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Globalization and Health
Published in: Globalization and Health 1/2017

Open Access 01-12-2017 | Debate

Implementation framework for chronic disease intervention effectiveness in Māori and other indigenous communities

Authors: John Oetzel, Nina Scott, Maui Hudson, Bridgette Masters-Awatere, Moana Rarere, Jeff Foote, Angela Beaton, Terry Ehau

Published in: Globalization and Health | Issue 1/2017

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Abstract

Background

About 40% of all health burden in New Zealand is due to cancer, cardiovascular disease, and type 2 diabetes/obesity. Outcomes for Māori (indigenous people) are significantly worse than non-Maori; these inequities mirror those found in indigenous communities elsewhere. Evidence-based interventions with established efficacy may not be effective in indigenous communities without addressing specific implementation challenges. We present an implementation framework for interventions to prevent and treat chronic conditions for Māori and other indigenous communities.

Theoretical framework

The He Pikinga Waiora Implementation Framework has indigenous self-determination at its core and consists of four elements: cultural-centeredness, community engagement, systems thinking, and integrated knowledge translation. All elements have conceptual fit with Kaupapa Māori aspirations (i.e., indigenous knowledge creation, theorizing, and methodology) and all have demonstrated evidence of positive implementation outcomes.

Applying the framework

A coding scheme derived from the Framework was applied to 13 studies of diabetes prevention in indigenous communities in Australia, Canada, New Zealand, and the United States from a systematic review. Cross-tabulations demonstrated that culture-centeredness (p = .008) and community engagement (p = .009) explained differences in diabetes outcomes and community engagement (p = .098) explained difference in blood pressure outcomes.

Implications and conclusions

The He Pikinga Waiora Implementation Framework appears to be well suited to advance implementation science for indigenous communities in general and Māori in particular. The framework has promise as a policy and planning tool to evaluate and design effective interventions for chronic disease prevention in indigenous communities.
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Metadata
Title
Implementation framework for chronic disease intervention effectiveness in Māori and other indigenous communities
Authors
John Oetzel
Nina Scott
Maui Hudson
Bridgette Masters-Awatere
Moana Rarere
Jeff Foote
Angela Beaton
Terry Ehau
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Globalization and Health / Issue 1/2017
Electronic ISSN: 1744-8603
DOI
https://doi.org/10.1186/s12992-017-0295-8

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