Understanding and Improving Stroke Recovery for Māori and Their Whānau

Abstract

This thesis sought to understand ethnic disparities in stroke within Aotearoa, New Zealand, from the perspectives of Māori. Stroke burden is greatest for Māori, the indigenous peoples of New Zealand, who have higher rates and worse outcomes compared with non-Māori. Importantly for Māori with stroke, the disparity in outcomes (including dependence and quality of life) compared with New Zealand Europeans increases significantly in the 12 months after being discharged from hospital into the community. Reasons for this are not clear.

The study’s aims were twofold—to provide a deeper understanding of the stroke experience for Māori with stroke and their Whānau; and to design interventions that could potentially improve stroke outcomes. A qualitative approach to the research was taken in order to gain an understanding of people’s experience, attitudes and beliefs. Constructivist grounded theory was utilized to ensure a wider focus on societal influences. The project also involved Māori as researcher and researched and sought to make a positive difference for Māori with stroke and their Whānau. These concepts fit within the Kaupapa Māori research framework which also guided the research.

Five themes explaining the stroke experience were constructed from data collected from in-depth interviews with 18 Māori with stroke and nine people who identified themselves as Whānau caring for Māori with stroke. Personal context, optimal stroke care, Whānau wellbeing, a stand against discrimination and taking charge occur in isolation, or combine, to influence stroke recovery or Māori with stroke and their Whānau. The five themes were presented to three key stakeholder focus groups of Māori with stroke, Whānau of Māori with stroke, and stroke funders and providers. Two practical interventions were proposed by the groups: a DVD of role models and a person- and Whānau-centred assessment designed to engage the patient and their family in the process of recovery.

This research suggests that inequity of indigenous health and rehabilitation outcomes in stroke requires a comprehensive and multi-faceted response. A stroke strategy that achieves the aspirations of Māori to take charge is required.