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Oetzel JG, Simpson M, Meha P, Cameron MP, Zhang Y, Nock S, Reddy R, Adams H, Akapita N, Akariri N, Anderson J, Clark M, Ngaia K, Hokowhitu B. Tuakana-teina peer education programme to help Māori elders enhance wellbeing and social connectedness. BMC Geriatr 2024; 24:114. [PMID: 38291380 PMCID: PMC10826274 DOI: 10.1186/s12877-024-04703-0] [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: 05/12/2023] [Accepted: 01/11/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND There are significant inequities between Māori (Indigenous people) and non-Māori in ageing outcomes. This study used a strengths-based approach based on the key cultural concept of mana motuhake (autonomy and self-actualisation) to develop a tuakana-teina (literally older sibling-younger sibling) peer education programme to assist kaumātua (elders) in addressing health and social needs. The purpose of this study was to test the impact on those receiving the programme. Three aims identify the impact on outcomes, resources received and the cost effectiveness of the programme. METHODS Five Kaupapa Māori (research and services guided by Māori worldviews) iwi (tribe) and community providers implemented the project using a partnership approach. Tuakana (peer educators) had up to six conversations each with up to six teina (peer learners) and shared information related to social and health services. A pre- and post-test, clustered staggered design was the research design. Participants completed a baseline and post-programme assessment of health and mana motuhake measures consistent with Māori worldviews. Open-ended questions on the assessments, five focus groups, and four individual interviews were used for qualitative evaluation. FINDINGS A total of 113 kaumātua were recruited, and 86 completed the programme. The analysis revealed improvements in health-related quality of life, needing more help with daily tasks, life satisfaction, paying bills and housing problems. Qualitative results supported impacts of the programme on mana motuhake and hauora (holistic health) through providing intangible and tangible resources. Cost-effectiveness analysis showed that the intervention is cost effective, with a cost per QALY of less than the conventional threshold of three times GDP per capita. CONCLUSIONS A culturally-resonant, strengths-based programme developed through a participatory approach can significantly improve health and social outcomes in a cost-effective way. TRIAL REGISTRY Clinical trial registry: Trial registration: (ACTRN12620000316909). Prospectively registered 06/03/2020, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379302&isClinicalTrial=False .
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Grants
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
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Affiliation(s)
- John G Oetzel
- University of Waikato, Private Bag 3105, 3240, Hamilton, New Zealand.
| | - Mary Simpson
- University of Waikato, Private Bag 3105, 3240, Hamilton, New Zealand
| | - Pare Meha
- Rauawaawa Kaumātua Charitable Trust, 50 Colombo St, 3204, Hamilton, New Zealand
| | - Michael P Cameron
- University of Waikato, Private Bag 3105, 3240, Hamilton, New Zealand
| | | | - Sophie Nock
- University of Waikato, Private Bag 3105, 3240, Hamilton, New Zealand
| | - Rangimahora Reddy
- Rauawaawa Kaumātua Charitable Trust, 50 Colombo St, 3204, Hamilton, New Zealand
| | - Hariata Adams
- Te Korowai Hauora o Hauraki, 210 Richmond St, 3500, Thames, New Zealand
| | - Ngapera Akapita
- Ngāti Ruanui Whānau Ora, 96 Collins Street, 4610, Hawera, New Zealand
| | - Ngareo Akariri
- Tui Ora Limited, 36 Maratahu Street, 4342, New Plymouth, New Zealand
| | - Justina Anderson
- Tui Ora Limited, 36 Maratahu Street, 4342, New Plymouth, New Zealand
| | - Marama Clark
- Poutiri Trust, 35 Commerce Lane, 3119, Te Puke, New Zealand
| | - Kawarau Ngaia
- Te Korowai o Ngāruahine Trust, 4610, Hawera, PO Box 474, New Zealand
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Simpson ML, Ruru S, Oetzel J, Meha P, Nock S, Holmes K, Adams H, Akapita N, Clark M, Ngaia K, Moses R, Reddy R, Hokowhitu B. Adaptation and implementation processes of a culture-centred community-based peer-education programme for older Māori. Implement Sci Commun 2022; 3:123. [DOI: 10.1186/s43058-022-00374-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
Abstract
Background
Health inequities experienced by kaumātua (older Māori) in Aotearoa, New Zealand, are well documented. Examples of translating and adapting research into practice that identifies ways to help address such inequities are less evident. The study used the He Pikinga Waiora (HPW) implementation framework and the Consolidated Framework for Implementation Research (CFIR) to explore promising co-design and implementation practices in translating an evidence-based peer-education programme for older Māori to new communities.
Methods
The study was grounded in an Indigenous methodology (Kaupapa Māori) and a participatory research approach. Data were collected from research documentation, community meeting and briefing notes, and interviews with community researchers.
Results
The data analysis resulted in several key promising practices: Kaumātua mana motuhake (kaumātua independence and autonomy) where community researchers centred the needs of kaumātua in co-designing the programme with researchers; Whanaungatanga (relationships and connectedness) which illustrated how community researchers’ existing and emerging relationships with kaumātua, research partners, and each other facilitated the implementation process; and Whakaoti Rapanga (problem-solving) which centred on the joint problem-solving undertaken by the community and university researchers, particularly around safety issues. These results illustrate content, process, and relationship issues associated with implementation effectiveness.
Conclusions
This study showed that relational factors are central to the co-design process and also offers an example of a braided river, or He Awa Whiria, approach to implementation. The study offers a valuable case study in how to translate, adapt, and implement a research-based health programme to Indigenous community settings through co-design processes.
Trial registration
The project was registered on 6 March 2020 with the Australia New Zealand Clinical Trial Registry: ACTRN12620000316909. Prospectively registered.
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Oetzel J, Sika-Paotonu D, Penetito-Hemara D, Henry A. Healthier Lives Implementation Research Network for Māori and Pacific community health providers in Aotearoa New Zealand: a study protocol with an observational mixed methods design. Implement Sci Commun 2022; 3:122. [PMID: 36419125 PMCID: PMC9686062 DOI: 10.1186/s43058-022-00373-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/06/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Despite incremental gains in the Aotearoa New Zealand health sector, Māori and Pacific peoples still experience poorer health outcomes than non-Māori and non-Pacific. Access to the latest research and innovation is critical to improving and addressing health outcomes and health inequities in particular. However, there are numerous challenges to translating research into practice including that there is currently no known a specific infrastructure in Aotearoa New Zealand to facilitate this process. The aim of the project is to develop a network of community providers, researchers and health systems representatives that can help facilitate the implementation of novel and innovative programmes and products that help to meet the health needs of Māori and Pacific communities. METHODS This project has three stages, one of which has been completed. In Stage 1, we engaged with key leaders of organisations from various components in the health system through a co-design process to identify parameters and infrastructure of the network. In Stage 2, we propose to construct the network involving approximately 20-30 community providers (and other affiliated researchers and health system representatives) and refine its parameters through an additional co-design process. Additionally, we will use a mixed methods research design using survey and interviews to identify perceived implementation needs, facilitators and barriers to help inform the work in the third stage. In Stage 3, we will support the active implementation of evidence-based programmes with a smaller number of providers (approximately four to eight community providers depending on the complexity of the implementation). Mixed methods research will be conducted to understand facilitators and barriers to implementation processes and outcomes. DISCUSSION The proposed network infrastructure is an equity-oriented strategy focused on building capacity through a strength-based approach that can help address inequities over time. Our "proof-of-concept" study will not be able to change inequities in that time period given its relatively small scale and time period, but it should set the foundation for continued equity-oriented work.
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Affiliation(s)
- John Oetzel
- University of Waikato, Hamilton, New Zealand
| | | | | | - Akarere Henry
- South Waikato Pacific Islands Community Services, Tokoroa, 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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Oetzel JG, Hokowhitu B, Simpson M, Reddy R, Cameron MP, Meha P, Johnston K, Nock S, Greensill H, Harding T, Shelford P, Smith LT. Correlates of Health-Related Quality of Life for Māori Elders Involved in a Peer Education Intervention. JOURNAL OF HEALTH COMMUNICATION 2019; 24:559-569. [PMID: 31274386 DOI: 10.1080/10810730.2019.1637483] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The purpose of this study was to identify social determinant and communication correlates of health-related quality of life for kaumātua (Māori elders) in New Zealand. A total of 209 kaumātua completed a self-report survey of self-rated health, physical/mental quality of life, spirituality, and a series of questions about social determinants (e.g., factors related to income) and communication variables (e.g., loneliness, social support, cultural identity, and perceived burden/benefit). The survey was baseline data for a peer education intervention to help kaumātua work through life transitions in older age. The main findings of this study were that social determinants, particularly difficulty paying bills, accounted for a small amount of variance in physical/mental quality of life and self-rated health. Further, the communication correlates of loneliness, perceived burden, and desired support accounted for about three times as much variance in these two outcomes all with negative associations. Strength of tribal identity, importance of whānau (extended family), and knowledge of tikanga (customs and protocols) accounted for a moderate amount variance in spirituality with positive associations. These findings have important theoretical and practical implications for positive aging.
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Affiliation(s)
- John G Oetzel
- a Waikato Management School, University of Waikato , Hamilton , New Zealand
| | - Brendan Hokowhitu
- b Faculty of Māori and Indigenous Studies, University of Waikato , Hamilton , New Zealand
| | - Mary Simpson
- a Waikato Management School, University of Waikato , Hamilton , New Zealand
| | | | - Michael P Cameron
- a Waikato Management School, University of Waikato , Hamilton , New Zealand
| | - Pare Meha
- c Rauawaawa Kaumātua Charitable Trust , Hamilton , New Zealand
| | | | - Sophie Nock
- b Faculty of Māori and Indigenous Studies, University of Waikato , Hamilton , New Zealand
| | - Hineitimoana Greensill
- b Faculty of Māori and Indigenous Studies, University of Waikato , Hamilton , New Zealand
| | - Truely Harding
- a Waikato Management School, University of Waikato , Hamilton , New Zealand
| | - Pita Shelford
- a Waikato Management School, University of Waikato , Hamilton , New Zealand
| | - Linda Tuhiwai Smith
- b Faculty of Māori and Indigenous Studies, University of Waikato , Hamilton , New Zealand
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