Rural Māori experiences of accessing heart health care: a Kaupapa Māori qualitative analysis.

Introduction Rural Māori experience inequities in heart health outcomes compared to rural non-Māori and urban Māori. Access to health care is a significant contributor to these inequities. There is a wealth of literature that explores Māori access to health care; however, the voice of rural Māori within the literature is limited. Under Te Tiriti o Waitangi (The Treaty of Waitangi), Māori have legislative rights to access, engage, and participate in the health care system equitably. Aim This study aimed to investigate the barriers and facilitators of accessing heart health care for rural Māori. Methods The study was informed by Kaupapa Māori Theory, which centres on Māori worldviews and epistemologies. Rural Māori (n =11) with lived experience of (or who had supported their whānau (family) member with) acute coronary syndrome, heart failure or cardiovascular risk assessment were interviewed, and reflective thematic analysis of the data was undertaken. Results Three overarching themes were generated: rural Māori desires and expectations of heart health care; how the system engages with rural Māori; and knowing what is important to rural Māori when it comes to heart health. Discussion Participants experienced many barriers to accessing quality heart health care, some of which were unique to rural settings. Participants sought heart health care that was close to home, culturally responsive, included a representative Māori workforce, involved their whānau, and valued partnership. System-level action is needed to adequately address inequities in health care access and outcomes in rural Māori and to meet obligations under Te Tiriti o Waitangi.