Kaupapa Māori evaluation, transforming health literacy : a thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Te Kunenga ki Pūrehuroa, SHORE & Whāriki Research Centre, Aotearoa - New Zealand

Abstract

This thesis set out to evaluate the effectiveness of a cardiovascular disease medicines health literacy intervention. Kaupapa Māori evaluation was the guiding approach for gaining insights about the intervention from patients/whānau and Ngāti Porou Hauora health practitioners directly involved in the intervention as well as the wider Ngāti Porou community. Beyond this research setting, I sought to broaden the insights into health literacy approaches through Māori and international Indigenous key informant interviews, synthesising their insights with analyses of the evaluation data. In addition, the study sought to ground its understandings of health literacy interventions and approaches with Indigenous communities in other colonial contexts by collaboratively designing and testing an evaluation framework. As well as the focus on health literacy as a construct, I aimed to broaden understandings around the praxis of kaupapa Māori evaluation in the context of an iwi-centred approach. The key findings of the strands of the study are effective health literacy, with sub-themes for Ngāti Porou context and importance of whanaungatanga; kaupapa Māori evaluation – transformational praxis; reclamation of health literacy and contributions to the formation of Indigenous health literacy. To bring about change, we need to deepen health literacy’s scope to examine practices embedded in broader social narratives and cultural agency that recognise issues of equity, equality, and empowerment. Health literacy needs to be understood and enacted as a situated social and cultural construction that is negotiated, fluid, and shaped by people, whānau communities, and the complex array of other stakeholders. I propose transforming health literacy praxis at all levels – requiring the re-orientation and re-configuration of power relations that is congruent with current debates and discussions about decolonisation. Decolonising health literacy will involve revamped decision-making and recruitment processes grounded in Indigenous world views, tino rangatiratanga and mana motuhake. More specifically, transformation of health literacy will involve investing in cultural safety and competency training, applying new standards of practice, and ensuring internal and external Māori involvement at all levels of engagement.