He Ritenga Whakaaro - New Zealand Doctor

Tātaritanga ā Rangahau Hāngai - Literature Review 2
Several factors could explain this, including that Māori are more likely to live in households containing two or more
families, leading to undercounting, and that they are less likely to live in a household with a telephone and will thus
be more frequently missed by telephone surveys (StatsNZ 2002). However other studies suggest that the underrepresentation
is not entirely due to methodological problems. Although there is only limited research available,
preliminary data indicate that Māori view participation in surveys differently than do non-Māori.
Māori have often expressed reluctance to being observed and researched by non-Māori (Harvey 2002). Other
researchers have documented similar reluctance to be involved in research which is felt not to value Māori
knowledge, recognise Māori aptitudes, or stands to benefit Māori (Bishop 1994; Smith 1999). In addition, previous
poor experiences with researchers have led some Māori to reject research and academic theories (Smith 1990).
In an effort to encourage Māori participation one study developed interview questions from a Māori perspective,
included an over-sample of Māori, and generated lists of Māori households from the electoral offices’ ethnicity
database (Dacey 1998). The authors report that this approach was successful in ensuring that Māori had a high
response rate compared to other surveys.
Studies have also shown that:
• Māori-based research processes are preferred by Māori participants (Dyall 1999), including those that make
use of whānau, hui, people-centred approaches (Barnes 2000), and face-to-face discussions (Bishop & Glynn
1992).
• A Kaupapa Māori approach is preferred – where Māori are involved at all stages in the research and research
is designed to be empowering for the individuals participating as well as for the Māori community as a whole
(Bishop 1994).
A literature search for Māori-oriented patient satisfaction surveys and contacts among all District Health Boards and
major primary care organisations in New Zealand uncovered only three Māori-specific satisfaction survey tools. Like
other satisfaction surveys a variety of methods for collection of data have been used including: kanohi-ki-te-kanohi
(face-to-face), mail-out, and written questionnaires with reply-paid forms.
Lessons were also taken on board from a study of access to healthcare services for Medi-Cal enrolees in the United
States (Solis & Rodriguez 2002). The response rates of minority groups (such as Asian American/Pacific Islanders,
Native American, Blacks, and Latinos) in this study were greatly improved by:
• Offering telephone or in-person interviews rather than mail surveys (especially relevant to groups with lower
literacy);
• Having appropriate reviewers examine the survey tool for cultural and linguistic relevancy;
• Using survey questions that had been validated in other studies and that were specific to the survey
requirements; and
• Utilising bilingual/bicultural interviewers that reflect the target groups.
2.5.3 Kaupapa Māori research
Historically, the majority of research about Māori has been conducted by non-Māori, who perceived a ‘problem’
and then provided a ‘solution’ based on their non-Māori world-view. Since the 1970s Māori researchers have
debated and discussed appropriate research methods when Māori are involved in research as subjects and
participants (Bishop 1994).
Cunningham identifies three types of research approaches with Māori including (Cunningham 1999):
Research involving Māori – where Māori are a minor component in research controlled by non-Māori researchers.
Māori-centred research – where Māori are included as a significant part of a research project controlled by non-
Māori researchers.
Kaupapa Māori research – where Māori data or participants are a significant or an exclusive part in the research
project, the research methodology incorporates Māori and mainstream tools or methods, and the research is
controlled and analysed from a Māori context.
He Ritenga Whakaaro: Māori experiences of health services | 33