Persistent inequities in health experiences and outcomes are observed for Māori compared to non-Māori in Aotearoa New Zealand. We conceptualised factors associated with Māori consumer experiences of health programs and services and characterise how the recommendations arising from qualitative research inform strategies to address inequities. In this systematic review, electronic literature searching was conducted in February 2018. Qualitative studies reporting Māori consumer experiences of health services and programs in Aotearoa New Zealand were eligible. Māori consumer experiences of health services were mapped to the WHO Commission of Social Determinants of Health (CSDH) conceptual framework on health inequities as related to: (i) the socioeconomic and political context; (ii) socioeconomic positioning; or (iii) intermediary factors that increase exposure to health-compromising conditions. Recommendations to improve consumer experiences were mapped to the CSDH framework for tackling social determinants of health inequities as policy directions on: (i) unequal consequences of illness (individual interaction); (ii) risks of exposure to health-damaging factors (community); (iii) exposures to health-damaging factors (public policies); and (iv) mitigating effects of socioeconomic and political stratification (environment). Fifty-four studies were included. Māori consumer experiences mapped to social determinants of health inequities were most frequently related to direct interactions with health services and programs, particularly patient-clinician interactions (communication, relationships) and cultural competencies of clinicians and the system. Key recommendations by researchers mapped to potential strategies to address inequity were identified at all levels of the political, social and health system from individual interactions, community change, and broader public and system-level strategies. Recommendations were predominantly focused on actions to reduce risks of exposure to health-damaging factors including health literacy interventions, increased resources in cultural competencies and Māori capacity in health service development and workforce. Māori consumer experiences of health services and programs are an important informer of variables that impact health inequity. Strategies to tackle health inequities informed by Māori consumer experiences can be drawn from existing empirical research. Future qualitative exploration of how socioeconomic, political and public policies influence Māori consumer experiences of health services and programs could inform a broader range of structural policies to address health inequities.

/pdf/reported-maori-consumer-experiences-of-health-systems-and-19t0mbgx5e.pdf

Reported Māori consumer experiences of health systems and programs in qualitative research: a systematic review with meta-synthesis

Death is a universal event. It will happen to all of us, yet how we respond to death is particular and influenced by our cultural worlds. This study offers an investigation of the idiographic, of how one woman responded to, and made arrangements to, mourn and bury her mother. Specifically, we explore how she and her whanau (family) under pressure of time and grief and in the absence of clear final wishes met to consider issues and make decisions about the situation they were confronted with. This case forms part of a much larger programme of research into Maori death rituals, change and adaption. Informing a scholarly audience unfamiliar with the Maori world requires a significant amount of contextual information. The case study is a powerful strategy to achieve this and one that draws readers into deep understanding (Willig, 2008). This case provides insight into the struggles of an indigenous fourth-world people living within the heterogeneity of Aotearoa/New Zealand society; it demonstrates how values change across generations as people live their lives increasingly away from their ancestral homelands and how traditionally defined roles and responsibilities within the whanau (family) are challenged by members living away from each other. Copyright © 2012 John Wiley & Sons, Ltd.

/pdf/final-arrangements-following-death-maori-indigenous-decision-4np61b8dpk.pdf

Final Arrangements Following Death: Maori Indigenous Decision Making and Tangi

Background
Māori (indigenous peoples of New Zealand) men have a disproportionate prevalence of lifestyle-related illnesses and are targeted for national physical activity initiatives. While physical activity impacts on physical and mental health and overall wellbeing, current approaches to health promotion often lack cultural relevance. Having better understanding and incorporating relevant cultural values and motivators into program designs could improve the success of health initiatives for indigenous and minority men. Nevertheless, little is known about Māori men’s preferences, attitudes, or perspectives about physical activity, which are often interpreted through a colonized or dominant Western lens. Understanding perspectives of those groups whose values do not align with dominant cultural approaches will better equip health promoters and trainers to develop relevant community initiatives and private programs for indigenous and minority men.

/pdf/provider-father-and-bro-sedentary-maori-men-and-their-40wkk2ipc6.pdf

Provider, father, and bro - Sedentary Māori men and their thoughts on physical activity

CONTEXT: The death of a child is devastating, and complicated grief adversely impacts parental physical and psychosocial well-being. Most research currently is centered on bereaved mothers, and the experiences of fathers remains underexplored. OBJECTIVE: We systematically reviewed the literature to characterize the grief and bereavement experiences of fathers after the death of a child. DATA SOURCES: We searched Medline, PsycInfo, Embase, and Cumulative Index to Nursing and Allied Health Literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. STUDY SELECTION: Inclusion criteria encompassed English language articles published between 2007 and 2019 that evaluated the grief and bereavement experiences of fathers after the death of their child. We excluded studies describing paternal bereavement after the death of a child aged older than 21 years, stillbirth, miscarriage, or studies that did not specify age of death. DATA EXTRACTION: Extracted domains included study design, demographics, findings, and quality assessment. RESULTS: We screened 1848 deduplicated titles and abstracts and 139 full articles, yielding 21 articles for inclusion in this analysis. Fathers often avoided discussing their grief with others, returned to work earlier, and used goal-oriented tasks as coping strategies. Intense grief reactions and posttraumatic psychological sequelae diminished over time in mothers yet persisted in fathers. LIMITATIONS: Included studies were primarily descriptive in nature, without ability to ascertain causality. Limited paternal data exists in the literature compared with maternal data. CONCLUSIONS: Despite evolving gender roles, many fathers navigate loss through stoicism, self-isolation, and hard work. For some fathers, these coping mechanisms may be inadequate for navigating grief.

https://pediatrics.aappublications.org/content/pediatrics/early/2021/02/25/peds.2020-040386.full.pdf

Grief and Bereavement in Fathers After the Death of a Child: A Systematic Review

Loss During Pregnancy or in the Newborn Period: Principles of Care With Clinical Cases and Analysis

The loss of a baby is always hard to cope with and the grieving process is likely to be difficult. Interventions to work with Sudden Infant Death Syndrome (SIDS) families have improved grieving outcomes for many but the needs of Maori fathers are not well understood or catered to by existing services. This article presents narrative data from Maori fathers who have lost a baby to SIDS and analyzes these narratives in the context of the literature and of traditional Maori constructs about grief. The authors document a rarely discussed Maori concept, "the attainment of mauri tau," as the desired outcome of the grieving process; and begin a discussion around the changing face of the Maori grieving process and its implications for the grieving practices of Maori men.

Maori men and the grief of SIDS.

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Maori men and the grief of SIDS.