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Journal of The Royal New Zealand College of General Practitioners
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RESEARCH ARTICLE (Open Access)
Online Early

Cultural safety in paramedic practice: experiences of Māori and their whānau who have received acute pre-hospital care for cardiac symptoms from paramedics

Sarah Penney https://orcid.org/0009-0009-2285-676X 1 * , Bridget Dicker https://orcid.org/0000-0002-8151-7356 1 2 , Matire Harwood https://orcid.org/0000-0003-1240-5139 3
+ Author Affiliations
- Author Affiliations

1 Department of Paramedicine, Faculty of Health and Environmental Science, Auckland University of Technology, AUT South Campus, Private Bag 92006, Auckland, 1142, New Zealand.

2 Clinical Audit and Research, Hato Hone St John, 600 Great South Road, Ellerslie, Auckland, 1051, New Zealand.

3 Department of General Practice and Primary Care, Faculty of Medical and Health Sciences, University of Auckland, Building 507, 28 Park Avenue, Grafton, Auckland, 1023, New Zealand.

* Correspondence to: sarah.penney@aut.ac.nz

Handling Editor: Felicity Goodyear-Smith

Journal of Primary Health Care https://doi.org/10.1071/HC24010
Submitted: 31 January 2024  Accepted: 8 April 2024  Published: 3 May 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

Cardiovascular disease is a major health issue for Māori that requires timely and effective first-response care. Māori report culturally unsafe experiences in health care, resulting in poor health outcomes. Research in the pre-hospital context is lacking. This study aimed to explore experiences of cultural (un)safety for Māori and their whānau who received acute pre-hospital cardiovascular care from paramedics.

Methods

Utilising a qualitative descriptive methodology and Kaupapa Māori Research (KMR), in-depth semi-structured interviews were undertaken with 10 Māori patients and/or whānau, and a general inductive approach was used for analysis.

Results

Three key themes were identified: (1) interpersonal workforce skills, (2) access and service factors and (3) active protection of Māori. Participants described paramedics’ clinical knowledge and interpersonal skills, including appropriate communication and ability to connect. Barriers to accessing ambulance services included limited personal and community resources and workforce issues. The impact of heart health on communities and desire for better preventative care highlighted the role of ambulance services in heart health.

Conclusion

Māori experience culturally unsafe pre-hospital care. Systemic and structural barriers were found to be harmful despite there being fewer reports of interpersonal discrimination than in previous research. Efforts to address workforce representation, resource disparities and cultural safety education (focussing on communication, partnership and connection) are warranted to improve experiences and outcomes for Māori.

Keywords: emergency medical services, experience, health disparity, indigenous health, kaupapa Māori, Māori health, pre-hospital, qualitative research.

References

1  Ministry of Health. Annual Update of Key Results 2015/16: New Zealand Health Survey. Wellington; 2016. Available from: https://www.health.govt.nz/publication/annual-update-key-results-2015-16-new-zealand-health-survey

2  Chan WC, Wright C, Riddell T, et al. Ethnic and socioeconomic disparities in the prevalence of cardiovascular disease in New Zealand. N Z Med J 2008; 121(1285): 11-20.
| Google Scholar | PubMed |

3  Health Quality and Safety Commission New Zealand. A window on the quality of New Zealand’s health care. 2017. Available from: https://www.hqsc.govt.nz/resources/resource-library/a-window-on-the-quality-of-new-zealands-health-care-2017/

4  Wilson D. The significance of a culturally appropriate health service for Indigenous Māori women. Contemp Nurse 2008; 28(1–2): 173-88.
| Crossref | Google Scholar | PubMed |

5  Wilson D, Barton P. Indigenous hospital experiences: a New Zealand case study. J Clin Nurs 2012; 21(15–16): 2316-26.
| Crossref | Google Scholar | PubMed |

6  Mbuzi V, Fulbrook P, Jessup M. Indigenous peoples’ experiences and perceptions of hospitalisation for acute care: a metasynthesis of qualitative studies. Int J Nurs Stud 2017; 71: 39-49.
| Crossref | Google Scholar | PubMed |

7  Palmer SC, Gray H, Huria T, et al. Reported Māori consumer experiences of health systems and programs in qualitative research: a systematic review with meta-synthesis. Int J Equity Health 2019; 18(1): 163.
| Crossref | Google Scholar | PubMed |

8  Graham R, Masters-Awatere B. Experiences of Māori of Aotearoa New Zealand’s public health system: a systematic review of two decades of published qualitative research. Aust N Z J Public Health 2020; 44(3): 193-200.
| Crossref | Google Scholar | PubMed |

9  Pene BJ, Aspinall C, Wilson D, et al. Indigenous Māori experiences of fundamental care delivery in an acute inpatient setting: a qualitative analysis of feedback survey data. J Clin Nurs 2022; 31(21–22): 3200-12.
| Crossref | Google Scholar | PubMed |

10  Curtis E, Jones R, Tipene-Leach D, et al. Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. Int J Equity Health 2019; 18(1): 174.
| Crossref | Google Scholar | PubMed |

11  Miner-Williams W. Racial inequities in cardiovascular disease in New Zealand. Divers Equal Health Care 2017; 14(1): 23-33.
| Google Scholar |

12  Garofalo D, Grey C, Lee M, et al. Pre-hospital delay in acute coronary syndromes: PREDICT CVD-18. N Z Med J 2012; 125(1348): 12-22.
| Google Scholar | PubMed |

13  Dicker B, Garrett N, Wong S, et al. Relationship between socioeconomic factors, distribution of public access defibrillators and incidence of out-of-hospital cardiac arrest. Resuscitation 2019; 138: 53-8.
| Crossref | Google Scholar | PubMed |

14  Dicker B, Todd VF, Tunnage B, et al. Direct transport to PCI-capable hospitals after out-of-hospital cardiac arrest in New Zealand: Inequities and outcomes. Resuscitation 2019; 142: 111-6.
| Crossref | Google Scholar | PubMed |

15  Dicker B, Todd VF, Tunnage B, et al. Ethnic disparities in the incidence and outcome from out-of-hospital cardiac arrest: a New Zealand observational study. Resuscitation 2019; 145: 56-62.
| Crossref | Google Scholar | PubMed |

16  Kerr A, Lee M, Grey C, et al. Acute reperfusion for ST-elevation myocardial infarction in New Zealand (2015-2017): patient and system delay (ANZACS-QI 29). N Z Med J 2019; 132(1498): 41-59.
| Google Scholar | PubMed |

17  Curtis E. Indigenous positioning in health research: the importance of Kaupapa Māori theory-informed practice. AlterNative 2016; 12(4): 396-410.
| Crossref | Google Scholar |

18  Mahuika R. Kaupapa Māori theory is critical and anti-colonial. MAI Rev 2008; 3(4): 1-16.
| Google Scholar |

19  Smith LT. Decolonizing Methodologies: Research and Indigenous Peoples, 2nd edn. Otago Press; 2012.

20  Moyle P. A model for Māori research for Māori practitioners. Aotearoa N Z Social Work 2014; 26(1): 29-38.
| Crossref | Google Scholar |

21  Rewi T. Utilising kaupapa Mäori approaches to initiate research. MAI J 2014; 3(3): 242-54.
| Google Scholar |

22  Pihama L, Cram F, Walker SS. Creating methodological space: a literature review of Kaupapa Maori research. Can J Native Educ 2002; 26: 30-43.
| Google Scholar |

23  Smith LT Kaupapa Māori research- Some Kaupapa Māori principles. In: Pihama L, South K, editors. Kaupapa Rangahau A Reader: A Collection of Readings from the Kaupapa Maori Research Workshop Series Led. Te Kotahi Research Institute; 2015. pp. 46–52.

24  Thomas DR. A general inductive approach for analyzing qualitative evaluation data. Am J Eval 2006; 27(2): 237-46.
| Crossref | Google Scholar |

25  Pihama L. Kaupapa Māori theory: transforming theory in Aotearoa. He Pukenga Korero 2010; 9(2): 5-14.
| Google Scholar |

26  Reid P, Robson B. Understanding health inequities. In: Robson B, Reid P, editors. Hauora: Māori standards of health IV A study of the years 2000-2005. Wellington: Te Rōpū Rangahau Hauora a Eru Pōmare; 2007. pp. 3–10.

27  Kerr S, Penney L, Barnes HM, et al. Kaupapa Maori action research to improve heart disease services in Aotearoa, New Zealand. Ethn Health 2010; 15(1): 15-31.
| Crossref | Google Scholar | PubMed |

28  Arlidge B, Abel S, Asiasiga L, et al. Experiences of whānau/families when injured children are admitted to hospital: a multi-ethnic qualitative study from Aotearoa/New Zealand. Ethn Health 2009; 14(2): 169-83.
| Crossref | Google Scholar | PubMed |

29  Leitch S, Smith A, Crengle S, et al. The views of New Zealand general practitioners and patients on a proposed risk assessment and communication tool: a qualitative study using Normalisation Process Theory. Implement Sci Commun 2021; 2(1): 16.
| Crossref | Google Scholar | PubMed |

30  Newport R, Grey C, Dicker B, et al. Upholding te mana o te wā: Māori patients and their families’ experiences of accessing care following an out-of-hospital cardiac event. Am Heart J Plus 2023; 36: 100341.
| Crossref | Google Scholar | PubMed |

31  Anderson A, Mills C, Eggleton K. Whānau perceptions and experiences of acute rheumatic fever diagnosis for Māori in Northland, New Zealand. N Z Med J 2017; 130(1465): 80-8.
| Google Scholar | PubMed |

32  Levack WM, Jones B, Grainger R, et al. Whakawhanaungatanga: the importance of culturally meaningful connections to improve uptake of pulmonary rehabilitation by Māori with COPD - a qualitative study. Int J Chron Obstruct Pulmon Dis 2016; 11: 489-501.
| Crossref | Google Scholar | PubMed |

33  Cram F, Smith L, Johnstone W. Mapping the themes of Maori talk about health. N Z Med J 2003; 116(1170): 1p following U353.
| Google Scholar | PubMed |

34  Walker RC, Abel S, Palmer SC, et al. “We Need a System that’s Not Designed to Fail Māori”: experiences of racism related to kidney transplantation in Aotearoa New Zealand. J Racial Ethn Health Disparities 2023; 10(1): 219-27.
| Crossref | Google Scholar | PubMed |

35  Espiner E, Paine SJ, Weston M, et al. Barriers and facilitators for Māori in accessing hospital services in Aotearoa New Zealand. N Z Med J 2021; 134(1546): 47-58.
| Google Scholar | PubMed |

36  Thim T, Krarup NH, Grove EL, et al. Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. Int J Gen Med 2012; 5: 117-21.
| Crossref | Google Scholar | PubMed |

37  Lacey C, Huria T, Beckert L, et al. The Hui Process: a framework to enhance the doctor-patient relationship with Māori. N Z Med J 2011; 124(1347): 72-8.
| Google Scholar | PubMed |

38  Reid J, Cormack D, Crowe M. The significance of relational continuity of care for Māori patient engagement with predominantly non-Māori doctors: findings from a qualitative study. Aust N Z J Public Health 2016; 40(2): 120-5.
| Crossref | Google Scholar | PubMed |

39  Morrison TA, Tunnage B. Reporting Māori participation in paramedic education and the EMS workforce in New Zealand. Australas J Paramed 2014; 11: 1-6.
| Crossref | Google Scholar |

40  Curtis E, Reid P. Indigenous Health Workforce Development: challenges and successes of the Vision 20:20 programme. ANZ J Surg 2013; 83(1–2): 49-54.
| Crossref | Google Scholar | PubMed |

41  Cooper L, Powe N. Disparities in patient experiences, health care processes, and outcomes: the role of patient-provider racial, ethnic, and language concordance. 2004. Available from: https://www.commonwealthfund.org/publications/fund-reports/2004/jul/disparities-patient-experiences-health-care-processes-and

42  LaVeist TA, Nuru-Jeter A, Jones KE. The association of doctor-patient race concordance with health services utilization. J Public Health Policy 2003; 24(3–4): 312-23.
| Google Scholar | PubMed |

43  Ministry of Health. Rural Health Stratgey 2023. Wellington; 2023. Available from: https://www.health.govt.nz/publication/rural-health-strategy

44  Lilley R, de Graaf B, Kool B, et al. Geographical and population disparities in timely access to prehospital and advanced level emergency care in New Zealand: a cross-sectional study. BMJ Open 2019; 9(7): e026026.
| Crossref | Google Scholar | PubMed |

45  Crengle S, Davie G, Whitehead J, et al. Mortality outcomes and inequities experienced by rural Māori in Aotearoa New Zealand. Lancet Reg Health West Pac 2022; 28: 100570.
| Crossref | Google Scholar | PubMed |

46  Waitangi Tribunal. Hauora: Report on Stage One of the Health Services and Outcomes Kupapa Inquiry. WAI2575. Lower Hutt, New Zealand; 2019. Available from: https://natlib.govt.nz/records/42948781?search%5Bi%5D%5Bcreator%5D=Jones%2C+Carwyn%2C+1976-%2C+INNZNA&search%5Bpath%5D=items

47  Heart Foundation. Coronary artery disease. 2022. Available at https://www.heartfoundation.org.nz/your-heart/heart-conditions/coronary-artery-disease

48  Swain AH, Hoyle SR, Long AW. The changing face of prehospital care in New Zealand: the role of extended care paramedics. N Z Med J 2010; 123(1309): 11-4.
| Google Scholar | PubMed |

49  Todd VF, Swain A, Howie G, et al. Factors associated with emergency medical service reattendance in low acuity patients not transported by ambulance. Prehosp Emerg Care 2021; 26: 66-77.
| Crossref | Google Scholar | PubMed |

50  Ellard-Gray A, Jeffrey NK, Choubak M, et al. Finding the hidden participant: solutions for recruiting hidden, hard-to-reach, and vulnerable populations. Int J Qual Methods 2015; 14(5): 1609406915621420.
| Crossref | Google Scholar |