Barriers to optimal stroke service care and solutions: a qualitative study engaging people with stroke and their whanau.

AIM: The aim of this study was to explore the perspectives of people with stroke and their whanau on barriers to accessing best practice care across Aotearoa, and to brainstorm potential solutions. METHOD: We conducted ten focus groups nationwide and completed a thematic analysis. RESULTS: Analysis of the data collected from the focus groups identified five themes: (1) inconsistencies in stroke care; (2) importance of effective communication; (3) the role of whanau support; (4) the need for more person rather than stroke centred processes; and (5) experienced inequities. Participants also identified potential solutions. CONCLUSION: Key recommendations include the need for improved access to stroke unit care for rural residents, improved post-discharge support and care coordination involving the whanau, improved communication across the patient journey, and a concerted effort to improve culturally safe care. Next step is to implement and monitor these recommendations.

"I couldn't even do normal chores": a qualitative study of the impacts of injury for Maori.

AIMS: To investigate the rehabilitation experiences of Maori who were still reporting disability 24 months after an injury resulting in hospitalisation. METHODS: Participants had been hospitalised for an Accident Compensation Corporation (New Zealand's no-fault injury compensation insurer) entitlement claim injury between 2007 and 2009, and were experiencing disability 24 months post-injury. In-depth kanohi ki te kanohi (face-to-face) qualitative interviews with 12 participants aged between 37 and 71 years at the time of interviews were conducted. Interpretive analyses of interview transcripts, focused on the impacts of injury was conducted with the aid of NVivo software. RESULTS: The overarching theme identified during the analysis was "Impact" with four sub-themes of: Impact on daily life; Impact on relationships, Impact on employment; and, long-term or ongoing impacts. CONCLUSIONS: For Maori living with disability 24 months after hospitalisation for injury, adjusting to life after the injury and the rehabilitation process was challenging. Participants discussed frustration with feeling dependent on others, being bored and feeling unfulfilled after their injury, and that many aspects of their lives were impacted on and not always in the expected directions. Many reported longer lasting impacts even after rehabilitation was completed. Implications for rehabilitation programmes e.g., strengthening programmes by taking into account issues discussed by participants, recognising the long-term impacts on both those injured and their whanau (family), and further investigations required are also discussed.IMPLICATIONS FOR REHABILITATIONDisability after injury can have long term impacts for injured Maori and their relationships.Social impacts can be perceived as more debilitating than the physical impacts after injury.Experiences of employment changes and future prospects are often difficult to navigate for Maori returning to work after an injury.

The use of interpretive description within Kaupapa Maori research.

Kaupapa Maori research (KMR) is an Indigenous research approach that is decolonizing and transformative. Interpretive description (ID) is a qualitative methodology used to generate knowledge relevant to the applied health disciplines. In this article, we discuss how we combined KMR and ID to investigate the experiences of Maori (the Indigenous peoples of New Zealand) with aphasia and their whanau (extended family). This is novel because it is the first time these two approaches have been combined. In the context of aphasia research, we discuss how they work together in theory, and the synergies that became apparent in practice. We conclude that the combination of KMR and ID enables clinicians and Maori with aphasia to learn from each other and work together, thereby generating knowledge that makes a difference for Maori with aphasia and their whanau.

Maori experiences of aphasia therapy: "But I'm from Hauiti and we've got shags".

This study explored Maori experiences of aphasia therapy, with a view to ascertaining what makes a service culturally safe as well as "accessible to and culturally appropriate for" Maori with aphasia and their whanau (extended family). Maori are the indigenous peoples of New Zealand. This study incorporated interpretive description (a qualitative methodology) within kaupapa Maori research (a Maori approach to research). In-depth semi-structured interviews were undertaken with 11 Maori with aphasia and 23 of their nominated whanau members. They reported a wide variety of experiences of aphasia therapy, in six themes: We're happy to do the work, but we can't do it alone; Relationship; Our worldview; The speech-language therapy setting; Aphasia resources; and Is this as good as it gets? While some Maori with aphasia reportedly received an accessible and culturally appropriate service, others did not. It is concluded that, for Maori with aphasia, a strong therapeutic relationship is central. The success of this relationship is shaped by the SLP's appreciation of the worldview of the person with aphasia and whanau, the setting of the therapy, and the resources used. Successful therapy will involve collaboration between clinician and whanau, and therapy resources that affirm the identity of the person with aphasia.