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Maori adaptation of a low intensity mental health intervention in primary care

This study focuses on the adaptation of a low-intensity mental health intervention for Maori individuals in primary care. The intervention, an ultra-brief intervention (UBI), aims to address sub-threshold syndromes commonly managed in primary care. The study explores the feasibility and effectiveness of the adapted UBI through a collaborative process.

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Maori adaptation of a low intensity mental health intervention in primary care

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  1. Maori adaptation of a low intensity mental health intervention in primary care Fiona Mathieson University of Otago, Wellington Collaborators: Dr Kara Mihaere, Professor Sunny Collings, Professor Tony Dowell & Dr James Stanley

  2. Background/ Rationale • Sub threshold syndromes common, distressing, disabling, already managed in primary care • Access and engagement issues for Maori • A novel ultra brief intervention (UBI) has been developed, promising results • Aimed to adapt this for Maori • Feasibility study

  3. Approach that was adapted: UBI • Developed through collaborative process • Low intensity, CBT based guided self help • 3 ultra brief sessions + f/u call/email • Clinician as coach • Treatment manual & 3 self help booklets • Problem solving & behavioural change • Motivational interviewing components • ‘Power of prescription’: homework • Integrated with patient management system

  4. Adaptation Process • Partnership with Dr Kara Mihaere • Review of literature • Focus interviews with clinicians & Maori potential users of the intervention • Maori graphic designer employed

  5. Literature • Very little research • Expert opinion says need: • Socio-centric emphasis • Spirituality • Maori language (Te Reo) • Identity • Connectedness • but individual differences • International literature • Similar concepts and values

  6. Focus Interviews • Clinicians • Keep basic format • Scenario changes • Imagery changes • Include whanau & karakia • whakawhanaungatanga • Too wordy • Potential users of the intervention • Too wordy • More imagery • More Te Reo & wairua • Range of responses re karakia

  7. Adaptations made • Karakia (prayer) • Whakatauki (proverbs) • Whakawhanaungatanga (finding connections) • Imagery • Scenarios • Whanau (family) • Wairua (spirituality)

  8. Imagery

  9. Whakatauki • He manga wai koia kia kore e whikitia • It is a big river indeed that cannot be crossed • He moana pukepuke e ekengia e te waka • A rough sea can still be navigated • He toka tu moana ara he toa rongonui • Your strength is like a rock that stands in raging waters

  10. How consistent is this approach with Maori models of mental health? • Meihana model • Whanau • Wairua • Hinengaro • Tinana • Taio • Iwi-katoa

  11. Outcome domains & measuresAdministered at intake, 2 weeks, 6 weeks & 3 months • Demographics Socioeconomic status: NZI-dep • QOL:Whoqol-bref • Functioning: SF36 • Global mental health: K10 • Patient satisfaction • Clinician satisfaction

  12. K10 ScoresUBI UBI-Maori

  13. K10 ImprovementsUBI UBI-Maori

  14. SF-36

  15. Patient satisfaction

  16. Patient comments • ‘It.. felt as though he was helping me that step further’ • ‘It’s helped me as a person just to believe in myself again, have faith in myself again that I can actually pull through these tough times’ • ‘It gave me the power back’ • ‘I just felt safe in that environment’ • ‘He was…lifting me out of my hole but not mollycoddling me. I was doing it but he was there too’ • ‘I was quite amazed ..at how much Māoridom ..are up there and know what they’re talking about it’s not just “oh we’re saying it because this is what the pakeha have written’

  17. Clinician interview feedback • Good to have another tool • Familiar face helpful • Need help with pronunciation • Like getting to know process • Karakia put people at ease • Had to chase people for sessions 2&3 (text reminders helped) • Suggested extra training session • ‘Being able to..offer something..and having a framework so you don’t fall apart in the middle of it’ • ‘Nobody in her life had ever paid her that kind of attention…it was quite humbling’

  18. Uptake • Low uptake • Trained 22 clinicians of whom 4 actually used intervention • Recruited 16 patients of whom 9 completed • Follow-up data for 7 • Reasons for not completing

  19. Limitations & discussion • Small n, no control group, short follow up • Reasonably easy to adapt tool • Those who used it, liked it • Don’t be scared to work in the area of cultural adaptation when you are not of the same culture- as long as you are genuinely collaborative

  20. The future • Planned RCT with parallel Māori stream; possible URL • Possibly adapt it for Pacific Island people, youth?

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