Search Results (27)

Māori, the Indigenous people of Aotearoa New Zealand, experience wide-ranging inequities compared with non-Māori. This survey aimed to explore the holistic health, wellbeing, and disability experiences of New Zealand’s Indigenous Māori population from a Māori worldview, addressing gaps in culturally relevant data often overlooked by standard health surveys. A robust cross-sectional survey was conducted with 7359 participants of Māori descent using Kaupapa Māori Research principles. Data were analysed using the Te Pae Māhutonga framework, a Māori health promotion model. Participants demonstrated strong cultural identity, with 32.3% understanding spoken Māori fairly well and 97.3% defining a broad non-nuclear concept of whānau (family). While over half reported high life satisfaction, 58.4% experienced discrimination, mainly based on ethnicity and appearance. Access to healthcare revealed that 32.6% were unable to contact a general practitioner due to cost. Socioeconomic challenges were prevalent; nearly a quarter borrowed from family or friends to meet daily living costs, and over a third economized on fresh produce to save money. This study reveals significant gaps in mainstream health data and demonstrates that a culturally aligned, methodological approach is feasible and crucial for informing policies that address the needs and rights of Māori, as guaranteed under Te Tiriti o Waitangi. These results could inform global, indigenous research addressing culturally relevant health, wellbeing and disability inequities. Full article

This article investigates the colonial disruption of Māori parenting practices and its enduring effects on Indigenous identity and belonging. It explores how colonisation imposed Western parenting models, disrupting communal caregiving, and severing connections to whakapapa (ancestry) and whenua (land). Grounded in Kaupapa Māori methodologies, this research highlights pre-colonial parenting, attachment, and child development practices, demonstrating their alignment with contemporary child development theories and their potential to address intergenerational trauma. Drawing on oral literature, archival records, and studies, this paper proposes a framework for restoring ancestral parenting principles. It emphasises the importance of these practices in rebuilding cultural confidence, enhancing child wellbeing, and strengthening whānau relationships. By integrating ancestral principles into trauma-informed care, attachment-based parenting models, and culturally affirming teaching, the article envisions pathways for healing and resilience in Māori communities, contributing to broader Indigenous resurgence. Full article

Bipolar disorder (BD) is a serious mental health condition that is clinically complex to monitor and manage. While best practice guidelines exist, they vary internationally lacking consensus. Indigenous peoples, including Māori in New Zealand, experience higher community rates of BD. While New Zealand practice guidelines recommend providing culturally responsive care to Māori, studies show that Māori do not receive best practice. This qualitative study aimed to share the evidence about patterns of health service use and Māori patient experiences with focus group participants involved in the design and delivery of BD services, to discuss and develop guidelines for best practice for Māori with BD and address areas of unmet need. Three focus groups were conducted with 22 participants involved in the delivery of services to Māori with BD across three sites. Willing participants were sent background information and three focus group questions framed to elicit priority solutions to improve clinical, structural and organisational features of mental health service delivery for Māori patients with BD and their whānau (family). The nominal group technique was used to synthesise responses, and then develop a prioritised list of proposed solutions. Results identified system-level changes required at the clinical, structural and organisational levels of healthcare. Findings further evidence the need for healthcare reform in New Zealand, to be responsive to Māori with BD. Full article

Whānau Pakari is a healthy lifestyle assessment and intervention programme for children and adolescents with obesity in Taranaki (Aotearoa/New Zealand), which, in this region, replaced the nationally funded Green Prescription Active Families (GRxAF) programme. We compared national referral rates from the GRxAF programme (age 5–15 years) and the B4 School Check (B4SC, a national preschool health and development assessment) with referral rates in Taranaki from Whānau Pakari. We retrospectively analysed 5 years of clinical data (2010–2015), comparing referral rates before, during, and after the Whānau Pakari clinical trial, which was embedded within the programme. We also surveyed programme referrers and stakeholders about their experiences of Whānau Pakari, analysing their responses using a multiple-methods framework. After the Whānau Pakari trial commenced, Taranaki GRxAF referral rates increased markedly (2.3 pretrial to 7.2 per 1000 person-years), while NZ rates were largely unchanged (1.8–1.9 per 1000 person-years) (p < 0.0001 for differences during the trial). Post-trial, Taranaki GRxAF referral rates remained higher irrespective of ethnicity, being 1.8 to 3.2 times the national rates (p < 0.001). Taranaki B4SC referrals for obesity were nearly complete at 99% in the last trial year and 100% post-trial, compared with national rates threefold lower (31% and 32%, respectively; p < 0.0001), with Taranaki referral rates for extreme obesity sustained at 80% and exceeding national rates for both periods (58% and 62%, respectively; p < 0.01). Notably, a referral was 50% more likely for referrers who attended a Whānau Pakari training half-day (RR = 1.51; p = 0.009). Stakeholders credited the success of Whānau Pakari to its multidisciplinary team, family-centred approach, and home-based assessments. However, they highlighted challenges such as navigating multidisciplinary collaboration, engaging with families with complex needs, and shifting conventional healthcare practices. Given its favourable referral trends and stakeholder endorsement, Whānau Pakari appears to be a viable contemporary model for an accessible and culturally appropriate intervention on a national and potentially international scale. Full article

Young carers are a largely invisible and unsupported population of Aotearoa New Zealand (NZ) children and youth aged 25 years and under who physically, emotionally, socially, and/or spiritually support loved ones experiencing ill health, disability, substance misuse, mental illness, or advanced age. The total number of young carers in NZ is unknown because census data only capture those aged 15–25. The nine published NZ studies recommend further research, policies, and services for young carers. However, there is a lack of young carer voices to inform their implementation. This paper provides insight into the experiences and needs of 28 young carers, the largest self-identified cohort in NZ research. Throughout phenomenographic interviews, young caring was described as a natural and valued part of being in a whānau/aiga/family, aimed at supporting their loved one’s holistic wellbeing. However, the overwhelming nature of caring without recognition or support resulted in poor educational, social, and mental health outcomes for young carers. This paper concludes with a contextualised NZ young carer definition and an urgent call to address the Carers’ Strategy Action Plan and listen to, and deliver on, young carers’ expressed needs. Full article

The supply of, and demand for, housing in Aotearoa, New Zealand, is in a state of crisis. With all other areas of social deprivation, Māori are impacted disproportionately in the housing space, and have been locked out of the housing market. In order to address this crisis, a range of government, community and iwi initiatives have been established in Tāmaki Makaurau (Auckland) to provide various housing interventions, from emergency housing, accommodation supplements and subsidies to transitional housing, home ownership programmes and papakāinga (Māori settlement, village) development opportunities. Marae Ora, Kāinga Ora (MOKO) is a Kaupapa Māori (Māori approach) research project created to explore the role of marae (cultural centre) and kāinga (village, settlement) in supporting the wellbeing of whānau (family group), hapū (extended kinship grouping), iwi (extended kinship–tribal grouping) and communities, which includes the potential provision of housing. Five marae in the South Auckland landscape are partners in this research and bring to life the prospect of their contribution to housing solutions for their local Māori communities. This article presents some valuable insights into the aspirations of each whānau involved with the five marae with regard to their perspectives and developments with marae-led housing provision. Full article

The importance of breastfeeding and the appropriate introduction of complementary feeding are well recognised. Our objective was to investigate adherence to breastfeeding and complementary feeding guidelines in New Zealand (NZ) infants aged 7.0 to 10.0 months, based on the Ministry of Health’s healthy eating guidelines for NZ babies and toddlers (0–2 years), which recommend exclusive breastfeeding to “around” six months of age, at which time, complementary feeding should be initiated. This investigation was conducted within the First Foods New Zealand (FFNZ) study. From 2020 to 2022, FFNZ recruited an ethnically diverse sample of 625 infants living in Auckland and Dunedin. Participants completed two study visits, which included two 24-hour diet recalls and the completion of demographic and feeding questionnaires. Infants and caregivers were aged 8.4 (0.8) months (mean (SD)) and 32.7 (4.9) years, respectively. The majority (98%) of caregivers were the infant’s mother. More than half of the caregivers had a university education (64.9%) and were not currently employed (66.9%). Approximately half the caregivers were first-time mothers (48.7%). In FFNZ, exclusive breastfeeding was defined as exclusive breastfeeding to at least five and less than seven months of age. Within FFNZ, 43.2% of infants met this guideline. At the time of participation, 66.2% continued to breastfeed. The introduction of solid food at around six months of age was achieved by 75.2% of participants. Most infants were provided puréed foods (80.3%) and were spoon fed (74.1%) when starting solid foods. The findings indicate that most FFNZ infants met guidelines for the age of introduction, texture, and method of feeding complementary foods. However, our guidelines for breastfeeding in NZ were not met to the same extent, indicating the need for further support for NZ whānau to achieve to current breastfeeding recommendations. Full article

Background: Community-based case managers in health have been compared to glue which holds the dynamic needs of clients to a disjointed range of health and social services. However, case manager roles are difficult to understand due to poorly defined roles, confusing terminology, and low visibility in New Zealand. Aim: This review aims to map the landscape of case management work to advance workforce planning by clarifying the jobs, roles, and relationships of case managers in Aotearoa New Zealand (NZ). Methods: Our scoping and mapping review includes peer-reviewed articles, grey literature sources, and interview data from 15 case managers. Data was charted iteratively until convergent patterns emerged and distinctive roles identified. Results: A rich and diverse body of literature describing and evaluating case management work in NZ (n = 148) is uncovered with at least 38 different job titles recorded. 18 distinctive roles are further analyzed with sufficient data to explore the research question. Social ecology maps highlight diverse interprofessional and intersectoral relationships. Conclusions: Significant innovation and adaptations are evident in this field, particularly in the last five years. Case managers also known as health navigators, play a pivotal but often undervalued role in NZ health care, through their interprofessional and intersectoral relationships. Their work is often unrecognised which impedes workforce development and the promotion of person-centered and integrated health care. Full article

People with lived experience of disability have poorer health and socioeconomic outcomes than people without it. However, within this population, certain social groups are more likely to experience poorer outcomes due to the impacts of multiple intersecting forms of oppression including colonisation, coloniality and racism. This paper describes the multidimensional impacts of inequities for Indigenous tāngata whaikaha Māori (Māori with lived experience of disability). Semi-structured in-depth interviews were conducted with 28 tāngata whaikaha Māori and their whānau (extended family) using a kaupapa Māori Research methodology. An equity framework was used to analyse the data. The results describe: (1) inequitable access to the determinants of health and well-being; (2) inequitable access to and through health and disability care; (3) differential quality of health and disability care received; and (4) Indigenous Māori-driven solutions. These data confirm that tāngata whaikaha Māori in the nation-state known as New Zealand experience racism, ableism and disablism, compounded by the intersection between these types of discrimination. Recommendations from the data support the inclusion of tāngata whaikaha Māori in decision-making structures, including all policies and practices, along with equal partnership rights when it comes to designing health and disability systems and services. Full article

Objective: To determine the impact of a family-based assessment-and-intervention healthy lifestyle programme on health knowledge and beliefs of children and families affected by obesity. Second, to compare the health knowledge of the programme cohort to those of a national cohort in Aotearoa/New Zealand (NZ). Design: This mixed-methods study collected health knowledge and health belief data in a questionnaire at baseline and 12-, 24-, and 60-month follow-up assessments. Health knowledge over time was compared with baseline knowledge and with data from a nationally representative survey. A data-driven subsumption approach was used to analyse open-text responses to health belief questions across the study period. Setting: Taranaki region, a mixed urban–rural setting in NZ. Participants: Participants (caregiver/child dyads) from the Whānau Pakari randomised trial. Results: A greater proportion of the cohort correctly categorised foods and drinks as healthy or unhealthy at 12 months compared to baseline for most questionnaire items. Retention of this health knowledge was evident at 24- and 60-month follow-ups. More than twice as many participants correctly reported physical activity recommendations at follow-up compared to baseline (p < 0.001). Health knowledge of participants was similar to the national survey cohort at baseline, but surpassed it at 12 and 24 months. Participant beliefs around healthy lifestyles related to physical functioning, mental and emotional wellbeing, and enhancement of appearance, and gained greater depth and detail over time. Conclusions: This study demonstrates the important role that community-level healthy lifestyle programmes can have in knowledge-sharing and health promotion. Full article

Good nutrition in early childhood is essential for optimal brain development, growth, learning to eat, and establishing healthy food preferences. Little is known about exposure to food insecurity among young children in Aotearoa New Zealand and the impact of this on child nutrition. This study sought to understand the relationship between household food grant/foodbank use when children were aged 9- and 54-months old and eight indicators of early childhood nutrition. Data were from the Growing Up in New Zealand cohort (n = 6032) born in 2009/10. Descriptive and multivariate logistic regression were used. At 9 months of age, 12% of mothers reported using food grants/foodbanks in the past 12-months, decreasing to 8.4% at 54-months. However, these were largely different families. Ethnic inequities were marked: 34.5% of tamariki Māori and 40.3% of Pasifika children experienced food grant/foodbank use at either or both time points. Children living in households accessing food grants/foodbanks were significantly more likely to have poorer nutrition across the eight indicators. After adjustment for differences in household income and size, child ethnicity, mother’s age and education, and neighbourhood deprivation, infants whose mothers had made use of special food grants/foodbanks were more likely to have tried sugary drinks (AOR:1.45, p < 0.01) and unhealthy foods (AOR:1.44, p < 0.01) compared to other infants. At 54-months of age, they were nearly twice as likely to be served a low variety of vegetables (AOR:1.91, p < 0.01) compared to other children. In the early 2010s, the use of food grants/foodbanks was common in young families, and ethnic inequities were stark and persistent. Food insecurity was associated with multiple aspects of child nutrition. Policy responses to food insecurity must be made in meaningful partnerships with Māori and Pasifika whānau and communities, and enable sufficient support for families with young children, to ensure all tamariki have the best nutritional start in life. Full article

Despite evidence that Indigenous peoples’ multiple subjectivities engender diverse lived experiences both between and within Indigenous groups, the influence of multiple subjectivities on Indigenous peoples’ vulnerability and adaptation to climate change is largely un-explored. Drawing on ethnographic research with Indigenous Māori women in Aotearoa New Zealand, this paper provides empirical evidence that subjectivity-mediated power dynamics operating within Indigenous societies (at the individual and household scale) are important determinants of vulnerability and adaptation which should be considered in both scholarship and policy. Using an intersectional framework, I demonstrate how different Māori women and their whānau (families) live, cope with, and adapt to the embodied physical and emotional health effects of climate change in radically different ways because of their subject positionings, even though they belong to the same community, hapū (sub-tribe), or iwi (tribe). In underlining these heterogenous experiences, I provide an avenue for reconsidering how climate adaptation scholarship, policies, and practices might better engage with the complex, amorphous realities within Māori and other Indigenous communities. I argue it is possible to develop more inclusive, tailored, and sustainable adaptation that considers divergent vulnerabilities and adaptive capacities within Indigenous communities, groups, and societies and supports customised vulnerability-reduction strategies. Full article

More than one in five children in New Zealand live in food poverty, meaning that they live without access to sufficient wholesome food for good health. Evidence suggests that Māori mothers are more likely to experience food insecurity due to inequities in income, education, employment, and housing security. The aim of the study was to explore the perspectives, experiences, and strategies employed by Māori mothers to meet food access needs for their whānau. In-depth unstructured interviews were conducted with twenty Māori mothers living in Kaitaia in the far north of New Zealand who had at least one child aged two years or younger. An inductive approach was undertaken to allow findings to emerge from the data. Interviews investigated dietary habits and routines, methods of food procurement, nutrition knowledge, skills, and perceptions towards healthy food. Recorded interviews were transcribed and thematic analysis using NVivo was undertaken to identify, analyse, and report themes. Three key themes were identified. Firstly, ensuring whānau are fed using inexpensive but less nutritious foods, they reported missing meals, and feeding tamariki was prioritised. Secondly, accessing food from multiple avenues is a time-consuming journey. Participants reported accessing food grants and food banks to ensure adequate food for the household, which required time and effort, increasing stress and anxiety. Finally, the need to cope with the unexpected and unplanned, such as health and housing issues, influenced food access needs. Being well-connected to whānau, community groups, support services, and online digital access was pivotal for Māori mothers to meet whānau food needs. Māori mothers placed priority on ensuring that their whānau were fed, despite understanding healthy food choices, cost, and taste of food were driving factors in food purchase decisions. Connections were key to navigating multiple avenues to access food and cope with unexpected and unplanned circumstances. Full article

Our current food system is failing to deliver on health and well-being, equity, and food security and Hawke’s Bay has one of the fastest-growing rates of childhood obesity. ‘He wairua tō te kai’ suggests that there is more to food than nutrition and advances a cultural connectedness approach to food and nourishment of tamariki (children) and rangatahi (youth). A stakeholder and community enquiry directed this initiative to focus on children’s Hauora in a holistic fashion in order to build food security; include mātauranga Māori throughout the project; work with existing initiatives, community, and whānau; start its implementation in schools. Quantitative baseline monitoring was carried out in 43 primary and secondary schools with 2300 students (Age 9 or 13) with surveys covering food security, well-being (WHO5), food behaviours (sources of lunch, breakfast, etc.), and we measured age-standardised BMI for each student. Our food security results indicate that, while approximately one in five children live in households that regularly run out of food, up to two-thirds of students in a school may be affected, and this is not restricted to students in low-decile schools (where most nutritional programmes focus). Overall, only half of the student population in Hawke’s Bay was a healthy weight. This study is the first of its kind to present a detailed picture of Hauora for a comprehensive community-wide sample across 43 schools including schools participating in the Ka Ora, Ka Ako School Lunch programme. These data form the baseline of a before–after evaluation of the programme’s impact on multiple aspects of food environments and nutritional well-being. Full article

Cardiovascular disease (CVD) is the largest cause of death in New Zealand, Aotearoa, causing 33% of all deaths, with one in twenty-one adults currently living with heart disease. There is a well-known equity gap in disease prevalence and mortality rate between Māori and other New Zealanders, with the total CVD mortality being twice as high for Māori compared to others. From a nutritional perspective, when considering how to address these significant inequities, it is essential to develop tools that provide practical solutions to effectively engage Māori communities and whānau and are also fit for purpose. The assessment of dietary recall is often undertaken to establish the association between dietary intake, health and disease. A food frequency questionnaire (FFQ) is often used as a dietary assessment tool within clinical, community and research settings. Anecdotal evidence gained from discussions with researchers, academics and Māori research participants involved in a recent Kaupapa Māori nutrition intervention funded by the Heart Foundation identified a potential need for an in-depth look at how fit for purpose current dietary recall tools are, such as the food frequency questionnaire. This presentation will form part of a scoping exercise to inform a Kaupapa Māori Master’s thesis looking at barriers and enablers to administering and filling out dietary recall questionnaires to assess dietary intake. It will briefly look at FFQ examples and discuss qualitative feedback received from research participants. The focus of the presentation will look at the different protocols commonly utilised in administering FFQs and any adaptations or alternatives used to support different populations. Furthermore, it will look at what challenges participants have in completing FFQs. Results: Feedback from Māori participants of the Heart Foundation nutrition research highlighted challenges to the cultural appropriateness, health literacy and ease of filling out FFQs. Full article