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      Implementation framework for chronic disease intervention effectiveness in Māori and other indigenous communities

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          Abstract

          Background

          About 40% of all health burden in New Zealand is due to cancer, cardiovascular disease, and type 2 diabetes/obesity. Outcomes for Māori (indigenous people) are significantly worse than non-Maori; these inequities mirror those found in indigenous communities elsewhere. Evidence-based interventions with established efficacy may not be effective in indigenous communities without addressing specific implementation challenges. We present an implementation framework for interventions to prevent and treat chronic conditions for Māori and other indigenous communities.

          Theoretical framework

          The He Pikinga Waiora Implementation Framework has indigenous self-determination at its core and consists of four elements: cultural-centeredness, community engagement, systems thinking, and integrated knowledge translation. All elements have conceptual fit with Kaupapa Māori aspirations (i.e., indigenous knowledge creation, theorizing, and methodology) and all have demonstrated evidence of positive implementation outcomes.

          Applying the framework

          A coding scheme derived from the Framework was applied to 13 studies of diabetes prevention in indigenous communities in Australia, Canada, New Zealand, and the United States from a systematic review. Cross-tabulations demonstrated that culture-centeredness ( p = .008) and community engagement ( p = .009) explained differences in diabetes outcomes and community engagement ( p = .098) explained difference in blood pressure outcomes.

          Implications and conclusions

          The He Pikinga Waiora Implementation Framework appears to be well suited to advance implementation science for indigenous communities in general and Māori in particular. The framework has promise as a policy and planning tool to evaluate and design effective interventions for chronic disease prevention in indigenous communities.

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          Most cited references86

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          Community-based participatory research contributions to intervention research: the intersection of science and practice to improve health equity.

          Community-based participatory research (CBPR) has emerged in the last decades as a transformative research paradigm that bridges the gap between science and practice through community engagement and social action to increase health equity. CBPR expands the potential for the translational sciences to develop, implement, and disseminate effective interventions across diverse communities through strategies to redress power imbalances; facilitate mutual benefit among community and academic partners; and promote reciprocal knowledge translation, incorporating community theories into the research. We identify the barriers and challenges within the intervention and implementation sciences, discuss how CBPR can address these challenges, provide an illustrative research example, and discuss next steps to advance the translational science of CBPR.
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            Exploring the role of community engagement in improving the health of disadvantaged populations: a systematic review

            Background Although community engagement (CE) is widely used in health promotion, components of CE models associated with improved health are poorly understood. This study aimed to examine the magnitude of the impact of CE on health and health inequalities among disadvantaged populations, which methodological approaches maximise the effectiveness of CE, and components of CE that are acceptable, feasible, and effective when used among disadvantaged populations. Design The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We carried out methodological assessments of the included studies using rating scales. The analysis focussed on model synthesis to identify the key CE components linked to positive study outcomes and comparative analysis between positive study outcomes, processes, and quality indicators of CE. Results Out of 24 studies that met our inclusion criteria, 21 (87.5%) had positively impacted health behaviours, public health planning, health service access, health literacy, and a range of health outcomes. More than half of the studies (58%) were of good quality, whereas 71% and 42% of studies showed good community involvement in research and achieved high levels of CE, respectively. Key CE components that affected health outcomes included real power-sharing, collaborative partnerships, bidirectional learning, incorporating the voice and agency of beneficiary communities in research protocol, and using bicultural health workers for intervention delivery. Conclusions The findings suggest that CE models can lead to improved health and health behaviours among disadvantaged populations if designed properly and implemented through effective community consultation and participation. We also found several gaps in the current measurement of CE in health intervention studies, which suggests the importance of developing innovative approaches to measure CE impact on health outcomes in a more rigorous way.
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              Implications of the foresight obesity system map for solutions to childhood obesity.

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                Author and article information

                Contributors
                joetzel@waikato.ac.nz
                nina.scott@waikatodhb.health.nz
                maui@waikato.ac.nz
                bridgette.masters-awatere@waikato.ac.nz
                morarare@waikato.ac.nz
                jeff.foote@esr.cri.nz
                angela.beaton@wintec.ac.nz
                ehauterry@yahoo.co.nz
                Journal
                Global Health
                Global Health
                Globalization and Health
                BioMed Central (London )
                1744-8603
                5 September 2017
                5 September 2017
                2017
                : 13
                : 69
                Affiliations
                [1 ]ISNI 0000 0004 0408 3579, GRID grid.49481.30, University of Waikato, ; Private Bag 3105, Hamilton, 3240 New Zealand
                [2 ]ISNI 0000 0000 9021 6470, GRID grid.417424.0, Waikato District Health Board, ; Pembroke Street, Private Bag 3200, Hamilton, 3240 New Zealand
                [3 ]ISNI 0000 0001 2234 622X, GRID grid.419706.d, The Institute of Environmental Science and Research, ; 34 Kenepuru Drive, PO Box 50348, Porirua, 5240 New Zealand
                [4 ]GRID grid.431757.3, Waikato Institute of Technology, ; Private Bag 3036, Waikato Mail Centre, Hamilton, 3240 New Zealand
                Author information
                http://orcid.org/0000-0003-3188-776X
                Article
                295
                10.1186/s12992-017-0295-8
                5584010
                28870225
                75a9b9ab-e683-44e4-9eee-1ff019e66989
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 9 September 2016
                : 30 August 2017
                Funding
                Funded by: Healthier Lives National Science Challenge
                Award ID: HL-T1CR-D 13058/1 SUB1320
                Award Recipient :
                Categories
                Debate
                Custom metadata
                © The Author(s) 2017

                Health & Social care
                kaupapa māori,community-engaged research,systems thinking,culture-centeredness,integrated knowledge translation,implementation science

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