Background: The REGIONS Care study found that rural Māori experience the worst stroke outcomes in Aotearoa New Zealand.
Aims: To identify key barriers to quality stroke care for Māori with stroke residing in rural areas and to support co-designed improvement strategies.
Methods: Mixed methods study including rural Māori health worker questionnaire and focus groups involving health providers (n=5) and Māori with lived experience of stroke (n=4). The predominantly free-text survey responses and focus group transcripts underwent a narrative thematic analysis and quantitative survey data was summarized using a descriptive statistics approach.
Results: Of 19 (21% response rate) health worker survey responses 73.6% were Māori and 90% cared for >50% Māori patients. Questionnaire themes included “transportation and isolation,” “connecting with whānau (family),” “health literacy,” “whānau wellbeing,” and “competing priorities.” These themes were then presented to health workers to identify implementation priorities resulting in five updated themes: “health literacy and education for whānau,” “relatable information,” “addressing reluctance in asking for help,” and “local faces.” Lived experience focus group discussions confirmed the theme of “relatable information” extending to “real support and information from doctors,” but also strongly highlighted the need for “rural health worker upskilling” and “respect” in light of all attendees reporting delayed stroke diagnosis and being initially “dismissed” despite seeking care promptly and eventual stroke confirmation. “Education on healthy eating” by people who “look like us” and are known to the community (e.g., again “local faces”) constituted a final theme.
Conclusions: Health education represented a key theme across all activities with a major divergence between health workers who primarily emphasized the need for patient education compared with people with lived experienced who stressed education of health workers to aptly and respectfully identify stroke symptoms and optimize management. Provision of care by known and trusted community members was also highlighted as important.