He Pikinga Waiora Implementation Framework: A tool for chronic disease intervention effectiveness in Māori and other indigenous communities

Health outcomes for Māori are significantly worse than non-Maori in New Zealand; these inequities mirror those found in indigenous communities elsewhere. Evidence-based interventions with established efficacy may not be effective in indigenous communities without addressing specific implementation challenges. We present an implementation framework for chronic condition interventions for Māori. Theory/Methods: The He Pikinga Waiora Implementation Framework has indigenous self-determination at its core and consists of four elements: cultural-centeredness, community engagement, systems thinking, and integrated knowledge translation.  All elements have demonstrated evidence of positive implementation outcomes.  A coding scheme derived from the Framework was applied to 13 studies of diabetes prevention in indigenous communities from a systematic review. Results: Cross-tabulations demonstrated that culture-centeredness (p=.008) and community engagement (p=.009) explained differences in diabetes outcomes and community engagement (p=.098) explained difference in blood pressure outcomes. Discussion and Conclusions: The He Pikinga Waiora Implementation Framework is well suited to advance implementation science for Māori and other indigenous communities. The framework has promise as a policy and planning tool to evaluate and design effective interventions for chronic disease prevention. Lessons Learned: We needed to revise the coding framework in order to make the implication framework concrete. Limitations: This study has a limitation in that we coded information about interventions from the published articles and not the interventions themselves. Additionally, the study only included 13 interventions. Suggestions for Future Direction: Further research should provide stronger evidence of the usefulness of the framework particularly with Māori end-users. There will also be a need to understand the differential contribution of each of the four elements to health outcomes.