Development of a hauora wellbeing assessment tool for wahine hapu (pregnant women) and Maori adults with long-term conditions

Name: Hauora assessment Why: to assess health and wellbeing needs of the participant and support these needs What: We plan to partner with a range of stakeholders to develop a hauora (wellbeing) assessment tool to assess and meet needs for wahine hapu, and Maori adults with chronic disease. The comprehensive wellbeing screening and support tool, the Hauora assessment, will have follow-up protocols for each question and will be administered by a trained Maori navigator to support whanau to access a range of services, including providing help when possible. For example, checking general practice (GP) enrolment and if not enrolled supporting enrolment, asking about smoking and supporting smoking cessation, healthy homes check (asking a few questions about whether the home is warm, dry, insulated and not overcrowded), cancer screening and immunisations as well as other identified relevant topics. These are yet to be determined through the co-design process. The stakeholders for co-design will include: Waikato hospital clinicians working in maternity and with patients with chronic diseases, including doctors, nurses, dieticians, podiatrists, as well as other hospital staff working with these patients, e.g. kaitiaki (cultural support workers) and social workers. Other Waikato District Health Board (DHB) staff involved will include the General Practice (GP) liaisons, Whare ora (Health Homes) coordinator, stop smoking service coordinator, immunisations coordinator, family violence coordinator, cancer screening coordinator, and any other relevant service leaders/coordinators identified during the co-design process. We will also engage with community. This includes Maori health providers in the Waikato region, birth care centres and Maori antenatal program leads (there are currently 2 running in Hamilton/Waikato). Stakeholder engagement will generally include face to face or virtual meetings with each stakeholder to discuss the screening question and pathway/protocol as well as any issues/barriers or solutions for Maori patients (for approximately 1 hour). There may be more than 1 session with some stakeholders, depending on the complexity of the topic. Lastly, we will run 4 focus groups with Maori mothers (both rural and Hamilton city) and 4 focus groups with patients with chronic disease (1 focus group per condition). All focus groups will run with approximately 7-10 people, for up to 2 hours. Each participant will sign a consent form before the focus group begins and be provided with a $100 supermarket voucher as koha/gift for their participation. We will use a systems level approach to ensure all aspects of the hauora programme assessment tool are high quality, clinically safe, continuously improved and to advocate for change at multiple levels when required. This means that the tool will be updated and modified on an as-needed basis, e.g. if a participant, stakeholder or advisory group member identifies an area of concern. Modifications will be made and reviewed by the whole research team, along with stakeholder input where required, before they are implemented into the live version of the hauora assessment. We will not be monitoring adherence to the assessment tool but will collect data on questions completed, which will capture assessment completeness. We will also be measuring secondary outcomes to assess if certain protocols are completed successfully, e.g. enrolment with a GP or stop smoking service. Who provided: The assessment will be administered by a trained Maori navigator to support whanau to access a range of services where needed. Training will for the navigator will include a combination of in-house training on the hauora assessment and other Waikato DHB or Ministry training associated with specific topics in the hauora assessment. For example, how to screen for family violence (Waikato DHB family violence coordinator runs 1 day training sessions on this), and the Ministry of Health NZ online smoking cessation training (1 hour). In-house training will include going over and role playing completing a hauora assessment with wider research team members (at least 3 practice sessions, approximately 1 hour each) and practicing with other members of the Maori Health service (at least 2, for approximately 30-40 min each time). There will also be a 1 hour session with the director of Tikanga (Maori protocol expert) or with a delegated person, to learn about approaching and engaging with Maori whanau and participants. How: the assessment will be delivered face to face with an individual and their whanau will be present if they wish. Where: For pregnant women: the assessment will take place in the community at the home or other chosen location of the participant if they are recruited from the community. For women recruited through maternity services at Waikato hospital the assessment may take place in a private room at the hospital or at the participants home. Where: for those with chronic conditions: assessments will take place primarily at outpatient clinics for each condition on site at Waikato Hospital. When and how much: the assessment will be conducted once at the time of recruitment. It is expected to take between 20-40 minutes to complete. Modifications: the assessment will be co-designed from the start and it is expected that where needed modifications will be made to the intervention throughout the course of the trial. This will be informed by the research and co-design groups.