June 10, 2021

We’re proud to be contributing $60,0000 towards a Kaupapa Māori qualitative study in partnership with Johnson & Johnson NZ, led by Dr Maxine Ronald (FRACS), pictured above.

The purpose of the project is to understand how Māori living in Te Tai Tokerau (Northland) believe that the National Bowel Screening Programme can be delivered in a more culturally appropriate manner to ensure optimal uptake of the roll-out later this year.

Below is the first progress report.

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Bowel Cancer NZ – Focus on achieving equitable outcomes for Māori through the National Bowel Screening Program

Project: How the National Bowel Cancer Screening Program Should Be Delivered in Te Tai Tokerau, Aotearoa to Māori – An Equity Focused Kaupapa Māori Qualitative Study

Dr. Moea Nimmo (MBChB) Primary researcher
Dr. Maxine Ronald (FRACS) Study supervisor

Project Objectives
– Highlight the need – for such a programme to improve outcomes for Māori.
– Demonstrate – how such a programme could look and roll out an effective pilot.
– Drive effective change – by showing what can be achieved in a culturally appropriate way we hope to begin a cascade of multi-year change in the way that health care is delivered to Māori.

Overview of Project to date
The purpose of the project is to understand how Māori living in Te Tai Tokerau think that the National Bowel Screening program should be delivered in order to have optimal uptake and success of the bowel screening program once it is rolled out in Te Tai Tokerau in October 2021. The purpose has been to support the implementation of a colorectal cancer screening programme which is informed and designed by Māori communities in Northland, is culturally safe and competent, and which will achieve a high level of engagement with the program.

The project recognises that there are a number of barriers to equitable bowel screening for Māori and aims to mitigate some of those barriers. It is hoped that information gained from the project will inform actions to improve access and reduce barriers to the bowel screening program.

The project has been underway for the last 6 months and has involved face to face interviews with the primary researcher and multiple Māori health organisations and iwi and hapu throughout Te Tai Tokerau. The information gained from the interviews has been compiled and analysed and key themes identified. The final interviews have were conducted in late April 2021.

The large geographical area of Northland, pressure on Māori health organisations and iwi and hapu due to Covid-19 and other organisational demands have provided challenges in terms of timeliness of conducting the interviews.

Both the primary researcher and project supervisor are Māori who have iwi connections to Te Taitokerau and the project has been conducted in close relationship with the Māori Health Directorate of Northland DHB who sponsor the primary researcher’s position.

Key themes have emerged from the data provided to date and divided broadly into barriers and enablers to successful engagement with the bowel screening program. Two interviews are yet to be transcribed and analysed.

Barriers accessing the bowel screening program include: embarrassment, concerns about the collection and return of faecal samples (FIT kit) and further investigations including maintaining mana and issues to do with transgressions of tapu, fatalism about dying young, lack of knowledge and information provided in a way that is understandable and acceptable to Māori, distrust of the health system, lack of cultural competency, inappropriate public health messaging and lack of involvement of Māori health providers, socioeconomic barriers to transport.

Potential enablers include: use of Te Reo Māori in information pamphlets, use of Māori health providers to deliver information, education and screening packages, using kaiawhina (Māori support workers) for delivery and pick-up of bowel screening packages, design of local bowel screening program by Māori, linking program with marae based activities and programs.

Secondary outcomes of the project have been increasing education about the bowel screening program and developing stronger relationships between the DHB and Māori communities.

Once the final two interviews are transcribed the data will be analysed. In accordance with Kaupapa Māori principles, the information obtained will be given back to the participating groups to ensure that what has been transcribed is correct and that they agree with the conclusions made. The project team will then discuss with the Māori Health Directorate, Māori health providers and iwi and hapu how the funds provided for this project should best be used.

At this stage, no funds have been used as the recommendations are yet to be confirmed. Based on the information gained to date it is anticipated funds may be used to develop information and educational content in Te Reo Māori and to resource Māori health providers, and iwi and hapu workers to provide educational sessions at marae and community centres on bowel screening, and to deliver and collect the FIT kits. Time frames for this would be approximately late May/early June 2021 in anticipation of the bowel screening program starting in October this year.

Once the project is completed it will be submitted for publication. A draft of the project is attached for interest regarding methodology and interim results but is not complete and requires further analysis and finalisation.