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Walsh K, Carroll B, O'Shea E, O'Donovan D. Countering social exclusion through inclusive homecare provision: Utilising a participatory life-course approach to influence policy. Soc Sci Med 2024; 352:117003. [PMID: 38901211 DOI: 10.1016/j.socscimed.2024.117003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 03/04/2024] [Accepted: 05/19/2024] [Indexed: 06/22/2024]
Abstract
Homecare models can be effective mechanisms in securing wellbeing and ageing-in-place goals prevalent in health policy agendas. However, the relevance and utility of these models for those living in socially and environmentally insecure conditions has rarely been considered. This is marked by an assumption of in-situ care delivery in private dwellings, and the absence of such groups from homecare development processes. This study aims to harnesses the experiences and preferences of older people in homelessness (OH), older Irish Travellers (OT), and professional stakeholders in an evidence-based co-production of policy recommendations for inclusive homecare provision. The study employed a participatory approach involving the integration of lived experience evidence in a multistakeholder co-production process. Methods comprised: five separate focus groups with OH, OT and service providers (n = 30); two consultative forums involving focus group participants together; and 49 life-course interviews with OH (n = 27) and OT (n = 22) and adults. Findings demonstrate that sizeable gaps in care remain for these groups, and that resource constraints and legislative restrictions prevail for professional stakeholders. Co-produced policy recommendations for inclusive homecare provision based on these experiences and group preferences are presented and discussed.
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Affiliation(s)
- Kieran Walsh
- Irish Centre for Social Gerontology, Institute for Lifecourse and Society, University of Galway, Galway, Ireland.
| | - Brídín Carroll
- Irish Centre for Social Gerontology, Institute for Lifecourse and Society, University of Galway, Galway, Ireland.
| | - Eamon O'Shea
- Irish Centre for Social Gerontology, Institute for Lifecourse and Society, University of Galway, Galway, Ireland.
| | - Diarmuid O'Donovan
- School of Medicine, Dentistry and Biomedical Sciences, Queens University, Belfast, Antrim, Ireland.
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Oetzel JG, Bragg C, Wilson Y, Reddy R, Simpson ML, Nock S. Cultural and co-designed principles for developing a Māori kaumātua housing village to address health and social wellbeing. BMC Public Health 2024; 24:1313. [PMID: 38750473 PMCID: PMC11094867 DOI: 10.1186/s12889-024-18771-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 05/03/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The current study is a case study of a Māori (Indigenous people of New Zealand) organisation and their developmental processes in creating a kaumātua (older people) housing village for health and social wellbeing. This study identifies how a set of established co-design and culturally-centred principles were enacted when creating and developing the village. METHOD A mixed-method concurrent design was used in creating the case with interviews (n = 4), focus groups (N = 4 with 16 total participants) and survey questionnaires (n = 56) involving kaumātua and organisation members. RESULTS Survey results illustrate that suitable and affordable housing are associated with self-rated health, loneliness, and life satisfaction. The primary purpose of the housing village was to enable kaumātua to be connected to the marae (community meeting house) as part of a larger vision of developing intergenerational housing around the marae to enhance wellbeing. Further, key themes around visioning, collaborative team and funding, leadership, fit-for-purpose design, and tenancy management were grounded in cultural elements using te ao Māori (Māori worldview). CONCLUSION This case study illustrates several co-design and culturally-centred principles from a previously developed toolkit that supported the project. This case study demonstrates how one community enacted these principles to provide the ground for developing a housing project that meets the health and social wellbeing of kaumātua.
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Affiliation(s)
| | | | | | | | | | - Sophie Nock
- University of Waikato, Hamilton, New Zealand
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Oetzel JG, Zhang Y, Nock S, Meha P, Huriwaka H, Vercoe M, Tahu T, Urlich J, Warbrick R, Brown G, Keown S, Rewi P, Erueti B, Warbrick I, Jackson AM, Perry T, Reddy R, Simpson ML, Cameron MP, Hokowhitu B. Enhancing health outcomes for Māori elders through an intergenerational cultural exchange and physical activity programme: a cross-sectional baseline study. Front Public Health 2023; 11:1307685. [PMID: 38148874 PMCID: PMC10749953 DOI: 10.3389/fpubh.2023.1307685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/14/2023] [Indexed: 12/28/2023] Open
Abstract
Background The study offers baseline data for a strengths-based approach emphasizing intergenerational cultural knowledge exchange and physical activity developed through a partnership with kaumātua (Māori elders) and kaumātua service providers. The study aims to identify the baseline characteristics, along with correlates of five key outcomes. Methods The study design is a cross-sectional survey. A total of 75 kaumātua from six providers completed two physical functioning tests and a survey that included dependent variables based in a holistic model of health: health-related quality of life (HRQOL), self-rated health, spirituality, life satisfaction, and loneliness. Results The findings indicate that there was good reliability and moderate scores on most variables. Specific correlates included the following: (a) HRQOL: emotional support (β = 0.31), and frequent interaction with a co-participant (β = 0.25); (b) self-rated health: frequency of moderate exercise (β = 0.32) and sense of purpose (β = 0.27); (c) spirituality: sense of purpose (β = 0.46), not needing additional help with daily tasks (β = 0.28), and level of confidence with cultural practices (β = 0.20); (d) life satisfaction: sense of purpose (β = 0.57), frequency of interaction with a co-participant (β = -0.30), emotional support (β = 0.25), and quality of relationship with a co-participant (β = 0.16); and (e) lower loneliness: emotional support (β = 0.27), enjoyment interacting with a co-participant (β = 0.25), sense of purpose (β = 0.24), not needing additional help with daily tasks (β = 0.28), and frequency of moderate exercise (β = 0.18). Conclusion This study provides the baseline scores and correlates of important social and health outcomes for the He Huarahi Tautoko (Avenue of Support) programme, a strengths-based approach for enhancing cultural connection and physical activity.
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Affiliation(s)
| | - Yingsha Zhang
- School of Tourism Management, Sun Yat-sen University, Zhuhai, Guangdong, China
- Key Laboratory of Sustainable Tourism Smart Assessment Technology, Ministry of Culture and Tourism of China, Zhuhai, Guangdong, China
| | - Sophie Nock
- University of Waikato, Hamilton, New Zealand
| | - Pare Meha
- Rauawaawa Kaumātua Charitable Trust, Hamilton, New Zealand
| | | | | | | | | | | | | | | | | | - Bevan Erueti
- Massey University, Palmerston North, New Zealand
| | - Isaac Warbrick
- Auckland University of Technology, Auckland, New Zealand
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Carroll B, Walsh K, Scharf T, O'Donovan D, Keogh S. Positive health and ageing policies for older Irish travellers and older people who have experienced homelessness in Ireland: Life-course meanings and determinants. Soc Sci Med 2023; 336:116264. [PMID: 37806148 DOI: 10.1016/j.socscimed.2023.116264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 04/25/2023] [Accepted: 09/22/2023] [Indexed: 10/10/2023]
Abstract
Marginalised groups of older people remain neglected in positive health and ageing (PHA) agendas, whether they concern healthy or active ageing concepts. Questions exist around the meaning of such constructs and the factors that enable disadvantaged populations to achieve equitable later-life experiences. Focusing on two such groups in Ireland, this study investigates the constituent dimensions of PHA for older Irish Travellers and older people who have experienced homelessness and the role of life-course and structural determinants in constructing PHA trajectories for these groups. The study involves a qualitative, participatory voice-led methodology, with analysis based on 49 in-depth life-course interviews with people aged 50 years and over from the two populations. Five interconnected dimensions of PHA are identified and presented. Four determinants related to life-course experiences and structural factors are identified as contributing to these dimensions: social relations, material and accommodation circumstances, formal supports and systems, and critical transitions and resilience. While illustrating the validity of PHA agendas for these groups when understood through their lived experiences, the findings highlight the significant deprivations and risks to rights that must be accounted for to secure meaningful gains in PHA for the groups.
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Affiliation(s)
- Brídín Carroll
- Irish Centre for Social Gerontology, Institute for Lifecourse and Society, J.E. Carines School of Business and Economics, University of Galway, Galway, Ireland.
| | - Kieran Walsh
- Irish Centre for Social Gerontology, Institute for Lifecourse and Society, J.E. Carines School of Business and Economics, University of Galway, Galway, Ireland.
| | - Thomas Scharf
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE1 4LP, UK.
| | - Diarmuid O'Donovan
- School of Medicine, Dentistry and Biomedical Sciences, Queens University, Belfast, Antrim, Northern Ireland.
| | - Sinéad Keogh
- Department of Enterprise and Technology, School of Business, Atlantic Technological University, Galway, Ireland.
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Fraser C, Honeyfield J, White M, Qiu W, Sims D, Proverbs A. Using Cultural Lens Theory to Investigate the Impact of a Nursing Education Practicum in Aged Healthcare: Aotearoa New Zealand's Bi-cultural Framework. J Cross Cult Gerontol 2022; 37:237-256. [PMID: 36074216 PMCID: PMC9453732 DOI: 10.1007/s10823-022-09458-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2022] [Indexed: 11/27/2022]
Abstract
Aim The aim of this paper is to apply Cultural Lens Approach theory to data collected from third year nursing students related to an assignment undertaken during their month-long practicum placement in an aged residential care facility. We explore the extent to which a national vision of bi-culturalism and inclusivity is evident in students’ quality improvement project topic selection and practice. Background Aotearoa New Zealand is a nation of dual heritage, informed by the cultures of Māori as the indigenous tangata whenua (people of the land), and Pākehā, (European) settlers. All public sectors, including all higher education providers and the curricula they deliver, are required to incorporate and promote a contemporary, bi-cultural world-view. Methods Stage one of the research reported in this paper involved a) document analysis of 93 students’ quality improvement project reports; b) focus groups with 18 students; and c) an online questionnaire for 16 key stakeholders including aged care managers, clinical nurse leaders and student nurse educators. Stage two reviewed the above data through a five-step Cultural Lens Approach process to identify cultural biases and assumptions. Results Qualitative analysis revealed students’ increased professional confidence, improving communication and critical thinking skills. Responses as to development of cultural competence and cultural safety were mixed: a key barrier identified was that staff in the placement setting received minimal professional development to ensure appropriate tikanga (customary protocols and practice) for Māori residents was in place. Conclusion Viewed through a cultural lens, a westernized concept of aged healthcare provision continues to prevail in most settings. Nursing students noted gaps between cultural learning and practice.
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Affiliation(s)
- Cath Fraser
- Research Office, Toi Ohomai Institute of Technology, PB 12001, Tauranga, 3143, New Zealand.
| | - Judith Honeyfield
- Department of Nursing, Toi Ohomai Institute of Technology, PB 12001, Tauranga, New Zealand
| | - Mary White
- Department of Nursing, Toi Ohomai Institute of Technology, PB 12001, Tauranga, New Zealand
| | - Walley Qiu
- Access New Zealand, Hamilton, New Zealand
| | - Deb Sims
- Department of Nursing, Toi Ohomai Institute of Technology, PB 12001, Tauranga, New Zealand
| | - Adam Proverbs
- Department of Nursing, Toi Ohomai Institute of Technology, PB 12001, Tauranga, New Zealand
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Lay-Yee R, Milne BJ, Wright-St Clair VA, Broad J, Wilkinson T, Connolly M, Teh R, Hayman K, Muru-Lanning M, Kerse N. Prevalence of loneliness and its association with general and health-related measures of subjective well-being in a longitudinal bicultural cohort of older adults in advanced age living in New Zealand: LiLACS NZ. J Gerontol B Psychol Sci Soc Sci 2022; 77:1904-1915. [PMID: 35767846 PMCID: PMC9535776 DOI: 10.1093/geronb/gbac087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES There is evidence that loneliness is detrimental to the subjective well-being of older adults. However, little is known on this topic for the cohort of those in advanced age (80 years or over) which today is the fastest growing age group in the New Zealand population. We examined the relationships between loneliness and selected subjective well-being outcomes over five years. METHODS We used a regional, bicultural sample of those in advanced age from 2010 to 2015 (LiLACS NZ). The first wave enrolled 937 people (92% of whom were living in the community): 421 Māori (Indigenous New Zealanders aged 80-90 years) and 516 non-Māori aged 85 years. We applied standard regression techniques to baseline data and mixed effects models to longitudinal data, while adjusting for socio-demographic factors. RESULTS For both Māori and non-Māori, strong negative associations between loneliness and subjective well-being were found at baseline. In longitudinal analyses, we found that loneliness was negatively associated with life satisfaction as well as with mental health-related quality of life. DISCUSSION Our findings of adverse impacts on subjective well-being corroborate other evidence, highlighting loneliness as a prime candidate for intervention - appropriate to cultural context - to improve well-being for adults in advanced age.
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Affiliation(s)
- Roy Lay-Yee
- Centre of Methods and Policy Application in the Social Sciences (COMPASS), School of Social Sciences, Faculty of Arts, University of Auckland, New Zealand
| | - Barry J Milne
- Centre of Methods and Policy Application in the Social Sciences (COMPASS), School of Social Sciences, Faculty of Arts, University of Auckland, New Zealand.,Department of Statistics, Faculty of Science, University of Auckland, New Zealand
| | | | - Joanna Broad
- Freemasons Department of Geriatric Medicine, School of Medicine, University of Auckland, New Zealand
| | - Tim Wilkinson
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Martin Connolly
- Department of Medicine, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Ruth Teh
- Department of General Practice & Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Karen Hayman
- Department of General Practice & Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | | | - Ngaire Kerse
- Department of General Practice & Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
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Oetzel JG, Ruru S, Zhang Y, Simpson ML, Nock S, Meha P, Holmes K, Clark M, Adams H, Akapita N, Ngaia K, Murphy S, Moses R, Reddy R, Hokowhitu B. Enhancing Well-Being and Social Connectedness for Māori Elders Through a Peer Education (Tuakana-Teina) Programme: A Cross-Sectional Baseline Study. Front Public Health 2021; 9:775545. [PMID: 34957027 PMCID: PMC8692656 DOI: 10.3389/fpubh.2021.775545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Māori kaumātua (elders) face stark health and social inequities compared to non-Māori New Zealanders. The tuakana-teina (older sibling-younger sibling) peer education programme is a strengths-based approach to enhance well-being and social connectedness. The purpose of this study is to present the baseline data from this programme and identify correlates of well-being outcomes. Method: Participants included 128 kaumātua who completed a self-report survey about health-related quality of life, spirituality, social connection and loneliness, life satisfaction, cultural identity and connection, elder abuse, health service utilisation and demographics. Findings: Multiple regression models illustrated the following correlates of outcomes: (a) self-rated health: needing more help with daily tasks (β = −0.36) and housing problems (β = –0.17); (b) health-related quality of life: needing more help with daily tasks (β = –0.31), housing problems (β = –0.21), and perceived autonomy (β = 0.19); (c) spiritual well-being: understanding of tikanga (cultural protocols) (β = 0.32) and perceived autonomy (β = 0.23); (d) life satisfaction: social support (β = 0.23), sense of purpose (β = 0.23), cultural identity (β = 0.24), trouble paying bills (β = –0.16), and housing problems (β = –0.16); (e) loneliness: elder abuse (β = 0.27), social support (β = –0.21), and missing pleasure of being with whānau (extended family) (β = 0.19). Conclusions: Key correlates for outcomes centred on social support, housing problems, cultural connection and perceived autonomy. These correlates are largely addressed through the programme where tuakana/peer educators provide support and links to social and health services to teina/peer recipients in need. This study illustrates needs and challenges for kaumātua, whilst the larger programme represents a strengths-based and culturally-centred approach to address health issues related to ageing in an Indigenous population.
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Affiliation(s)
- John G Oetzel
- Waikato Management School, University of Waikato, Hamilton, New Zealand
| | - Stacey Ruru
- Waikato Management School, University of Waikato, Hamilton, New Zealand
| | - Yingsha Zhang
- Waikato Management School, University of Waikato, Hamilton, New Zealand
| | | | - Sophie Nock
- Faculty of Māori and Indigenous Studies, University of Waikato, Hamilton, New Zealand
| | - Pare Meha
- Rauawaawa Kaumātua Charitable Trust, Hamilton, New Zealand
| | - Kath Holmes
- Rauawaawa Kaumātua Charitable Trust, Hamilton, New Zealand
| | | | | | | | | | - Shane Murphy
- Te Roopu Tautoko ki te Tonga, Dunedin, New Zealand
| | - Reuben Moses
- Te Roopu Tautoko ki te Tonga, Dunedin, New Zealand
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Hokowhitu B, Oetzel JG, Simpson ML, Nock S, Reddy R, Meha P, Johnston K, Jackson AM, Erueti B, Rewi P, Warbrick I, Cameron MP, Zhang Y, Ruru S. Kaumātua Mana Motuhake Pōi: a study protocol for enhancing wellbeing, social connectedness and cultural identity for Māori elders. BMC Geriatr 2020; 20:377. [PMID: 33008342 PMCID: PMC7530863 DOI: 10.1186/s12877-020-01740-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/30/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The Aotearoa New Zealand population is ageing accompanied by health and social challenges including significant inequities that exist between Māori and non-Māori around poor ageing and health. Although historically kaumātua (elder Māori) faced a dominant society that failed to realise their full potential as they age, Māori culture has remained steadfast in upholding elders as cultural/community anchors. Yet, many of today's kaumātua have experienced 'cultural dissonance' as the result of a hegemonic dominant culture subjugating an Indigenous culture, leading to generations of Indigenous peoples compelled or forced to dissociate with their culture. The present research project, Kaumātua Mana Motuhake Pōī (KMMP) comprises two interrelated projects that foreground dimensions of wellbeing within a holistic Te Ao Māori (Māori epistemology) view of wellbeing. Project 1 involves a tuakana-teina/peer educator model approach focused on increasing service access and utilisation to support kaumātua with the greatest health and social needs. Project 2 focuses on physical activity and cultural knowledge exchange (including te reo Māori--Māori language) through intergenerational models of learning. METHODS Both projects have a consistent research design and common set of methods that coalesce around the emphasis on kaupapa kaumatua; research projects led by kaumātua and kaumātua providers that advance better life outcomes for kaumātua and their communities. The research design for each project is a mixed-methods, pre-test and two post-test, staggered design with 2-3 providers receiving the approach first and then 2-3 receiving it on a delayed basis. A pre-test (baseline) of all participants will be completed. The approach will then be implemented with the first providers. There will then be a follow-up data collection for all participants (post-test 1). The second providers will then implement the approach, which will be followed by a final data collection for all participants (post-test 2). DISCUSSION Two specific outcomes are anticipated from this research; firstly, it is hoped that the research methodology provides a framework for how government agencies, researchers and relevant sector stakeholders can work with Māori communities. Secondly, the two individual projects will each produce a tangible approach that, it is anticipated, will be cost effective in enhancing kaumātua hauora and mana motuhake. TRIAL REGISTRATION Australia New Zealand Clinical Trial Registry ( ACTRN12620000316909 ). Registered 6 March 2020.
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Affiliation(s)
| | - John G. Oetzel
- University of Waikato, Private Bag 3105, Hamilton, 3240 New Zealand
| | | | - Sophie Nock
- University of Waikato, Private Bag 3105, Hamilton, 3240 New Zealand
| | - Rangimahora Reddy
- Rauawaawa Kaumātua Charitable Trust, 50 Colombo St., Hamilton, 3204 New Zealand
| | - Pare Meha
- Rauawaawa Kaumātua Charitable Trust, 50 Colombo St., Hamilton, 3204 New Zealand
| | - Kirsten Johnston
- Rauawaawa Kaumātua Charitable Trust, 50 Colombo St., Hamilton, 3204 New Zealand
| | | | - Bevan Erueti
- Massey University, Private Bag 11 222, Palmerston North, 4442 New Zealand
| | - Poia Rewi
- University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | - Isaac Warbrick
- Auckland University of Technology, Private Bag 92006, Auckland, 1142 New Zealand
| | | | - Yingsha Zhang
- University of Waikato, Private Bag 3105, Hamilton, 3240 New Zealand
| | - Stacey Ruru
- University of Waikato, Private Bag 3105, Hamilton, 3240 New Zealand
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Oetzel JG, Cameron MP, Simpson ML, Reddy R, Nock S, Greensill H, Meha P, Johnston K, Harding T, Shelford P, Smith LT, Hokowhitu B. Kaumātua Mana Motuhake: peer education intervention to help Māori elders during later-stage life transitions. BMC Geriatr 2020; 20:186. [PMID: 32471351 PMCID: PMC7260849 DOI: 10.1186/s12877-020-01590-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aotearoa/New Zealand has a population that is ageing and there are challenges to health and social outcomes related to related to key life transitions (e.g., retirement, change in health conditions, loss of spouse). Further, there are significant inequities between Māori (Indigenous people) and non-Māori in ageing outcomes. The purpose of this study was to test the impacts and cost effectiveness of a tuakana/teina (peer education) intervention on kaumātua (elders) receiving the intervention. This study was framed by a strengths-based approach based on the key cultural concept of mana motuhake (autonomy and self-actualisation). METHODS This study was grounded in principles of Kaupapa Māori and community-based participatory research to bring together a diverse group of stakeholders to co-develop and co-evaluate the intervention. The intervention had tuakana (peer educators) having conversations with up to six teina (recipients) and providing information related to health and social services. The research design was a pre- and post-test, clustered staggered design. Participants completed a baseline assessment of health and mana motuhake measures consistent with Māori worldviews along with two follow-up assessments (one after the first intervention group completed its activities and a second after the second intervention group completed its activities). Additionally, five focus groups and open-ended questions on the assessments were used to provide qualitative evaluation. FINDINGS A total of 180 kaumātua were recruited to the intervention with 121 completing it. The analysis revealed improvements over time in the expected direction on most of the variables. However, only three of the variables had statistically significant intervention effects: received support, tribal identity, and trouble paying bills. Qualitative results supported impacts of the intervention on mana motuhake, social connectedness, and tangible/information support related to services. Cost-effectiveness analysis showed that the intervention is cost effective, with a cost per QALY of less than the conventional threshold of three times gross domestic product per capita. CONCLUSIONS The findings support the relevancy and importance of kaumātua knowledge to create a strengths-based approach to improve health and social outcomes. This study demonstrates that a contextually based and culturally safe age-friendly environments can facilitate engagement and participation by kaumātua for kaumātua. TRIAL REGISTRY Australia New Zealand Clinical Trial Registry (ACTRN12617001396314); Date Registered: 3 October 2017 (retrospectively registered); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373733&isClinicalTrial=False.
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Affiliation(s)
- John G Oetzel
- University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand.
| | - Michael P Cameron
- University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | - Mary L Simpson
- University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | - Rangimahora Reddy
- Rauawaawa Kaumātua Charitable Trust, 50 Colombo St., Hamilton, 3204, New Zealand
| | - Sophie Nock
- University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | | | - Pare Meha
- Rauawaawa Kaumātua Charitable Trust, 50 Colombo St., Hamilton, 3204, New Zealand
| | - Kirsten Johnston
- Rauawaawa Kaumātua Charitable Trust, 50 Colombo St., Hamilton, 3204, New Zealand
| | - Truely Harding
- University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | - Pita Shelford
- University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | | | - Brendan Hokowhitu
- University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
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