"I like to be treated like a person, a little smile never costs a thing" : weaving kaumātua experiences of living with osteoarthritis in Hawkes's Bay, Aotearoa New Zealand into a collaborative osteoarthritis-management toolkit : a thesis presented for the requirements for the degree of Doctor of Philosophy, Public Health, Massey University, Palmerston North, New Zealand

Abstract

The global burden of osteoarthritis has major ramifications for societies and governments around the world. Despite a high rate of osteoarthritis, there is a low level of osteoarthritis-management knowledge and awareness in the Māori community. Numerous studies of Māori health have identified a need for new health communication approaches to osteoarthritis-management, in order to close the disconnection between Māori and non-Māori disease rates. Positive health management is the topic of the present thesis, as viewed through Māori eyes. It has been informed by the memories and aspirations of kaumātua who have lived through the challenges of living with osteoarthritis, but have emerged with qualities that enable them to enjoy older-age and to contribute to their own whānau, the Māori world, and wider society. These factors have been brought together into a Māori-centred toolkit, appropriate to modern health promotion, as they apply to Māori health perspectives of kaumātua in Hawke’s Bay. The present research was undertaken within the interpretivist paradigm using qualitative methods and Māori principles, aligned to a tīkanga (cultural principles) base. It is argued that Western science and a Māori-centered approach are relevant to research concerning osteoarthritis-management in the contemporary context, and reflect the realities of kaumātua with osteoarthritis, who live in both the Māori world, and wider society. The study drew upon the experiences, attitudes and beliefs of 20 kaumātua with osteoarthritis, employing interviews and group hui, to inform constructing an osteoarthritis-management toolkit, process and outcome appraisal. The research found that osteoarthritis-management for kaumātua, can be characterised by a two dimensional concept that incorporates a process dimension and an interpretive appraisal dimension. The process dimension is consistent with a values perspective. The appraisal dimension can be described in terms of complementary Māori specific outcome indicators of osteoarthritis-management. The outcome indicators are encapsulated by the idea that kaumātua, family and whānau know what issues deserve their attention and what is needed to address local problems. The Māori-specific outcome indicators for optimal osteoarthritis-management identified in the present study are: ‘Manākitanga’ (kind support); ‘Tino rangatiratanga’ (self-determination, and; ‘Oritetanga’ (equity and assessment). The overarching indicator is ‘Manākitanga-ā-tinana’ (culturally relevant approach to osteoarthritismanagement and relationship-based care).