Abstract
Colonisation has negatively impacted the lives of Māori and demonstrates a perpetual system of power that still shapes health outcomes today. The resultant intergenerational trauma, systemic racism and unequal access to the key determinants of health are reflected in the inequities in the quality and accessibility of healthcare, as well as Māori health outcomes. Māori adults experience disproportionately worse oral health outcomes, including a greater prevalence of dental caries, periodontal diseases, and tooth loss compared with non-Māori. The existing oral health system has resulted in populations experiencing financial barriers to accessing both preventive and curative dental treatment. Despite these inequities, the academic discourse seldom features the specific oral health needs and aspirations of Māori adults and communities.
This kaupapa Māori thesis explores opportunities to improve oral health service delivery for Māori adults living in Rotorua, Aotearoa New Zealand. The research question was how do Māori adults want oral health care services to be delivered in their community? Through community wānanga at Te Kuirau Marae, the aspirations of 17 whānau members were centred to ensure that solutions are culturally responsive and community driven. A thematic analysis identified five themes from the wānanga; (1) childhood experiences have influenced engagement as adults; (2) culturally safe oral health care; (3) access to the Māori oral health workforce; (4) world-class iwi and hapū kaupapa Māori facility; and (5) iwi-led oral health data to drive service delivery.
Drawing on the strengths and priorities of Māori communities, the research identified and concludes that there is an urgent need to improve oral health service delivery for Māori communities. There is a need for iwi- and hapū-led dental services, as well as innovative approaches to grow the Māori oral health workforce, including training opportunities to be provided locally. It is important that oral health services deliver care according to Māori concepts, values and tikanga, including whānau-friendly services that deliver care within a culturally safe environment. Oral health care should extend beyond the clinic, with more education and initiatives delivered within the community setting. Within this, a need for evidence-based approaches are required to ensure that service delivery is responding to community realities. Iwi- and hapū-led data collection mechanisms could help to achieve this.