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

Fiona MathiesonUniversity of Otago,Wellington

Collaborators: Dr Kara Mihaere, Professor Sunny Collings, Professor Tony Dowell & Dr James Stanley

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

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

Adaptation Process

Partnership with Dr Kara Mihaere Review of literature Focus interviews with clinicians &

Maori potential users of the intervention

Maori graphic designer employed

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

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

Adaptations made Karakia (prayer) Whakatauki (proverbs) Whakawhanaungatanga (finding

connections) Imagery Scenarios Whanau (family) Wairua (spirituality)

Imagery

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

How consistent is this approach with Maori models of mental health? Meihana model

Whanau Wairua Hinengaro Tinana Taio Iwi-katoa

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

K10 Scores

UBI UBI-Maori

K10 ImprovementsUBI UBI-Maori

SF-36

Patient satisfaction

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’

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’

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

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

The future

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