Abstract
BackgroundAbout 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 frameworkThe 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 frameworkA 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 conclusionsThe 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.
Highlights
About 40% of all health burden in New Zealand is due to cancer, cardiovascular disease, and type 2 diabetes/obesity
We identified the culture-centered approach (CCA), community engagement/community-engaged research (CE/CEnR), systems thinking, and integrated knowledge translation (IKT) as areas that provide theoretical relevance to the context of implementation science in indigenous communities and conceptual fit with Kaupapa Māori
The four elements are wrapped around a center grounded in indigenous critical theory (i.e., Kaupapa Māori) and each element is consistent with, and supportive of, indigenous knowledge creation and use
Summary
New Zealand faces significant challenges relating to chronic, non-communicable diseases such as diabetes and obesity. Theoretical foundation The implementation framework supports researchers, practitioners and public policy makers to create sustainable and effective intervention pathways to improve health for Māori communities. We identified the culture-centered approach (CCA), community engagement/community-engaged research (CE/CEnR), systems thinking, and integrated knowledge translation (IKT) as areas that provide theoretical relevance to the context of implementation science in indigenous communities and conceptual fit with Kaupapa Māori (see Fig. 1). It is similar to recognition of voice in culture-centeredness and yet distinct because it recognizes different levels in how knowledge is shared with others These four elements have an evidence-base demonstrating improved implementation effectiveness for indigenous and other communities experiencing health inequities. Our work suggests that centering indigenous perspectives through ensuring community voice, collaborative partnership, systems thinking, and the collaborative creation of knowledge represents a promising approach for improving health and achieving health equity. The Healthier Lives Challenge NSC is implementing the Framework in part, and over the decade we will have further evidence of the impact of such a framework on health and equity
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