Facilitators and barriers for implementation of health programmes with Maori communities.

BACKGROUND: Addressing health inequities that Maori (Indigenous peoples) communities face in New Zealand is a key aim of researchers and practitioners. However, there is limited understanding of the implementation processes and outcomes of health programmes for addressing these inequities. The aim of this study was twofold: (a) to identify correlates of implementation outcomes and (b) to identify facilitators and barriers to implementation effectiveness. METHODS: The study involved a concurrent mixed method approach. Through an online survey, 79 participants with experience in implementing a health programme with a Maori community identified outcomes and processes of the programme. Additionally, nine Maori community providers shared their perceptions and experience of facilitators and barriers to implementation effectiveness through an in-depth interview. The quantitative and qualitative findings were integrated to address the aims of the study. RESULTS: For the first aim, we identified two key outcomes: overall health impacts and sustainability. Three of the variables had significant and positive bivariate correlations with health impacts: cultural alignment, community engagement, and individual skills. The only significant correlate of sustainability was evidence-based. For the second aim, participants described four facilitators (leadership, whanaungatanga [relationships], sharing information, digestible information) and four barriers (system constraints, lack of funding, cultural constraints, lack of engagement) to effective implementation. CONCLUSION: Overall, leadership, aligning culture, and building on whanaungatanga, while getting financial resources and systems support, are the core elements to supporting implementation efforts in Maori communities.

Strengthening Maori participation in the New Zealand health and disability workforce.

Substantial progress has been made in Maori health and disability workforce development in the past 15 years. Key factors in successful programs to increase Maori health workforce recruitment and retention include Maori leadership, mentorship and peer support; and comprehensive support within study programs and in the transitions between school, university and work. The interventions to date provide a strong basis for ongoing action to address inequities in Maori health workforce participation, and are likely to be relevant to health workforce development approaches for other indigenous peoples.