Achieving Equitable Asthma Services for Māori

Abstract

Introduction: Significant inequities exist in Aotearoa New Zealand for tamariki (children) Māori with asthma, who suffer a high burden of disease and high hospital admission rates, as compared to non-Māori. Primary healthcare, as the main point of contact for people with asthma, is the first line of treatment that when effective, should effectively prevent hospitalisation for tamariki Māori. Methods: This thesis describes a qualitative, phenomenological study that explored the experiences of practitioners delivering asthma services to tamariki Māori and their whānau in primary healthcare. A kaupapa Māori methodology provided a Māori worldview that privileged Māori perspectives throughout all stages of this research. An equity framework was used in the analysis and interpretation of the results, to ensure that they aligned with Māori values and aspirations. Results: Fifteen practitioners from Māori, mainstream and Very Low Cost Access providers of asthma services were interviewed. The main findings showed that although some local initiatives had been implemented to improve asthma services, most practitioners encountered a number of challenges in the delivery of these services. The results are presented using the Pou Ora framework with four main themes: 1) Hauora (Compatible Environments) highlighted a lack of prioritising and funding of asthma services, along with barriers for Māori needing to access the services; 2) Toi Ora (Knowledge Transfers) demonstrated a gap in the use of health literacy techniques when delivering asthma services to Māori; 3) Whānau Ora (Empowering relationships) indicated a lack of cultural competency for some practitioners; 4) Mauri Ora (Enhancing Potential) emphasised that the motivations and attitudes of practitioners significantly contributed, either positively or negatively, towards empowering tamariki Māori and their whānau to manage asthma effectively and reach their full potential. Discussion: While practitioners have a responsibility as individual professionals to deliver culturally and clinically competent asthma services, provider organisations and policy makers also play a key role. The health system role includes setting national respiratory health targets along with fully funded, quality asthma services that achieve equitable outcomes for tamariki. Government also needs to invest in research that provides evidence for effective asthma interventions, so that providers are able to develop and support equitable asthma services. Health organisations need to promote cultural responsiveness as a core organisational value, along with provision for flexible asthma services that meet the needs of tamariki. Support from government should include ensuring that practitioners are adequately trained in health literacy techniques, so they can deliver understandable, effective services. Practitioners need to be proficient in applying Māori models of health, in order to achieve desirable asthma outcomes. The monitoring of all asthma services is necessary to ensure that equitable health outcomes are achieved for tamariki. In conclusion, health systems need to prioritise respiratory health and resource health organisations so they can restructure their services to provide long-term asthma services with equitable health outcomes. Primary healthcare practitioners (e.g. doctors, nurses) need to be supported so they can maintain a high level of cultural and clinical competence in delivering holistic asthma care that achieves equity for tamariki Māori and their whānau.