Using Andersen's behavioural model of health care use we examined the predictors of health care utilisation (visits to general practitioners/family physicians, and hospital/outpatient and emergency services) via a cross sectional survey of 502 community dwelling New Zealand Māori (the indigenous population of New Zealand). We found that the model was of limited utility in accounting for variation in health care use in this group. In line with other research findings health need and worries about health emerged as the most salient predictors. We argue that this model may be limited in its applicability to this cultural group and that some re-evaluation of the ways in which health professionals have traditionally dealt with members of the Māori population, may be necessary.

We report two studies about shifting practices of quantification in tradestores in Oksapmin communities (Papua New Guinea). In Study 1, we enlisted 7 local tradestore clerks to collect information about customers' language practices of quantification, age cohort, schooling level, and cost of purchase. Analyses of 305 exchanges revealed that older cohorts tended to use indigenous practices and extensions of the indigenous language. Younger cohorts – particularly those with some schooling -- tended to use practices that involved Melanesian Pidgin. In Study 2, we analyze interviews with 9 tradestore clerks who described typical purchase transactions with customers from different age cohorts/schooling levels. Analyses of interviews revealed that elders tended to structure multi-item purchases into sequential transactions and use extensions of indigenous approaches to quantification. Schooled adults tended to purchase multiple items in a single transaction and use Pidgin quantifiers. We argue that tradestores today sustain multiple practices of quantification but also support change towards the exclusive use of Melanesian Pidgin.

Confidence in identifying different diagnostic categories of mental disorders by general health workers who provide the bulk of Papua New Guinea's (PNG) mental health care is vital for the country's provision of mental health care. Making a psychiatric diagnosis is complicated by PNG's diverse culture and estimated 800 distinct languages. These cultural-linguistic factors influence help-seeking behaviour and continued use of traditional treatment despite the introduction of western approaches to mental health care. The aim of this study was to determine the confidence of health workers in identifying and diagnosing different categories of mental health problems in this complex environment. A sample of 209 Papua New Guinea health workers from four geographic regions completed a questionnaire that assessed background levels of training and confidence in diagnosing a range of modern and culture specific diagnoses. Overall, respondents reported relatively little prior mental health training. Consistent with this were the relatively low levels of confidence for culture specific diagnoses (e.g. sorcery), but significantly higher levels of confidence with modern diagnoses (e.g. depression). The implications of the findings for training and provision of mental health care are discussed.

Hauora Pacific (HP), a research group for Māori and Pacific nursing students, explored the adaptation of a behaviour modification programme as a health promotion strategy and smoking cessation resource for Māori and Pacific people. Each of seven HP members, supported by a mentor from their family or church, conducted a focus group with about six participants of their own ethnicity. The focus groups met twice. Data were collected on smoking beliefs, and what might aid smoking cessation. In the second meeting, themes common to the seven focus groups from the first meetings were validated, and a draft behaviour modification workbook for “quitting in groups” was discussed and edited. The initial surprise for HP members was that their participants did not share the dominant discourse on health risks from smoking; nor did they want to be told they should quit. Participants framed smoking as a positive activity. Discussion highlighted the common belief that “quitting in groups” would not be a preferred way to stop smoking, linked to personal shame from an inability to stop smoking; and the potential for a group to be too judgmental or pressuring. Although some work on the adaptation of a behaviour modification resource for “quitting in groups” did occur, participants felt that much more Māori or Pacific input would be required to shift an essentially western approach to behaviour change, into something another culture could feel ownership of. Addiction was seen as the issue that had been least well addressed in the past, and participants believed that having more trained-and-available people would be their preferred health resource.

This paper describes the processes and challenges presented when Pākehā lecturers supervised a research project undertaken by Māori and Pacific nursing students in a New Zealand Bachelor of Nursing programme. It reflects on the reality of translating institutional policies from paper to practice and is situated in the framework of the Treaty of Waitangi and cultural safety. Cultural safety is a nursing concept that focuses on power in health-care relationships. People involved in the project experienced degrees of vulnerability in different cultural contexts, in terms of cultural identity, personal, professional and cultural values and beliefs, nursing and psychology knowledge and academic and institutional policies and practices. Culture is used in a broad sense and not confined to ethnicity. Various issues encountered during the project are identified, and examples of difficult experiences discussed. The paper concludes that working across broad cultural borders requires working with the complexities of multiple realities and discourses.