Māori Access to Health Services
Funded by the Ministry of Health
The aim of this project was to answer the question, How can access to health services be improved for Māori? This work underpinned the Ministry of Health's 2014 Equity of Health Care for Maori: A framework.
The focus of this project was on cancer, diabetes, and cardiovascular disease. The three objectives were to:
Increase the health sector’s understanding of the issues affecting Māori access to health services
Provide an evidence base for action to improve access to health services for Māori
Provide solutions to improve access to health services for Māori
In addition to literature reviews on interventions to improve access to diabetes, cardiovascular and cancer health care, key informants were interviewed for their views about improving access to health services. Individual reports were produced in each area, as well as an overall research report on improving Māori access to health care. The five reports are available below.
1.Access_ResearchReport.pdfImproving Māori access to health care: research report
June 2014
This report provides an integration of the findings from three literature reviews and key informant interviews. The reviews examined interventions to improve access to health care for each of the conditions – cancer, cardiovascular disease, and diabetes – for Māori and other Indigenous and ethnic minority patients (in particular Hispanic and African American patients). The reviews drew on research conducted in the United States, Australia, New Zealand and, to a lesser extent, Canada and the Pacific. Key informants working in community, primary, secondary and tertiary health care in New Zealand were asked about improving access to health care for patients, and in particular Māori patients.
2.Access_KeyInformants.pdfImproving Māori access to cancer, diabetes and cardiovascular health care: Key informant interviews
June 2014
Forty-seven key informants working in cancer, CVD, diabetes, Māori health, funding and planning, Ministry of Health, and health research were interviewed. They were asked about their knowledge of evidence- and practice-based interventions to improve access to health care for the general population, as well as specifically improving access for Māori. The four themes of patient, health practitioner, health organisation, and health system provided a broad structure for the analysis of key informant interviews. Key informants highlighted several opportunities for improving Māori access to health care. Māori patients need to be considered within the context of their whānau and reached out to by health care providers who can operate in relationship-based ways while delivering professional health services. Māori staff, and culturally competent non-Māori staff, can help make health organisations places where Māori are welcomed. In the long term the commitment of organisational leadership to reducing health care disparities may see the strengthening of organisational capacity to deliver culturally responsive health care.
3.Access_CancerLit.pdfImproving Māori access to cancer health care: Literature review
June 2014
This report examines 2007-2013 literature on how to successfully intervene to make cancer health care services more accessible for Māori through a focus on interventions that have worked for Māori and other Indigenous and ethnic minority peoples. Five systematic reviews, two meta-analyses, and 37 intervention studies were identified from the literature search. The reviews and meta-analysis and 17 studies focused on improving access to cancer screening. Two of the reviews also examined access to cancer diagnosis and treatment. In addition two of the reviews and seven studies looked at diagnosis; one review and 10 studies looked at treatment; and there were four comprehensive or ecological intervention studies.
Culturally tailored education material helps increase patient knowledge and may support screening behaviour. Such information can also be tailored to address patient-specific needs and barriers through interactive delivery platforms (e.g., websites). These low intensity resources are also more effective when they are used in conjunction with other community-based or navigation services. This can be supported by health system investment in community capacity to deliver educational programmes.
Community health workers can facilitate cancer patients’ health care journeys through the provision of culturally tailored support, education, counselling and coaching. Community health workers may be from the same communities as cancer patients, and may themselves be cancer survivors. Patient navigators can support patients’ cancer care journeys, and buffer them from a health practitioner workforce or health organisation that lacks cultural competence.
Building health practitioners skills improves their knowledge, attitudes and ability to be culturally responsive. Chart-based reminders for health practitioners also improve health care delivery. Organisational changes, including responsiveness to community input, can improve patient access to health care. However a lack of organisational stability or leadership can derail organisational initiatives. The health system an support patient access to cancer care through the reduction of any financial barriers and through national campaigns (e.g., to encourage screening).
4.Access_DiabetesLit.pdfImproving Māori access to diabetes health care: Literature review
June 2014
This report examines 2007-2013 literature on how to successfully intervene to make diabetes health care services more accessible for Māori through a focus on interventions that have worked for Māori and other Indigenous and ethnic minority peoples. Thirty-two papers were included in the review.
Aggressively treating hypertension, hyperglycaemia and hyperlipidaemia was ‘considerably more cost-effective’ for African Americans with diabetes, compared to general population diabetics. The burden of diabetes in the Māori population is similar to the African American population, suggesting that such aggressive treatment will also be cost-effective for Māori.
Self-management is difficult for people with type 2 diabetes to sustain. Success in managing risk factors is possible if interventions are culturally appropriate and relevant, community-based, and focused on small changes over time. Community health workers provide practical help, health education, and emotional and motivational support to those with diabetes within the community and in health clinics. Their success is due to their socio-cultural characteristics, combined with their personal qualities and training.
Nurses have an important role to play in supporting people with diabetes maintain normal glycaemia. When diabetes nurses can also adjust medication, patients report satisfaction and there are fewer referrals to general practitioners – thereby decreasing their workloads. The cultural-tailoring of health clinic policies, organisation and health care models is also important, as individual health practitioners can only do so much to improve access to health care without organisational back-up.
5.Access_CVDLit.pdfImproving Māori access to cardiovascular health care: Literature review
June 2014
This report examines 2007-2013 literature on how to successfully intervene to make cardiovascular health care services more accessible for Māori through a focus on interventions that have worked for Māori and other Indigenous and ethnic minority peoples. In addition to five reviews 15 cardiovascular disease access intervention studies were included in the present review.
Hypertension among ethnic minority populations has been shown in several large studies to be amenable to effective and sustainable change (lowering) through culturally responsive health care that uses system level (access to care) as well as personal (behavioural and pharmacological) strategies.
Culturally and linguistically tailored behavioural interventions, delivered by multidisciplinary teams that include community health workers are effective. The leadership of nurses within these and other initiatives is also acknowledged in the literature. Health practitioners can improve access through the application of clinical guidelines and advice. An ‘electronic backbone’ can support health practitioners in this. Health organisations can improve access by building their capacity to deliver culturally tailored health care to Māori patients. This includes the collection of accurate patient ethnicity data. Regulatory reforms and policy drivers can also be exerted by the health system to ensure, for example, the collection of accurate ethnicity data, the development of local-level plans and initiatives, and engagement with Māori leaders and communities.