The Effectiveness of a Maori Noho Marae smoking cessation intervention: utilising a kaupapa Maori methodology

Abstract

Maori smoking prevalence rates are double those of non-Maori. Despite recent government funded health promotion targeting Maori, this disparity appears to be widening. Smoking prevalence rates for Pakeha New Zealanders continue to fall, whereas Maori smoking prevalence rates remain stable at 50% of all Maori adults over the age of 15. In response to community demand for smoking cessation assistance, some Maori health providers developed a residential intervention based on marae. This study examined the effectiveness of that approach to aiding smoking cessation among Maori. A secondary purpose of the study was to support the development of uniquely Maori approaches to research, by utilising a kaupapa Maori methodology. The literature on kaupapa Maori health research methodology was reviewed. Consequently, Te Whare Tapa Wha, a contemporary Maori paradigm is used as the central organising framework for analysing and understanding both the act of research and smoking behaviour. Two groups of smokers were interviewed, a group undertaking a Noho Marae smoking cessation programme (n=26) and a group of unaided quitters (n=104). Participants were interviewed prior to their quit attempt and again four months later. Nineteen of the unaided quitters were lost to follow-up. Both quantitative and qualitative data was collected. Few significant differences existed between the groups at the first interview. Among participants who completed both interviews, point prevalence at follow-up was 35% for the Noho Marae group versus 14% for the unaided group. The findings support the effectiveness of Noho Marae smoking cessation interventions. Recommendations on how to strengthen New Zealand's tobacco control programme are made. A greater emphasis on delivering to whanau, rather than focusing interventions on individuals, is recommended. Priority is currently given to groups identified as having higher smoking rates. Decline in smoking prevalence may be hastened by identifying and serving the groups most ready to change smoking behaviour. Further research is indicated, for example, to better understand the smoking cessation needs of pregnant Maori women.