Kia Piki Te Mauriora Māori M Ā ORI ENGAGEMENT STRATEGY

1. Kia PikiTeMauriora MāoriMĀORI ENGAGEMENT STRATEGY Mr Tuwhakairiora Williams Dr Tristram Ingham NZ Respiratory Conference 9-10 October 2014 Wellington

2. Acknowledgements • Māori Reference Group • The Asthma Foundation Board • Angela Francis(Chief Executive) • Janice Kuka (Board Member/ MRG Chair) • Sharon Cavanagh (Māori Health Manager) • Pania Lee (Project Researcher)

3. Background • Our Vision: Better respiratory health for all New Zealanders • Our Goal: Reduce hospital admissions caused by asthma and other respiratory conditions by 25%, by 2025

4. Respiratory Hospitalisations(Hospitalisations, All DHB’s, 2006-2011) Data: Asthma Foundation/ University of Otago 2013

5. Burden of Respiratory Disease(Hospitalisations, All DHB’s, 2006-2011) INFLUENZA/PNEUMONIA ASTHMA URTI OTHER LRTI COPD LUNG CANCER Data: Asthma Foundation/ University of Otago 2013

6. Strategy Aims • Explore ways in which the Asthma Foundation can collaborate with Māori health provider networks & communities to improve Māori respiratory health • Inform the Asthma Foundation’s strategic direction & responsiveness to Māori policies

7. Desired Outcomes • To enable the Asthma Foundation to establish stronger working relationships with Whānau Ora collectives and Māori health providers to: • enable closer, more meaningful collaborations at local and regional levels • contribute to improving the access of whānau to services, information and support • reduce the burden of respiratory illnesses for Māori.

8. Phased Approach • Phase 1: • Scoping & Needs Assessment • Phase 2: • Collaboration & Intervention Development • Phase 3: • National Deployment

9. PROJECT PHASE 1 SCOPING & NEEDS ASSESSMENT

10. Phase 1 Objectives • Meeting the collectives to introduce the Foundation and what it does • Outlining its commitment to improving Māori respiratory health conditions • Outlining how it intends to carry out that commitment • Finding out what collectives are doing in respiratory health, especially for Māori • Identifying the gaps and what is working • Identifying other areas the Foundation can help with their work in respiratory care

11. Kia Piki Te Mauriora Māori • This was the cultural plan used to guide the engagement strategy with Whānau Oracollectives • Kia Piki Te Mauriora Māori adopts Te Ira Atua, Te Ira Whenua, and Te Ira Tangata as the core to engagement and Te Whare Tapa Whā as the practice model. • Tapu and noa permeate the model which incorporates whakawhanaungatanga, whakamanawa and mauri as the essential concepts of engagement. The model is holistic and focuses on:

12. Kia Piki Te Mauriora Māori From: Kia Piki Te Mauriora Māori, Tu Williams, 2014

13. Whānau Ora Collectives • Kotahitanga • (South Auckland) • Papakura Marae • Te Kaha o Te Rangataki Trust • TurukiHealthcare Trust • Heretaunga Providers • (Hawkes Bay) • Te Kupenga Hauora – Ahuriri • Te Taiwhenua o Heretaunga • Choices Kahungunu Health Services • Central Health • Takiri Mai Te Ata • (Lower Hutt) • Kokiri Marae Keriana Olsen Trust • Kokiri Marae Maori Women’s Refuge • ManaWahine • NakuEneiTamariki • Tu Kotahi Maori Asthma Trust • Wainuiomata Marae • WhaiOranga o Te Iwi Health Centre

14. Methodology • Methods: • Qualitative research design using ‘hui method’ underpinned by Kaupapa Māori Research (KMR) framework • Sampling Framework: • Health professionals and staff from three Whānau Ora collectives and affiliated Māori Health Providers • Collectives purposively selected (asthma experience, convenience) • Focus Groups: • Kanohikitekanohi, semi-structured, open-ended Discussion, English & Te Reo Māori • Analysis: • Audio-taped & transcribed. Thematic analysis (grounded theory), results validated through review by collectives & external peer-review • Participants: • 23 staff participated (6 males, 17 females) • Auckland (n=9), Hawkes Bay (n=3), Hutt Valley (n=11)

15. Focus Group Questions • What does your provider/collective do for Māori respiratory health? • What are some of the gaps in supporting Māori respiratory health? • What does your provider/collective do well for Māori respiratory health • How can the Foundation assist or support your provider/collective? • Do providers/collectives want a relationship with the Asthma foundation and if so how? And what does that look like?

16. Strengths & Limitations Strengths • Kaupapa Māori Methodology • Established networks • Team complimentary skills Limitations • Aimed only to be an initial engagement • Limited number of providers • Limited time engaging with key informants • Staff, not patients • Tight timeframes

17. Asthma Foundation Awareness “I don’t even know who they are…Which one’s that? Oh, is that the one with the balloons?” (Hawkes Bay) “I didn’t know that there was a Asthma Foundation, my asthma foundation is Tu Kotahi […] that’s where we refer them [our patients]” (Takiri Mai) The Asthma Foundation Balloon Day 

18. Successes • Holistic Approach to Health Wrap-around Services “…mother and pēpi contract which we support a mother from as soon as they find out they’re pregnant to babies born, and right through to 2 years old if necessary. So from there they have a kaiawhina and you know that helps them get a midwife, anything that needs to be done for them, if they have no transport getting them to those appointments like your scans, stuff like that as they go through there’s appointments with WINZ, getting them to the curtain bank, any needs that they need” (Heretaunga) Feathers and pounamu: unknown Rotorua woman - oil Artist: Lindsay Mitchell

19. Going beyond the biomedical model “GP’s: It’s asthma, it’s a virus, here’s the pamol” (Kotahitanga) Promoting the role of, and strengthening the evidence base for, complimentary therapies: • Exercise (promoting the role in respiratory health) • Mirimiri (massage) • Rongoā (traditional medicines) Ngā Kaitiaki o Te PunaRongoā o Aotearoa – The Māori Pharmacists’ Association Inc.

20. 2. ‘Hard to Reach’ whānau vs. ‘Hard to Reach’ services KahohiKitea (The seen face) “So we have Māori and Pacific here. I say when they ask now what’s your hard reach I say 60% yeah. And often they’re not, they’re not hard to reach for us ‘cause we know the communities and hard to reach maybe for hospitals and places like that ‘cause they don’t go out into the community” (Takiri Mai) Innovative Approaches to Engagement • Asthma Camps • Māori Traditional Games • Promotion and modelling of healthy lifestyles • Community events

21. Challenges 1. Best Practice: Consistency of Messages “…when you talk about education and best practice, obviously you know, when whānau go to the doctors, they get information from one doctor - how to use their nebulisers, how to use the spacers, then they’ll go to the nurse. They’ll be shown a different way to do it, then they’ll go to the hospital and they’re shown a different way again” (Kotahitanga). Care Pathways “…they need to have like some kind of plan or pathway so if you come in several other times or they can go straight to the children’s ward or they are referred automatically to organisations like Tu Kotahi” (Takiri Mai)

22. Medication Challenges • Medication sharing • Lack of warning when running low • Dispensed individually (monthly, repeats expire) • Need multiple (school, home, other whānau houses) • Cost (prioritisation vs other expenses) • Better explanations regarding value Equipment Funding/ Point of Care Testing: “…ideally we’ve got the spirometry machine in the boot, when we identify someone in the home or wherever it is, we can complete the spirometry, but the Māori providers have got no funding” • (Heretaunga)

23. 2. Resources Culturally Appropriate Resources: Need for resources that are culturally relevant, accessible & appropriate, i.e. anatomical cartoon maps, resources with whānau experience, a media strategy, improved health literacy training “…the stuff that’s for Māori: so for Māori means we’ll stick some Māori words in there […] then we’ll stick a few pictures of brown people on and we’ll stick a few Māori words on the titles and things, then we’ve got the Māori version…” (Heretaunga) What Maui Learnt About Asthma Written by WakaCookson.

24. 3. Workforce Development, Training & Education Workforce Development “I think Māori health providers definitely need support along those sort of lines of that training, like I say the spirometry … but support around all those training needs definitely, because obviously we want to be delivering an excellent service, a better service than they were receiving in mainstream, and to achieve that we’ve got to put in that workforce, the development, the ongoing training and support”(Heretaunga) School-based Programmes “…we’ll provide […] an asthma kit for them at school so that they can go and access an inhaler. Also provide education to them about a 10 and 15 minute session at a visit at school with them. We also offer education to the staff and sometimes we end up with about 20 staff in the staffroom” (Tu Kotahi)

25. 4. Accessing the Community & Health Promotion Events “…a presence you know like how we have those festivals[…] a day you’re going to get all the whānau out […] you’re going to get them at the […] festival, having a presence there, those are the places you’re going to get, we’re all going to roll out then, Waitangi Day we’re all going to go to those things, and it doesn’t matter it’s having a presence there” (Heretaunga) Smoking Cessation “Yes, so certainly smoking cessation is a key health promotion of education situation that’s under threat at the moment, actually” (Kotahitanga)

26. 5. Policies and Funding Funding “Unless it’s a target they won’t focus, or they [government] won’t put resources to it. So providers won’t get those resources so it has to be a health target”. (Kotahitanga) “For any successful strategy the government wants at the end of the day, has to have…action. Do talk to whānau and be able to talk to them about a particular issue, whether it’s clinical, whether it’s going into their homes. I think those are the important face-to-face stuff that you’ll get some change” (Kotahitanga) Prime Minister visits Asthma Foundation, February 2014

27. Social Determinants of Health “What good is the clinical best practice by itself unless you’ve got the social drivers, like damp houses and all that?”(Kotahitanga) Equal Access to Health “…is the criteria really working for those that really need it, or is it just because they know how to get it, these people […] our families that don’t know aren’t getting it, so is it really going to where it should be going?” (Heretaunga) Living rough: Home for Cora Coleman is a damp Housing NZ property that the Tenancy Tribunal has ruled is not fit to live in. Photo: Nicholas Boyack. Stuff (Aug 2012)

28. Recommendations Recommendation One: • Continue to build the Asthma Foundation’s relationship with Māori (through whānau ora collectives) to better understand their specific needs; to raise their awareness of the foundation and to collaboratively co-develop a Māori respiratory strategy

29. Recommendation Two: • Investigate and explore innovative resources i.e. multimedia that will be of more relevance to Māori communities.

30. Recommendation Three: • Collaboratively develop a Māori respiratory research agenda resulting in improved respiratory health outcomes for Māori. For example research to improve health literacy; understanding of complimentary methods of respiratory wellness and reduced health disparities, and innovative service delivery models.

31. Recommendation Four: • Collaboratively develop best practice support structures that are responsive and relevant to Māori to support practitioners working with Māori whānau

32. Recommendation Five: • Understand specific needs of whānau ora collectives around workforce training and development and to use these recommendations to broaden and revise the existing Asthma Foundation training programmes.

33. PROJECT PHASE 2 COLLABORATION & INTERVENTION DEVELOPMENT Bernadette Jones with Cheryl Davies and whānau

34. Aims • To continue to engage with three Whānau Ora collectives • To collaboratively develop and pilot a ‘best-practice support’ package for Māori providers (using tamariki asthma as a development model)

35. Methodology • Kaupapa Māori methodology • Participatory Action Research (PAR) • Three Plan-Do-Study-Act cycles • Embedded capacity • Possible actions, to develop: • Practise audit tool • Service specification template • Staff development training programme • Asthma resource training tool • Community education programme

36. Conclusion: FutureEngagements Engagements with Whānau Ora Collectives have the potential to inform the Foundation’s future strategic planning in: • Health Sector Positioning and Stakeholder Relationships: Organisational responsiveness to Māori; as a model for engaging with both Māori and mainstream providers • Research: Health Literacy; service delivery models; & complimentary therapies • Education: Resources and staff development to meet the needs of Māori • Media: improved community awareness; health promotion activities; and targeted dissemination (e.g. community events, iwi radio, and Māori Television)

37. Kia Piki Te Mauriora MāoriMĀORI ENGAGEMENT STRATEGY Asthma Foundation Māori Engagement Strategy Team: Tuwhakairiora Williams, Tristram Ingham, PaniaLee