Māori aspirations following stroke: A pathway forward for the speech-language therapy field

Figures & data

Table 1. Characteristics of stroke survivors.

ID	Ethnicity	Gender	Age	Time post-stroke	Languages spoken	Whānau interviewed
Tūī	Māori	Female	70	10 years	Te reo Māori, English	Pererū (Husband)
Takahē	Māori	Male		5 months	Te reo Māori, English	Korimako (Wife)
Kōtare	Māori	Female	60	4 years	English, New Zealand Sign Language	Nil
Kāhu	Māori	Male		4 years	Te reo Māori, English	Nil

Table 2. Characteristics of speech-language therapists.

ID	Ethnicity	Gender	Age	Languages spoken
Pītoitoi	Pākehā (non-Māori)	Female	33	English
Whio	Māori, Pākehā (non-Māori)	Female	29	English
Huia	Māori, New Zealand European	Female	39	English
Hihi	European	Female	32	English, French
Kōkako	Māori, New Zealand European	Female	45	English

Table 3. Semi-structured interview guide.

Questions for stroke survivors and whānau	Questions for Māori and non-Māori SLTs
What was SLT like for you? When did SLT work well? When did SLT not work well? How was your SLT? What did you like? What did you not like? Is there anything you would want to change about the SLT you had? How could SLTs best support Māori after stroke? What are your hopes for SLT in the future?	When providing support for Māori post-stroke, what things worked well? When providing support for Māori post-stroke, were there any challenges? What do you think about the cultural competency of SLTs working with Māori post-stroke? What are your hopes for future SLT provided to Māori stroke survivors? Is there anything that could help SLTs work effectively with Māori?

Table 4. Quotes in the theme of tautoko (support).

Tautoko	Stroke survivors and whānau	Speech-language therapists
Experiences	“It [SLT] gives my freedom back … As well as … being able to communicate” (Tūī). “I have been wrapped around all the way through [the SLT journey]” (Kōtare). “There’s a lot of people [in the community] don’t wanna do it too … .Don’t wanna talk to you … .Because the way you talk” (Kāhu).	“I think everyone’s [SLTs’] hearts are in the right places … And I know that every person I talked to wants to be doing their best for Māori. So I think we’re doing really well with that. We have really good intentions and good hearts for what we’re doing” (Hihi). “The medical profession hasn’t been historically very good at engaging with people who are Māori” (Pītoitoi). “I think awareness of communication impairments … is very low … .And I think that’s even less so for Māori” (Pītoitoi). “And I think it’s the people who, who run the [university SLT] courses … I think they have … a passion for it … I think that, they’ve … managed to get some really good leaders in those programmes … who really care about it” (Hihi).
Aspirations	“Make sure that those who’ve got speech problems or communication problems get an alarm. … I feel more safe going out on my own now … I could be in the mall or somewhere and I lose my speech … and I can pull this [safety alarm]” (Tūī). “For speech therapy, is there anything else you would really like to see in the future” (Interviewer)? “Make sure that becoming a therapist, part of it will be that these modern technology phones … that, in the future … social welfare, whatever, remember that people like me … do need these tools … so we’re able to communicate to other people” (Kōtare). “You have to remove all those barriers. … Removing fear and obstacles and barriers and going … we see them, we acknowledge them … but we believe ourselves to be bigger than that” (Korimako).	“Just a bit more acknowledgement [in SLT] that different cultures need different needs. … And that … one standard form doesn’t fit … all” (Kōkako). “What I would love to see is just a workforce … that feels like they can engage in day-to-day Māori tikanga [Māori customary values and practices]” (Hihi). “Certainly, a bit more education [for SLTs] would be nice” (Kōkako). “Teaching more around … tikanga [Māori customary values and practices] models. … What I’d hope to see … is that they [universities] don’t stop at those models. … Like actually translating it into practice … .You don’t have to practice the models on people who are disordered. Could be on just people out in the community” (Huia). “Even more of … the core competencies for SLTs, having cultural competency … at the same level as we put on dysphagia and communication. I, that is like my dream … .And that being filtered down then essentially, to the universities” (Whio). “And then also reaching different communities. Like when public health people go to talk to people about stroke prevention … having a speech therapist there to talk about … patients that they’ve … seen” (Whio). “More visibility of … Māori [and] Pasifika … .More … minority cultures in … stakeholder positions” (Whio).

Table 5. Quotes in the theme of kaupapa Māori (Māori approach).

Kaupapa Māori	Stroke survivors and whānau (family)	Speech-language therapists
Experiences	“He recited … karakia [Māori ritual chants] yesterday. Like, four of them. … But when they [the SLT] assessed him they said, ‘can you read?’ And we’re like, ‘he just read four karakia [Māori ritual chants]’. … And like … ’are you able to recite?’ I’m like, ‘did you not just hear it?’ … But because it’s not in that structure that they’re using” (Korimako). “They [the SLT] did this assessment … where they ranked him on different things … and he got like ones and twos. He didn’t want to talk for the next three days … He sunk … It took me two days to undo that” (Korimako).	“We’re going to very much the … Calderdale type frameworks. … Which is very … a European-based style. So we’re going away, again, even further from where we need to be going” (Kōkako). “I think … we expect so much of our … patients, and particularly our Māori patients to accommodate us … .As opposed to making the changes ourselves … and support them” (Pītoitoi). “Not being able to speak te reo Māori [Māori language] … .that has certainly been a barr-, like they [Māori stroke survivors] are almost like disappointed” (Whio). “We’re also so medical focused … .They [Māori stroke survivors] want to be able to think of medicine in a … different way” (Kōkako). “For a lot of our cognitive communication patients … the type of therapy that you do is … You’re trying to stop them from being tangential, stop them from trying to … go off topic and … you try and rein them in … That kind of therapy and doing impairment-based stuff is not … I feel like I would have to have a really good relationship with the patient and their whānau [family] to be able to do stuff like that” (Whio). “But what I felt was extremely valuable was that it [kaupapa Māori ward] was so open and … whānau were encouraged to stay … .They were welcomed to stay … on that ward. … It seemed like, from what they were telling me that it … felt really supportive, and … less kind of singled out or on your own I think” (Pītoitoi).
Aspirations	They’ve [universities have] got to recognise there’s two sides to a coin … If you try and force the Pākehā way onto Māori it doesn’t work” (Tūī). “Your wairua [spirit] and all that. … That’ll be … part of the [SLT] programme. … The hinengaro [mind]. … You need all of that. … Waiatas [songs]. … That’s all part of it too. … For your atua [gods] and … your wairuas [spirit] … .It’s all part of it. … With our Māori programmes … We gotta have some Māori [Māori language]. … Well I understand about kai [food]. … That’s being Māori. … Well that’s what I’m saying, another programme … and now this is the way” (Kāhu). “You have to find a [an SLT] programme that’s gonna … help Māori … .And … I think that … it’s nice to be a Māori … .You have to be a Māori [SLT] … to do that” (Kāhu).	“I’d like to see … a speech therapy service where that’s [a Māori way of working is] the mainstream … rather than just a siloed part of our work” (Hihi). “They [SLTs] want to be like, ‘give me some resources’ … ‘where [are] some resources that are translated … into te reo [Māori language]?’ … .Actually just translating the WAB [Western Aphasia Battery] into te reo [Māori language] isn’t gonna get you … what you want … .Or using a semantic feature analysis … and just translating that isn’t necessarily going to … change the outcomes or the practice … . People … I think, wanted those resources … .And you know, it’s kind of that, that understanding of, that’s the end point … .Not the starting point … .You know, it’s that slow process … .And actually creating resources in a … mātauranga Māori [Māori knowledge] … framework that are appropriate” (Huia). “It’d be cool to have a waiata [singing] group or a kapa haka [Māori performing arts] group” (Whio).

Table 6. Quotes in the theme of whanaungatanga (relationships).

Whanaungatanga	Stroke survivors and whānau (family)	Speech-language therapists
Experiences	“That’s another thing that keeps me going. … People like herself [person with aphasia] and other people [with aphasia]” (Kāhu).	“When you’re trying to build genuine connections with people and try to undo some of those negative experiences that might have happened in the past … having a time limit of six hours across six weeks, is just not conducive to that” (Pītoitoi). “The environment really makes a difference … .Being in their environment” (Hihi).
Aspirations	“I know … it’d not be easy for you, but you are a speech-language person [therapist]. So, you have to step over the fence, climb down and do the other person’s [client’s] perspective” (Kōtare). “Having people [SLTs] around like that. … To support us. … That’s what we need, people like that to support them [Māori stroke survivors] … .Just to have that start … .There at the start” (Kāhu).

Table 7. Quotes in the theme of tino rangatiratanga (autonomy).

Tino rangatiratanga	Stroke survivors and whānau (family)	Speech-language therapists
Experiences	“I get so frustrated when people go, ‘you do it this way’” (Tūī). “I don’t understand … their [aphasia group] rules sometimes … We have to listen to a person that is making a speech … And we cannot … interrupt them … until the end … But the thing is, you need it to be on the spot … You will forget … So, you can interrupt them surely … But … These are the rules set in stone” (Kōtare). “But with the information that we got when I first had my stroke, I couldn’t understand a word that they, they had it in [unintelligible] words … .Instead of having it, well I guess in Māori, but in simple terms” (Tūī).	“We don’t really … take feedback from … patients … ..We’re not very good at … asking … how well are we doing … for you? So without … that … piece … we’re kind of just saying from our point of view, what we think … is going well” (Huia). “We’ve talked about doing surveys … of people with … communication difficulties … There’s outpatient surveys that people can fill in online … I don’t know what … percentage of Māori fill those in … I don’t think it’s, matches the percentage of people … who access health care … People [sigh] don’t wanna fill out paper … Conversations are … really important” (Huia).
Aspirations	“We have really got to start fighting for what we are entitled to … instead of being suppressed” (Pererū).

Table 8. Quotes in the theme of taiao (environment).

Taiao	Stroke survivors and whānau (family)	Speech-language therapists
Experiences		“I’ve been very lucky that with … my two workplaces … that … I’ve always been very support- do whatever it takes to … get it right for our Māori patients. But … I know that others in other … work settings have not had that same experience” (Whio). “It probably depends on … the environment as well as … acute, rehab, community” (Huia). “I think it’s a bit of a mixed bag … Some of it is dependent on the team, the environment … What part of the country you might be in … Like you could work … up in Northland [region in the North Island of Aotearoa New Zealand] for example, and be … really immersed in … Māori culture and tikanga [Māori customary values and practices] and have … people supporting you really closely. Not to say that they’re always gonna do a great job of it, but that opportunity … Whereas … compare it to Christchurch [city in the South Island of Aotearoa New Zealand] … I don’t know what it’s like in the community … Inpatients are still very much a Western … environment” (Huia). “There was a really good phrase … about the hospital world … I think, we get just kind of embedded in it … when we start working in a hospital. And there’s a certain way of doing things, which is just ingrained in the day-to-day operations in a hospital. … It’s very oppressive and it’s very Western oppressive” (Hihi). “They [Māori stroke survivors] want all those supports around them. And we just don’t have those facilities … [Sigh] our whānau [family] room has [hospital] beds in it” (Kōkako).
Aspirations	Nil	Nil

Table 9. Quotes in the theme of kōnekeneke (change).

Kōnekeneke	Stroke survivors and whānau (family)	Speech-language therapists
Experiences		“As a profession, I think we’re improving … our services … .There’s more awareness and more … opportunities for people to be able to support Māori … .It’s moving … with the expansion of models and the teaching … Hui Process and Meihana Model … .And then you’ve got … Karen’s [Karen Brewer’s] … module … .Which is really great to help people [SLTs] kind of move … to a bit more practical” (Huia). “There’s … a lot of work being done on individual levels to change things” (Pītoitoi).
Aspirations		“I think we’re just at the right time to be like, catching that wave and just like, you know, going on with it and just keep pushing” (Whio).