Description of the process used to adapt a brief mental health intervention in primary care, for Maori.

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

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
 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

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?