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Kaumatua Mana Motuhake: A study protocol for a peer education intervention to help Maori elders work through later-stage life transitions.

ABSTRACT: BACKGROUND:The Aotearoa/New Zealand population is ageing and numerous studies demonstrate with this phenomenon comes increases in non-communicable diseases, injuries and healthcare costs among other issues. Further, significant inequities exist between M?ori (Indigenous peoples of Aotearoa/New Zealand) and non-M?ori around poor ageing and health. Most research addressing these issues is deficit oriented; however, the current research project takes a strengths-based approach that highlights the potential of kaum?tua (elders) by asserting mana motuhake (autonomy, identity and self-actualisation). We believe that the esteem of elders in M?ori culture signals transformative potential. Specifically, this project utilises a 'tuakana-teina' (older sibling/younger sibling) peer-educator model, where kaum?tua work with other kaum?tua in relation to health and wellbeing. The objectives of the project are (a) to develop the capacity of kaum?tua as peer educators, whilst having positive impacts on their sense of purpose, health and wellbeing; and (b) to enhance the social and health outcomes for kaum?tua receiving the intervention. METHODS:The research is grounded in principles of Kaupapa M?ori and community-based participatory research, and brings together an Indigenous community of kaum?tua, community health researchers, and academic researchers working with two advisory boards. The project intervention involves an orientation programme for tuakana peer educators for other kaum?tua (teina). The research design is a pre- and post-test, clustered staggered design. All participants will complete a baseline assessment of health and wellbeing consistent with M?ori worldviews (i.e., holistic model). The tuakana and teina participants will be divided into two groups with the first group completing the intervention during the first half of the project and the second group during the second half of the project. All participants will complete post-test assessments following both interventions allowing comparison of the two groups along with repeated measures over time. DISCUSSION:The findings will provide an evidence base for the importance and relevancy of kaum?tua knowledge to create contextually based and culturally safe age-friendly environments that facilitate engagement and participation by kaum?tua for kaum?tua. If the model is effective, we will seek to facilitate the dissemination and scalability of the intervention. TRIAL REGISTRATION:Australia New Zealand Clinical Trial Registry ( ACTRN12617001396314 ); Date Registered: 3 October 2017 (retrospectively registered).

SUBMITTER: Oetzel JG

PROVIDER: S-EPMC6367813 | biostudies-other | 2019 Feb

REPOSITORIES: biostudies-other

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Kaumātua Mana Motuhake: A study protocol for a peer education intervention to help Māori elders work through later-stage life transitions.

Oetzel John G JG Hokowhitu Brendan B Simpson Mary M Reddy Rangimahora R Nock Sophie S Greensill Hineitimoana H Cameron Michael P MP Meha Pare P Johnston Kirsten K Harding Truely T Shelford Pita P Smith Linda Tuhiwai LT

BMC geriatrics 20190207 1

<h4>Background</h4>The Aotearoa/New Zealand population is ageing and numerous studies demonstrate with this phenomenon comes increases in non-communicable diseases, injuries and healthcare costs among other issues. Further, significant inequities exist between Māori (Indigenous peoples of Aotearoa/New Zealand) and non-Māori around poor ageing and health. Most research addressing these issues is deficit oriented; however, the current research project takes a strengths-based approach that highligh ...[more]

PMID: 30732566

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Project description:Background: Māori kaumātua (elders) face stark health and social inequities compared to non-Māori New Zealanders. The tuakana-teina (older sibling-younger sibling) peer education programme is a strengths-based approach to enhance well-being and social connectedness. The purpose of this study is to present the baseline data from this programme and identify correlates of well-being outcomes. Method: Participants included 128 kaumātua who completed a self-report survey about health-related quality of life, spirituality, social connection and loneliness, life satisfaction, cultural identity and connection, elder abuse, health service utilisation and demographics. Findings: Multiple regression models illustrated the following correlates of outcomes: (a) self-rated health: needing more help with daily tasks (β = -0.36) and housing problems (β = -0.17); (b) health-related quality of life: needing more help with daily tasks (β = -0.31), housing problems (β = -0.21), and perceived autonomy (β = 0.19); (c) spiritual well-being: understanding of tikanga (cultural protocols) (β = 0.32) and perceived autonomy (β = 0.23); (d) life satisfaction: social support (β = 0.23), sense of purpose (β = 0.23), cultural identity (β = 0.24), trouble paying bills (β = -0.16), and housing problems (β = -0.16); (e) loneliness: elder abuse (β = 0.27), social support (β = -0.21), and missing pleasure of being with whānau (extended family) (β = 0.19). Conclusions: Key correlates for outcomes centred on social support, housing problems, cultural connection and perceived autonomy. These correlates are largely addressed through the programme where tuakana/peer educators provide support and links to social and health services to teina/peer recipients in need. This study illustrates needs and challenges for kaumātua, whilst the larger programme represents a strengths-based and culturally-centred approach to address health issues related to ageing in an Indigenous population.

Project description:BackgroundHealth 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.MethodsThe 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.ResultsThe 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.ConclusionsThis 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 registrationThe project was registered on 6 March 2020 with the Australia New Zealand Clinical Trial Registry: ACTRN12620000316909 . Prospectively registered.

Project description:BackgroundThe Aotearoa New Zealand population is ageing accompanied by health and social challenges including significant inequities that exist between Māori and non-Māori around poor ageing and health. Although historically kaumātua (elder Māori) faced a dominant society that failed to realise their full potential as they age, Māori culture has remained steadfast in upholding elders as cultural/community anchors. Yet, many of today's kaumātua have experienced 'cultural dissonance' as the result of a hegemonic dominant culture subjugating an Indigenous culture, leading to generations of Indigenous peoples compelled or forced to dissociate with their culture. The present research project, Kaumātua Mana Motuhake Pōī (KMMP) comprises two interrelated projects that foreground dimensions of wellbeing within a holistic Te Ao Māori (Māori epistemology) view of wellbeing. Project 1 involves a tuakana-teina/peer educator model approach focused on increasing service access and utilisation to support kaumātua with the greatest health and social needs. Project 2 focuses on physical activity and cultural knowledge exchange (including te reo Māori--Māori language) through intergenerational models of learning.MethodsBoth projects have a consistent research design and common set of methods that coalesce around the emphasis on kaupapa kaumatua; research projects led by kaumātua and kaumātua providers that advance better life outcomes for kaumātua and their communities. The research design for each project is a mixed-methods, pre-test and two post-test, staggered design with 2-3 providers receiving the approach first and then 2-3 receiving it on a delayed basis. A pre-test (baseline) of all participants will be completed. The approach will then be implemented with the first providers. There will then be a follow-up data collection for all participants (post-test 1). The second providers will then implement the approach, which will be followed by a final data collection for all participants (post-test 2).DiscussionTwo specific outcomes are anticipated from this research; firstly, it is hoped that the research methodology provides a framework for how government agencies, researchers and relevant sector stakeholders can work with Māori communities. Secondly, the two individual projects will each produce a tangible approach that, it is anticipated, will be cost effective in enhancing kaumātua hauora and mana motuhake.Trial registrationAustralia New Zealand Clinical Trial Registry ( ACTRN12620000316909 ). Registered 6 March 2020.

Project description:IntroductionObstructive sleep apnoea syndrome (OSAS) is one of the most common chronic diseases. It may be associated with symptoms of excessive daytime sleepiness and neurocognitive and cardiovascular complications. First line therapy for OSAS involves home continuous positive airway pressure (CPAP), however, nearly half of patients do not adhere with this treatment over the long term. Cognitive-behavioural interventions that include health professionals and patient and public involvement are increasingly advocated in the fields of education and research. We hypothesise that a peer-driven intervention could help patients with OSAS to resume CPAP use after discontinuation.Methods and analysisWe have designed a prospective, multicentre randomised, controlled trial that will be coconducted by health professionals, a home provider of CPAP and patients as experts or peers or participants. The primary aim is to evaluate the impact of a 6-month, peer-driven intervention to promote the resumption of CPAP after discontinuation. We anticipate that 20% of patients in the intervention group will reuse CPAP as compared with 6% in control group, thus, 104 patients must be included in each group. The secondary aims are (1) to evaluate the impact of the peer-driven intervention on adherence to CPAP compared with the control group (mean adherence and percentage of nights with at least 4 hours' use/night for 70% of nights); (2) to determine factors associated with resumption of CPAP; (3) to assess patient satisfaction with the peer-driven intervention at 6 months; (4) to evaluate the feasibility and the execution of the peer-driven intervention and peer satisfaction. Adult outpatients with an established diagnosis of severe OSA (Apnoea-Hypopnoea Index >30 events/hour) that have stopped using CPAP within 4-12 months after initiation will be recruited. The peers who will perform the intervention will be patients with OSAS treated with CPAP with good adherence (at least 4 hours/night, 70% of nights) and trained in motivational enhancement and cognitive-behavioural therapies. Trained peers will conduct three interviews within 6 months with participants.Ethics and disseminationEthical approval has been obtained from the French Regional Ethics Committee CPP Ouest II-Angers, (IRB 21.02.25.68606 (2021/2025)). All participants will sign written informed consent. The results will be presented at conferences and published in peer-reviewed journals as well as public media.Trial registration numberNCT04538274.

Dataset Information

Kaumatua Mana Motuhake: A study protocol for a peer education intervention to help Maori elders work through later-stage life transitions.

Publications

Kaumātua Mana Motuhake: A study protocol for a peer education intervention to help Māori elders work through later-stage life transitions.

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