As part of an ethical and respectful approach, Indigenous methodologies need to explicitly include cultural protocols, values and behaviours as integral components of the research
. These factors should be thought about reflexively, declared openly as part of the research design, discussed as part of the final results and disseminated back to the people in culturally appropriate ways in a language that can be understood [Ibid, pg 15]. In accordance with these principles, this paper has documented the procedure of implementing a longitudinal, qualitative study of Māori parents’ experiences of living with a child with asthma, and critically evaluated these processes through feedback from the participants. The key factors in the success of this study, notably the retention of the participants and their good feedback, were (1) the relationship between the participants and the interviewing researcher (BJ), and (2) the support and buy-in from Tu Kotahi and the local Māori community.
A well established and mutually beneficial partnership with a Māori health provider Tu Kotahi was pivotal to the overall success of this research
. The consultation and development of the relationship took a real commitment from both the community and researchers’ perspective. While this involved a considerable investment in staff resources and was time-consuming for both parties it was vital for all concerned to ‘get this right’ prior to the commencement of the study. The research methods and recruitment strategies involved a kanohi-ki-te-kanohi (face-to-face) approach and an opportunity for whānau (families) to attend a hui (meeting) outlining the results of the study.
This establishment of a meaningful community relationship is known as the KMR principle of kanohi kitea (the seen face) which advocates that researchers know, and be known by, the community with which they intend to conduct research
. There are a number of parallels between this culturally-based paradigm and what Johnson refers to as the validation strategy of ‘extended fieldwork’
. By this he notes that as a researcher “you should spend sufficient amount of time studying your research participants and their setting so that you can have confidence that the patterns of relationships you believe are operating are stable and so that you can understand why these relationships occur”. Our longstanding a priori consultative relationship with Tu Kotahi and local Māori communities, along with the longitudinal aspects of the follow-up all contributed to the basis for the theoretical validity of this research. This was confirmed by the reciprocal view, of a Māori Provider (CD): “Developing a long-term meaningful relationship with a research institute eventuated in an opportunity for us [Tu Kotahi] to have a voice in a project that directly affected our community. We were treated as a significant partner having been involved in all aspects of the project.”
A key indicator of the success of this study was the retention of participants. Such retention depends on a combination of respectful relationships between the researchers and families, and a method that families feel allows them to tell their story. The inclusion of repeat visits with parents and children fitted with cultural expectations of being able to establish a trusted relationship before divulging personal experiences and beliefs. These repeat visits also permitted more accurate collection of information due to seasonal variations and subtle changes that impacted on the management of their child’s asthma. The research experience for families was by no means uniform. Some families opened up at the first interview, others were more reticent and only spoke openly at the third or fourth interview. Even so many of the participating families were amenable to being involved in further research. This was pleasantly rewarding for the research team given the popular myth of Māori being reluctant to be involved in research. This myth likely has its roots in historical experiences of research that could not ‘hear’ Māori voices, let alone promote any evidence-based change based on Māori experience
The use of multiple methods, interrogated under KMR, not only added to the robustness and trustworthiness of the data but more importantly these methods were found to be culturally acceptable by the Māori participants. They provided tools that could be used to explore gaps in services, knowledge and understanding from an appreciative inquiry perspective
 that helps build the research capacity of whānau instead from a deficit model. The use of IPA within KMR was found to be highly appropriate for this Māori community as it upheld the rights of the participants throughout the study while allowing for an analysis of societal structures that impacted on their experiences
The semi-structured interview technique was well suited to this study as it allowed the researcher the flexibility to explore the individual experiences of participants who, although all Indigenous, were by no means a homogenous group. A further benefit to the interview process was its capacity to make space for extended family to participate, contribute, and engage. These inputs were seen to enrich the interview content by incorporating different perspectives, as many of these informants were also carers who contributed to the child’s asthma management. Additionally, the involvement of these family members also provided support, encouragement and prompted further discussion. This practice aligned well with Māori/Indigenous frameworks of sharing stories and involving extended family collectives
The questionnaire, while predominantly designed to collect an asthma history and demographic data was well received by participants. It served as a useful medium to generate discussion, and acted as a prompt that enabled participants to ask questions about asthma triggers, medication and environmental factors. This reversal of participants questioning the researcher was an example of the power sharing that the use of the KMR paradigm facilitated. Of note from the asthma questionnaire was the level of morbidity experienced by participating whānau. Although we purposefully aimed to sample a range of asthma severities, the majority of children studied had poorly controlled asthma with frequent and/or severe symptoms, and hospitalisation. Despite this level of morbidity a number of children did not have an asthma plan or peak flow meter.
While many of the children were too shy to verbally engage at length during the interviews they all welcomed the opportunity to draw and they found the lung representations a fun and engaging way of participating in the research, and generated much discussion about their lungs, and experiences of asthma. Many parents also saw the process of observing the researcher engage with the child whilst completing and discussing the lung drawings, as a non-threatening way of asking their own questions about lungs and asthma that they had previously been uncertain how, and/or too embarrassed, to ask. The discussion topics generated by participants included: basic lung anatomy and physiology; the causes and triggers of asthma; and the subsequent effects of asthma on their body. Overall, this method proved to be a powerful tool which provided a non-threatening context to explore understandings about asthma, and allow participants opportunities to address areas of uncertainty.
Photovoice as a method was embraced by most participants however others were unfamiliar with this approach and struggled to photograph images that were asthma-related. Many requested more detailed explanations and visual examples illustrating a range of items to use before they were confident in taking their own photographs. One of the challenges faced by the researchers was in getting the right balance between providing too little information or being prescriptive and influencing participants’ photograph selections.
An additional challenge in the coding process, for the researchers not directly involved in the interview, was interpreting participants ‘sense-making’ as some of the narratives were not always clearly articulated in the text, but were implicit in the shared understanding between the interviewer and the participant.
Having research credibility in the eyes of Māori participants is not only about good research processes and the right selection of research methods, but also about ensuring that the taonga (gift/treasure) of the participants’ stories is shared and well-represented to the wider community. The research team also have a responsibility to advocate for evidence-based change within the health system so that Māori asthma disparities might be reduced.