Co-designing an mHealth tool in the New Zealand Māori community with a “Kaupapa Māori” approach

●    Culturally-specific visioning process and preparation stage (education for all parties eg technological and cross-cultural communication) AS PART OF RELATIONSHIP BUILDING●    Focus groups and follow-up focus groups groups (Community consultation/engagement)o    "creative and expressive methods" - Artistic expression (visual representation of partner exercise in defining health and wellbeing o    Photos, Audio and reflections●    Culturally-rooted generative data-collection, co-design methods●    Metaphors and storytelling to foster expression reflection and sharing●    Written words or statements on boards and in paired discussions

Responding to a need for effective health interventions, this study utilizes co-design and kaupapa Māori research approaches to design a healthy lifestyle app to supports the health goals of Māori communities. Within the study, a holistic view of health was emphasized: one that centred on family well-being, as well as on maintaining connections to people and to place. In addition to describing the background, methods and results of their study, the authors also advocate for co-design approaches to be utilized in future research involving Māori communities.

● Co-Design approach with collaborative partnership b/w researchers and maori community end-users
● Māori partners lead the conceptualisation, design, implementation and interpretation of research outcomes
● Used kaupapa Māori research principles and norms (tikanga) in all aspects of the research process (e.g. All hui were initiated with karakia (a prayer which sets an atmosphere of mindfulness and readiness to share and engage), introductions and the sharing of food).
● Acknowledged that a truly collaborative research involved the need to loosen the parameters of the research. (ie health objectives identified by community needed to be priority)
● Balanced the needs and time-frames of academic researchers with the availability and readiness of communities to contribute to the research process
● Defined principles of engagement:
o Trust—building trust with our teams and communities
o Respect—respecting our different worldviews, cultures, and expertise
o Manaakitanga—working, learning, and sharing together and supporting one another
o Empathy—listening and communicating with openness and transparency
o Innovation—thinking outside the square
o Adaptability—open to change and flexible in our approach
o Tika Pono/Aroha—doing what's right and wrapping it up with love

Table 2. Key tikanga principles implemented in the OL@-OR@ research approach.

Tikanga principalImplementation in Implementation in OL@-OR@

Nana
(Mead & Mead, 2003; Smith, 1999).
 Respect for all involved in the research through protecting the integrity, power and authority of all and acknowledging that information gathered ultimately belongs to the participants and the broader Maori collective.
 

He kanohi i kitea (a face seen)
(Jones, Crengle, & McCreanor, 2006;
Pipi et al., 2004).
 Researchers are physically seen and known to the community they are partnering with and are prepared to give their time and expertise in order to gain and maintain trust.
 

Tapu
(Jones et al., 2006; Mead & Mead, 2003)
 Acknowledgement of the unique worth of each individual involved in the research and the need to ensure their cultural, emotional and physical safety. This including ensuring the safety of the researchers through provision of appropriate training and support.
 

Whakawhanaungatanga
(Walker et al., 2006).
 Sufficient time is allowed for the establishment of trusting relationships, creating a partnership and negotiating access to community members.
 

Manaakitanga
(Mead & Mead, 2003).
 Nurturing relationships and ensuring the well-being of everyone Involved in the research by including the use of re teo, appropriate customs and rituals of engagement and allowing for safe disengagement from the research.
 

Koha
(Mead & Mead, 2003; Pipi et at, 2004).
 Reciprocity; giving back to the people who have participated in the research in terms of time, resources and knowledge as an acknowledgement of their valuable contributions.
 

Aroha
(Mead & Mead, 2003).
 Having an authentic concern for the community and acting in their best interests at all times.
 

Māori knowledge systems, creation stories, proverbs, and oral histories and stories provide a culturally empowering way to generate discussion and insights from Māori whānau and communities. It also provides culturally relevant knowledge to “conceptualise, design and prototype an mHealth tool that supports the health aspirations of Māori communities and reduces inequalities in noncommunicable disease rates” (Te Morenga, L., Pekepo, C., Corrigan, C., Matoe, L., Mules, R., Goodwin, D., ... & Jull, A., 2018, (p. 97).

Interventions designed for the general population tend to be less effective for Māori communities and may contribute to increased health inequities. Pertinent and successful health and well-being conceptualization, practices, and instruments centred on whānau wellness can build healthier Māori communities. The combination of “kaupapa Māori and co-design research processes has led to the creation of a culturally tailored mHealth tool to support Māori hauora aspirations”. (Te Morenga, L., Pekepo, C., Corrigan, C., Matoe, L., Mules, R., Goodwin, D., ... & Jull, A., 2018, p. 98)

When Māori communities are empowered and listened, research process are not only successful but positive health interventions are possible.

Photographs, audio recordings and the reflections of the community researchers.

Ongoing knowledge sharing (of the process, research stages, data collection, changes, protocols completion, etc.) with the community through formal community meetings.

"In line with previous research with Māori communities, our participants expressed views of health as being a very holistic concept. Health and well-being were centred on whānau wellness achieved through maintaining strong connections with people and to place" (p. 94)

Health