Whakawhirinakitanga ahua : exploring a Māori model of health service delivery : a thesis submitted for the degree of Doctor of Philosophy in Public Health (Māori Health) Massey University

Abstract

Maori health service delivery is underpinned by Maori tikanga, philosophies, values and processes; and Maori providers have consistently developed and delivered tikanga-based services to meet the needs of Maori and whanau. This thesis explored a Maori model of health service delivery, Whakawhirinakitanga Ahua, developed by an iwi health provider, Best Care (Whakapai Hauora) Charitable Trust. It aimed to uncover if health service delivery was reflective of the model, and if it addressed the health needs of Maori accessing services at Whakapai Hauora. This research was undertaken within the interpretivist paradigm using qualitative methods aligned to Maori-centred research. It drew upon the experiences, attitudes and beliefs of 50 key informants; health professionals (Maori and non-Maori) who delivered services and Maori who accessed services at Whakapai Hauora. The primary focus is on collaborative processes involved in the delivery of integrated health care. Findings in this research indicated how Maori and non-Maori work together in a Maori health environment, how they work with clients and whanau, and also at the interface with mainstream services. It demonstrated how Maori utilise tikanga-based service delivery in the provision of care to individuals and whanau; and how non-Maori working at Whakapai Hauora utilise significant aspects of tikanga-based and Treaty principles in service delivery, in response to Maori health interests within the context of Government health priorities and social policy. This thesis draws a distinction between client-centred care and whanau focused care. While client-centred practice has been a widely accepted philosophy in holistic approaches to care, whanau focused care places whanau central to all service delivery processes. It challenges health professionals to reconsider the way in which they engage with Maori and whanau, shifting mindsets from working with individuals to whanau as a collective. It challenges health professionals to acknowledge the wider environment and the determinants that impact on health and wellbeing. This thesis also acknowledges the expertise and strengths from both Te Ao Maori and Te Ao Pakeha, and highlights the significance of health professionals having to walk in both worlds in order to facilitate better outcomes for Maori.