Academic journal article New Zealand Journal of Psychology

Cultural Invisibility: Maori People with Traumatic Brain Injury and Their Experiences of Neuropsychological Assessments

Academic journal article New Zealand Journal of Psychology

Cultural Invisibility: Maori People with Traumatic Brain Injury and Their Experiences of Neuropsychological Assessments

Article excerpt

In this paper, we will report findings from a qualitative study with Maori about their experiences of neuropsychological testing. Maori have high morbidity and mortality rates associated with neurological trauma, and are highly likely to present for neuropsychological testing for rehabilitation purposes. However, neuropsychological functioning is not determined by brain functioning alone and can be affected by a number of other factors such as effort (Tombaugh, 1996), fatigue (van der Linden, Frese, & Meijman, 2003), pain (Grigsby, Rosenberg, & Busenbark, 1995), and cultural experience (Ardila, 1995; Uzzell, 2007). Various theories have been postulated to account for between cultural group differences and include diverse explanations such as genetic variation, the utilisation of tests that measure different cognitive constructs in different cultures, and the clinicians' understanding of and experience with different ethnic groups which has been found to systematically impact that group's test performance (Brickman, Cabo, & Manly, 2006). Neuroimaging has provided us with knowledge about the brain's exceptional plasticity and flexibility. There is now research that suggests that this pliability in the development and organisation of the human nervous system may be directly influenced by cultural experience and its correlations with education and acculturation (Ansari, 2012; Baltes & Singer, 2001; Gergen, 2010)).

Maori have been colonised, and similar to other Indigenous peoples experience marked health inequities (King et al., 2008). They make up 15% of the population (Statistics New Zealand, 2013a) and have overall the poorest health status of all ethnic groups in New Zealand (Ministry of Health, 2010). The disparity in health status between Maori and non-Maori is an unacceptable phenomenon common with other comparable Indigenous populations worldwide (Ring & Brown, 2003). One of the barriers to equitable health outcomes for Maori lies in the failure of health organisations to deliver culturally appropriate services that embrace Maori cultural practises and which are user-friendly and accessible to Maori. Equitable health-related access and outcomes for Maori in New Zealand when they seek health care services is a guaranteed right under Article 3 of the Treaty Waitangi (an agreement between the Queen of England and Maori and administered by the New Zealand Crown), which says that Maori have the same rights as others living in New Zealand (Durie, 1998). Acknowledgement of the Treaty of Waitangi is now firmly embedded in the NZ Psychological Society's Code of Ethics and its values underpin the New Zealand's Psychologist Board's guidelines for competent practice for psychologists (New Zealand Psychological Society, 2002).

Mortality and morbidity rates show neurological disorders feature prominently in the overall poor state of Maori health. In a recent incidence study, Maori had a significantly higher relative risk (RR 1.23) of mild traumatic brain injury (TBI) than other ethnic groups living in New Zealand, and are 3-4 times more likely to have assault as the cause of a TBI (Feigin et al., 2013). Furthermore, the stroke incidence for Maori is similarly disproportionate (RR 1.7-2.7; depending on type), and they also suffer stroke earlier than non-Maori (mean = 65 years vs 75 years) (Feigin et al., 2006).

Individuals with neurological insult are often required to undergo a neuropsychological assessment to determine if cognitive impairment has occurred. However, there is now an international body of research indicating culture is a confounding factor on neuropsychological performance, and those individuals who are not of the dominant western culture may be disadvantaged (Agranovich, & Puente, 2007; Walker, Batchelor, & Shores, 2009). The few studies conducted in New Zealand also suggest that Maori may have performed sub-optimally due to the exclusion of culture in the assessment process (Ogden & McFarlane, 1997; Ogden, Cooper, & Dudley, 2003). …

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