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Introduction: In 2016 the He Pikinga Waiora implementation framework was developed to guide the successful development of chronic condition interventions specific to Indigenous communities. The framework has Indigenous self-determination at its core, and four key elements essential to implementation: cultural centredness, community engagement, systems thinking, and integrated knowledge translation. To test its efficacy, in 2015 the He Pikinga Waiora academic research team established partnerships with two Māori (NZ’s Indigenous peoples) community health organisations: Te Kōhao Health and Poutiri Trust. Each community partnership is entrusted with co-designing and implementing an intervention that primarily focuses on reducing the risk of progression from pre-diabetes to diabetes. The first evaluation of the implementation process was undertaken in December 2017/January 2018. Theory/Methods: Based on the framework, a process evaluation tool was produced to measure how well the researchers, communities, and both partnerships are following the framework while in the process of developing and implementing an intervention. The questions were grouped into 14 sub-categories that are centred around the core elements of the implementation framework, and identifies positive practices for engaging in community based research partnerships. The evaluation tool was administered in two parts – an online survey and a semi-structured interview. Ten members directly involved in the implementation and co-design process participated in the evaluation. Eight completed the online survey, and nine participated in the interview. The data is used to reflect on what is working in the partnerships, and/or what areas might need improvement. Results: Overall, the participants rated the partnership as very positive, with high levels of commitment towards transformation and community engagement, and trust. The participants also rated highly the partnership’s capacity to effect change. Although all participants agreed that the partnership was following the framework, there were some areas that needed improvement. The community participants’ were a little less optimistic about the sustainability of the interventions beyond the research funding period, and its capacity to affect wider change. They also rated resource sharing and invovlement in research to a lesser degree than the researchers. Discussion and Conclusions: The He Pikinga Waiora framework is well suited to evaluating the implementation of health interventions. The tool also helps facilitate better collaboration between researchers and communities, and to reflect on relationships of power and privilege. Lessons Learned: Reflection is important to ensure that a collaboratively developed intervention remains true to is principles. Researchers and community members do not always have the same perceptions about the process and reflecting on these differences helps to ensure that the partnership meets its long-term goals. Limitations: Small sample size results in insufficient power to apply across the general population, and limited the ability to make statistical comparisons between the researchers and the communities. Suggestions for Future Direction: Undertake a second evaluation after the implementation of the interventions and disseminate the process evaluation tool to end-users who intend to develop new co-designed interventions.

Critically reflecting on researcher–community partnerships is a key component in implementing chronic condition interventions in Indigenous communities. This paper draws on the results and learnings from a process evaluation that measures how well two research–community partnerships have followed the He Pikinga Waiora (HPW) Implementation Framework while co-designing chronic condition interventions in primary care. The HPW framework is centred on Indigenous self-determination and knowledge surrounded by community engagement, cultural centredness, systems thinking and integrated knowledge translation. The evaluation included in-depth interviews and online surveys with 10 team members. The findings demonstrate that the HPW framework was followed well, with strengths particularly in community engagement and relationship building. Areas for improvement included systems thinking and integrated knowledge translation to support sustainability of the interventions. The need for partnerships to use process evaluation results to support critical reflection is asserted, which helps build strong trust and synergy, power sharing and effective and sustainable implementation practices. It is concluded that the HPW framework is well suited to evaluating implementation of health interventions in primary care as it assists in the facilitation of better collaboration between researchers and Indigenous communities, and encourages the implementation team to reflect on power and privilege.

This paper highlights the importance of people as a central factor in improving health for Māori (Indigenous people of New Zealand). How whānau (family) relationships, connections, values and inspiration are integral to achieving Indigenous health goals is explained. Descriptions of how community researchers, healthcare staff, consumers and academics worked together to design interventions for two health services (in the Waikato and Bay of Plenty regions) is included. Through highlighting the experiences of health consumers, the potential for future interventions to reduce the advancement of pre-diabetes among whānau is described. Evidence from the study interviews reinforces the importance of whānau and whakapapa (heritage) as enabling factors for Indigenous people to improve health. Specifically, the positive effect of whānau enhancing activities that support peoples’ aspirations of tino rangatiratanga (self-determination) in their lives when engaging with health care has been observed. This study highlights the many positives that have emerged, and offers an opportunity for taking primary health to the next level by placing whānau alongside Indigenous primary care providers at the centre of change strategies.