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/
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

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

6. 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

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

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

9. Imagery

10. 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

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

12. Outcome domains & measures Administered 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

13. K10 Scores UBI UBI-Maori

14. K10 Improvements UBI UBI-Maori

15. SF-36

16. Patient satisfaction

17. 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’

18. 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’

19. 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

20. 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

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