Applying indigenous Māori Pasifika research methodologies to frame Queensland Māori Pasifika experiences of child health service delivery: an exploration of a lack of uptake of health services

BACKGROUND: A Queensland Health report points out that Māori and Pacific Island communities in Queensland are vulnerable due to social disadvantage and limited health service access. The researcher applies decolonisation and cultural safety models, emphasising the importance of understanding the historical, political, and socio-contextual determinants of these groups. Ethical considerations as applied in this research must be flexible and culturally safe, focusing on a reflective and respectful approach to data collection. The literature review is based on Charmaz's constructivist contextual framework, which underpins and later reveals that the socio-contextual determinants for Māori and Pacific Island communities in Queensland are multifaceted, with one direct factor being disengagement from child and family health services. To explore this, qualitative research used both decolonisation and cultural safety methodologies, with a focus on ethical considerations and the service user's experience, specifically examining how care is delivered, and not just the type of care provided. METHODS: Embracing a decolonial perspective, the Talanoa method guided the data collection process. This involved interviewing 29 Māori and Pacific Island families in Townsville and Brisbane, as well as eight child health service providers in these areas. During data analysis, key interpretations were informed by conceptualisations of culturally safe health service delivery, supported by Charmaz's constructivist grounded theory, which aligns with the cultural safety methodology. RESULTS: The data analysis revealed key themes, including power dynamics, positionality, and identity versus cultural differences, the deficit discourse of trans-culturalism, and cultural disconnection in the portrayal of health service delivery to Queensland Māori and Pacific Island families. In this research context, trans-culturalism is associated with a deficit discourse. CONCLUSIONS: The application of the theoretical framework of cultural safety and decolonisation was two-fold; it reveals the importance of working in partnership and reveals significant power imbalances, causing a lack of engagement between service users and service providers. Furthermore, it reveals the unexamined privileges of service providers and the inherent marginalisation of service users. Of significance to the research problem statement, the 'lack of uptake of health service delivery', the grounded theoretical and traditional perspectives of cultural safety and decolonisation shift the focus from service users (Māori and Pacific Island communities) to explore the experiences of child health service providers in their interactions with Māori and Pacific Island families. The analysis uncovered misconceptions and a tendency to assume that healthcare delivery using a trans-cultural approach was culturally safe. Unearthing an understanding that challenges the deficit discourse of trans-culturalism to comprehend participants' positionality is essential for resolving and addressing the health issues faced by Queensland Māori and Pacific Island families accessing services. This recognition indicates an ongoing reliance on colonial imposition rather than promoting (a principle of cultural safety) self-determination in access to health service delivery for Queensland Māori and Pacific Island families.