains such as physical education and sport. The ramifications of physical education becoming the first subject areato offer overtures to Maori, are examined. Lastly, I suggest that the naturalization of Maori as sportspeople contributed to the colonization process by assimilating Maori in an area that highlighted their supposed inherent physicality

Prospective Outcomes of Injury Study: recruitment, and participant characteristics, health and disability status.

The Prospective Outcomes of Injury Study aims to identify predictors of disability following injury. Participants were selected from the entitlement claims register of New Zealand's no-fault compensation insurer, the Accident Compensation Corporation, and followed up by interview for 2 years. This report describes changes to intended Prospective Outcomes of Injury Study methods and key characteristics of the cohort, with an emphasis on general health and disability before injury and soon afterwards. There were 2856 injured participants in the first interview, which occurred 3.2 months (median) after injury. The recruitment period was extended to enable inclusion of sufficient Maori participants. At the first interview, most participants were experiencing worse health status and increased disability compared to before injury, despite less than one-third reporting admission to hospital because of their injury. Analysis of outcome predictors related to post-injury function, disability and return-to-work soon after injury and 1 year later is now under way.

Rangatiratanga and Oritetanga: responses to the Treaty of Waitangi in a New Zealand study.

INTRODUCTION: Although opportunities exist for positive experiences in research, Maori in New Zealand, like other indigenous people colonised by Europeans in the nineteenth century, have also been subject to research and associated policies that have had long-lasting negative consequences. Researchers have subsequently been challenged by Maori to conduct research that is acceptable, accountable and relevant. Much of this debate has taken place within the framework of the Treaty of Waitangi, a treaty of cession signed between Maori and British Crown representatives in 1840. Nowadays, health and health research statutes exist that require researchers to respond to the 'principles' of the Treaty. Few practical examples of how health researchers have undertaken this have been published. AIMS: We examine how, in developing a national study of injury outcomes, we responded to the Treaty. Our study, the Prospective Outcomes of Injury Study, aims to quantitatively identify predictors of disability following injury and to qualitatively explore experiences and perceptions of injury outcomes. DISCUSSION: Responses to the Treaty included: consultation with Maori groups, translation of the questionnaire into te reo Maori, appointment of interviewers fluent in te reo Maori, sufficient numbers of Maori participants to allow Maori-specific analyses and the inclusion of a Maori-specific qualitative component. While this article is located within the New Zealand context, we believe it will resonate with, and be of relevance to, health researchers in other former settler societies. We do not contend this project represents an 'ideal' model for undertaking population-based research. Instead, we hope that by describing our efforts at responding to the Treaty, we can prompt wider debate of the complex realities of the research environment, one which is scientifically, ethically and culturally located.