Mäori cultural competencies for providers, part 1 - Issue 17 (Apr 2004)

Issue 17 April 2005

On this page

  1. General points
  2. Introduction
  3. What is Cultural Competence?
  4. The Impact of Culture
  5. Tikanga Mäori - Mäori Customs and Practices
  6. Where To Start
  7. References

General points

  • There is a significant difference in the rate at which Mäori and the general population claim for ACC services. This difference appears to be most marked for non-earners, the young and the elderly
  • A Summary Guideline has been developed to assist providers in delivering culturally competent care to Mäori claimants/patients
  • The goal of culturally competent care is to establish and maintain relationships and achieve better health outcomes for Mäori
  • Important components of culturally competent care are:
  • an understanding of Mäori values and customs (tikanga Mäori )
  • effective collection and use of ethnicity data
  • communication skills.

Introduction

The provision of culturally competent health services is an important aspect of access to health care for Mäori. This review summarises the key concepts of the ACC Summary Guideline on Mäori Cultural Competencies for Providers(1) developed in 2004.

Adherence by Mäori to Mäori cultural norms and practices varies widely. Dialogue with claimant and whänau (family) is important when considering how to use the information in the Guideline.

Analysis of ACC claims shows that claims by Mäori are significantly lower (per 100,000 claims) than claims by non-Mäori. The disparities are greatest for young and elderly Mäori. New Zealand and overseas studies suggest that disparities in access to health services cannot be explained by socio-economic status and the cost of services alone(3)(4)(5) and that cultural differences between patients and health professionals are also important(6)(7)(8)(9)(10).

What is Cultural Competence?

Professor Mason Durie expresses it this way: “Cultural competence is about the acquisition of skills to achieve a better understanding of members of other cultures”. He notes that the goal of culturally competent care is to improve relationships and thereby achieve “better clinical results”.

“The degree of comfort individuals feel with seeking health services impacts on their use of services and, in turn, health outcomes. Comfort is a product of both individual attitudes and the way in which services are delivered. The delivery of care in a culturally appropriate manner is an important element in determining both the willingness of people to access services and the success of any treatment or care then delivered.”(11)

Reflection on one’s own cultural identity, history, attitudes and experiences is important in understanding the impact of professional practice and interactions with people from different cultures(14).

The Impact of Culture

People respond differently to illness and injury because of social, cultural and psychological factors. For instance, some Mäori may, like other cultures, bear injuries stoically, putting up with considerable pain in order to maintain dignity, independence or even honour as a “warrior”, especially where the injuries occur during sport.

This is similar to the typical New Zealand male understatement when ill. “I’m feeling a bit crook, doc” can indicate a minor illness or a life-threatening health event. Understanding the culturally-determined responses of people to different situations can help with providing the most effective health care(9)(11)(12)(13).

Tikanga Mäori - Mäori Customs and Practices

Understanding the concepts that comprise tikanga Mäori (Mäori beliefs and customs) is the key to effectively meeting the requirements of Mäori claimants/patients. The concepts of pono, noa, tapu, ea, mana, aroha, wairua, whänaungatanga, and whakapapa form the underlying philosophy that guides tikanga Mäori.

Like members of all cultures, Mäori may unconsciously follow traditional customs and practices, as well as attempting to conform to the norms of the dominant Pakeha culture. At times of stress such as impending death, or serious injury, many Mäori may adhere to Mäori tikanga, and the responsibilities that involves. For example, distant relations may drop everything to attend tangihanga (funerals) or to support the family of a person undergoing an operative procedure, even when they have not been in close contact for many years.

Where To Start

The Summary Guideline emphasises communication and the collection of good quality ethnicity data as key components of culturally competent care.

Collection of ethnicity data

The Summary Guideline suggests that it is important to ask claimants about their ethnicity, rather than guessing, and explain why, how and when the information will be used.

Detailed information on the collection of ethnicity data in the health and disability sector, including protocols, is available at www.nzhis.govt.nz.

Communication

Effective treatment and rehabilitation is built upon successful communication with claimants/patients and their whänau. Successful communication involves a willingness to seek assistance with the correct pronunciation of Mäori, and understanding the importance of family for many Mäori, their preferences for communication and the protocols around initial contacts and impending death. The second ACC review in the series on Mäori Cultural Competencies for Providers deals with communication.

References

  1. Accident Compensation Corporation. Summary Guideline On Cultural Competencies for Providers. Wellington: ACC, 2004
  2. Ajwani S, et al. Decades of Disparity: Ethnic mortality trends in New Zealand
    1980-1999. Wellington: Ministry of Health and University of Otago 2003.
    See www.moh.govt.nz
  3. Baxter J. Barriers to Health Care for Mäori with Known Diabetes. NZ National Working Group on Diabetes and Te Roopu Rangahau Hauora a Ngai Tahu 2002.
  4. Ministry of Health. Reducing Inequalities in Health. Wellington: Ministry of Health, 2002. See www.moh.govt.nz
  5. Krupat E, Bell RA, et al. When physicians and patients think alike: patient-centered beliefs and their impact on satisfaction and trust. J Fam Pract. December 2001; 50(12):1057-62
  6. Schoen C, et al. Primary Care and Health System Performance: Adults experiences in five countries. Health Affairs. October 28, 2004.
  7. Gribben B. Ethnicity and Resource use in General Practice in West Auckland. Experience in Practice 1999; March. Vol 1, No 1.
  8. Jansen P. Improving Consultations with Mäori Clients. NZ Fam Phys 1998; April: 25(2)
  9. Arroll B, Goodyear-Smith F, Lloyd T. Depression in Patients in an Auckland General Practice. NZ Med J 2002; April: 115 (1152).
  10. Durie M. Cultural Competence and Medical Practice in New Zealand. Report to the Australia and New Zealand Boards and Councils Conference, 2001.
  11. Durie MH. Mäori Attitudes to Sickness, Doctors and Hospitals. NZ Med J
    1997; 86: 483-485
  12. Durie M. Mäori Ora: the dynamics of Mäori health. 2001. Auckland: Oxford
    University Press.
  13. Nursing Council of New Zealand. Guidelines for Cultural Safety, the Treaty of Waitangi, and Mäori Health in Nursing and Midwifery Education and Practice. Wellington: Nursing Council of New Zealand, 2002. See www.nursingcouncil.org.nz