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Global Health. 2017 Sep 5;13(1):69. doi: 10.1186/s12992-017-0295-8.

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

Author information

1
University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand. joetzel@waikato.ac.nz.
2
Waikato District Health Board, Pembroke Street, Private Bag 3200, Hamilton, 3240, New Zealand.
3
University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand.
4
The Institute of Environmental Science and Research, 34 Kenepuru Drive, PO Box 50348, Porirua, 5240, New Zealand.
5
Waikato Institute of Technology, Private Bag 3036, Waikato Mail Centre, Hamilton, 3240, New Zealand.

Abstract

BACKGROUND:

About 40% of all health burden in New Zealand is due to cancer, cardiovascular disease, and type 2 diabetes/obesity. Outcomes for Māori (indigenous people) are significantly worse than non-Maori; these inequities mirror those found in indigenous communities elsewhere. Evidence-based interventions with established efficacy may not be effective in indigenous communities without addressing specific implementation challenges. We present an implementation framework for interventions to prevent and treat chronic conditions for Māori and other indigenous communities.

THEORETICAL FRAMEWORK:

The He Pikinga Waiora Implementation Framework has indigenous self-determination at its core and consists of four elements: cultural-centeredness, community engagement, systems thinking, and integrated knowledge translation. All elements have conceptual fit with Kaupapa Māori aspirations (i.e., indigenous knowledge creation, theorizing, and methodology) and all have demonstrated evidence of positive implementation outcomes.

APPLYING THE FRAMEWORK:

A coding scheme derived from the Framework was applied to 13 studies of diabetes prevention in indigenous communities in Australia, Canada, New Zealand, and the United States from a systematic review. Cross-tabulations demonstrated that culture-centeredness (p = .008) and community engagement (p = .009) explained differences in diabetes outcomes and community engagement (p = .098) explained difference in blood pressure outcomes.

IMPLICATIONS AND CONCLUSIONS:

The He Pikinga Waiora Implementation Framework appears to be well suited to advance implementation science for indigenous communities in general and Māori in particular. The framework has promise as a policy and planning tool to evaluate and design effective interventions for chronic disease prevention in indigenous communities.

KEYWORDS:

Community-engaged research; Culture-centeredness; Implementation science; Integrated knowledge translation; Kaupapa Māori; Systems thinking

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