Māori Health

Evaluation of the Green Prescription (GRx) Maternal Nutrition programme, 2014-15

Delivered by Sport Hawke's Bay. This evaluation is funded by Hawke's Bay District Health Board and being conducted by Fiona Cram and Aneta Cram.

Sport Hawke’s Bay has been contracted by Hawke’s Bay District Health Board (DHB) to implement a specialised antenatal programme based on the fundamentals of the Green Prescription (GRx) initiative. The programme will provide supportive healthy lifestyle approaches around pregnancy for Māori, Pacific, and young mothers-to-be. Katoa Ltd has been contracted to work alongside Sport Hawke’s Bay and the DHB on a formative evaluation of the first six months of the programme’s implementation. The formative evaluation will allow for programme and evaluation development in response to the assessment of whether the programme is reaching and engaging with its target audiences, and whether outcomes are being appropriately measured and achieved. At the end of the formative evaluation phase Sport Hawke’s Bay will be well prepared for on-going delivery of this programme within a learning environment, and the evaluation will have firmed up implementation and outcome assessment measures.

Reporting: Cram, F., Cram, A. & Greening, T. (2015). Green Prescription (GRx) Maternal Nutrition: Evaluation report. Prepared by Katoa Ltd for Hawke’s Bay District Health Board.

E Hine, University of Otago, 2010-2014

Fiona Cram is collaborating with colleagues on this Health Research Council funded project. The project is based at the Women's Health Research Centre in collaboration with Te Rōpū Rangahau Hauora a Eru Pomare,  University of Otago, Wellington. The project was funded by the Health Research Council from August 2010 - July 2013, with subsequent funding from the Ministry of Health.

Māori infants are more likely to have poorer health outcomes, less access to health services and are more likely to die in the first year of life than non-Māori. Māori infants also have more admissions to hospital for respiratory illnesses and are less likely to be fully immunised than non-Māori. To understand what is happening to Māori infants, we are using qualitative research methods to identify barriers to, and facilitators of, appropriate health care and wellness for pregnant Māori women under years of age. We are also examining the social, economic and policy factors that may impact on health outcomes. Our findings will inform policy, and together with results of a related retrospective 10-year cohort study of Māori and non-Māori pregnant women, will provide essential information for the design of an appropriate whānau ora intervention to improve health outcomes (reduced mortality and disability) for Māori infants.


Adcock, A., Cram, F. & Lawton, B. (2018). E Hine: Young Māori women's journeys through pregnancy, birth, and motherhood. In D. Akella (Ed.). Socio-cultural influences on teenage pregnancy and contemporary prevention measures. Hershey, PA: IGI Global. pp. 250-272.

Adcock, A., Lawton, B. & Cram, F. (2016). E Hine: talking about Māori teen pregnancy with government groups. AlterNative: An International Journal of Indigenous Peoples12(4), 380-395. DOI: 10.20507/AlterNative.2016.12.4.4. Download at the bottom of this page

Cram, F. (coming soon). E Hine: Young Māori mothers talk about welfare benefits. Paper prepared for the Ministry of Social Development.

Dhunna, S., Lawton, B. & Cram, F. (2018). An affront to her mana: Young Māori mothers’ experiences of intimate partner violence. Journal of Interpersonal Violence. First Published On-line December 17, 2018. Request this paper.

Lawton, B., Makowharemahihi, C., Cram, F., Robson, B., & Ngata, T. (2016). E Hine: Access to contraception for Indigenous Māori teenage mothers. Journal of Primary Health Care8(1), 52-59.

Lawton, B., Cram, F., Makowharemahihi, C., Ngata, T., Robson, B., Brown, S. & Campbell, W. (2013). Developing a Kaupapa Māori research project to help reduce health disparities experienced by young Māori women and their babies. AlterNative: An International Journal of Indigenous Peoples9(3), 246-261Download at the bottom of this page

Makowharemahihi, C., Lawton, B., Cram, F., Ngata, T., Brown, S. & Robson, B. (2014). Initiation of maternity care for young Māori women <20 years of age. New Zealand Medical Journal127 (1393).

Stevenson, K., Filoche, S., Cram, F. & Lawton, B. (2016). Lived realities: Birthing experiences of Māori women under 20 years of age. AlterNative: An International Journal of Indigenous Peoples12(2), 124-137. Download at the bottom of this page

A Dashboard for Monitoring Ngāti Kahungunu Health and Well-being, 2013-14

Fiona Cram

In 2006 Ngāti Kahungunu Iwi Incorporated developed Te Ara Toiora, the strategic vision for the peoples of the Iwi to achieve “excellence in all areas of their lives”: “Kahungunu, Ki Te Whaiao, Ki Te Ao Marama. The three aims of Te Ara Toiora are for Ngāti Kahungunu whanui: to be Kahungunu; to participate as a contributing nation in the world; and to be healthy and enjoy a high standard of living.

Tuahiwi, the Ngāti Kahungunu Iwi Dashboard, has been developed out of Te Ara Toiora. The goals of Tuahiwi are twofold: to measure the responsiveness of organisations to whānau, and to measure the wellbeing of whānau. Ngāti Kahungunu Iwi Incorporated contracted Katoa Ltd to undertake the initial development of a framework to meet these goals. An initial framework was developed, along with a proposal for the next steps of development and testing of the framework.

Reporting: Cram, F. (2014). Tuahiwi: Whaia te mana me te mauri. A report prepared for Ngāti Kahungunu Iwi Incorporated. Auckland: Katoa Ltd.

Improving Māori Access to Health Services, Ministry of Health, 2012-13

Fiona Cram

The aim of this project is to answer the question 
How can access to health and disability services be improved for Māori? The objectives of the project are to:

  • Increase the health and disability sector’s understanding of the issues affecting Māori access to health and disability services
  • Provide an evidence base for action to improve access to health and disability services for Māori
  • Provide solutions to improve access to health and disability services for Māori

The project looks along the continuum of care for initiatives that will improve Māori access to cancer, cardiovascular disease, and diabetes mellitus health care services. The first part of the project is literature reviews of interventions that improve access for Māori, Indigenous and other ethnic minority groups. In the second part of the project key informants are being interviewed and asked for their expert advice for improving Māori access to healthcare. In the third part of the project a health system framework is being developed for improving access.


The reports from this project are now available.

  • Improving Māori access to health care: Research report
  • Improving Māori access to cancer, diabetes and cardiovascular health care: Key informant interviews
  • Improving Māori access to cancer health care: Literature review
  • Improving Māori access to diabetes health care: Literaure review
  • Improving Māori access to cardiovascular health care: Literature review

Pukapuka Hauora: Parent's knowledge of preventing and treating their child's asthma, 2009-12

Fiona Cram is working alongside Bernadette Jones and Tristram Ingham, University of Otago, Wellington; Cheryl Davies, Tu Kotahi Māori Asthma Trust, Kokiri Marae; and Sarah Dean, University of Exeter Medical School.

The prevalence of asthma for Māori is amongst the highest in the world. Recent evidence shows ethnic differences in asthma symptom prevalence in Aotearoa New Zealand has increased, with the prevalence of asthma symptoms among Māori children nearly 1.5 times greater than for European children and Māori hospitalisation rates consistently higher than European across all age-groups – especially for children and adolescents. 

The aim of the Kaupapa Māori Pukapuka Hauora (Healthy Lungs) Asthma Study is to "collect and understand the insights of Māori parents, and their children, exploring their day-to-day realities, beliefs about asthma management as well as their experiences and challenges in achieving optimum asthma outcomes” (Jones et al., 2013, p.2). Thirty-two whānau (families) have each participated in four in-depth interviews done over the course of 12 months. During these interviews whānau have talked about their experiences of having a child with asthma. The findings from this study are currently being written up for publication.


Jones, B., Ingham, T.R., Cram, F., Dean, S. & Davies, S. (2013). An Indigenous approach to exploring health-related experiences among Māori parents: The Pukapuka Hauora asthma study. BioMed Central13:228 (15 March 2013).

Jones, B., Ingham, T., Davies, C. & Cram, F. (2010). Whānau Tuatahi: Māori community partnership research using a Kaupapa Māori methodology. MAI Review, Issue 3.

Evaluation of the Vulnerable Pregnant Women's Multidisciplinary Team, Hawke's Bay District Health Board, 2011

Fiona Cram and Adreanne Ormond

The Vulnerable Pregnant Women's Multidisciplinary Team aims to reduce the vulnerability of pregnant women and ensure that every pregnancy has the healthiest outcome for mother and baby. Inter-agency collaboration is deployed as a way for people and organisations to combine their vision, strategy, multiple skills, knowledge and experience to facilitate solutions to the complex issues (e.g., socio-economic, health, community and cultural issues) that vulnerable women face. A high number of referrals to the Team cme from those in the DHB or from the women’s lead maternity carer. This evaluation relied on the Team's data and insights from Team members to assess the Team’s work. 

The data provided an overview of how the Team attended to vulnerable women and their babies, and when and why their case files were closed. A third of the cases in the database had been closed by the Team because there were no further concerns. In many cases the women and babies had been referred to appropriate providers. What stood out was that the Team was able to maintain a watching brief over these women in their community; they knew these women, where they were, and how they were doing – both formally and informally.

The evaluation concluded that the Vulnerable Pregnant Women’s Multidisciplinary Team employed a collaborative team model in order to provide a wraparound service from multiple agencies. The agencies in the Team were committed to their support roles and shared a common vision to assist women, babies, and families to achieve the healthiest possible outcomes. Team members found the collaboration to be valuable in terms of supporting the women as well as the Team. At first they were unaware of each agencies’ role, expertise and knowledge. This changed over time as they worked closely together, discussed collaborative solutions, and demonstrated expertise and knowledge. The Team leadership was stable and facilitated an environment of trust where various perspectives and approaches to sensitive topics could be rigorously discussed.

A presentation at the 2012 AES Conference, 'Quizzing purposeful Relationships', discusses the relationship questionnaire used in this evaluation.

Māori Oral Health projects, 2010-11

Two projects were conducted in collaboration with Research Evaluation Consultancy. The first project was an evaluation of the Māori Oral Health Providers Project. The second project examined Future Directions for a Māori Dental Therapy Workforce. Read more

Shifting Māori Health Needs, 2010

This paper examines Māori population trends and the impact these are likely to have on Māori demands for health services over the next 10-20 years, looking specifically at the demands on the Māori medical workforce. Read more

Journeys in Māori Health Research, Ministry of Health Hui, 2006

In August 2006 the Ministry of Health, in conjunction with the Health Research Council of New Zealand, held a hui at Te PapaTongarewa, Wellington, for emerging and experienced Māori health researchers. This hui was organised by Katoa Ltd and preceded the HRC's Hui Whakapiripiri. Read more

Whakatātaka 2006, Ministry of Health Hui, 2005

This Ministry of Health workshop in April 2005, organised by Katoa Ltd, brought over 50 people together to begin a conversation about the Ministry's Māori health research priorities for the next 5-10 years. Read more

Closure of the Whakatu Freezing Works, 1994-

Te Rōpū Rangahau Hauora a Eru Pomare, the Māori Health Research Centre at the University of Otago Wellington, has been working with Ngāti Kahungunu Iwi Incorporated over the past 17 years to carry out research on the health effects of the closure of Whakatu and Tomoana Freezing Works. Read more

Māori Patients and Pākehā General Practitioners Talk About Māori Health, 1999

A major feature of this research project was that it involved parallel investigations by Māori and Pākehā teams of researchers, respectively, of the Māori and Pākehā discourses on Māori health.Read more

He Oranga Poutama, Evaluations of Years 2 and 3, 1998-1999

He Oranga Poutama was initially developed by the Hillary Commission and subsequently established as one of the key medium-term strategies for Omangia Te Oma Roa (Run the Long Journey/Participate in Life), to facilitate Maori aspirations for health and wellness. Read more about the evaluations of years 2 and 3 of He Oranga Poutama.
Fiona Cram,
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Fiona Cram,
17 Aug 2018, 22:54
Fiona Cram,
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