Te Whare Tapa Research Articles

Agency support for at-risk families: service provision, challenges and effective elements for intervention

ABSTRACT There is an urgent need to locate effective interventions for parents involved with child protection services (CPS), Oranga Tamariki in Aotearoa New Zealand. This article describes a qualitative research study that sought to understand: (1) the nature of service provision to families; (2) workers’ perceptions of challenges and effective treatment components in delivering intervention; and (3) effective practices for working with Māori. Participants were staff members working within NGOs, providing interventions to families with ongoing Oranga Tamariki involvement. Data comprised responses to semi-structured interviews (n = 9), interpreted using thematic analysis. Findings highlighted that all participants worked within family homes to deliver intervention, and drew on Te Whare Tapa Whā. Challenges included ongoing child maltreatment concerns and participants’ sense of responsibility for keeping children safe whilst being unable to do so adequately within their non-mandated roles. Perceived effective elements were: strong relationships, transparency, and having courageous conversations when needed. For indigenous clients, self-determination and the effects of colonisation were of prime importance. Themes highlighted responsive practice, with a pragmatic understanding that family priorities may not always align with professional views. This is consistent with international findings regarding challenges in delivering parenting interventions and identifies potential essential components for effective practice. HIGHLIGHTS Practitioners’ perceptions of essential elements to effective practice included: strong relationships, honesty, reciprocity, and directness regarding child protection concerns. Effective practices seen to be particular to working with Māori families were trusting, reciprocal relationships and ensuring self-determination and autonomy. Ethical tensions and a sense of complicity and helplessness at times were described, with ongoing child protection concerns evident during intervention for some families. Practitioners took a holistic approach to their work, expressing non-judgment, sympathy for, and understanding of the complex circumstantial and personal challenges faced by Oranga Tamariki-involved parents. Glossary of Māori terms: awhi: embrace, cherish; kaimahi: staff members; kanohi ki te kanohi: face to face; karakia: blessing; kaupapa Māori: Māori approach; kete: basket; kōrero: to speak; mana: prestige; manaakitanga: hospitality; mana whenua: people with rights over the land; marae: meeting house; Pākehā: New Zealander of European descent; pepeha: introduction; pēpi: baby; pono: true; pōwhiri: welcome ceremony; tamariki: children; tangata: people; tika: correct; tikanga: custom; tutū: mischevious; waiata: song; whakapapa: genealogy; whānau: family; whanaungatanga: relationship; whare: house.

Development of a culturally informed tool to assess chronic pain for Māori: the Pictorial Representation of Illness and Self Measure-Aotearoa (PRISM-A)

Chronic pain is one of the most common long-term conditions in Aotearoa (New Zealand), and there is a higher prevalence and greater impact of pain for Māori (Indigenous People of New Zealand). Māori tend to have a more holistic interpretation of pain compared with western views; therefore, current assessments may not capture the full meaning and impact of pain for Māori. This study developed a holistic assessment tool for chronic pain in collaboration with Māori clinicians and Māori with chronic pain. The Pictorial Representation of Illness and Self Measure–Aotearoa (PRISM-A) is a verbal and visual assessment tool that is based on Te Ao Māori (Māori world), imbeds whakawhanaungatanga (relationship formation) between the patient and clinician, and incorporates Te Whare Tapa Whā, a Māori model of health. The tool is likely to provide a more meaningful assessment of pain and facilitate better outcomes for Māori with chronic pain.

Exploring the relationship between trout fishing and wellbeing: insights from Aotearoa New Zealand trout anglers

ABSTRACT Internationally, there is growing interest in understanding the potential for recreational fishing to enhance the wellbeing of participants. To date, no studies have investigated the potential for recreational trout fishing to influence wellbeing in the Aotearoa New Zealand context. To address this gap, nine semi-structured interviews were conducted with anglers in the local community and explored their understanding of wellbeing and how they percieve trout fishing contributes to their wellbeing. The interviews were audio-recorded, transcribed, analysed thematically, and examined using the Te Whare Tapa Whā model of holistic wellbeing. For trout anglers, wellbeing incorporated mental, physical, spiritual, and relational health. Trout fishing was perceived as enhancing these elements of wellbeing by fostering positive states of being; cultivating connection with self, others, place and nature; allowing for disconnection from stressors; and providing physical exercise. These exploratory findings highlight the potential for trout fishing to enhance all dimensions of holistic wellbeing within the Te Whare Tapa Whā model and a need for further research in this area.

Navigating Pacific nutrition and health at Brown Buttabean Motivation (BBM): Process evaluation and systems dynamics research at a flax-roots organization

Brown Buttabean Motivation (BBM) is a Māori and Pacific-driven community-based organisation operating in Tāmaki Makaurau (Auckland) and Tokoroa. It provides free community exercise bootcamps and other social and health support programs. BBM’s foundational mission was to reduce, among Māori and Pacific people, the prevalence of obesity in Auckland through exercise and nutrition programs.1 This study aimed to understand participants’ engagement with BBM, and the meaning it has had in their lives, with a focus on nutrition. Combining Pacific Fonofale and Te Whare Tapa Wha frameworks, this was a process evaluation to understand the impact of BBM’s services on the community using qualitative methods and a systems analysis to identify program sustainability and improvement. Semi-structured interviews explored the benefits and values of engagement with BBM. Followed by cognitive mapping interviews (CMI) and group model building (GMB) to identify the motivations and challenges of sustained engagement. Participants described holistic health benefits and impacts on community wellbeing. BBM responds to inequitable nutrition contexts, through its FoodShare (food bank), community kitchen, and BBM Kai (nutrition literacy). Engagement changed family nutrition patterns, and benefits included healthier spending habits, and addressing food insecurity. Social inclusiveness represented the Fonofale foundation (family) and the roof (culture) was described as ethnic cultural practices and BBM culture. Nutrition was not highlighted by BBM participants in CMI or GMB activities. However, participants suggested BBM increase nutrition initiatives to enable all members to improve their health journeys. BBM was seen as not just an exercise program but their own and their family’s new way of life, that health was a journey, not a destination. Moreover, although participants mentioned nutrition and health benefits, there was an overwhelming understanding that the values of BBM, Pacific culture, and social collectivism were the drivers of engagement, motivating healthier practices. BBM could leverage existing strengths by incorporating nutrition-enabling initiatives that are achieved collectively. Opportunities for systematic intervention will be presented.

Patient perceptions of barriers to attending annual diabetes review and foot assessment in general practice: a qualitative study.

Introduction Regular diabetic foot checks, at least annually, are important for early identification of risk factors and prevention of ulceration and amputation. To ensure this, most general practices in Aotearoa New Zealand (NZ) offer free annual diabetes reviews (ADRs) which include a comprehensive foot evaluation. However, attendance rates at these ADRs are low. Aim To explore patients' perspectives on the barriers to attending ADRs and foot checks. Methods Semi-structured interviews with people with type 2 diabetes who were overdue their ADR (n = 13; 7 women, 6 Māori) from two urban practices were conducted. Interviews were audio recorded and transcribed verbatim and then analysed using an inductive thematic analysis approach. Results We identified three key themes demonstrating barriers to attendance: healthcare-associated factors (suboptimal clinician-patient relationship, not having a consistent general practitioner (GP)); patient-related factors (co-morbid health conditions, issues surrounding identity, and logistical issues); and systemic factors (COVID-19 pandemic, travel distance to the practice, unawareness of available foot care services). Participants' feedback focused on patient-centred approaches for improvements to service delivery, for example using online educational materials, and utilising culturally appropriate models of health including Te Whare Tapa Whā and Whānau Ora approach. Discussion We identified several barriers to attendance, some of which are potentially modifiable. Addressing modifiable barriers and incorporating suggestions made by participants may improve access to the ADR and reduce non-attendance. Further participatory action research could explore these insights in ways that facilitate tino rangatiratanga (self-determination) and palpable action.

A living curriculum: Interweaving Te Whare Tapa Whā, model of Māori holistic health and wairua, into postgraduate mental health and addictions nursing

A living curriculum: Interweaving Te Whare Tapa Whā, model of Māori holistic health and wairua, into postgraduate mental health and addictions nursing

Te Whare Tapa Whā and Facebook

In 2020, New Zealand Māori made up 6.8% of postgraduate students at the University of Otago (Sizemore, 2020). These students are supported by the author in her role as Māori Postgraduate Support Adviser (hereafter “the Adviser”). During the country’s first COVID-19 lockdown in 2020, the Adviser used Facebook—specifically the University of Otago’s page for Māori postgraduate students—to communicate with this cohort.

Companion Animal Fostering as Health Promotion: A Literature Review.

There is growing interest in the health-promoting potential of human-companion animal relationships from a broad public health perspective while acknowledging barriers to ownership, particularly for older adults. Companion animal fostering is an alternative to pet ownership that aligns with the Ottawa Charter health promotion principle that caring for others in everyday settings promotes health. This narrative review of the literature on companion animal fostering draws on Te Whare Tapa Whā (the four-sided house), an indigenous model of health that is influential in Aotearoa/New Zealand, and the Ottawa Charter. We found that companion animal fostering can be considered health-promoting for human and non-human animals, using a broad and multidimensional understanding of health. As well as improving the long-term outcomes for homeless animals, companion animal fostering has the potential to promote the health of the individuals, families, and communities who provide foster homes. Our review highlights the importance of health promoters considering the reciprocal relationship between human and animal health. Future research should explore different aspects of human and non-human health, perspectives of different types of fosterers in different settings and communities, barriers to fostering, and methods that explore the role of caring for a wider range of companion animals in creating and sustaining wellbeing.

Building Culturally Centered System Dynamics Logic Models for the Brown Buttabean Motivation Organization: Protocol for a Systems Science Approach.

Brown Buttabean Motivation (BBM) is an organization providing support for Pacific people and Indigenous Māori to manage their weight, mainly through community-based exercise sessions and social support. It was started by DL, a man of Samoan and Māori descent, following his personal weight loss journey from a peak weight of 210 kg to less than half that amount. DL is a charismatic leader with a high media profile who is successful in soliciting donations from corporations in money and kindness. Over time, BBM's activities have evolved to include healthy eating, food parcel provision, and other components of healthy living. A co-design team of university researchers and BBM staff are evaluating various components of the program and organization. The purpose of this study is to build culturally centered system dynamics logic models to serve as the agreed theories of change for BBM and provide a basis for its ongoing effectiveness, sustainability, and continuous quality improvements. A systems science approach will clarify the purpose of BBM and identify the systemic processes needed to effectively and sustainably achieve the study's purpose. Cognitive mapping interviews with key stakeholders will produce maps of their conceptions of BBM's goals and related cause-and-effect processes. The themes arising from the analysis of these maps will provide the initial indicators of change to inform the questions for 2 series of group model building workshops. In these workshops, 2 groups (BBM staff and BBM members) will build qualitative systems models (casual loop diagrams), identifying feedback loops in the structures and processes of the BBM system that will enhance the program's effectiveness, sustainability, and quality improvement. The Pacific and Māori team members will ensure that workshop content, processes, and outputs are grounded in cultural approaches appropriate for the BBM community, with several Pacific and Māori frameworks informing the methods. These include the Samoan fa'afaletui research framework, which requires different perspectives to be woven together to create new knowledge, and kaupapa Māori-aligned research approaches, which create a culturally safe space to conduct research by, with, and for Māori. The Pacific fonofale and Māori te whare tapa whā holistic frameworks for interpreting people's dimensions of health and well-being will also inform this study. Systems logic models will inform BBM's future developments as a sustainable organization and support its growth and development beyond its high dependence on DL's charismatic leadership. This study will adopt a novel and innovative approach to co-designing culturally centered system dynamics logic models for BBM by using systems science methods embedded within Pacific and Māori worldviews and weaving together a number of frameworks and methodologies. These will form the theories of change to enhance BBM's effectiveness, sustainability, and continuous improvement. Australian New Zealand Clinical Trial Registry ACTRN 12621-00093-1875; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382320. PRR1-10.2196/44229.

Engaging with Brown Buttabean Motivation for Sustained Weight Loss.

Context Brown Buttabean Motivation (BBM) is a grassroot Pacific-led organisation aiming to reduce obesity amongst Pasifika (Pacific people in Aotearoa New Zealand) and Indigenous Maori, helping them choose a healthy and active life-style for themselves, their children and their wider family. BBM offers a holistic approach to weight loss, recognising that mental health, family and cultural factors all play essential and critical roles in nutrition and physical activity patterns. Objective To understand how participants experience and engage with BBM. Study Design &; Analysis Qualitative study conducted by our co-design research team within a broader BBM research project. Initial inductive thematic approach followed by theoretical deductive analysis of coded data guided by Pacific Fonofale and Māori Te Whare Tapa Whā health models. In this meeting-house metaphor, the floor is family, roof is culture, house-posts are physical, mental, spiritual and socio-demographic health and well-being, surrounded by environment, time and context. Setting South Auckland, New Zealand 2021 Population Studied BBM participants Instrument Semi-structured interviews Outcome Measures Narrative data Results 22 interviewees (50% female) aged 24-60 years of mixed Pacific and Māori ethnicities. Majority self-reported weight loss (between three and 135kg) since starting BBM. Two researchers independently coded data with adjudication (kappa=0.61) Participants identified the interactive holistic nature of health and wellbeing from BBM. As well as physical, mental and spiritual benefits, BBM helped many re-connect with both their family and their culture. BBM is seen as a new way of life. Participants "immediately belong to BBM family" regardless of culture or size, "with no judgements" and adopt the BBM motto "no excuses". Conclusions Many weight loss studies provide programmes to improve physical exercise and nutrition, but seldom address sustainability and other core factors such as mental health and motivation. BBM is a community-embedded Maori and Pasifika-led intervention, with no reliance on researchers nor external authorities for its ongoing implementation. It addresses factors impacting participants' lives and social determinants of health, including vaccination drives, food parcels and adapting to the COVID-19 pandemic and lockdowns. Our three-year longitudinal cohort study assessing sustained weight loss is ongoing.

Māori Academic Challenges: Delivering Mātauranga Māori During COVID-19

In March 2020, the COVID-19 pandemic disrupted academic educational programmes in universities across the world, including Aotearoa New Zealand. For Māori academics who implement mātauranga Māori as a pedagogy, it became theoretically and practically challenging teaching virtually and online. The Te Taha Tinana, of Te Whare Tapa Wha model, created by aDurie in 1984 (Health Navigator, 2022) regarding the four dimensions of well-being, focuses on the physical presence, physical embodiment, and physical behaviour. This could not be easily taught virtuality through a computer screen during COVID-19 lockdown. For Māori academics transitioning from teaching Mātauranga Māori in person to an online environment brought forth these challenges. The challenges re-emerged in August 2021 when New Zealand went into Level 4 lockdown overnight because of the new COVID-19 Delta Virus variant. In 2022, the Omicron variant caused many universities in Aotearoa New Zealand to continue their first semester teaching online. Mātauranga Māori is a body of knowledge exercised by Māori people in New Zealand. Sadler (2007) argues Mātauranga Māori was first invented by Māori when Pākehā (English people) arrived in New Zealand. He suggests Mātauranga Māori is a paradigm where Māori define the parameters. Royal (2009; 2012) claims this knowledge was brought to New Zealand by Polynesian ancestors and is an evolutionary continuum of knowledge that relates to encountering the world as Māori with the focus on improving humankind. Le Grice, Braun, and Wetherell (2017) state Mātauranga Māori incorporates theories, practices, and protocols that are bound to relationships, people, and places in a world that supports Māori ambitions. This knowledge, for me an Indigenous Māori academic, incorporates the physical and spiritual worlds embracing the energies of the universe handed down by our forefathers. This position paper discusses the pedagogical challenges encountered during COVID-19 Lockdown for Indigenous academics to continue delivering programmes requiring indigenous expertise and human contact. It explores: 1) the Covid 19 Educational Barriers; 2) Online Academic Challenges; 3) Managing Cultural Shifts; 4) Sustaining Indigenous Pedagogy. It asserts that Mātauranga Māori contributes to the growth of Indigenous knowledge on a world stage and the challenges indigenous academics encounter brought by a global pandemic.

Process evaluation of in-person, news and social media engagement of a community-based programme Brown Buttabean Motivation (BBM): a research protocol

IntroductionThe community group Brown Buttabean Motivation (BBM) initially began to assist Auckland Pasifika and Māori to manage weight problems, predominantly through community-based exercise sessions and social support. BBM’s activities expanded...

Understanding and experience of climate change in rural general practice in Aotearoa-New Zealand.

Climate change is already affecting Aotearoa New Zealand (Aotearoa-NZ). The public health effects are varied and complex, and rural primary care staff will be at the front line of effects and responses. However, little is known about their understanding and experience. To determine understanding, experiences and preparedness of rural general practice staff in Aotearoa-NZ about climate change and health equity. A mixed-methods national cross-sectional survey of rural general practice staff was undertaken that included Likert-style and free-text responses. Quantitative data were analysed with simple descriptive analysis and qualitative data were thematically analysed using a deductive framework based on Te Whare Tapa Whā. A proportion of survey respondents remained unsure about climate science and health links, although many others already reported a range of negative climate change health impacts on their communities, and expected these to worsen. Twenty to thirty percent of respondents lacked confidence in their health service's capability to provide support following extreme weather. Themes included acknowledgement that the health effects of climate change are highly varied and complex, that the health risks for rural communities combine climate change and wider environmental degradation and that climate change will exacerbate existing health inequities. The study adds to sparse information on climate change effects on health in rural primary care. We suggest that tailored professional education on climate change science and rural health equity is still needed, while urgent resourcing and training for interagency disaster response within rural and remote communities is needed.

Understanding engagement with Brown Buttabean Motivation, an Auckland grassroots, Pacific-led holistic health programme: a qualitative study

ObjectivesThe aim was to understand how participants engage with Brown Buttabean Motivation (BBM) a grassroots, Pacific-led holistic health programme and the meaning it has in their lives. The objectives were...

Considering practice frameworks for culturally diverse populations in the correctional domain

It is a ubiquitous pattern around the globe that indigenous peoples who have endured historic and ongoing collective trauma (e.g., colonization) are overrepresented in negative life outcomes such as poverty and imprisonment. Part of the colonizing imperative is to undermine indigenous knowledge as a valid and viable knowledge system, particularly via the hegemony of dominating Western scientific values and practices. We discuss some of these conceptual issues in relation to correctional practice and the position of indigenous Māori peoples in Aotearoa-New Zealand. We then examine the utility of the Practice Frameworks theory introduced by Ward and Durrant (2021) in relation to bicultural practice, and highlight some of the epistemic, social, and ethical factors for consideration. A preliminary exemplar is provided via examination of the potential collaborative relationship of the Good Lives Model and Te Whare Tapa Whā for intervention development. This exemplar highlights the rich array of therapeutic knowledge available when more than one knowledge system is drawn upon to provide culturally responsive intervention. • Critical issues with offender intervention development and cultural responsivity are examined. • Inequities in the treatment of indigenous knowledge systems compared to Western scientific knowledge systems are highlighted. • The potential of ‘cultural collaboration’ in intervention development is examined. • The Good Lives Model and Te Whare Tapa Whā, an indigenous Māori model of human functioning, are presented as an exemplar.

Reflecting on cultural meanings of spirituality/wairuatanga in post-traumatic growth using the Māori wellbeing model of Te Whare Tapa Whā

ABSTRACT This paper engages with the notion of universality by critically exploring the concepts of trauma and post-traumatic growth from a cultural perspective. Drawing on the indigenous Māori model of wellbeing “Te Whare Tapa Whā”, the inter-relationships between family relationships, physical wellbeing, mental and emotional health, and spirituality are examined as a holistic model. Spirituality is a key component of this holistic approach and arguably an inseparable aspect of holistic wellness and can be defined as “a broad universal construct associated with individuals’ ways of making meaning of their lives and the acknowledgment of the presence of a higher being”. Within the cultural context of Aotearoa New Zealand, we make a case for the value of holistic interventions to support people who have experienced trauma that prioritise spirituality alongside other aspects of wellbeing.

Moving with the times: evolution of Buttabean Motivation – a community-based, Pacific-centred approach to health

Buttabean Motivation (BBM) is a grassroot initiative aiming to improve Pasifika and M?ori health through free community bootcamps offering exercise, motivation and nutritional advices, and with online programmes of workouts and meal plans. It is a dynamic organisation, responding to community needs, providing practical solutions to issues such as food insecurity and influenza vaccination while maintaining its core focus of reducing obesity among Pasifika and M?ori through nutrition and physical activity.. BBM forms active and changing relationships with numerous organisations that offer support. They would like to work with the government and the district health boards, but the structure and changing nature of their organisation does not fit traditional funding models. To show that BBM is effective for Pacific people beyond anecdotal evidence, BBM has partnered with University of Auckland researchers. The research team are using a kaupapa M?ori and co-design approach to explore how BBM might benefit the community and reduce health inequities, especially whether BBM’s model of social collectivism enables sustainable weight loss for Pasifika and M?ori in the current obesogenic environment. Weight reduction programmes typically find that after initial success, participants have reverted to pre-programme weight by five years. BBM’s “whole of life change” approach may lead to sustained weight loss not demonstrated by other programmes. Using co-design, a BBM/University of Auckland partnership is evaluating the effectiveness of the BBM programme for sustained health and wellbeing. BBM is grounded in the Pacific/indigenous health frameworks fonofale, te whare tapa wh? and fa’afaletui addressing physical, mental, spiritual, family and social health in the context of people’s lives. The research will use a longitudinal cohort approach study design, using metrics and outcomes of relevance to its participants and the programme. A systems analysis will facilitate understanding of the strengths and challenges to delivering a holistic and sustained service for the community. BBM provides much promise in reducing health inequities for Pasifika and M?ori, however the model creates challenges for ongoing funding, business structure and evaluation. The goal is to find ways that both the programme and social institutions, including funders and evaluators, can adapt to meet these real-world challenges.

Lived experiences of ngā tāne Māori with hip and knee osteoarthritis Te Whatarangi

Osteoarthritis (OA) is a debilitating condition affecting an individual’s quality of life in multiple ways. However, little is known about about the experiences of täne (men) Māori living with OA in Aotearoa New Zealand. We aimed to explore the lived experiences of ngā tāne Māori with OA. This qualitative study was guided by tikanga and kaupapa Māori philosophies. Interviews were conducted in a semi-structured method, with seven tāne Māori living with OA. Key themes were identified and developed from the data through thematic analysis, and were informed by Tā Mason Durie’s Māori health frameworks, Te Whare Tapa Whā and Te Pae Māhutonga. Four themes developed from the data and were named: (1) The interface of masculine embodiment and mana, (2) Taha whānau and connection as central to ngā tāne Māori wellbeing, (3) The benefits of taha wairua (spiritual wellbeing), and (4) Te urutau kia uru ki te punaha tiaki hauora: Adapting to access the health-care system. OA places a significant burden on ngā tāne Māori and their whānau, impacting on all aspects of hauora (health). The unique lived experiences and impact on wider whānau of Māori living with OA indicates the need to consider te ao Māori (Māori world view) when developing clinical services and a Model of Care for OA.

Performing Te Whare Tapa Whā: building on cultural rights to decolonise prison theatre practice

ABSTRACT Ngā Pātū Kōrero: Walls That Talk (2019) is a documentary theatre production staged by incarcerated men at Unit 8 Te Piriti at Auckland Prison in Aotearoa New Zealand. The performance was built around Te Whare Tapa Whā (The House of Four Sides) – a model of Māori health that participants engaged with as part of their therapy for being convicted of sex offences. This article discusses the use of masks in performance and the significance of Te Whare Tapa Whā as a dramaturgical device. What insights for decolonising prison theatre practices can be advanced by building on foundations of cultural rights?

Te whare tapa whā: The impact of physical distancing on the health and well-being of kuia and koroheke

The effects of the COVID-19 lockdown and physical distancing were broad, impacting multiple sectors, particularly health, for Māori and Indigenous peoples. This situation report considers health and well-being using Te Whare Tapa Whā, and looks at the experiences and voices of kuia and koroheke—considered to be at high risk of contracting coronavirus—to better understand their health and well-being impacts from physical distancing. This report then reflects on these experiences to identify how help groups can best support communities in future lockdown situations. The recommendations for future support efforts are threefold and centre on increasing coordination amongst the efforts of the different help groups, using a holistic approach such as Te Whare Tapa Whā to address the various pillars of health, and considering individual health and well-being needs.