Implementation framework for chronic disease intervention effectiveness in Māori and other Indigenous communities

This particular research used:
• Factors identification in data collection of each study including setting, location (rural or urban), intervention level, governance (shared, private, community), and study quality
• Use of the He Pikinga Waiora Implementation Framework to code the interventions in these studies to illustrate the potential post-hoc explanatory power of the study framework

This research involved a systemic review of 13 diabetes prevention studies in Indigenous communities in Australia, Canada, New Zealand, and the United States. The researchers used the He Pikinga Waiora Implementation Framework to code the interventions from these studies. Findings included how culture centeredness and community engagement can make a differences in diabetes outcomes.

He Pikinga Waiora [Enhancing Wellbeing], is a traditional Māori proverb which refers to the relationship between positive feelings and a sense of self-worth, key aspects of well-being. This research project uses He Pikinga Waiora as a theoretical and ethical framework and foundation to reframe health interventions work for Māori communities.

Based on He Pikinga Waiora, the project conceives indigenous self-determination at its core and the four that define it: cultural-centeredness, community engagement, systems thinking, and integrated knowledge translation.

It relies on the three pillars of "Kaupapa Māori approach: a) addressing unequal power by transforming hegemonic structures and systems; b) reaffirming of the importance of tikanga and mātauranga in the development of relationships and program; and c) promoting greater community participation and control across the spectrum of program design, implementation, and evaluation" (Oetzel, J., Scott, N., Hudson, M., Masters-Awatere, B., Rarere, M., Foote, J., ... & Ehau, T., 2017, p. 3).

Reviews of 13 studies of diabetes prevention in indigenous communities in Australia, Canada, New Zealand, and the United. Cross-tabulations demonstrated that culture centeredness and community engagement explained differences in diabetes outcomes and community engagement explained difference in blood pressure outcomes.

Integrated knowledge translation Toi te kupu, toi te mana, toi te whenua (hold fast to the language, the culture and the land)

"Centering the discourse with those people most affected empowers them to exercise their own agency; community members can make sense of and create localized health solutions framed by their everyday experiences" (p. 3).

Heath
Science