Manawataki Fatu Fatu for ACCESS (Maori and Pacific Hearts in Unison for Achieving Cardiovascular Care in Equity StudieS). Protocol for a Mixed Methods Programme of Research

Maori and Pacific peoples in Aotearoa New Zealand (NZ) face significant inequities in cardiovascular disease (CVD) risk factors, hospitalisations and management rates, compared with non-Maori, non-Pacific peoples. These inequities are intimately linked to factors such as colonisation and the intergenerational impacts of systemic racism. This is the protocol for Manawataki Fatu Fatu for ACCESS (Maori and Pacific hearts in unison for Achieving Cardiovascular Care in Equity StudieS), a mixed-methods programme of research, combining kaupapa Maori and Pacific research methodologies (i.e. incorporating the knowledges, skills and values of Maori and Pacific peoples). In this Maori and Pacific led research programme, we will use qualitative and quantitative methodologies to identify evidence-practice gaps along the healthcare continuum that can be addressed to improve heart health outcomes for Maori and Pacific people in NZ.The programme is built on three foundation projects: (i) the assessment and management of CVD risk in primary care; (ii) pre-hospital delays in accessing care following an acute cardiac event in the community; and (iii) post-discharge and long-term management of heart failure. There are three phases. Phase 1 aims to systematically document research, completed or underway, about equitable access to evidence-based heart health care. We will establish a national collaboration of equity-focused heart health researchers and providers, and undertake systematic reviews relating to the three foundation projects. In Phase 2, we will undertake qualitative and quantitative research in the three foundational projects, to identify interventions to increase access to heart health care that have most potential to improve Maori and Pacific health outcomes and achieve equity. The quantitative and qualitative studies will be undertaken in parallel and will inform each other. Phase 3 will use findings from Phases 1 and 2 to create a Quality-Improvement-Equity Roadmap to inform interventions to improve Maori and Pacific people's access to evidence-based CVD care.