Abstract
Community engagement in health care has gained increased focus in recent decades as an effective strategy for improving the design of health services. When conducted effectively, successful engagement can give community a sense of empowerment and control over the health care they receive. Variation in successful community engagement suggests that ‘a one size fits all’ approach is not necessarily suitable for all communities. In New Zealand, the Treaty of Waitangi/Te Tiriti o Waitangi, guides the relationship between the Crown and Māori. The Ministry of Health has obligations to work in partnership with Māori in the design, delivery and monitoring of the New Zealand health and disability system. Community engagement can be seen as a key part of this partnership.
The aim of the research presented in this thesis was to evaluate the process of community engagement that occurred as part of the development of a regional primary and community care strategy. A case study approach was utilised to investigate community engagement relating to the Southern Health System’s Primary and Community Care Strategy. The first case centred on the overall community engagement with a focus on Māori and iwi engagement. The Primary Maternity Strategy, which was developed and implemented in parallel, was the focus of the second case study.
To inform this evaluation a formal scoping review of relevant literature was conducted. The literature review identified 17 key papers that focused on community engagement in primary and community care in New Zealand and the United Kingdom. The research gaps identified in the literature review informed the development of interview guides for the case studies. The findings from a qualitative document analysis also supported the development of the interview guides.
A total 19 key informants participated in semi-structured qualitative interviews. The results of these interviews were thematically analysed and synthesised with the other components of this thesis to provide the overall findings. The community engagement processes on which this research focused were affected by several barriers. The Māori and iwi engagement did not meet the obligations set out in the Treaty of Waitangi/Te Tiriti o Waitangi. The overall level of community engagement conducted was low. This judgement is based on the reported poor quality and quantity of community engagement conducted. This research is timely and provides evidence to support the development and implementation of a set of expectations for community engagement into the legislation and policy that underpins the current major health reforms in New Zealand.