title: Māori patients' experiences and perspectives of chronic kidney disease: a New Zealand qualitative interview study.
abstract: To explore and describe Māori (the indigenous people of New Zealand) patients' experiences and perspectives of chronic kidney disease (CKD), as these are largely unknown for indigenous groups with CKD.
  
  
  
  Face-to-face, semistructured interviews with purposive sampling and thematic analysis.
  
  
  
  3 dialysis centres in New Zealand (NZ), all of which offered all forms of dialysis modalities.
  
  
  
  13 Māori patients with CKD and who were either nearing the need for dialysis or had started dialysis within the previous 12 months.
  
  
  
  The Māori concepts of whakamā (disempowerment and embarrassment) and whakamana (sense of self-esteem and self-determination) provided an overarching framework for interpreting the themes identified: disempowered by delayed CKD diagnosis (resentment of late diagnosis; missed opportunities for preventive care; regret and self-blame); confronting the stigma of kidney disease (multigenerational trepidation; shame and embarrassment; fear and denial); developing and sustaining relationships to support treatment decision-making (importance of family/whānau; valuing peer support; building clinician-patient trust); and maintaining cultural identity (spiritual connection to land; and upholding inner strength/mana).
  
  
  
  Māori patients with CKD experienced marginalisation within the NZ healthcare system due to delayed diagnosis, a focus on individuals rather than family, multigenerational fear of dialysis, and an awareness that clinicians are not aware of cultural considerations and values during decision-making. Prompt diagnosis to facilitate self-management and foster trust between patients and clinicians, involvement of family and peers in dialysis care, and acknowledging patient values could strengthen patient engagement and align decision-making with patient priorities.
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.|Hawke's Bay District Health Board, Hawke's Bay, Hastings, New Zealand.
authors.forename: Rachael C
authors.initials: RC
authors.lastname: Walker
authors.affiliation: Maungaharuru-Tangitū Trust, Napier, New Zealand.
authors.forename: Shayne
authors.initials: S
authors.lastname: Walker
authors.affiliation: NHMRC Clinical Trials Centre, Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia.
authors.forename: Rachael L
authors.initials: RL
authors.lastname: Morton
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.|Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
authors.forename: Allison
authors.initials: A
authors.lastname: Tong
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Howard
authors.affiliation: Department of Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: Suetonia C
authors.initials: SC
authors.lastname: Palmer
mesh_terms: D000328:Adult; D000368:Aged; D003469:Culture; D003657:Decision Making; D057210:Delayed Diagnosis / Q000523:psychology; D003717:Denial, Psychological; D004644:Emotions; D005239:Fear; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology; D006801:Humans; D007398:Interpersonal Relations; D007676:Kidney Failure, Chronic / Q000208:ethnology* / Q000523:psychology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000208:ethnology; D017060:Patient Satisfaction / Q000208:ethnology; D006435:Renal Dialysis; D012649:Self Concept; D012752:Shame; D057545:Social Stigma; D055815:Young Adult
keywords: NEPHROLOGY; QUALITATIVE RESEARCH