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In New Zealand health disparities between Maori and non-Maori are well documented,1,2 as is the role of the Treaty of Waitangi in health.3 The Health Practitioners Competency Act (2003) identifies that all professional health regulatory bodies require health practitioners to demonstrate appropriate levels of cultural safety and competency in order to be fit for practice.4,5 However, the evidence is less clear on how individual health practitioners can positively incorporate cultural competency into clinical practice.6-8
The Indigenous Health Framework developed at the University of Otago, Christchurch aims to translate the principles of cultural competency and safety into an approach that health practitioners can use in everyday practice and, by doing so, improve health service delivery for Maori patients/whanau. The Indigenous Health Framework is comprised of the Hui Process9 and the Meihana model10 and is used primarily in the medical interview, building on the widely used Calgary-Cambridge model.11
The Hui Process describes recommendations for enhancing the doctor-patient relationship with Maori. It includes mihimihi (initial greeting engagement), whakawhanaungatanga (making a connection), kaupapa (attending to the main purpose of the encounter), and poroporaki/whakamutunga (closing the session).
The Meihana model describes how the kaupapa (purpose of the encounter) can extend standard history taking to give a broader understanding of Maori patients' presentations. It has also been specifically developed for use by both non-Maori and Maori health practitioners.
The Meihana model was created using the foundations of the well-documented Maori health model, Te Whare Tapa Wha.12 The Meihana model was initially published in 200710 and described six components of the model (whanau, wairua, tinana, hinengaro, taiao and iwi katoa) and introduced a concept referred to as Maori beliefs, values and experiences (MBVEs) which overlaid the six components.
Over the last 6 years the authors and their colleagues based at the University of Otago (inclusive of Christchurch, Wellington and Dunedin campuses) have trained medical students, medical doctors, allied health professionals (nurses, psychologists, physiotherapists, occupational therapists), Maori health workers and administrative staff on the principles and practicalities of implementing the Meihana model. These training initiatives have been evaluated through student/staff/patient feedback forms, a qualitative case study, case presentations and observed structured clinical examinations (OSCE) and have been shown to increase quality interactions between health practitioners, Maori patients and whanau.9,10,13
The use of this...