Exploring Māori Experiences of Bariatric Surgery

Abstract

Aim This thesis sought to present evidence encasing Māori experiences of bariatric surgery using Kaupapa Māori Research (KMR) methodology to lay the foundations for future research on Māori health and bariatric surgery. Methods A mixed methods approach was used to address the overall study aim. First, the thesis aimed to set the context for Māori health in surgery and bridge the gap between what is known and what is not known in the space of Māori health and bariatric surgery in Aotearoa New Zealand. Counties Manukau Health (CMH) houses the largest public bariatric service in the country and serves a high number of Māori. It was deemed to be the best locality to undertake this research. The following studies were performed in succession: 1. Systematic review of disparities in surgical care for Māori along the surgical care continuum 2. Systematic review of bariatric surgery among Indigenous peoples worldwide 3. Retrospective review of print news media related to Māori and bariatric surgery as a way to understand wider societal perspectives of this important issue in Aotearoa/NZ 4. Retrospective cohort review of all patients who were referred to the CMH bariatric service to identify whether Māori face inequitable access to bariatric surgery and to investigate where in the process this might be occurring 5. Qualitative analysis of semi-structured interpersonal interviews with Māori who had bariatric surgery at CMH to inform service-level changes that may enhance responsiveness to Māori Results Two systematic reviews conveyed an urgent need for research surrounding Māori and bariatric surgery. A review of print news media coverage of Māori and bariatric surgery was predominantly limited to government announcements of additional funding through Māori members of parliament. Health equity rarely featured among all news articles, which more than likely reflected that health equity for Māori in bariatric surgery is not widely prioritised. With a general understanding that publicly funded bariatric surgery in NZ is accessed mostly by NZ Europeans, a retrospective cohort review sought to investigate whether this is also the case at CMH. Overall, referrals were highest for Māori and Pacific compared to NZ Europeans; however, NZ Europeans were more likely to receive bariatric surgery at CMH, even after adjustment for individual factors such as age, gender, comorbidity and deprivation. Semi-structured interviews with 31 Māori participants who had bariatric surgery at CMH shared numerous experiences of their bariatric surgery journey and their lives prior to surgery. From these experiences, four key changes to the CMH bariatric pathway, that would greatly enhance the programme for Māori, are proposed. These include the institution of Kaupapa Māori standards of health, bariatric surgery mentors, a bariatric psychologist and integrating the CMH bariatric service with community-led health programmes in South Auckland, NZ. Conclusion Understanding the role bariatric surgery has in achieving health equity for Māori is an important but highly under-researched issue. Additionally, Māori experiences of bariatric surgery have not before been investigated in the literature. As a result, publicly funded bariatric services have no contextual guidelines on how they can prioritise health equity for Māori who engage with their service. Māori participants at the largest public bariatric service in NZ described a need for Kaupapa Māori and more supportive changes to be implemented into the bariatric pathway. Through these mechanisms, bariatric pathways may begin to enhance their responsiveness to Māori who engage with bariatric services.