Action Researching Health Aspirations amonst New Zealand Maori

University Degree Subjects allied to Medicine

Final Report

Introduction

Ngati He and Ngai Te Ahi are two hapū in Tauranga Moana. Together they have formed Ngati He, Ngai Te Ahi Hauora (the Hauora), a kaupapa Māori health organisation to drive improvement in the health and wellness of their whānau. The Hauora has been delivering services to their community for almost a decade and this time has been a time of learning for the trustees, staff and community. The face of the health sector is changing at both local and national levels, the current set of reforms began in 2001 and these have led to increased focus on locally responsive and led services. As a result, the Hauora trustees have started to consider how their priorities are set and how non-Māori have influenced their decisions regarding service provision.

Western Bay of Plenty Primary Health Organisation (WBOPPHO) recently approached the Hauora along with other kaupapa Māori providers in the area requesting that they conduct a needs assessment of their constituent hapū. The proposed needs assessment was intended to align with previous work conducted by the Bay of Plenty District Health Board (BOPDHB) and the WBOPPHO. However, the Hauora identified that the illness focused indicators of health utilized by these agencies were at odds with the wellness focused, kaupapa Māori approach espoused by their own people.

The Hauora is developing their own approach to needs assessment utilizing their own people’s concepts of health / wellness, identifying their own health aspirations and the support needed to maintain whānau ora. This report details the initial work in this ongoing process.

Background

The need to address specific health issues within Māori communities has been identified by the Ministry of Health (MoH) (MoH 2000, 2002, 2002b, Public Health Intelligence 2006), BOPDHB (BOPDHB 2005, BOPDHB 2006) and the WBOPPHO (Carter 2005, WBOPPHO 2005). The evidence to support this need has been gathered through epidemiological processes led by the BOPDHB and the MoH’s Public Health Intelligence Unit, consultation has been undertaken in developing plans however, this has been done at an Iwi level across the Bay of Plenty (BOPDHB 2006) and given that it is the hapū that deliver health services within Tauranga Moana, this has created frustration within the existing kaupapa Māori health organisations.

The New Zealand Health Strategy (MoH 2000) identifies a need for “relevant information to improve decision making… at community level, enabling a greater role in decision making by communities” and this is further developed for Māori in the Regional Health Needs Assessment Project where Mitchell (2001) asserts that “meaningful involvement of Māori in the needs assessment process is a Treaty right, and it is essential to ensure that the needs assessment leads to improved health for Māori”. The majority of Māori providers have identified that being able to define their own health need is essential in achieving long-term and sustainable gains (Mitchell 2001) and Te Puni Kokiri (cited in Mitchell 2001) echoes this, identifying that “wider holistic concepts of health such as wellbeing and family are [also] considered important factors in health outcomes for Māori”.

Given the above, it is interesting to note that whilst the BOPDHB health needs assessment (2005) identifies the need to work with communities to improve their wellness, it remains focused on illness and fails to take into account Māori concepts of health in its use of indicators and identification of priorities. The WBOPPHO have utilized similar data to conclude that “Māori have the highest health needs of any ethnic group in the PHO” (Carter 2005) and it is encouraging to note that this organisation has identified that local research on Māori health is needed to ensure that health development is appropriate and evidence based. The disappointment is that the PHO is requesting that kaupapa Māori organisations utilize illness rates as a means of measuring health rather than the holistic wellness focused models used by the Hauora and other kaupapa Māori health providers.

Literature Review

This report focuses on how the Hauora will conceptualise and measure wellness. This is not the first report to consider Māori wellness and its measurement; it is however the first for the Hauora, as a starting point it is useful to consider existing ideas around health and wellness. Kiro et al (2004) note that definitions of health “cannot be confined to the absence of disease or survival alone... definitions of what constitutes a healthy life are subject to personal interpretations of culture, class, ethnicity, gender, age and similar factors… commonly accepted views of wellness include being able to function in society, achieving personal expression, achieving physical, mental, spiritual and cultural fulfilment, living without the threat of violence, being able to love and be loved, having a secure home and a sense of belonging within family, community and culture”.

The “1988 Royal Commission on Social Policy, guided by Māori expertise, identified… four prerequisites of Māori health… whanaungatanga – kinship relationships; taonga tuku iho – cultural heritage; te ao turoa – environment and turangawaewae – land base” (Ratima et al 2006). These prerequisites have provided an excellent platform for the development of Māori health models since then. Ratima et al (2006) identify the common features of these models, they are “holistic in nature, locating individuals within the family context, recognising determinants of health (spiritual, cultural, social and biological), emphasising continuity between the past and the present, and viewing good health as a balance between interacting variables”. They also note that maintaining access to cultural resources and having a secure Māori identity are central to wellness.

Professor Durie (cited in Smith 2000) states that “unless Māori themselves are active in developing policies for health and bringing effective health services to their own people, then no amount of expert advice will provide the conviction of ownership”. It is from thinking like this that the kaupapa Māori health revolution has drawn. Pihama and Gardiner (2005) identify the need for Māori to develop initiatives for change that are located within Māori frameworks, to them kaupapa Māori is work that involves Māori and Māori approaches by and for Māori.

A key to understanding kaupapa Māori is accepting that “te reo Māori me ōna tīkanga are viewed as valid and legitimate” (Smith 2000) and that to be Māori is the norm. Although one must also recognise that Māori are not a singular people, the diversity within Māori (whānau, hapū, iwi, kaumatua, rangatira, pakeke, rangatahi, tamariki, tanē, wāhine, takatāpui, urban Māori) must be recognised in order for kaupapa Māori to be available to all (Smith 2000). Graham Hingangaroa Smith (cited in Smith 2000) highlights six integral elements within kaupapa Māori:

tino rangatiratanga (self-determination)
taonga tuku iho (cultural aspirations)
ako Māori (culturally preferred pedagogy/andragogy)
kia piki aki i nga raruraru o te kainga (socio-economic)
whānau
kaupapa (collective philosophy).

For me however, the key question is “can Pākehā contribute and participate in kaupapa Māori reseach?” Barnes (2000) notes that “frequently, issues of concern to Māori are not seen to be adequately addressed by non-Māori researchers and fail to answer questions other than those that are causation, disease and individually focused”, and given that “research has historically privileged Western ways of knowing and is intrinsically linked to imperialism and colonialism” (Smith 2000) I must tread the ground carefully. Mead (cited in Smith 2000) outlines a number of questions which he believes underline kaupapa Māori research:

What research do we want to carry out?
Who is that research for?
What difference will it make?
Who will carry out this research?
How do we want the research to be done?
How will we know it is a worthwhile piece of research?
Who will own the research?
Who will benefit?

Having raised these questions, I will leave the reader to consider whether this report describes a kaupapa Māori research project. I do not believe it is my place as Pākehā to label this process, to do so would be to dishonour the right of Māori to define kaupapa Māori research.

This is a preview of the whole essay

Māori have many terms associated with wellness; the term hauora has risen in prominence in recent years in both te ao Māori and the Pākehā world. Hauora is “an encompassing concept which includes various life aspects such as the spiritual, mental, physical, familial and environmental” (Kiro et al 2004), models such as Te Wheke (Pere 1997), Te Whare Tapa Wha (Durie 1994) and Nga Pou Mana (BOPDHB 2006) express this well. The proliferation of Māori models in Pākehā strategic documents is seen by many as an acceptance of the Māori view of wellness however models can be “restrictive and promote stereotypical and simplistic approaches to understanding health” (Kiro et al 2004). As noted previously, needs assessments produced by Pākehā agencies continue to focus on ill health rather than wellness confirming the notion that these agencies have failed to grasp Māori concepts of health whilst at the same time they play lip service to the various models.

People’s own ideas and perceptions about health are mediated by their experiences and the various influences in their lives. Various determinants of health have been acknowledged by both Pākehā and Māori academics (Kiro et al 2004, National Health Committee 1998), these include socio-economic conditions, gender, culture and lifestyle. Inclusion of a spiritual dimension is also important to a Māori understanding of wellness (Durie 1994, Kiro et al 2004, Kruger et al 2004, Ratima et al 2006).

National Health Committee 1998

Nga Puhi kaumatua and kuia have defined Hauora as “an impression of wellness and everything about wellness… health in a wide sense… including more spiritual and mental aspects of health… being holistic and more concerned with wellness” (Kiro et al 2004). They also noted that hauora and health were related but separate concepts. Central to the interviewees’ concept of hauora was “an overall concern for family life… Māori being responsible for their health and the health of their whānau”. This concern with whānau is increasingly articulated in the health literature (Kruger et al 2004, MoH 2002b, Pihama & Gardiner 2005). The whānau is the basis of Māori society, providing a principal source of strength, support, security and identity, it must play a key role in the wellbeing of Māori individually and collectively (MoH 2002b, Smith 2000).

He Korowai Oranga (MoH 2002b) identifies the wellness outcomes for whānau as:

whānau experiencing physical, spiritual, mental and emotional health;
whānau having control over their own destinies;
whānau members living longer and enjoying a better quality of life;
whānau members (including those with disabilities) participating in te ao Māori and wider New Zealand society.

In order to achieve whānau ora, there is a need to move from a focus on the individual to a focus on the collective, Māori must be reconnected with their whakapapa, Māori worldviews and cultural processes must be honoured, and wellness focused behaviour needs to be recognised as worthy of mana. Māori must be enabled to participate fully and equitably in society (Kruger et al 2004, MoH 2002b).

Key to developing services to support whānau ora is measuring need. Witkin & Altshud (cited in Mitchell 2001) describe need as the “discrepancy or gap between ‘what is’, or the present state of affairs in regard to the group and situation of interest, and ‘what should be’, or a desired state of affairs”. Within this must also be recognised the capacity to benefit for “there is no point in devoting resources… if there is little chance that people can benefit”(Crampton & Lugeson cited in Mitchell 2001). An often used approach to need is Bradshaw’s typology (cited in Mitchell 2001):

“Normative need is what experts define as need (e.g. completed childhood vaccinations). Usually measured by national database analyses.

Expressed need is what can be inferred about need from observing how people use services (So measurement of services and their utilisation is taken to be an indicator of expressed need or demand)

Comparative need infers that the needs arising in one location can be deemed to be similar to those in another location if people have the same socio-demographic characteristics (measured by inter-regional comparisons)

Felt need is what residents in a location say is a need, problem or concern for them (measured by consultation)”

It will be recognised that the last of these, felt need, is the one of most importance to the Hauora in working with their whānau and yet, it is this that has been least explored by existing research.

Health indicators are a frequently used means of measuring health need, they are used to “show whether or not this state of health is achieved or the degree to which it is achieved (Kiro et al 2004). Adamson (cited in Kiro et al 2004) describes indicators as “statements of values, carrying with them implicit messages about what is considered good, or bad, positive or negative, to be encouraged or discouraged”. It should be noted that Māori population health profile indicators, developed to provide an indication of Māori health do not draw on Māori concepts of health (Public Health Intelligence 2006) and that the focus, instead of supporting a move to wellness provides another opportunity for “Māori to be labelled as ‘under-achievers’, ‘deviant’, ‘abnormal’, ‘needy’, ‘helpless’ and ‘violent’” (Kruger et al 2004).

Culturally appropriate alternatives to the usual health status measurements have been suggested, Durie (cited in Mitchell 2001) suggests:

whanaungatanga – a measure of how whānau are able to carry out their various tasks including care, redistribution of goods and services, guardianship, empowerment and future planning;
kaumatua resources – Māori estimates of the health or strength of a family or tribe are closely linked to the number and strength of its elderly population;
mauri – which encompasses spiritual and physical dimensions, individual and group health, human and environmental forms.

Ratima et al (2006) acknowledge the need to utilise Pākehā indicators but also stress the need to use indicators which reflect Māori priorities, they suggest wairua, te reo, tikanga and kawa values, whakapapa knowledge, whānau relationships, knowledge of health services, participation in cultural activities, the extent to which whānau are able to meet their basic needs and marae participation as areas for development. The Māori Health Decade Conference (cited in Mitchell 2001) identified a number of indicators of Māori health:

Number of Māori in positions of influence
Value of resources in Māori ownership
Increase in educational achievement
Use of te reo Māori
Increase in quality or life
Drop in the crime rate
Economic success

It is now for Ngai Te Ahi and Ngati He to work with the Hauora and decide how they will conceptualise health for their people and how this can be measured in order to maintain and improve whānau ora.

Methodology

My own work, study and interests relate to communities, individuals and their wellness. I utilise a model of wellness developed by Mason Durie (1994), Te Whare Tapa Whā.

Te Whare Tapa Wha

Ministry of Education 1999

This model presents wellness as being a result of physical factors, mental and emotional factors, spiritual factors, relationships, language and the environment. Within this model, wellness is very much a local construct, influenced by the aforementioned factors. Many similar models have been developed throughout the world but this one has always spoken to me as a holistic model of wellness for all people. When I consider my understanding of wellness, I find it impossible to consider any approach to ontology other than that of post-modernism. I believe that each individual and / or group constructs their own reality, truth for one individual or community cannot always be truth for the next.

My work as a community-based practitioner has always drawn strongly on the discipline of informal education. Smith (1997) describes informal education as working through and being driven by conversation. He goes on to identify the core values of informal education practitioners as:

work for the wellbeing of all;
respect for the unique value and dignity of each human being;
dialogue;
equality and justice;
democracy and active involvement in the issues that affect people’s lives.

I fully agree with Smith’s ideas and to me this means that knowledge can only come from the group, and that it is particular to that situation and those people. There may be situations where knowledge is transferable between groups and situations but that is for the group to decide. I believe this thinking places me into the contextualism camp within epistemology.

I have made use of an action research approach in this project. This approach “blurs the lines between researcher and practitioner, through bringing together improvement or change (action) and increased knowledge and understanding (research)” (Qualitative Research Group in Health 2003). Action research has been defined as a “participatory, democratic process concerned with developing practical knowing in the pursuit of worthwhile purposes” (Reason & Bradbury 2001), what better purpose can there be for any work? I am thrilled to have been able to utilise an approach to research which fits so tightly with my beliefs.

Action research has been defined as a “methodology which has the dual aims of action and research” (Dick 1993). It involves “an iterative cycle of problem identification, diagnosis, planning, intervention and evaluation of the results of action in order to learn and plan subsequent interventions” (Cassell & Johnson 2006). As a process, action research is both qualitative and participative (Dick 1993, O’Brien 1998), it aims to be practical in the immediate situation as well as furthering academic knowledge, requiring active collaboration and co-learning (Gilmore, Krantz & Ramirez, cited in O’Brien 1998).

Participatory action research (PAR) takes as its starting point a participatory worldview, acknowledging that we are part of a whole, joined with our fellow humans and in relation with the living world (Heron & Reason 1997). This participatory worldview enables us to “see ourselves as co-inhabitants of the planet… the current Western worldview has come to the end of its useful life” (Heron & Reason 1997). The key to the participatory worldview is an emphasis on the person as an “embodied experiencing subject among other subjects; its assertion of the living creative cosmos we co-inhabit; and its emphasis on the integration of action with knowing” (Heron & Reason 1997). I believe that my acceptance of this participatory worldview aligns me very closely with a Māori worldview.

PAR is about creating a positive social change; it is one of the few research methods which embraces principles of participation, reflection, empowerment and emancipation (Seymour-Rolls & Hughes 2000). This approach issues from the aspirations of the community (Cassell & Johnson 2006) and adopts a collaborative, constructive, reflective and action-oriented stance (Seymour-Rolls & Hughes 2000). I have chosen to base my work on the Deakin cycle, this involves “a defined cycle of research and the use of participatory methods… the cycle… consists of four steps: plan, act, observe and reflect” (Dick 1993)

The Deakin Action Research Model

Monash University 2006

Method

Like many community based research projects, this project began over a cup of coffee. The Hauora had been approached by the WBOPPHO and asked to tender for a small research project to look at the health needs of their hapū. In my discussions with a trustee of the Hauora, we discussed their frustrations with the direction being pushed upon them by the PHO and agreed that undertaking a research project which would attempt to articulate the community’s concepts of wellness and to identify their wellness aspirations would be a first step in advocating for a kaupapa Māori approach to health promotion.

I exchanged emails with a trustee of the Hauora, explaining the participatory action research process and how it might be utilised to achieve their goal. It was agreed that, as a next step in the process, I would meet with the Kaiwhakahaere and some of the other trustees of the Hauora to discuss how the project might go forward however due to time demands this did not prove possible. Instead, the Kaiwhakahaere and a trustee of the Hauora provided me with numerous documents which supported their approach to the wellness of their community and, combined with our korero, I developed a discussion document as a means of engaging with a small group of community members. This document identified the need for the Hauora to push for autonomy and a leadership role in addressing whānau ora, it identified that the two hapū need to take action to communicate their knowledge and aspirations, develop their own priorities and initiatives and create a real and effective partnership with their funders. The document set out a path for understanding and recording their health aspirations, articulated my own learning regarding the health needs of Māori as a result of our discussions and proposed the use of Durie’s Te Pae Māhutonga (1999) as a means of pushing for a greater Māori health promotion agenda.

Alongside the development of the discussion document, I reviewed tools that had been used to attempt to capture health needs in other communities:

Raeburn House Community Needs Assessment (Health Promotion Forum 2002);
Health Needs Interview Questionnaire (Mitchell 2001);

and read a number of needs assessments and strategy documents (Barryman-Kamp 2005, BOPDHB 2005, 2006, Capital PHO 2004, Carter 2005, Kiro et al 2004, Kruger et al 2004, MoH 2000, 2002, 2002b, National Health Commission 1998, Public Health Intelligence 2006, Ratima et al 2006, WBOPPHO 2005, Wellington School of Medicine 2001). I then developed a draft survey tool (see Appendix I), it was intended that the trustees of the Hauora would recruit volunteers to talk with whānau members in a very informal manner and then record responses around people’s understanding of wellness, factors that impact on wellness, and how wellness might be improved.

I then met with four representatives of the Hauora, including the Kaiwhakahaere and one trustee. We discussed the research project, their existing wellness indicators (particularly the numbers of kuia and koroua within the hapu, use of rongoa and access to the Marae and Ngahere) and the language used to articulate health and wellness by different generations. Of particular concern was how any data should be captured, it was agreed that turning up at people’s homes with written surveys or recording conversations would not be an appropriate course of action. A more appropriate approach was deemed to be initiating discussions with whānau members around wellness, taking an unstructured path without overtly recording information. The facilitators of the discussions would then take notes afterwards, paying particular attention to the language used by the different generations.

As a group we discussed the need to slowly build a picture of wellness what it means to the community and how we might capture whānau health aspirations. We then developed four questions to form the basis of initial discussions:

What does wellness mean to you?
What is missing when you are not well?
What does wellness mean to your whānau?
What is missing when your whānau is not well?

I then created a brief tool for use by volunteers in recording discussions around these questions (see Appendix II). The volunteers are to be briefed prior to using the tool to ensure that they make participants aware that the discussions will be recorded and how any information gathered will be used. Participants will also be invited to be involved in the ongoing research project and the work of the Hauora.

The tool was then taken to the Board of trustees for discussion. I was informed that the trustees were very excited about the approach we were taking. The focus on wellness rather than illness had concerned them as a group for some time and they were pleased to see the steps the project is taking in order for the Hauora to move to an even greater wellness focus. Adopting a kaupapa Māori approach to health promotion and service delivery was a major concern to them and they identified that through gathering information to support this they will be in a much stronger position when negotiating contracts with providers. The ownership of the research was also a major issue for the trustees, approaches by other organisations had focused on research being conducted by the Hauora with the intellectual property associated with that research being ultimately vested in an external non-Māori funding agency. In placing the ownership of the project and any findings with the Hauora, it was identified that we would increase community investment in the process.

The next step in the process is to finalise the tool with the group that developed it and then for volunteers to begin discussions with their whānau in order to capture the data. Discussions around wellness have already begun to take place in the community, creating momentum before we even start to collect data.

Outcomes & Discussion

This report is being prepared to fit with a timetable defined by the University of Waikato; it is still too soon to report any findings of the research project. Discussions to date around the wellness of the Ngai Te Ahi and Ngati He have identified that they see themselves as a well community:

they have a significant number of kuia, with women in their 70’s and early 80’s not yet ready to take on Kaumatua responsibilities at the Marae due to the number of kuia in their late 80’s and early 90’s, and men not willing to join Kaumatua groups as their mothers are still there;
their tupuna looked ahead and saw the need to maintain the Ngahere as a place for gathering kai, finding peace, sustaining the spirit, rejuvenating and linking to whakapapa;
they have access to traditional medicines and healing practices thanks to their preservation of the Ngahere and the level of knowledge available to the hapū resting in the older people;
they have maintained their right to self-determination and continue to teach and observe the practices taught to them by their ancestors;
they maintain their cultural values and have many people actively participating in the life of whānau, hapū and iwi.

Although, it is recognised that these ideas around wellness come from the more mature members of the two hapū and that much work remains to be done to capture ideas around wellness from across the community. Some kaumatua have expressed concern regarding the loss of a traditional worldview and traditional practices amongst the younger generations and the impact this may be having on whānau ora. I had initially thought that the first round of data collection may have taken place by this time; however the very nature of PAR requires that the participants lead and own the process and any attempt to bypass this would render the research null and void. Despite the failure of the project to produce any formal results at this time, it has been a major learning experience for me.

I have had the opportunity to learn from Māori about their concerns, to share in their insights and to consider my role in supporting Māori health. I had previously reviewed and accepted much of the Ministry of Health literature around health inequalities in Aotearoa. However, as a result of my increased exposure to a Māori worldview and to Māori approaches to wellness, I now see the weaknesses in these. A focus on mortality and morbidity will not engage Māori as this approach is at odds with the Māori worldview, attempts to have kaupapa Māori organisations use this data to develop their programmes is a further attempt at colonisation of this emerging sector. Gathering data to inform and guide the development of kaupapa Māori programmes must recognise the approaches used by Māori. A focus on the collective, not just the individual, is key to this, along with an understanding of the holistic construct used by Māori to understand their wellness.

I have also gained a greater understanding of the barriers Māori face in their interactions with Pākehā institutions. There is an ongoing failure by those institutions to grasp that if one cannot accept a Māori worldview as legitimate and recognise the need for Māori to lead and own their own initiatives then success at best will be limited. Engaging with Māori must be at multiple levels, much consultation is undertaken by the various instruments of Government. However if this consultation fails to engage with those working in the field then it will not grasp the needs and aspirations of communities. Engaging with iwi when hapū based entities are delivering health services results in decisions being made without the knowledge to underpin them.

As noted earlier, Māori must be active in developing effective health policies and services for their people, this means Pākehā institutions engaging with Māori institutions in such a way as to:

ensure that the Māori worldview is honoured and valued, whilst accepting the diversity of Maori;
utilise Māori models of health and wellness in gathering information and developing programmes;
develop true partnerships at every level of programme implementation from data collection to planning to delivery to evaluation;
ensure that their systems do not seek to colonise Māori approaches but rather to honour and embrace these.

Areas for further investigation

This project is a small start by one organisation to own their own needs and identify how these can be measured and met. The Ministries of Health and Social Development have gathered much data to show that Māori are disadvantaged when compared with Pākehā however this does little other than to continue the labelling of Māori as failure. It is time to refocus the lens, to take on board a Māori approach to wellness and begin to address this. As was noted earlier, Māori are not a single homogenous group and, as such, research will need to encompass the many experiences of Māori, as city dwellers, as rural people, as tangata whenua, as children, young people, adults and older people, as whānau, as hapū, as iwi.

The Hauora will continue to work with the people of Ngai Te Ahi and Ngati He to capture their understanding of wellness and the language they use to communicate this. We will then use this as the basis for the development of a needs assessment in order to capture the needs and aspirations of the community.

Conclusion

With an understanding of community need, the Hauora can begin to establish programmes of work which will meet these needs. It is anticipated that by focusing on the felt needs of the people, health promotion initiatives can be developed which are owned by local people and with this ownership will come a sense of collective responsibility and an empowered population. Māori health improvement can be achieved but it must be on Māori terms and over the next few months, Ngai Te Ahi, Ngati He Hauora will strengthen its ability to communicate these to funders and will position itself as a leading practitioner of true kaupapa Māori health promotion and service delivery.

APPENDIX I

Collection Form

This sheet is to be used to capture the content of any conversations around health or wellness you might have with whānau members and others who might now, or in the future, use the services of Ngati He, Ngai Te Ahi Hauora.

There is no need to write down every word or to worry about spelling and grammar.

Please let the people you talk to know that you will be recording their views and make sure they are happy about this. At no point will anyone be identified and the information will only be used by Ngati He, Ngai Te Ahi Hauora to make sure their programmes can support whānau ora.

Please tell us who was involved in the conversation:

Please continue overleaf if you need more room.

The information recorded here will be treated as confidential. Personal details will not be released to Ngati He, Ngai Te Ahi Hauora or any other agency. The report produced as a result of this research will be available to all via Ngati He, Ngai Te Ahi Hauora and this will be used to shape further work to identify the heath aspirations of whanau within Ngati He and Ngai Te Ahi and the development of work to support whanau ora.

Completed forms should be returned to Tim Antric, PO Box 748, Tauranga.

For further information, please contact Tim on 07 579 0377 or .

APPENDIX II

The trustees of Ngai Te Ahi, Ngati He Hauora have set themselves a vision of optimum wellness for the people of our community. We have been working towards this goal for a number of years and we are now planning how we can support individuals and whānau in being well now and into the future.

As a start to our planning we need to understand how well our community is, this involves talking to individuals and groups about their understanding of wellness and health, the language they use to describe their wellness and how we as a community can continue to be well both now and in the future.

We need to be able to stand up to the organisations that fund our work and say these are the needs of our people, this is the place we need to start in order to ensure the health and wellness of our tamariki, rangatahi, pakeke and kaumatua.

As a first step we are trying to get an idea of how a small group of our people think about their wellness. It would be great if you could talk with your whānau and then make some notes about their views of heath and wellness, you should try and get an idea of what wellness means to them and their whānau and what they think is missing when they or their whānau are not well.

Please don’t just ask questions but encourage people to share their ideas of wellness, let them know why we’re doing this and that the information they share will be treated as confidential and will help the Hauora to support their whānau wellness now and in the future. Please try and record the language they use to describe health and wellness and encourage them to say what they think and not what they think others want to hear.