Since this is the first publication that specifically analyses the Māori POIS data, we have presented a wide range of pre-injury descriptive characteristics. The majority of the cohort was male. This was expected due to the greater proportion of males on the ACC entitlement claims’ register, from which participants were recruited. The mean age at first interview for this cohort was 38.8 years. This is younger than that of the total POIS cohort (mean age = 41.4 years) but reflects the population distribution in New Zealand where the median age of the Māori population is 13.2 years younger than that of the total population
. Almost half of this cohort reported Māori ethnicity as their sole ethnicity. This pattern is similar to that observed in the New Zealand Census
. Despite half of the cohort reporting one or more pre-injury chronic illnesses, the overwhelming majority (92%) also reported having ‘good’ to ‘excellent’ overall pre-injury health. According to NISS, 81.4% of the cohort has ‘least severe’ or ‘middle severity’ injuries. One of the strengths of POIS is that we have a range of injury types and severities in the study cohort. Many injury outcome studies tend to focus on specific injury types (e.g., spinal cord injury or traumatic brain injury), causes (e.g., motor vehicle traffic crashes of falls) or severities (e.g. emergency department patients).
From our analyses, just over 20% of the cohort were less satisfied with life three months after injury than before (i.e., 71% three months after injury compared to 93% pre-injury). Despite the great majority of Māori reporting being satisfied with their life three months after injury, nearly a third were not (29%); this suggests that such research investigating outcomes and reasons for good (and poor) outcomes is warranted.
Variables from all four Te Whare Tapa Whā dimensions were included for consideration in the building of the multivariable model. Yet only having a more severe injury (according to NISS; tinana dimension), not being satisfied with pre-injury social relationships (such as the quality and frequency of relationships and contact with their partner, relatives and friends; whānau dimension), and having poor self-efficacy (such as solving difficult problems, accomplishing goals, and dealing with unexpected events; hinengaro dimension) were independently associated with being less likely to be satisfied with life three months after injury.
Interestingly, the variable that we had grouped into the wairua dimension (i.e., comfort in faith and spiritual beliefs) was not retained in the model. Additionally, overall happiness and health pre-injury were not independently associated with life satisfaction at three months after injury. Furthermore, despite identifying additional socio-demographic characteristics as potential predictors of post-injury life satisfaction (such as adequacy of pre-injury household income), none of these were found to be independently associated with the outcome of interest.
One of the obvious limitations of the present analyses is that we re-interpreted a questionnaire originally designed for the general population via an indigenous health model. As discussed previously, POIS was not set up to specifically measure aspects of these dimensions, although the majority of the questions in the first interview were able to be grouped into the four dimensions. Regardless, there remains definitional incongruence based on epistemological differences that limits the results. For example, the wairua (spiritual) dimension can encompass various notions of ‘faith’ and ‘spiritual’ beliefs, but more readily accounts for an entity’s spiritual essence. Interestingly, this was also highlighted as a potential limitation of POIS in Delaibatiki-Cammock et al.’s paper
 with regard to POIS’s ability to capture Pacific health values identified by the Fonofale model
. Therefore, future studies wanting to investigate ‘spirituality’ aspects in greater detail should carefully consider such potential definitional differences during questionnaire development.
It is also important to remember that these results are from a sample of Māori who have gained access to the ACC. We are therefore unable to extrapolate our findings to those not accessing ACC. We are very aware that people not accessing ACC support may have very different experiences after injury and further research investigating these is required.
Our results indicate that for health providers and agencies seeking to help improve life satisfaction among Māori following injury, perhaps greater effort should be put into identifying, and then working alongside, injured Māori who reported poor self-efficacy, were not satisfied with their pre-injury social relationships, and who had ‘severe’ injuries to ensure greater likelihood of satisfaction with life in the early stages after injury.
To our knowledge, this study is one of very few that have used the commonly referenced Te Whare Tapa Whā model as a framework for informing quantitative analysis of a Māori cohort. This article does not aim to ‘test’ the model, or its ability to predict post-injury outcomes for Māori. Rather, it has been used as a framework to help inform the injury outcome of interest (i.e. post-injury life satisfaction) and its potentially important predictors.
As discussed previously, there is very little published literature that examines injury outcomes for Māori. This paper, and subsequent others from POIS, will help address the current knowledge gap in this important area. There is also very little published literature internationally that explores outcomes after injury for other indigenous populations. By focusing on predictors for specific outcomes for Māori soon after injury in POIS, we hope that this will encourage researchers to do so for other indigenous populations.