Struggling to Be Involved: a Grounded Theory of Māori Whānau Engagement with Healthcare
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Struggling to be Involved: A grounded theory of Māori whānau engagement with healthcare Dianne Wepa A thesis submitted to Auckland University of Technology in fulfilment of the requirements for the degree of Doctor of Philosophy (PhD) 2016 Faculty of Health and Environmental Sciences AUT University ATTESTATION OF AUTHORSHIP 2 ATTESTATION OF AUTHORSHIP I herby declare that this submission is my own work and that, to the best of my knowledge, it contains no material previously published or written by any other person (except where explicitly defined), nor material which to a substantial extent has been submitted for the award of any other degree or diploma of a university or other institution of higher learning. Signed: Dianne Wepa Dated: 1st August 2016 ABSTRACT / PITOPITO KŌRERO 3 ABSTRACT / PITOPITO KŌRERO Aspirational whānau enable future generations to succeed in an Indigenous world and a Western world. Relationships that are positive within the whānau become mutually beneficial when access is being sought for a range of services. The world that Māori whānau exist in today is vastly different from that of past generations. What has endured over this time is the whānau unit and the processes that contribute to its longevity. The aims of this study were to explain the processes that Māori and their whānau used to have their spiritual and cultural needs met when engaging with health care services, and generate a substantive theory of what happens for Māori and their whānau when they engage with health care services. The research question was, “What is happening with Māori and their whānau when they engage with health care services?” Twenty Māori whānau were interviewed about their engagement with healthcare services in Hawke’s Bay. Constructivist grounded theory developed by Kathy Charmaz (2006, 2014a), was utilised as the methodology for this study and Kaupapa Māori processes ensured that both whānau and the researcher were kept culturally safe. Struggling to be Involved emerged as a core process and substantive theory that explained how Māori whānau experienced healthcare services. Being Māori and surviving the experience provided positive mediating factors as whānau management strategies and a natural resource to assist with obtaining a healthcare service. The discrimination faced by Māori whānau while they were seeking to improve their health was a constant struggle. Despite the many negative experiences, collective ownership or we-dentity contributed to their resolution to receive the best healthcare, as they deserved no less. Current healthcare interventions in New Zealand are not working for Māori whānau. Struggling to be Involved contributes new knowledge about Māori whānau engagement with healthcare services by providing an original contribution to reduce continuing inequities between Māori and other New Zealanders. 3 ACKNOWLEDGEMENTS / MIHI 4 ACKNOWLEDGEMENTS / MIHI Tenei te karanga o te kawa whakaruruhau Nau mai, haere mai Mauriora mai ra te aroha e This mihi is a tribute to those that have contributed to the development of cultural safety before me and to those that will follow. I invite the reader to join me in this journey and to imagine a world where Māori whānau are flourishing, living healthy, vibrant lives now and into the future. This thesis was made possible because of a Māori doctoral scholarship from the Health Research Council of New Zealand and AUT University’s travel assistance funding. I am also grateful to Hawke’s Bay District Health Board’s Te Wahanga Hauora Māori Whānau and Tūmuaki, Tracee Te Huia for kindly allowing me time to undertake this research. To my kaumātua Turoa Haronga, ka nui te mihi mo to awhi me to tautoko. Your wise guidance ensured a culturally safe process for myself and the whānau in this study. To my primary supervisor Dr Denise Wilson, thank you for taking me with you to AUT. With your patience, guidance and exacting standards, I have developed academically and personally to a level that truly reflects the depth required to complete this thesis. To my second supervisor Dr Jane Koziol- McLain, thank you for your feedback, particularly during the early stages of writing. To the grounded theory group at AUT, thank you so much for your support especially during the beginning of the study. My whānau have endured this journey with me. In particular, to my husband Maurice, thank you for keeping things together on the home front, smoothing out the ups and downs at home and providing a sounding board. To the whānau, you gave generously of your time and trusted me with your stories. I hope this thesis honours you and your whānau by capturing moments in your healthcare journey that can be shared for the betterment of future whānau. TABLE OF CONTENTS 5 TABLE OF CONTENTS ATTESTATION OF AUTHORSHIP .............................................................................................................. 2 ABSTRACT / PITOPITO KŌRERO............................................................................................................... 3 ACKNOWLEDGEMENTS / MIHI ................................................................................................................ 4 TABLE OF CONTENTS ............................................................................................................................... 5 LIST OF TABLES ........................................................................................................................................ 8 LIST OF FIGURES ...................................................................................................................................... 9 CHAPTER ONE: INTRODUCTION / KO TE PŪ ......................................................................................... 10 Background ....................................................................................................................................... 11 Historical influences on Māori whānau ............................................................................................ 12 Historical trauma – enduring effects on health and wellbeing ........................................................ 15 Evolving nature of Māori whānau ..................................................................................................... 19 Contemporary health status ............................................................................................................. 19 Te Tiriti o Waitangi/Treaty of Waitangi ............................................................................................ 23 Research question and aim ............................................................................................................... 25 Definitions of key concepts ............................................................................................................... 25 Thesis outline .................................................................................................................................... 29 Conclusion ......................................................................................................................................... 30 CHAPTER TWO: LITERATURE REVIEW / KO TE WEU ............................................................................. 32 Introduction ...................................................................................................................................... 32 Locating the literature ...................................................................................................................... 32 What the literature revealed ............................................................................................................ 33 Conclusion ......................................................................................................................................... 48 CHAPTER THREE: METHODOLOGY / TE KUPENGA MATAURANGA ...................................................... 50 Introduction ...................................................................................................................................... 50 Research at the interface .................................................................................................................. 50 Kaupapa Māori research ................................................................................................................... 52 TABLE OF CONTENTS 6 Grounded theory .............................................................................................................................. 53 Grounded theory’s suitability to this study ...................................................................................... 59 Constructivist grounded theory ........................................................................................................ 60 Constructivism .................................................................................................................................. 61 Intrepretivism ................................................................................................................................... 61 Conclusion ......................................................................................................................................... 62 CHAPTER FOUR: METHODS / TE AKA .................................................................................................... 63 Introduction .....................................................................................................................................