Māori are the indigenous people of New Zealand. As a population group Māori have on average the poorest health status of any ethnic group in New Zealand (Ministry of Health, 2007). Much of this disproportionate ill-health is linked to manageable and/or preventable conditions. Given this, there is much scope for effective Māori health promotion in particular, as the Māori population is relatively young. The primary objective of the case study research was to determine the organisational pre-requisites necessary to fund, implement and sustain Māori health promotion within a primary care setting. Secondary aims were to; identify how health promotion is perceived within a ‘Māori’ primary health care setting, identify existing health promotion practice, and test the feasibility of implementing a current Māori health promotion framework. The case study research was informed by 19 key informant interviews and two focus group sessions. A literature review including an organisational document review was also undertaken. Findings indicated that many of the pre-requisites necessary for effective Māori health promotion implementation sat outside the scope of the organisation and needed to come from a variety of sources including the Ministry of Health, District Health Board’s (DHB’s), community organisations and health providers, whānau (family), hapū (sub tribe) and iwi (tribe), including support from other sectors. The research also found a number of underlying issues that impacted greatly on the health of the Māori population within the PHO. These issues need to be addressed at a number of levels and given high New Zealand priority. In testing the feasibility of a current Māori health promotion model (Kia Uruuru Mai a Hauora) it was considered by participants to fit well with the goals, principles and values of the case study site and within primary health care in general, complementing critical health care service delivery components that already exist. The study’s conclusion found that there was much scope for Māori health promotion that was fully supported, recognised, and adequately and appropriately resourced by the New Zealand Government, Ministry of Health and DHB’s in order to provide long term cost effective and sustainable health benefits.

Research has shown that the oral health of Māori is far worse than non-Māori across all age groups. The objective of this research study was to assess the dental wellbeing of 5-year olds with a specific focus on Māori children currently residing in the Hamilton City region. In addition, this research focused on the impact that social, economic, cultural and environmental factors have on oral health. A total of 32 participants were invited to take part in this research: 15 5-year-old children from three selected schools, 15 (of the children's) caregivers and 2 dental therapists who work in the Hamilton City region. The findings indicated that overall Māori children and children of lower socio-economic status had a much higher prevalence of dental caries (tooth decay) than non-Māori children and children of higher socio-economic status. A number of contributing factors were shown to be responsible for this disparity including the cultural inappropriateness of oral health services and resources, affordability, role-modelling, parental awareness and education, and the transient nature of families. It was found that no one strategy or intervention will achieve dramatic improvements in Māori oral health as a concerted effort is required by Local and Central Government, the Health Sector and Māori communities.

Abstract The original intention for the Partnership Community Worker (PCW) project in 2006 was for it to be an extension of the Pegasus Health General Practice and furthermore to be a bridge between the community and primary healthcare. It was believed that a close working relationship between the Practice Nurse and the PCW would help the target population of Māori, Pacifica and low income people to address and overcome their perceived barriers to healthcare which included: finance, transport, anxiety, cultural issues, communication, or lack of knowledge. Seven years later although the PCW project has been deemed a success in the Canterbury District Health Board annual reports (2013-14) and community and government agencies, including the Christchurch Resettlement Service (2012), many of the Pegasus Health General Practices have not utilised the project to its full extent, hence the need for this research. I was interested in finding out in the first instance if the model had changed and, if so why, and in the second instance if the promotional material currently distributed by Pegasus Health Primary Health Organisation reflected the daily practice of the PCW. A combination of methods were used including: surveys to the Pegasus Health General Practices, interviews with PCWs, interviews with managers of both the PCW host organisations and referring agencies to the PCW project. All the questions asked of all the participants in this research were focussed on their own perception of the role of the PCW. Results showed that the model has changed and although the publications were not reflecting the original intention of the project they did reflect the daily practice of the PCWs who are now struggling to meet much wider community expectations and needs. Key Results: Partnership Community Worker (PCW) interviews: Seventeen PCWs of the 19 employed were interviewed face to face. A number expressed interest in more culturally specific training and some are pursuing qualifications in social work; for many pay parity is an issue. In addition, many felt overwhelmed by the expectations around clients with mental health issues and housing issues now, post-earthquakes. Medical Practice surveys: Surveys were sent to eighty-two Pegasus Health medical practices and of these twenty five were completed. Results showed the full capacity of the PCW role was not clearly understood by all with many believing it was mostly a transport service. Those who did understand the full complexity of the role were very satisfied with the outcomes. PCW Host Community Manager Interviews: Of the ten out of twelve managers interviewed, some wished for more communication with Pegasus Health management because they felt aspects of both the PCW role and their own role as managers had become blurred over time. Referring organisations: Fifteen of the fifty referring community or government organisations participated. The overall satisfaction of the service was high and some acknowledged the continuing need for PCWs to be placed in communities where they were well known and trusted. Moreover results also showed that both the Canterbury earthquakes 2010-2011 and the amalgamation of Partnership Health PHO and Pegasus Health Charitable Limited in 2013 have contributed to the change of the model. Further future research may also be needed to examine the long term effects on the people of Canterbury involved in community work during the 2011-2014 years.

Minimal literature exists relating to the experiences of Maori within the New Zealand public hospital system. Maori are highly represented in morbidity and mortality statistics and are high users of the secondary health care system. A Case Study methodology with a Maori centred approach was used to describe Maori experiences of hospitalisation. Multiple sources of evidence were gathered, including participant interviews, statistical data from the New Zealand Health Information Service, and international literature relating to indigenous experiences of hospitalisation. Eleven people (nine female and two males) identifying as Maori, of various iwi (tribal) affiliations and from a range of regions, participated in the interviews. All participants had either been admitted, or cared for by a family member who had been admitted to a medical or surgical ward in a public hospital anywhere in New Zealand within the last 15 years. Participants were aged between 20 to 75 years. All interviews were audio recorded, transcribed and then thematically analysed. A retrospective interrupted time series design was used to examine length of stay for Maori patients receiving treatment in the secondary medical and surgical setting, from 1989-2004. The data included the records of all medical and surgical discharges for Maori and non-Maori from the New Zealand public hospitals. Medical and surgical admissions were screened to include those over the age of 17 years and who had a length of stay greater than 1 day and less than 90 days. From the analysis of all the data three key interpretations emerged: 1. Maori are marginalised within the mainstream health system. 2. Maori believe that the hospital environment is not conducive to healing. 3. Maori experiences in hospital contribute to their decision to leave as soon as possible. The recommendations include the integration of more culturally acceptable and appropriate interventions within secondary and tertiary health services, and a review of the effectiveness of cultural safety education in practice and inclusion/revision of the cultural competence for all health care workers.

Professional ethics and legal competencies require midwives practising in New Zealand to provide care for childbearing women in a partnership characterised by continuity, equality, mutual respect, trust, shared responsibility and decision making. New Zealand is culturally and legislatively a bi-cultural environment and the cultural safety of Maori (indigenous peoples) are prioritised within health legislation. The midwifery philosophy of partnership and bi-cultural legislation, have provided a foundation for developing a research methodology for the profession. This thesis stories the interweaving of multiple epistemologies, theoretical tenets, philosophical concepts, indigenous and Western European world views as well as women’s narratives in creating and implementing a contextually relevant qualitative research methodology, ‘Te Whakamaramtanga’. The methodology was trialled in the field of miscarriage; a practice issue for midwives in New Zealand. Research participants were recruited through ‘word of mouth’ and snowballing methods. Twenty women participated in the research project and of these nine identified as midwives. Twelve participants were of Non Maori descent, including four women who were immigrants to New Zealand, and eight participants identified as Maori. Participants’ stories were gathered through dialogical interviews, which recognised the co-construction and exploration of knowledge. Ethical tenets outlined in the methodology involved the use of extensive, ongoing consultation with Maori, midwifery and local communities. Maori, women, and midwives share an oral culture that values narratives as facilitating the constitution of identities, creation and transmission of knowledge, and the development of social relationships. Whole narrative, thematic and narrative elements analyses of participants’ miscarriage-related talk have been developed through drawing on kaupapa Maori philosophy, the social theories of Pierre Bourdieu, Michel Foucault, Bruno Latour, Paul Ricouer, and Rom Harre as well as the narrative concepts of Arthur Frank and Margaret Somers. Substantive chapters explore whakapapa, corporeal temporalities, narrative silences and women’s desires for recognition and relationships. A new theory is advanced that methodologies, narratives, genealogies, temporalities, silences and women voices are simultaneously co-constituted metaphysical and material technologies. These heterogeneous and relational entities are collectively perceived as actants, hybrid actors, actor networks as well as technologies, which exist within a range of dynamic and hierarchical networks and/or fields in which this thesis is also embedded. My development of a multicultural midwifery research methodology informed by multidisciplinary theoretical approaches is innovative for midwifery research and theory, and potentially other health disciplines. My research also addresses gaps in midwifery, miscarriage–related, professional development, Maori health and health research literature.

Content removed due to copyright restriction: Nixon, M. (2001). What are the potential benefits of eel consumption for Maori health? Te Taarere aa Tawhaki 1, 132-135. / This ground breaking doctoral thesis brings together science, history and the values derived from lore and tikanga to address a significant health issue for contemporary Maaori. The specific contribution of this research thesis is the combination of knowledge bases from two perspectives. The thesis first presents a scientific view, then a Maaori view, discovered through an interface of customary and contemporary knowledge. The method first examines Western academic theoretical methodologies, then, Kaupapa Maaori methodologies, then introduces and develops the concept of inherited knowledge supported by the mandatory Standards required in an academic context. Therefore the major findings present the syntheses of the two approaches. The framework used is reproducible through an accepted or approved example of something against which others are judged or measured. At this point the thesis explores the theoretical framework for a health intervention by surveying whether it is possible to combine knowledge traditions in a contemporary setting. Thus the accessed inherited traditional and scientific knowledge discovered in this thesis has been adapted for the nine point health intervention designed for Maaori participation. This thesis hypothesises that the staple long finned eel diet contained the essential fatty acid omega-3 and is presented as a metaphor for Hauora, thus being consistent with modern scientific knowledge where the scientific findings presented. The long finned eel was chemically assayed for the presence of the unsaturated essential fatty acid omega-3, and assayed again to assess the stability and quality of fresh and smoked eel. Type II diabetes mellitus is offered as a story and why it has suddenly occurred in Maaori subsequent to urban migration and thereafter. In addition a ten year study of Waikato hapuu supports the research that regular consumption of the long finned eel prevents Type II diabetes. And that prior to urban migration holistic practice, through established lifestyle choices and inherited knowledge, provided nutritional, other physiological benefits and broader wellness outcomes. The double vowel has been used for all te reo Maaori words in the thesis because that is the kawa or protocol of the Tainui Kiingitanga.

Content removed due to copyright restriction: Nixon, M. (2001). What are the potential benefits of eel consumption for Maori health? Te Taarere aa Tawhaki 1, 132-135. / This ground breaking doctoral thesis brings together science, history and the values derived from lore and tikanga to address a significant health issue for contemporary Maaori. The specific contribution of this research thesis is the combination of knowledge bases from two perspectives. The thesis first presents a scientific view, then a Maaori view, discovered through an interface of customary and contemporary knowledge. The method first examines Western academic theoretical methodologies, then, Kaupapa Maaori methodologies, then introduces and develops the concept of inherited knowledge supported by the mandatory Standards required in an academic context. Therefore the major findings present the syntheses of the two approaches. The framework used is reproducible through an accepted or approved example of something against which others are judged or measured. At this point the thesis explores the theoretical framework for a health intervention by surveying whether it is possible to combine knowledge traditions in a contemporary setting. Thus the accessed inherited traditional and scientific knowledge discovered in this thesis has been adapted for the nine point health intervention designed for Maaori participation. This thesis hypothesises that the staple long finned eel diet contained the essential fatty acid omega-3 and is presented as a metaphor for Hauora, thus being consistent with modern scientific knowledge where the scientific findings presented. The long finned eel was chemically assayed for the presence of the unsaturated essential fatty acid omega-3, and assayed again to assess the stability and quality of fresh and smoked eel. Type II diabetes mellitus is offered as a story and why it has suddenly occurred in Maaori subsequent to urban migration and thereafter. In addition a ten year study of Waikato hapuu supports the research that regular consumption of the long finned eel prevents Type II diabetes. And that prior to urban migration holistic practice, through established lifestyle choices and inherited knowledge, provided nutritional, other physiological benefits and broader wellness outcomes. The double vowel has been used for all te reo Maaori words in the thesis because that is the kawa or protocol of the Tainui Kiingitanga.

Western health professions have historically struggled with the notion that spirituality could be studied empirically. This trend has changed in recent decades with there being a marked increase in the health literature pertaining to spirituality. For indigenous people spirituality is a fundamental attribute of their worldviews. Mäori, as the Indigenous people of Aotearoa, have always acknowledged the importance of wairua, (spirituality as defined by Mäori worldviews) to their health and well-being. This thesis aims to explore wairua as an important aspect of Mäori well-being from a psychological perspective. Two research goals underpin this thesis. The first goal involved developing an understanding of what Mäori mean when they talk about wairua. This was achieved through a qualitative study. While there are implicit shared understandings among Mäori regarding the nature of wairua, this study was one of the first attempts to make some of those shared understandings more explicit. The second goal involved investigating the relationship between an orientation to wairua and Mäori well-being using a newly developed measure. This was a quantitative study. Conceptualisations of wairua fell into four themes; direct descriptions, personal experiences, personal beliefs and Mäori worldviews. According to the qualitative information, wairua was described as a fundamental attribute that enables Mäori to engage with their reality; an intuitive consciousness. Through wairua Mäori identity is expressed, relationships are forged, balance is maintained, restrictions and safety are adhered to, healing is transmitted, and the connection between te ao wairua and te ao Mäori are maintained. These aspects of Mäori reality are inclusive and interconnected. The qualitative study information led to the formation of a 30 item self report measure named the Kia Ngawari ki te Awatea Orientation to Wairua measure. This measure was used to investigate the relationship between an orientation to wairua and Mäori health and well-being. The results showed that orientations to wairua had relatively modest associations with wellbeing when conceptualised and measured in a variety of ways. Due to the variability in the results, support for the overarching hypothesis of a relationship between wairua and well-being was mixed. A number of limitations were acknowledged with recommendations for future research offered. The findings of these studies have a number of implications for clinical psychological practice with Mäori clients.

This study was concerned with the health implications of new forms of gambling such as casinos, pokie machines and internet gambling for Māori women and their families in Auckland and the Bay of Plenty region of Aotearoa (New Zealand). It set out to discover what culturally appropriate services were available and the extent to which Māori women gamblers were utilising them. The literature documenting Māori perceptions of gambling shows that Māori women gamblers and their partner/whānau members and gambling service providers have been little studied previously. These goals translated into the following specific aims: 1) to study how Māori women problem gamblers, their partner or whānau members and key informants perceived gambling, what it meant to them and why they did it; 2) to investigate the consequences of gambling for Māori women, whānau and service providers in dealing with the effects of gambling; 3) to report on how these three groups dealt with the effects of gambling; and 4) to discover what helped to bring about positive changes for the three groups. All of the aims were achieved. A Māori approach (Kaupapa Māori), combined with a naturalistic approach to data collection, was adopted. Qualitative methods are most appropriate to use when working with some Māori, as there is a growing realisation that research with Māori needs to be interactive. A Māori research procedure modelled on the ritual ceremony of encounter (Pōwhiri) provided an appropriate structure for the development and presentation of the research process. The major focus was on the qualitative data obtained from semi-structured interviews in two locations - Rotorua and Auckland. The interviews were conducted with twenty Māori women gamblers, sixteen whānau members including partners and ten interviews with staff involved in services that provided help for problem gamblers. The three interview schedules were based on a number of broad themes and open-ended questions to obtain meaningful descriptive data. The interviews were audio recorded and used to produce transcripts that were then sent back to the participants for feedback. Qualitative data analysis was conducted on the returned documents. The findings from this study revealed major impacts of the women's socio-economic, familial and societal circumstances on gambling behaviour and its effects, which are areas of concern for mental health professionals and researchers. The mythical Māori canoes on which Māori voyaged from their place of origin (Hawaiiki) to Aotearoa, the Waka, provided an appropriate metaphor to present the interrelationship between the pull and push factors toward gambling, and its implications for society. This is illustrated as a spinning waka, Te Waka Hūrihuri. On the other hand, Te Waka Māia (courageous) demonstrates the relationships between the variables that help Māori women gamblers to cope and helpful strategies found to assist them to modify or stop their gambling behaviour. It is recommended that the government limit the proliferation of gaming venues and continue to encourage development of emerging Māori services. Moreover, a coordinated approach is essential, as Māori women gamblers, partners and whānau members need to heal together for positive outcomes for Māori health development in Aotearoa. The main implication of this study is that a wide range of further research into Māori and gambling is required. Recommendations on ways in which the current delivery of services in Rotorua and Auckland could be improved are: That the Ministry of Health purchase services that establish support groups for Māori people with problem gambling and their whānau, and That non-Māori provider services and organisations support the development of emerging Māori services. Heeding the outcome of this research should help improve New Zealand's existing health policy and capacity for Māori women's health development. It should also enrich our understanding of the adaptation patterns of Māori whānau member/s, and thus should have implications, not only for Māori health policies, but also relevance for the wider field of international cross-comparative research on indigenous gambling and mental health issues. Limitations of this study included a small, localised sample that means the findings can only tentatively be generalised to the wider population of Māori women gamblers. Nonetheless, information gained from the study contributes to understanding of the adaptation patterns of Māori women gamblers, their whānau member/s, and those who are trying to help them. It is hoped that the study will make it at least a little less true that every day is a war day for Māori women and their whānau trying to deal with the problem of gambling.