Whānau Māori perspectives on antibiotic guideline use in Aotearoa: a qualitative study

INTRODUCTION: Māori in Aotearoa New Zealand (NZ) experience large and persistent inequities in infectious diseases and antimicrobial resistance. Appropriate antibiotic prescribing is one component of effective care that can be supported by the use of antibiotic guidelines. AIM: This study aimed to gain insights into the perspectives of Māori regarding antibiotic guideline use in primary care and explore alignment with their expectations and aspirations for health and wellbeing. METHODS: Qualitative research methods were grounded in Kaupapa Māori theory and practice, supporting critical analysis that prioritised Māori and Māori knowledge. Participants aged 18 years and over who identified as Māori were recruited from an urban Māori health provider to attend a focus group. Sub-themes and themes were identified through inductive thematic analysis. RESULTS: Fifteen Māori participants attended focus groups. Four interconnected themes that underpin the use of antibiotic guidelines in primary care were identified: Whakapono (trust and confidence), Māramatanga (clarity and understanding), Kairangi (culturally safe and quality care) and Hauora (holistic health and wellbeing aspirations). DISCUSSION: Antibiotic guideline use is a relational practice situated within systems of trust, power and quality of care. When used within culturally safe, respectful and holistic models of care, guidelines can support high-quality care, build understanding and strengthen confidence in antibiotic decision-making. As NZ implements its first national antibiotic guidelines Te Whata Kura, there is a critical opportunity to ensure that use is culturally safe, barriers to access are addressed and that rongoā Māori (the traditional healing system of Māori) is accessible alongside biomedical approaches.