Māori Women’s Experiences of Engagement with Primary Health Care (PHC)

Abstract

Māori are the indigenous people of Aotearoa-New Zealand. As a population, Māori have on average the poorest health status of all ethnic groups in Aotearoa (Reid & Robson, 2007). Much of this ill health is manageable and preventable with adequate Primary Health Care (PHC) (Hefford, Crampton, & Foley, 2005). Despite longstanding health inequalities and inequities, barriers to accessing and utilising PHC for Māori women, continue to compound health issues (Buetow, Janes, Steed, Ihimaera, & Elley, 2007). This has prompted considerable interest in the area of Māori access to, and utilisation of PHC, by researchers in recent decades (Crengle, 2000; Jansen, 2009; Malcolm, 1996). Māori women’s experiences of engagement with their providers, as determinants of access and utilisation of PHC, remain largely under-researched. Drawing upon a kaupapa Māori framework and the employment of a general inductive approach to qualitative research, the present study explored the experiences of Māori women’s engagement with their usual PHC providers. The primary aim of this research was to identify and understand the experiences that discouraged or encouraged a group of Māori women in Auckland, to seek and attend care with their usual PHC providers. This study employed a purposeful sampling method to recruit twelve Māori women. The women participated in initial meetings to establish a rapport with the researcher, and then a second meeting that used in-depth interviews to collect data. Findings indicated that many of the prerequisites for adequate engagement with PHC were consistent with current treaties, policies and research, but required more effective implementation. In addition, the findings suggested a need for more opportunities in service design and a more personal approach in service delivery, with both design and delivery maintaining a level of cultural competence. Importantly the research also found that the women exerted agency in various ways when posed with challenges during engagement with PHC. These findings have important implications for strengthening the enablers and breaking down the barriers to engagement in PHC for Māori women. The study’s conclusion suggests service design and delivery enablers that have the potential to improve engagement experiences and encourage the women to seek and attend care with their usual PHC providers. Ensuring the implementation of adequate PHC that is recognised, supported and adequately resourced by the New Zealand government is required to improve engagement experiences and provide long term sustainable and equitable PHC for the Māori women in this study.