Co-creating culturally safe primary care for whānau Māori with cancer: a qualitative case study of systems change in general practice

Abstract

INTRODUCTION: Māori experience later cancer diagnosis and poorer cancer outcomes than non-Māori. Although consultation-level cultural safety frameworks exist, less is known about embedding cultural safety across general practice to improve outcomes, guided by whānau (family) voices. AIM: This study aimed to identify what culturally safe primary care looks like for whānau Māori with cancer, and to describe development of a whānau-led systems-change model within a single general practice. METHODS: A qualitative Kaupapa Māori (Māori approach) and Appreciative Inquiry study design was used. Māori patients with cancer, their whānau (family), and general practice staff participated in iterative phases of interviews and group hui. Reflexive thematic analysis and mahi ā rōpū (group work) informed theme development. A companion methods paper details methodology, data collection, and analysis. RESULTS: Whānau and staff described culturally safe care grounded in relationships, continuity, and environments that signal belonging. Through the research process, participants co-created a shared set of values and formed a whānau-staff working group that initiated practical changes in the clinic environment, access pathways, communication processes, and team culture. The project generated an actionable systems change model, demonstrating how cultural safety can potentially be embedded over time through sustained whānau involvement. DISCUSSION: This case study offers a pathway for general practices seeking to embed cultural safety at the service level. Practical considerations - leadership, commitment, whānau partnership, and willingness to address system constraints - are highlighted, and transferable pointers for other primary care services are outlined.