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

Mary Louisa Simpson; Stacey Ruru; John Oetzel; Pare Meha; Sophie Nock; Kathrine Holmes; Hariata Adams; Ngapera Akapita; Marama Clark; Kawarau Ngaia; Reuben Moses; Rangimahora Reddy; Brendan Hokowhitu

doi:10.1186/s43058-022-00374-3

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

Implement Sci Commun. 2022 Nov 24;3(1):123. doi: 10.1186/s43058-022-00374-3.

Authors

Mary Louisa Simpson¹, Stacey Ruru², John Oetzel³, Pare Meha⁴, Sophie Nock⁵, Kathrine Holmes⁶, Hariata Adams⁷, Ngapera Akapita⁸, Marama Clark⁹, Kawarau Ngaia¹⁰, Reuben Moses¹¹, Rangimahora Reddy⁴, Brendan Hokowhitu¹²

Affiliations

¹ Waikato Management School, University of Waikato, Hamilton, New Zealand. mary.simpson@waikato.ac.nz.
² University of Waikato, Hamilton, New Zealand.
³ Waikato Management School, University of Waikato, Hamilton, New Zealand.
⁴ Rauawaawa Kaumātua Charitable Trust, Hamilton, New Zealand.
⁵ Faculty of Māori and Indigenous Studies, University of Waikato, Hamilton, New Zealand.
⁶ Ranolf Medical Centre, Rotorua, New Zealand.
⁷ Te Korowai Hauora O Hauraki-Thames, Thames, New Zealand.
⁸ Ngāti Ruanui W'anau Ora, Hāwera, New Zealand.
⁹ Poutiri Charitable Trust, Te Puke, New Zealand.
¹⁰ Te Korowai o Ngāruahine Trust, Hāwera, New Zealand.
¹¹ Te Roopu Tautoko Ki Te Tonga, Dunedin, New Zealand.
¹² University of Queensland, Brisbane, QLD, Australia.

Abstract

Background: Health inequities experienced by kaumātua (older Māori) 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 Māori to new communities.

Methods: The study was grounded in an Indigenous methodology (Kaupapa Māori) 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: Kaumātua mana motuhake (kaumātua independence and autonomy) where community researchers centred the needs of kaumātua in co-designing the programme with researchers; Whanaungatanga (relationships and connectedness) which illustrated how community researchers' existing and emerging relationships with kaumātua, 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.

Keywords: Co-design; Community-engaged research; Culture centred; Health inequity; Implementation frameworks; Indigenous; Māori.

Grants and funding

18566SUB1953/Ministry of Business, Innovation and Employment