Inequalities between Maori and non-Maori men with prostate cancer in Aotearoa New Zealand.

Maori experience poorer health statistics in terms of cancer incidence and mortality compared to non-Maori. For prostate cancer, Maori men are less likely than non-Maori men to be diagnosed with prostate cancer, but those that are diagnosed are much more likely to die of the disease than non-Maori men resulting in an excess mortality rate in Maori men compared with non-Maori. A review of the literature included a review of the epidemiology of prostate cancer; of screening; of access to healthcare and of treatment modalities. Our conclusion was that there are a number of reasons for the disparity in outcomes for Maori including differences in staging and characteristics at diagnosis; differences in screening and treatment offered to Maori men; and general barriers to healthcare that exist for Maori men in New Zealand. We conclude that there is a need for more culturally appropriate care to be available to Maori men.

Health service provider responses to indigenous peoples with cancer: An integrative review.

Indigenous populations around the world have a higher burden of cancer incidence, severity and mortality. This integrative review aims to identify and appraise the evidence of health providers' responses to the issue of indigenous peoples with cancer. A surprisingly small number of studies were found (n = 9) that reported on programmes and interventions for indigenous people with cancer, the majority of which were from the USA. Our review shows that a service delivery approach that is focused on the indigenous population and includes culturally appropriate activities, resources and environments resulted in an increase in cancer knowledge, reduction in treatment interruption, improved access to cancer care and enrolment in clinical cancer trials, and increased satisfaction with health care. However, the question of why there are so few published studies needs further consideration.

Cultural health literacy: the experiences of Maori in palliative care.

Health literacy is a concept that is frequently applied to the patient's ability to find and comprehend health information. However, recent literature has included the skill of the health professional and the accessibility of health resources as important factors in the level of health literacy achieved by individuals and populations. In 2014 a qualitative study undertaken in Aotearoa New Zealand, investigated the context of health literacy for Maori in a palliative care setting (Maori are the indigenous people of Aotearoa New Zealand). The study included the experiences of patients, whanau (families), and health professionals. METHOD: Individual semi-structured interviews were held with 21 patients, whanau and six key informants: a medical specialist, a service leader involved in developing culturally specific responses to patients, two Maori service managers, and two Maori health team leaders. Focus groups were held with a total of 54 health professionals providing palliative care services. DATA ANALYSIS: A thematic analysis was undertaken using a general inductive approach. The trustworthiness and reliability of the analysis was supported by sharing analysis of the transcripts among the research team. Member checking or respondent validation was used in seeking confirmation of the interim findings at five hui (meetings) with the research communities involved. FINDINGS: This study found that the shock and grief that attends a life-limiting illness made hearing and processing health information very difficult for patients and whanau. Further, 'hard conversations' about moving from active treatment to palliative care were often avoided by health professionals, leaving patients and whanau distressed and confused about their choices and prognosis. Finally, poor cultural health literacy on the part of organisations has likely impacted on late access to or avoidance of palliative care for Maori.

Cultural issues in research, a reflection.

In New Zealand, Maori have been the subject of research where the objectives, methodology and outcomes have failed to address many issues for Maori including power, equity, and the validity of alternative understandings of health and knowledge. A community-based diabetes intervention in the Waikato was designed as a partnership between Maori, health workers and researchers to demonstrate a significant reduction in diabetes incidence in Maori over 3 years. The priorities and challenges which face Maori and community-based researchers are explored in this paper particularly with reference to being both providers of and participants in research.