title: Whakawhanaungatanga: the importance of culturally meaningful connections to improve uptake of pulmonary rehabilitation by Māori with COPD - a qualitative study.
abstract: BACKGROUND
  Pulmonary rehabilitation is known to improve function and quality of life for people with chronic obstructive pulmonary disease (COPD). However, little research has been conducted on the influence of culture on experiences of pulmonary rehabilitation. This study examined factors influencing uptake of pulmonary rehabilitation by Māori with COPD in New Zealand.
  
  
  METHODS
  Grounded theory nested within kaupapa Māori methodology. Transcripts were analyzed from interviews and focus groups with 15 Māori and ten New Zealand non-Māori invited to attend pulmonary rehabilitation for COPD. Māori participants had either attended a mainstream hospital-based program, a community-based program designed "by Māori, for Māori", or had experienced both.
  
  
  RESULTS
  Several factors influencing uptake of pulmonary rehabilitation were common to all participants regardless of ethnicity: 1) participants' past experiences (eg, of exercise; of health care systems), 2) attitudes and expectations, 3) access issues (eg, time, transport, and conflicting responsibilities), and 4) initial program experiences. These factors were moderated by the involvement of family and peers, interactions with health professionals, the way information on programs was presented, and by new illness events. For Māori, however, several additional factors were also identified relating to cultural experiences of pulmonary rehabilitation. In particular, Māori participants placed high value on whakawhanaungatanga: the making of culturally meaningful connections with others. Culturally appropriate communication and relationship building was deemed so important by some Māori participants that when it was absent, they felt strongly discouraged to attend pulmonary rehabilitation. Only the more holistic services offered a program in which they felt culturally safe and to which they were willing to return for ongoing rehabilitation.
  
  
  CONCLUSIONS
  Lack of attention to cultural factors in the delivery of pulmonary rehabilitation may be a barrier to its uptake by indigenous, minority ethnic groups, such as New Zealand Māori. Indigenous-led or culturally responsive health care interventions for COPD may provide a solution to this issue.
authors.affiliation: Department of Medicine, University of Otago, Wellington, New Zealand.
authors.forename: William Mm
authors.initials: WM
authors.lastname: Levack
authors.affiliation: Department of Medicine, University of Otago, Wellington, New Zealand.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Jones
authors.affiliation: Department of Medicine, University of Otago, Wellington, New Zealand.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Grainger
authors.affiliation: Department of Medicine, University of Otago, Wellington, New Zealand.
authors.forename: Pauline
authors.initials: P
authors.lastname: Boland
authors.affiliation: Department of Medicine, University of Otago, Wellington, New Zealand.
authors.forename: Melanie
authors.initials: M
authors.lastname: Brown
authors.affiliation: Department of Medicine, University of Otago, Wellington, New Zealand.
authors.forename: Tristram R
authors.initials: TR
authors.lastname: Ingham
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001294:Attitude to Health / Q000208:ethnology; D065246:Culturally Competent Care / Q000379:methods / Q000458:organization & administration; D003469:Culture; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009520:New Zealand / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D044382:Population Groups / Q000523:psychology; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000208:ethnology / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation; D036301:Qualitative Research; D011788:Quality of Life
keywords: COPD; cultural safety; health care access; indigenous peoples; pulmonary rehabilitation; qualitative research