Hapū māmā experiences of the Whanganui Best Start Model of Care in primary care: a qualitative study

Introduction Early pregnancy engagement is important for maternal and infant wellbeing, yet Māori continue to experience inequities in access to timely and culturally responsive care. The Whanganui Best Start Model of Care was developed to strengthen equitable, culturally grounded, early pregnancy support within primary care. Aim This study aimed to explore hapū māmā (pregnant women) experiences of early pregnancy care delivered through the Whanganui Best Start Model of Care, with a focus on equity, cultural acceptability, relational safety, and systems implications for primary care. Method A qualitative study guided by Kaupapa Māori research (KMR) principles was conducted with nine hapū māmā who received a Best Start assessment in a very low cost access clinic or iwi-owned practice. Semi-structured interviews were analysed using reflexive thematic analysis, with cultural review by a senior Māori researcher (HG). Results Māmā described Best Start as a valuable entry into maternity care when delivered with whakawhanaungatanga, clear communication, and responsive follow-up. Positive experiences included feeling heard, supported, and connected to community, mental health, and Kaupapa Māori services. Challenges included variable introduction to Best Start, inconsistent follow-up, difficulties accessing midwifery care, and assessments that felt overly checklist-driven. Kaupapa Māori and/or relaxed assessment environments enhanced safety and reduced anxiety. Conclusion The Best Start Model of Care can strengthen early pregnancy engagement and support equity for Māori when delivered consistently. System improvements are needed to ensure relationally grounded communication, standardised follow-up pathways, reliable midwifery navigation, and ongoing collaboration with Kaupapa Māori services.