Abstract
Introduction: Colonisation has devastating consequences for Maaori (the Indigenous Peoples of Aotearoa me Te Waipounamu; New Zealand) and Indigenous Peoples in other colonised countries. Colonisation has adversely affected rangatahi Maaori (Maaori youth), who experience higher rates of suicide, and hospitalisation and mortality inequities related to infectious and respiratory diseases, compared to non-Maaori youth.
Health-related quality of life (HRQoL) measures are used globally to describe and measure population and individual health. Indigenous Peoples, including Maaori, often hold distinct conceptualisations of health, differing from Western models. While some HRQoL measures contain questions that align with aspects of hauora (health) important to Maaori, such as tinana (physical) and hinengaro (mental), other aspects, like wairua (spiritual) and whaanau (family) health, are typically omitted. It is imperative that HRQoL measures are appropriate for, and measure, aspects of health important to Indigenous Peoples.
The overall aims of this study are to: (i) describe and understand hauora rangatahi from the perspectives of rangatahi Maaori and whaanau, and (ii) describe what (if any) relationships exist between hauora rangatahi and commonly-used child/youth HRQoL measures.
Methods: A scoping review was conducted to identify published empirical research reporting the use of HRQoL measures among Indigenous child/youth populations within the Pacific Rim.
Two waananga (a Maaori method of qualitative data collection) were then held with rangatahi Maaori and their whaanau. Waananga 1 (with 23 rangatahi and 17 whaanau members) focused on important hauora dimensions for rangatahi Maaori. This resulted in the creation of a provisional Hauora Rangatahi Maaori model, using the puuraakau (stories) of Taane-mahuta, the deity of the forest and mankind, to depict these dimensions. Waananga 2 (with 24 rangatahi and 14 whaanau members) presented the themes depicted in the Hauora Rangatahi Maaori model back to participants for further discussion and refinement of the themes and model. Both waananga, and the resulting model, were grounded in a Kaupapa Maaori paradigm.
Results: The scoping review screened 1393 paper titles and abstracts, 543 were eligible for full-text review. Of these, 40 papers were eligible, from 32 distinct studies. Only seven papers acknowledged Indigenous concepts of health and only two Indigenous-specific HRQoL measures were identified.
Ten hauora rangatahi Maaori themes were identified: whanaungatanga/family and relationships, tinana/physical, maatauranga/education, hangarau/technology, te ao Maaori/the Maaori world, kaitiakitanga/environment, tuakiri/identity, hinengaro/mental and wairua/spiritual. In investigating commonly used child/youth HRQoL measures, some aspects of hauora rangatahi Maaori (e.g. physical and mental health) are included, however, there are many important omissions (e.g. wairua, kaitiakitanga, and te ao Maaori).
Conclusion: Indigenous people have the right to the highest attainable standard of health. In Aotearoa me Te Waipounamu, we are also obligated by Te Tiriti o Waitangi to ensure equal rights to high standards of health for Maaori. To assess HRQoL among rangatahi Maaori, measures need to provide accurate and meaningful representation of hauora dimensions important to rangatahi Maaori. This is vital for developing interventions, policies, and improved decision-making to address health inequities effectively.