Wintec: Traditional pathways of wellbeing have the potential to positively influence Māori health outcomes, possibly in ways that Western models of healthcare have so far failed to achieve.

‘If we look at primary health care, our health systems do not motivate our whānau (family) to access those systems, and when we do, we access them late. They don’t incorporate our ways of viewing the world, they don’t incorporate our view of wellbeing, and they definitely don’t incorporate our pathways to wellbeing,’ explains Dr Andre McLachlan, clinical psychologist and Wintec academic.

Dr McLachlan goes on to say that this is often also true of providers of Māori health services, as they deliver the same Ministry of Health contracts and report on the same parameters as Western-style service providers. However, a lot of Māori providers advocate and negotiate their way through so they can be more responsive and Māori-centred in their work.

Dr McLachlan led a team in developing research to identify cultural pathways (both activities and concepts) to wellbeing for Māori, acknowledging that wellbeing incorporates both mauri ora (a strong lifeforce) and a secure cultural identity.

The team began with a literature review that identified 36 papers that met the study criteria (from a total of 228). From there, six themes or ngā ara (pathways) of wellbeing were proposed through a thematic analysis. These were ngā ara reo Māori (Māori language), ngā ara taiao (connection with the environment), ngā ara wairua (Māori spiritual beliefs and practices), ngā ara mahi-a-toi (Māori expressive art forms), ngā ara take pū whānau (Māori relational values), and ngā ara whakapapa (intergenerational relationships).

The second phase of the research utilised a wānanga (collective analytic discussion) to explore the six themes, with attention given to examples of real-world application. In August 2018, approximately 40 practising Māori psychologists and psychology students at the National Māori Psychologists’ Symposium, He Paiaka Totara, held at Te Kōpū Mānia Marae – Wintec took part in the process. Participants were split into six groups and they provided examples of where they could or had used cultural concepts to enhance Māori wellbeing based on each pathway. General feedback from participants indicated that the six pathways to wellbeing ‘just made sense’.

‘Our goal in developing the framework was to promote the importance of and facilitate supporting whai ora Māori (Māori clients) and their whānau to increase their knowledge of and comfort in cultural pathways to wellbeing, and to increase their active participation in these pathways,’ explains Dr McLachlan.

Te reo Māori, the first pathway to wellbeing, was identified in the literature as a common marker of Maōri identity and was specifically linked to personal mana (dignity) and a secure identity. Wānanga participants reported that they supported whānau to develop their te reo, offering bilingual resources and a Māori-friendly space.

Secondly, in relation to ngā ara taiao (environmental connection), participants spoke of encouraging activities that guided whai ora to return to traditional ngā maunga (mountains), ngā awa (rivers), and ngā ngahere (forests) as sources of healing; to use natural resources for craftwork like weaving or carving; and to grow food, alongside other traditional knowledge and skills.

Thirdly, the importance of ngā ara wairua (spiritual beliefs and practices) was supported by accounts of encouraging whai ora to return to ancestral lands, learn karakia (incantations) and discuss family stories and oral histories.

Fourthly, in connection to ngā ara mahi-a-toi (expressive art forms), participants detailed examples of providing resources to guide karakia (prayer) and waiata (song), the use of rāranga-harakeke (flax weaving) and tī rākau (stick games) with whai ora.

The fifth theme yielded practical examples of ngā ara take pū whānau (relational values) including assisting whai ora to understand whānau structures and relationships through whakapapa kōrero (genealogical conversations) and exploring historical whānau narratives.

Finally, participants discussed ngā ara whakapapa (intergenerational relationships) in terms of using whakapapa to explore strengths and challenges, and to contextualise the issues that whai ora were presenting to clinics with. They also guided whai ora to engage with knowledge holders either online or via tribal organisations.

The findings of the research led to Dr McLachlan’s team developing a framework promoting traditional pathways to wellbeing, called Whiti Te Rā. 

‘The six themes were placed within the sun image as ihi (sun rays). This was then made interactive by the creation of a rating system. As presented in the Whiti Te Rā image, each ihi (sun ray) is split down the middle. With poutama (stairs) on each side. This reflects Tane's journey for the three baskets of knowledge. One side of the ihi is labelled hono, which reflects the individual’s level of active engagement with the ihi, and the other side is labelled mahuru which reflects that individual’s level of comfort in knowledge of that ihi. This framework then allows practitioners and whai ora to explore and rate (based on the poutama) their level of engagement (hono) and knowledge/comfort (mahuru) in order to set goals for further development,’ says Dr McLachlan. 

Whiti Te Rā highlights the need for practitioners to engage with their community to explore local options that respond to Māori aspirations and preferences for pathways to wellbeing, as presented by the model.

‘There is a growing body of evidence around the importance of traditional pathways for Māori wellbeing, but there is still a massive disconnect between evidence-based practice and practitioners in the field,’ explains Dr McLachlan.

The model was completed in 2019 and as an image, can be used as a tool to work directly with whai ora Māori. Dr McLachlan has since developed a manual to support the practical use of Whiti Te Rā. Other ongoing work to operationalise the framework includes the development of worksheets and activities, as well as workshops to support its implementation by Māori health providers across the country.

Whiti Te Rā has been well-received by practitioners. It provides a good basis to develop local connections, to really dig down to understand what whai ora need to engage in different cultural activities and practices locally, such as carving or weaving. The model allows for practitioners to acknowledge the diverse Māori cultural identities across whai ora, and to support people to slowly engage at their own pace.

Evidence is emerging of the success of the framework as it moves from concept to practice via the workshops. These workshops are taking place around Aotearoa, with attention to rural as well as urban areas.

‘At a prison-based workshop recently, prison staff hadn’t conceptualised how they could connect the Māori men in prison with ngā ara teteio, the environmental pathway. By the end of the workshop, they had designed areas of knowledge that they could access about their local rivers, about the spawning of eels, and they were designing and were going to create hīnaki (eel traps) inside the prison. They realised they could do a whole lot of stuff to prepare their men to connect with the environment without being out in the river,’ recounts McLachlan.

Two services have already adopted the use of Whiti Te Rā, they will develop community pathways and use peer support workers to promote the pathways and connect people with them.

‘Whiti Te Rā and the work around it draws attention to Māori pathways to wellbeing, what those pathways are and how they are effective. It reminds us, as Māori, that we promote these activities but are we developing the pathways locally so whānau can access them?’ says McLachlan of the model’s impact nationally.

Dr McLachlan, along with Dr Waikaremoana Waitoki, has a book chapter coming out soon with more guidance for practitioners. Using a case study, it demonstrates how Whiti Te Rā can work in tandem with Suzanne Pitama’s health and assessment framework, the Meihana model.

‘We assume responsibility for taking the knowledge we have developed in Whiti Te Rā and stepping it out into the field,’ says Dr McLachlan.

• Horiana Jones and Parewahaika Harris received funding from Matua Raḵi, New Zealand National Addictions Workforce Development Group to undertake a literature review which contributed to the formation of the project.
  
  
• The research team included Andre McLachlan, Horiana Jones, Waikaremoana Waitoki and Parewahaika Harris. 
  
  
• See 'Whiti Te Rā: A guide to connecting Māori to traditional wellbeing pathways,' by Andre McLachlan, Waikaremoana Waitoki, Parewahaika Harris, and Horiana Jones in the Journal of Indigenous Wellbeing, Te Mauri - Pimatisiwin, published on February 25, 2021.
  
  
• Dr Andre McLachlan, Ngāti Apa (Ngāti Kauae), Muaūpoko (Ngāti Pāriri), began his career in health in the early 1990’s at Tokanui hospital. He went on to work in Youth Services in Waikato and completed his training as a Certified Addictions Counsellor. He then achieved his master’s degree and completed his clinical psychology training. Dr MacLachlan continued to work within the addictions sector at Pai Ake Solutions and, more recently, completed a PhD focussed on collaborative service delivery in mental health and addictions.
  
  He has led kaupapa Māori based workforce development by contributing to the advancement of innovative and dynamic kaupapa Māori based therapeutic resources. He nurtures rangatahi who chose to enter the field and has maintained an integral role of manaakitanga for emerging Māori psychologists completing their undergraduate and clinical training, both informally as a leader in clinical psychology, and formally as a lecturer for Otago University and Wintec. 
  
  
• For information about Whiti Te Rā and to find out about workshops contact Dr Andre McLachlan.
  
  
• Visit Wintec's website.