Experiences of Maori of Aotearoa New Zealand's public health system: a systematic review of two decades of published qualitative research

Objective: This paper aims to synthesise the broader perspectives of Maori patients and their whanau (extended family, family group) of their treatment within the public health system. Our research question was 'What are the experiences of Maori in the public health and/or hospital system in Aotearoa New Zealand?' Methods: A systematic search using PRISMA protocols and reflexive typology organised around the categories of Maori, public healthcare and qualitative research identified 14 papers that covered all three categories. We undertook a qualitative metasynthesis on these papers using a critical community psychology approach. Results: Maori patients and whanau from the included papers mention both barriers and facilitators to health. We categorised barriers as organisational structures, staff interactions and practical considerations. Facilitators were categorised as the provision of whanau support in the form of practical assistance, emotional care and health system navigation. Conclusions: For many Maori, the existing public health system is experienced as hostile and alienating. Whanau members provide support to mitigate this, but it comes as a cost to whanau.