Dr Mary Simpson is a Senior Lecturer with the Waikato Management School, with 15 years health social-work experience, working primarily with elders and families. She is experienced in qualitative research, and working with elders, kaumātua, and Te Rauawaawa (research and with student volunteers for the Kaumātua Olympics and Kaumātua Idol).
A tuakana-teina/peer support approach to kaumātua managing life-transitions in older age: A culture-centred intervention
Rangimahora Reddy (Raukawa, Ngati Maniapoto, Waikato Tainui, Ngati Rangiwewehi me Rangitane ) is experienced in leading for-kaumātua-by-kaumātua organisation. She brings networks in the health and social services sector serving kaumātua and skills in project management, financial management and business development. She co-leads the project, managing contractual and working relationships with advisory and experts groups.
Dr Sophie Nock (Ngāti Kurī) is a senior lecturer in Te Pua Wānanga ki te Ao, the Faculty of Māori & Indigenous Studies. Sophie is primarily involved in the teaching and researching of te reo Māori, and has published in this area. Her PhD investigated the teaching and learning of te reo Māori in English-medium, secondary schools in relation, to materials, methodology and teachers’ linguistic and educational backgrounds.
Prof. John G. Oetzel uses community-based participatory research to collaboratively work with communities to address various health issues to improve health equity. His current work includes the collaborative development of interventions with two Māori health organisations related to pre-diabetes (He Pikinga Waiora) and positive ageing (Kaumātua Mana Motuhake). He co-leads the project contributing to research design and evaluation. He is committed to collaborative design so that the research and interventions fit the context and needs of communities, and are culturally centered.
In spite of research efforts designed to engage with Indigenous groups to better develop, and deliver, culturally based health programmes, health inequities persist for Indigenous communities, and more so for older Indigenous persons. In Aotearoa New Zealand, Māori kaumātua (elders 55-years-plus) do not realize their full potential because the dominant culture fails to recognise and respond to either, their roles within Te Ao Māori (Māori world), or their ongoing and emerging health needs. Innovative, culture-centred approaches are needed to privilege Māori kaumātua voices when identifying health, wellbeing, and life-transition related issues to address kaumātua health and wellbeing needs and associated inequities.
This panel reports on a culture-centred programme that took a strengths-based approach to highlight the potential of kaumātua mana motuhake (i.e., identity, autonomy) to extend meanings of improved health outcomes for Māori by having kaumātua be “tuakana-teina” (i.e., peer supporters). “Tuakana-teina” is a Māori cultural concept that encapsulates relationships between older and younger, same-sex siblings or cousins. Tuakana-teina support has been used effectively in education settings with younger Māori, but not with kaumātua. Our research, involved kaumātua working with kaumātua within tuakana-teina/peer support relationships as an approach to addressing health, wellbeing, and transitions in later life. This approach was driven by kaumātua themselves.
In total, 30 tuakana and 180 teina aged 55-years-and over participated in the study. After taking part in the tuakana orientation programme, each tuakana held a conversation with each of six teina at least three times. Conversations addressed relevant life-transitions of the teina. The research design was a pre- and post-test, clustered randomised staggered design with Tuatahi (fist intervention; n = 15) and Tuarua (second control; n = 15) groups. Tuatahi participated in an initial orientation programme, while Tuarua participated in a subsequent programme. The orientation programme comprised four sessions of four hours each which were facilitated by Māori, community, and health communication researchers.
We assessed the capacity of tuakana at three stages: pre-test, post-intervention for the Tuatahi group, and post-intervention of the Tuarua group, with teina completing three evaluations at the same stages. The research design enabled a rigorous comparison of the training whilst ensuring that all teina participated in the programme. All conversations were audio-recorded and coded using a fidelity check list. The findings provide a rich insight into the outcomes of a culturally-centred programme designed to address the health and wellbeing needs of Māori kaumātua. Key themes and lessons learnt will be presented.
Culture-centred Research Collaboration
Our culture-centred collaboration, centralised kaumātua (elders) mana motuhake (autonomy) so that kaumātua simultaneously had value and responsibility. Community-based participatory research (CBPR) is a collaborative research approach for something that matters, and is driven by self-determination, working together, and co-designing the research. Self-determination enhances research quality because all ways of knowing are respected, learning is expansive, and strengths are built together. In this study, integration of kaupapa Māori and CBPR is evident in long-term relationships of community, Māori studies, and health communication researchers that are based on trust, care and knowledge sharing.
Both Kaupapa Māori research and CBPR are attuned to ethics of promoting human rights, informing methodology, and ensuring the integrity of both research and researchers. This position ensures a commitment to a kaumātua-centred approach: That is, kaumātua mana motuhake kaupapa guides the mātāpono (principles) in developing the program. The research is co-led by a for-kaumātua-by-kaumātua Māori organization and therefore, tino rangatiratanga (self-determination) remains with kaumātua themselves. This part of the panel explains how the University of Waikato and Rauawaawa Kaumātua Charitable Trust, and Māori, community, and health communication researchers worked together. It explores practices the team developed to create and maintain culture-centred collaboration.
Culture-centred Research Design
Culture-centred approaches start within the culture, working with people to identify and develop culturally centre responses to issues of most concern to members. In this way the status quo is interrogated, rather than adapted to. Similarly, Aotearoa New Zealand’s cultural safety concept takes a health service user’s perspective. It aligns with culture-centred approaches by showing how Māori resistance to western dominance in approaches to ideas and practice of health care. In relation to Māori kaumātua, cultural safety and culture-centred approaches privilege their voices in identifying health, wellbeing, and life-transition related issues.
The value of tuakana-teina/peer-support for kaumātua is found in health interventions where attending to cultural factors positively improves participation rates and program effectiveness for adult Māori. Also, peer support with older people is effective with life-transitions, such as acute and chronic, situational, health, and social stressors. Thus, a culture-centred, te ao Māori (Māori worldview) driven, kaumātua tuakana-teina/peer-support program may improve kaumātua wellbeing through promoting cultural connections. This part of the panel explains the ways in which the research design was culture-centred in the development of the kaumātua tuakana-teina/peer-support program.
Culture-centred Pilot Programme
This part of the panel explains the development of a culture-centred, strength-based, holistic design kaumātua tuakana-teina/peer-support training program and outcomes of the pilot. The methodology ensured that the project was kaumātua- and end-user-led, with the design being guided by te ao Māori (The Māori World), consultation with kaumātua, input from the Board and Expert Advisory Groups, and peer education literature related to Māori and indigenous peoples; elders and health. The program utilised the Māori creation story and used three components as its framework: Te Korekore (The Nothingness), realising the potential of kaumātua, Te Pō (The Night), becoming the Tuakana, and finally Te Ao Mārama (The Light), being a Tuakana. The research team delivered the pilot program of three 2-3-hour sessions (including lunch) over three days. Throughout, the program structure of each session was consistent with Māori tikanga (Māori culture/protocols/philosophy) such as mihimihi (greetings), manaakitanga (sharing and caring) to name a few. Some of the key outcomes from the pilot included whakawhaungatanga (the forging and building of relationships); the complete willingness of kaumātua to participate in the pilot; Manaakitanga (sharing and caring); and the openness of the kaumātua to share their knowledge, their stories and their experiences.
Culture-centred Health and Wellbeing: The Outcomes
This part of the panel will discuss preliminary outcomes of pilot-informed revised kaumātua tuakana-teina/peer-support training program. Initial outcomes of the training program were: increasing whakawhaungatanga (forging/ building of relationships) between tuakana and teina; building of wairuatanga (spirituality); building of communities through supporting the health and social wellbeing of kaumātua; and enhancing a sense of responsibility and reciprocity in mutually beneficial ways uplifted the mana (pride/esteem) of both tuakana and teina. In the process, self-efficacy for tuakana and teina, benefited in increased social integration and engagement. Specifically, support from a tuakana may have prevented social isolation as teina worked through life-events, and tuakana identified increased meaning and engagement in the self-efficacy that supporting another can enable. Other positive impact included the layers of learning and cultural connectedness developed through kaumātua sharing stories, knowledge, and experiences. More broadly, the outcomes of the project promoted Indigenous creativity/innovation and the belief that Māori approaches, with the inherent relevance of kaumātua mātauranga (knowledge, create contextually based and culturally safe age-friendly environments and practices. That is, this collaborative project developed a program that can help to facilitate kaumātua engagement and participation, and thereby contribute to the quality of life of all New Zealanders.