1. Taku kupu i whakaheia ki runga o Māramarama-te-rangi current research objectives
My word fulfilled in broad daylight – an opportunity to talk about my research and explain the background to a survey that I have asked MIT to participate in.
© Stephanie Palmer, 2004

2. Ko ngā mea i te kōrero
Pedagogy, epistemology, bodies of knowledge, theoretical frameworks, driving principles, he pūtake
Hei oranga mō ngā wāhine hapū (ki Hauraki) I roto I te whare ora
Hōmai te Waiora ki Ahau
Te Rangahautanga Tuatahi
underlying principles, theoretical frameworks and principles which drive my research – there are three of these
Māori health research goals and aspirations
psychosocial mediators of life events
psychometric theory
The whakapapa of Te Rangahautanga Tuatahi – the survey on the meaning of waiora among contemporary Māori

3. He Pūtake Tuatahi: Māori health research
He Korowai Oranga, released at the end of 2002
captures the key components of Māori health goals and objectives for everyone in the health arena
fair to say that Māori have been working towards most of these goals for many years, did not materialize with the release of this document
has drawn the various threads and strands of the Māori health vision together
raised the profile of some issues especially whānau ora and whānau, hapū, iwi and community development – effective service delivery, resource allocation
is part of the NZHS and PHS and comes with $480m package – what proportion Māori will get remains to be seen, currently MPOs get 2% of the total health spend

4. Ka whawhai tonu mātou: Māori health research goals pre- He Korowai Oranga
Rangatiratanga
Treaty principles – partnership, participation and protection
disparities, inequities
consultation, representation
capacity and capability
infra-structure (governance, processes, access and networks)
skills and expertise (workforce development)
tools (measures, outcomes, performance)
Two inter-related objectives
Rangatiratanga
mana whenua, mana tangata, autonomy, control,
the right to shape our own future, the right to participate in te Ao Māori
the tools, skills and resources needed for Māori to do that
2. huge effort around Te Tiriti o Waitangi
consciousness raising, education, decolonisation, recreation, reclamation and restoration, establishment of procedures/strategies for acknowledgement/giving effect to te Tiriti
reduced to principles of partnership, participation and protection, a focus on, mostly
identification of disparities, inequities in health status and access
procedures around consultation, representation eg the Māori perspective – a whole set of pitfalls around eg mandating/decision-making structures, tokenism and integrity, how to effect real change
movement around Māori capacity and capability, eg
progress in infra-structure – Māori are stronger, smarter, more accessible and talking to each other – eg Te Matarau, Te Matawhānui, Te Wheke Alliance
workforce development – MPOs, health professionals, health researchers = HRC have 46 PhD scholars and 10 post-doc fellows, four research centres
still a lot of work to do but some progress towards the identification of Māori health outcomes and the development of tools for service evaluation and measuring performance

5. A paradigm for locating Māori health research
one of the products of the last decade has been the kōrero around kaupapa Māori research and practice paradigms
emerged simultaneously in education/psychology around the late 80’s
credit given to the Graham and Linda Smith from the University of Auckland – who have invested considerable energy in clarifying the issues
Linda’s book Decolonizing Methodologies (1999)
within the Māori health arena and among Māori health researchers, this topic has had a particularly painful history.
at one time or another, we all have to take an honest look at the objectives and methodologies of our work and decide what it is that we are truly hoping to achieve
in 1998, Cunningham produced this paradigm for locating Māori health research – a continuum in terms of participants, research team, methods, data analysis and contribution to Māori knowledge
the concept of kaupapa Māori health research has become a benchmark for the ideal methodology and, in its purest form, it is associated with te reo Māori,tikanga Māori and mātauranga Māori

6. Some Māori models of health
Mahuika, A (1973) Ngā Wāhine Kaihautu o Ngāti Porou
Pere, R (1982) Te Wheke
Durie, M (1982) Te Whare Tapa Whā
Te Rōpū Tautoko o Tokānui (1986) Galleries of Life
Royal Commission on Social Policy (1988) Ngā Pou Mana
Ministry of Education (1996) Te Whariki
Davies et al (1994) Pūtangitangi
Keenan, D. (1994). Haere Whakamua, Hoki Whakamuri
Bishop, R (1995) Whakawhānaungatanga, Tino Rangatiratanga
Durie et al (1995) Te Hoe Nuku Roa
Jahnke, R. (1996) Whaia te Iti Kahurangi
Ratima et al (1996) Whakaoranga Whānau
Ratima et al (1996) Whakapiripiri Whānau
Cleave, P. (1997) Rangahau Pae Iti Kahurangi
Kingi, TK & Durie, M (2000) Hua Oranga
among Māori there is no shortage of ideas about the determinants of health and the factors which Māori need for wellbeing
at the hui, Te Oru Rangahau in 1998, Arohia Durie identified 27 Māori models of health – the actual number is much greater than this, probably closer to 50 or even 100
each one of these has the potential to be a Māori health research paradigm

7. Te Pae Mahutonga
developed in the late 90’s for the MoH and released as part of the Māori Public Health Action Plan for
a framework based on the Southern Cross star constellation
the six stars symbolise the six key tasks of health promotion
mauriora (cultural identity)
waiora (physical environment)
toiora (healthy lifestyles)
te Oranga (participation in society)
nga manukura (community leadership), and
te mana whakahaere (autonomy)
each key task is associated with a number of indicators or promotional activities, eg
mauriora = Crowns obligations to ToW, all groups participate in society + cultural diversity is valued
as a health research paradigm, this model is saying that these promotional activities will lead to the experience of Mauriora
similarly, the model is suggesting that Te oranga (participation in society) is associated with affordable housing, favourable work conditions and quality education

8. Te Ngāhuru is a Māori outcomes schema, developed for TPK in 2002
it contains five central principles, two outcome domains and four outcome classes and ten outcome goals – each of which is linked to specific targets and indicators
for example, two of the targets associated with the outcome class Te Manawa = “secure cultural identity” are that 75% employers recognise Māori culture in employment contracts and 90% Māori are involved in iwi business
similarly, some of the outcome goals are
positive participation in society as Māori
vibrant Māori communities
enhanced whānau capacities
use of te reo Māori
as a Māori health research paradigm, Te Ngāhuru has identified specific, measurable activities and indicators which can be used to collect data and monitor performance and measure change in Māori communities

9. Te Hoe Nuku Roa
Te Hoe Nuku Roa is another example of Māori health research paradigm
it is a multi-dimensional Māori identity measure and a longitudinal household survey
involves more than 6,000 families
has been collecting data about Māori identity since the mid 90s
contains 4 axes, 15 subsets and 27 units of inquiry

10. Te Wheke Te Wheke is an earlier model of Māori health
put forward by Rose Pere in the mid-80s
8 tentacles of te Wheke as a symbol of Māori wellbeing, waiora
a river of life-giving forces which ebb and flow with the passage of time
each tentacle has a number of sub-dimensions (suckers) which feed the tentacles and contibute to the experience of good health

11. Te Whare Tapa Whā Te Whare Tapa Wha also emerged in the mid-80s
from discussions with the MWWL
likened good health for Māori to the four walls of a house and the need for structural integrity between
taha wairua
taha hinengaro
taha tinana
taha whānau
this image of Te Whare Tapa Wha was release by the MoH last year, and it seems to have undergone a bit of renovation

12. Hua Oranga
Te Whare Tapa Whā has formed the framework for development of Hua Oranga: a Māori measure of mental health outcomes
aims to measure the cornerstones of Te Whare Tapa Whā at a number of clinical endpoints
combines the views of three stakeholders: tangata whaiora, clinician, whānau member
aims to detect change over time

13. He Pūtake Tuarua: psycho-social resources and mediators of life events
coping strategies
cognitive
behavioural
social support
cognitive appraisal
culture and ethnicity
direct
indirect
inherent
life events can be mediated by a number of psycho-social processes
life-events is a term used to describe the significant experiences in life, used to be called stress - like a new job, moving house, getting sick, having an operation, the loss of a loved one, death and dying, experience of pain, pregnancy and childbirth –
physiologists have shown that stress and/or life events is associated with an increase in stress hormones, catecholamines, which can predispose us to sickness, mental illness, loss of quality of life
psycho-social refers to an experience or process which happens within ourselves, state-of-mind or within our social realm
“mediated” means made better, improved, the experience is less traumatic, less stressful, less likely to result in long-term problems, complications, people are more resilient
concepts of coping and social support have proven most robust as mediators of life events, for example, the concept of social support
is said to be complex and multi-dimensional, and
is known to involve the exchange of resources (tangible, emotional and informational)
and has been linked to characteristics of the recipient, context, amount, timing and source
processes of cognitive appraisal are also known to mediate life-events eg attitude, personal values, perceptions about trust, confidence, self-esteem and control
culture and ethnicity is also said to be a direct and indirect mediator of life events
direct because of the direct influence on the development of cognitive processes eg attitude, behavioural style, perceptions of stress and pain
indirect because of the way in which socialisation, peer/group dynamics etc determine the way in which we utilise psycho-social mediators like social support, coping strategies and cognitive appraisal
evidence of genetic memory, cultural memory

14. He Pūtake Tuatoru: Psychometric Theory
measurement of psychological qualities
advantages for Māori
classical vs modern psychometric theory
the gradual accumulation of knowledge about construct validity from a range of sources
content domain
nomological networks
Psychometric theory = mid 19thC, the science of measuring psychological qualities and attributes , how we develop psychological measurement tools, psychological = of the mind, psychic, non-physical, eg
attitudes, beliefs, values, feelings, perceptions and thoughts
components of te whare tapa whā, te wheke, waiora
advantages for Māori
demonstrate the advantages of participation in te ao Māori
explore, define and identify culturally relevant constructs integral in kaupapa Māori and Māori centred research designs
assist the development of theory and critical analysis of psychological measurement tools for Māori
the discipline is undergoing radical change and faces numerous challenges
criticism of overwhelming historical emphasis on classical techniques – the distribution of scores will always fit the normal curve, underpins use of large sample sizes, RCTs, standard error, confidence intervals, valid and reliable, basis for decisions around their every-day use eg mental health services, DSM diagnoses
modern psychometric theory challenges this assumption – the curve will fit the data, measures individual response to each item
emphasis on construct validity = the gradual accumulation of knowledge from a range of sources, two main steps
content domain = defining the concept, is the content of a test accurate, the need to define hinengaro before we can measure it
developing nomological networks which tell you whether responses to a test are causally related to any other factor – eg age, gender, place of residence, education, or do our feelings and experiences of Māori identity influence our perceptions about te whare tapa whā

15. Te Whare Tapa Whā – can we measure it?

16. Phase 1 questions – are they valid?

17. Is the assumption of triangulation valid?

18. What happens in the triangulation by endpoints?

19. Is the assumption of 4 dimensions valid?

20. What are implications of Phase 2 triangulation?

21. Are the Phase 2 questions valid?

22. This is what happens when the four dimensions of Hua Oranga are administered at every endpoint

23. And there are more questions if we want to understand the validity of Hua Oranga in an AOD context!!

24. Hei oranga mo ngā wāhine hapū I roto I te whare ora
Main research hypothesis:
Waiora is a psycho-social resource and mediator of Māori birth outcomes

25. Psycho-social mediators of birth outcome

26. Research design

27. Hōmai te Waiora ki Ahau

29. The scale Te Kore-Uenuku continuum self-rated
12 items plus overall waiora
aggregate score
presented as a series of pictures
“is this a source of waiora for you?”

31. Indicators of construct validity
able to be administered
sensitive to individual difference
between group differences on items
operates as predicted
acceptable internal consistency
respondents willing and able to complete the measure
response patterns were different for both individuals and groups, not guessing, have been chance
tikanga Pākehā and te ao hou more favourable among people who are employed
no difference between aggregated and self-rated waiora scores
none of the items were redundant, made their own contribution to the overall score

32. As a mediator of Māori birth outcomes
waiora predicted
prenatal social support, perceptions of control, maternal expectations, length of stage 1 labour, use of pethidine and CTG
some components of waiora also predicted birth outcome
hinengaro / whenua and social support / confidence / trust / use of coping strategies including obstetric care
te ao tawhito and use of epidural / obstetric techology score / postpartum quality
whatumanawa and use of syntocinon / pethidine / CTG
whanaungatanga and length of labour / quality perceptions
mauri predicted breastfeeding
te ao hou inversely related to infant gestation

33. PhD Outcomes empirical evidence and development of theory
waiora as a psycho-social resource and mediator of Māori birth outcomes
waiora is good for Māori birth

34. Implications for maternity service delivery

35. Limitations of the research
small sample size
borderline reliability
irregular distribution on some items
classical psychometric theory
little known about construct validity
is the content domain accurate
nomological networks
generalisability

36. Current research objectives
to gather information about the construct validity of Hōmai te Waiora ki Ahau
to prepare for the implementation of a collaborative research project which further explores the role of waiora as a psycho-social resource and mediator of Māori birth outcomes
develop the evidence-base around waiora as a mediator of Māori health outcomes

37. Research objectives

38. Te Rangahautanga Tuatahi
monthly online surveys (x 12)
aiming to describe the meaning of concepts in the waiora tool
self-rated agreement with statements
te reo Māori and English versions
unidentifiable, anonymity
timeframe for responding

39. Stephanie Palmer HRC Erihapeti Murchie Research Fellow Te Pūmanawa Hauora Te Pūtahi a Toi Massey University Wellington Campus ph (04) extn 6028,