The He Pikinga Waiora process evaluation tool guiding implementation of chronic condition interventions in Māori and other Indigenous communities

Introduction: In 2016 the He Pikinga Waiora implementation framework was developed to guide the successful development of chronic condition interventions specific to Indigenous communities. The framework has Indigenous self-determination at its core, and four key elements essential to implementation: cultural centredness, community engagement, systems thinking, and integrated knowledge translation. To test its efficacy, in 2015 the He Pikinga Waiora academic research team established partnerships with two Māori (NZ’s Indigenous peoples) community health organisations: Te Kōhao Health and Poutiri Trust. Each community partnership is entrusted with co-designing and implementing an intervention that primarily focuses on reducing the risk of progression from pre-diabetes to diabetes. The first evaluation of the implementation process was undertaken in December 2017/January 2018. Theory/Methods: Based on the framework, a process evaluation tool was produced to measure how well the researchers, communities, and both partnerships are following the framework while in the process of developing and implementing an intervention. The questions were grouped into 14 sub-categories that are centred around the core elements of the implementation framework, and identifies positive practices for engaging in community based research partnerships. The evaluation tool was administered in two parts – an online survey and a semi-structured interview. Ten members directly involved in the implementation and co-design process participated in the evaluation. Eight completed the online survey, and nine participated in the interview. The data is used to reflect on what is working in the partnerships, and/or what areas might need improvement. Results: Overall, the participants rated the partnership as very positive, with high levels of commitment towards transformation and community engagement, and trust. The participants also rated highly the partnership’s capacity to effect change. Although all participants agreed that the partnership was following the framework, there were some areas that needed improvement. The community participants’ were a little less optimistic about the sustainability of the interventions beyond the research funding period, and its capacity to affect wider change. They also rated resource sharing and invovlement in research to a lesser degree than the researchers. Discussion and Conclusions: The He Pikinga Waiora framework is well suited to evaluating the implementation of health interventions. The tool also helps facilitate better collaboration between researchers and communities, and to reflect on relationships of power and privilege. Lessons Learned: Reflection is important to ensure that a collaboratively developed intervention remains true to is principles. Researchers and community members do not always have the same perceptions about the process and reflecting on these differences helps to ensure that the partnership meets its long-term goals. Limitations: Small sample size results in insufficient power to apply across the general population, and limited the ability to make statistical comparisons between the researchers and the communities. Suggestions for Future Direction: Undertake a second evaluation after the implementation of the interventions and disseminate the process evaluation tool to end-users who intend to develop new co-designed interventions.