Māori lived experiences of Osteoarthritis: A Māori approach

Research that explores the perceptions and experiences of Māori adults living with osteoarthritis, from a Māori approach.

A summary of research done by Nikita McGruer under supervisors Associate Professor Peter Larmer, Dr Jennifer N Baldwin & Dr Tom Ruakere

Osteoarthritis (OA) is a significant burden on a person and is the most common form of arthritis in New Zealand. There are about 35,000 Māori adults that have OA.

Māori who undergo total joint replacements are younger, have poor general and mental health, have more significant pre-operative co-morbidities and have poorer post-operative outcomes than non-Māori.

As this condition has become increasingly problematic for Māori, it is vital to investigate their perceptions and experiences. Therefore, this study was undertaken by Māori, for Māori and with Māori, and was guided by Māori principles. It included seven Māori women aged between 44 and 71 years. The interviews identified eight themes.

Theme 1: Āhuatanga Māori (all things Māori related)

Many Māori grow-up enriched in all things Māori, so when discussing the impacts of OA on this, they all expressed deep levels of emotion. Pain inhibits their ability to do what is required from them at their marae. As a result of this, many were no longer attending their marae. Another reason they would stop visiting their marae is due to their inability to perform correct procedures or customs required at the marae.

Theme 2: Whakamā (to be ashamed, embarrassed or shy)

Having a sense of whakamā was a prominent theme that appeared throughout the interviews. Some may refuse medication or say they understand what the doctor says when, in fact, they have no understanding at all but are too whakamā to ask again. Some participants even added that they tend to avoid telling people they are in pain or have arthritis because they are too whakamā to ask for help.

Theme 3: Impacts on whānau and self 

Māori have always done things as a collective, rarely undertaking things individually. Therefore, when things begin to affect one individual, it can have a significant flow-on effect on those surrounding them, that is, the whānau. The severity of the pain prevented some participants from carrying out the simple tasks of personal care.

Theme 4: Coping strategies

Participants spoke of the variety of approaches they found were beneficial in reducing their pain levels during different situations, such as sleeping or carrying out their work.

Theme 5: Whakapapa (genealogy or the ancestral line)

Having knowledge and reciting your whakapapa is very important in te ao Māori. Māori frequently refer back to their whakapapa and often acknowledge the attributes of their ancestors. The characteristics and attributes in which some of the participants described witnessing their ancestors display, influenced the way they carried themselves.

Theme 6: Overwhelming frustration

All participants described having some level of frustration towards the condition. From how it has made them feel to the fact they have to live with it and are not able to do a lot about it.

Theme 7: Impact of medicine

There is often some form of distrust from Māori towards western medicine. Even in today’s environment, Māori still have a respectful awareness of Māori healing practices and resort to such healing methods when clinical interventions are either not understood or discarded altogether. Three of the participants discussed still using some form of traditional Māori medicine today as a form of treatment.

Those that were using western medicine spoke of the many adverse effects of medication, both mentally and physically. Some participants had ceased taking medication altogether.

Theme 8: Education

Patients still do not receive the education they need. When asked if they knew what OA was or the available treatment options for it, most stated they had not been told or given that information or were told only little about it. Some did online research, but others just left it and still do not know much about it. Most patients said they felt more education was needed.

Findings

The findings of this study indicate the severity of OA and how it impacts Māori in a multidimensional way, which is reflective of the Māori holistic outlook on life. To have a condition such as OA impact on one’s ability to be who they are as a Māori speaks to the severity of this condition and the importance of implementing appropriate strategies to address these issues.

A similar study investigating Māori adults living with gout arthritis produced several comparable findings. The findings included the limited information provided to patients about the condition, the impacts on relationships with whānau, the mental and physical implications on the patients and the adverse side effects of medication.

The findings from this study give a greater understanding of the impacts of OA on Māori adults and provide a platform for the development of culturally appropriate initiatives for the future.

Recommendations

Three recommendations are suggested to address the participants’ concerns. First, to provide education and relevant information to local marae which will allow marae the opportunity to implement appropriate strategies for the people of their marae who live with OA, while taking into consideration the appropriate tikanga of each marae. Second, to incorporate more whānau involvement in treatment planning so individuals can feel safe and supported throughout their care. Third, for health professionals to provide thorough and easy-to-understand education so that patients have a clear understanding of the condition, its treatments and long-term impacts.

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