Understanding and optimising access to heart healthcare for rural Māori communities
Aim: In Aotearoa New Zealand (AoNZ), Māori living in rural areas experience inequities in cardiovascular outcomes compared to rural non-Māori and urban Māori. Rural Māori communities also experience additional challenges in accessing care compared to their urban counterparts. This thesis seeks to understand the factors that influence access to cardiovascular care for rural Māori living in Te Tai Tokerau, Northland, and, by virtue, to develop recommendations for optimising access to care. Methods: We used a mixed methods approach guided by Kaupapa Māori methodology. The studies included a scoping literature review of the barriers and facilitators to accessing heart healthcare for rural Māori and Indigenous Peoples, semi-structured interviews with rural whānau Māori and healthcare providers in Te Tai Tokerau Northland, a quantitative analysis of ST-elevation myocardial infarction outcomes by ethnicity and across the rural-urban spectrum AoNZ, and a synthesis of findings using the Te Tiriti o Waitangi Framework. Results: Our scoping review identified several key drivers that influence access to heart healthcare for rural Indigenous peoples, but also found a lack of literature in the context of AoNZ. The semi-structured interviews with rural whānau Māori found that rural Māori desire heart healthcare that is close to home, culturally responsive, includes a representative Māori workforce, involves their whānau, and values partnership. Interviews with heart healthcare providers revealed how discourses of colonialism, metronormativity, and neo-liberalism influence narratives about healthcare access in rural Māori communities. The quantitative analysis discovered that rural Māori have poorer access to guideline-recommended interventions and worse heart health outcomes than some urban Māori and non-Māori. Our synthesis led to five recommendations for optimising heart healthcare for rural Māori communities: equitable resource distribution, Te Tiriti o Waitangi-centred care, rural Māori partnerships, valuing our heart healthcare workforce, and establishing a rural Māori heart health hub. Conclusions: Our research indicates that optimising heart healthcare for rural Māori communities is a complex challenge that requires targeted responses at the system, service, and community levels. Using Te Tiriti o Waitangi as a guiding framework for care optimisation offers a pro-equity and Māori-rights approach, driving transformative change for rural whānau Māori.
Cardiovascular diseases, Maori health, Rural health
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