1 Introduction

In Aotearoa New Zealand (Aotearoa), stark inequities in health outcomes exist between different ethnic groups. Māori, the Indigenous people of Aotearoa, and Pacific communities (a diverse population made up of Indigenous cultures from different Pacific Islands), experience significantly lower life expectancy and worse health outcomes than non-Māori and non-Pacific ethnic groups [1]. Current research recognises the importance of investing and developing Māori and Pacific health workforces as key interventions to reduce these inequities [2, 3]. Māori and Pacific groups also experience significant barriers to attaining educational outcomes that allow for entry into tertiary medical and health programmes [4, 5]. In recognition of these challenges, universities in Aotearoa devised a number of equity-based strategies to promote Māori and Pacific participation in health programmes [6, 7].

Vision 20:20 is an example of an equity-based health workforce initiative, established in 1999 at the University of Auckland’s Faculty of Medical and Health Sciences (FMHS). Its original aim was to increase Māori and Pacific workforce representation to 10 percent by the year 2020 [8]. The strategic intent of this vision continues beyond the year 2020 as Māori and Pacific inequities in the health workforce persist [9] despite increasing representation within medical student admission (now approximately 30% at the University of Auckland) [10]. Vision 20:20 has three interrelated components: Whakapiki Ake, the Māori and Pacific Admission Scheme (MAPAS), and Hikitia te Ora—Certificate in Health Sciences (CertHSc). Whakapiki Ake, is a Māori recruitment programme that engages with Māori secondary school students and their whānau (families) to support secondary school academic performance and transition into tertiary health study [11]. MAPAS provides comprehensive admission, academic and pastoral support to students of Māori and Pacific ancestry enrolled in health programmes [8]. Hikitia te Ora is a one-year bridging foundation programme for Māori and Pacific students aiming to enter health professional programmes of study.

Hikitia te Ora aims to address secondary education gaps and provides successful preparation for first year health courses that lead into specialised health professions including: Medicine, Nursing, Pharmacy, Optometry, Medical Imaging and Health Sciences. Offered since1999, the programme now includes 10 courses taught over a two-semester year. Chemistry, biology, population health and academic professional development are taught in both semesters, whereas mathematics is taught in semester one and physics in semester two. Student numbers in Hikitia te Ora each year are variable, ranging from 55 to 95 students a year. These are restricted by availability of teaching and laboratory spaces, therefore entry to the programme is competitive. The programme is based on Indigenous teaching pedagogy embodying Māori and Pacific cultural practices, includes Māori and Pacific content, and promotes cultural pride through a strength-based framework [4]. These approaches were found by Curtis et al. [4] to increase successful learning outcomes for Indigenous students. Content in Hikitia te Ora is delivered in lecture and non-lecture settings. Non-lecture settings include cultural wānanga (learning forums), held in Indigenous communal spaces. Academic and social support are provided to students on many levels. Teaching staff have set flexible ‘drop in’ academic support sessions outside of lectures and tutorials. All students are assigned a senior academic in the programme as their academic advisor. Students meet in one-to-one academic advisor sessions at least three times each semester where they discuss their academic progress, engagement in the programme, identify any learning support needed and pastoral challenges, as well as their career pathways. In addition, the programme has a dedicated MAPAS coordinator who provides pastoral and additional academic support for students via 1:1 sessions each semester (or as required), study villages, cohort lunches and coordination with academic and programme staff. Whakawhanaungatanga (the process of establishing relationships) is a focus of the programme, embedded through engagement with whānau of students, promotion of collective study and assessment practices, and the provision of shared culturally-specific study spaces [12].

Hikitia te Ora initially faced several challenges. In the mid2000s, the programme experienced high failure rates, challenges providing academic and pastoral support to increasing cohort sizes, inconsistent academic leadership and administrative support, and a lack of entry criteria resulting in low levels of literacy, mathematics and science exposure among the cohort [13]. Changes were made, including introducing admission requirements, increasing pastoral support, and enhancements to the curriculum. While these changes led to an increase in the student pass rate, there were ongoing concerns that this was not translating into increased success rates in degree-level study after the programme. A formal review in 2007 led to further refinements implemented [14]. Changes to programme delivery (i.e. educator behaviour), were made to help students adjust to the independent learning required of tertiary study. Māori and Pacific content and methods within the curriculum were extended. The programme increased focus on the quality of the tutors and tutorial teaching. The curriculum was adjusted from 8 × 15 point courses to 10 × 12 point courses.

With the year 2020 approaching, a mixed method study ‘Beyond 20:20’ was initiated in 2018, to inform the future direction of Indigenous health workforce development within the University of Auckland. This study investigated experiences and outcomes across the full range of Vision 20:20 programmes. This paper presents the findings relating to Hikitia te Ora to assist in strengthening similar Indigenous teaching and programmes.

2 Methods

This qualitative study undertook seven focus group interviews with Māori and Pacific students currently enrolled within FMHS programmes (including Hikitia te Ora, a 1 year programme, and former Hikitia te Ora students from previous cohorts in undergraduate and post-graduate programmes). Two workshops were also held with Māori whānau of Whakapiki Ake secondary school students participating in the Whakapiki Ake Next Steps programme (an enrichment intervention) held at the University of Auckland.

The project was supported by an advisory group of representatives from health professional programmes including Pacific health. Ethics approval was granted by the University of Auckland Human Participants Ethics Committee on September 2018 (reference 021917).

2.1 Positioning

The research was conducted from a Kaupapa Māori research positioning inclusive of Pacific research methodologies and principles [15, 16]. Kaupapa Māori research prioritises Māori knowledge, worldviews and experiences from a critical, decolonising positioning [17, 18]. Kaupapa Māori research takes a translational stance to achieve beneficial outcomes for Māori, rejecting victim blaming framing and discourse. Kaupapa Māori research has been undertaken with Māori and Pacific participants due to its strength in capturing societal dynamics of power that create inequitable environments including racism, privilege and agency that synergistically affect Māori and Pacific communities [19, 20]. This approach aligned with Pacific Talanoa research principles [15] which are based on removing distance between researcher and participant, and are orientated collectively towards defining, acknowledging, and developing Pacific aspirations and methodological preferences for research.

To ensure the research was responsive to Māori and Pacific, the project was led by Māori researchers and Pacific researchers played key roles as investigators and advisors.

2.2 Recruitment

2.2.1 Focus groups

A purposive heterogeneous recruitment strategy [21] was employed to recruit participants. Participants were Māori and Pacific students who were enrolled in Hikitia te Ora or were graduates of Hikitia te Ora enrolled in other FHMS programmes supported by Vision 20:20. Students were identified through student databases and were contacted through email with an invitation advertisement. Students who accepted the invitation to participate contacted a research assistant and were allocated into an appropriate focus group based on their ethnicity and programme exposure. Participant information was anonymised by the research assistant.

2.2.2 Workshops

All Year 13 Whakapiki Ake students and their whānau were sent invitation adverts and information sheets about the research study prior to attending the Whakapiki Ake Next STEPS programme. All those who attended Next STEPS were invited to join the appropriate workshop, however engagement was voluntary.

2.3 Data collection

2.3.1 Focus groups

Focus groups were held with a maximum of 10 students. In alignment with Kaupapa Māori research principles, all focus groups included karakia (prayers), time for whakawhanaungatanga, provision of kai (food) and koha (acknowledgment) of a $50 voucher. Focus groups were led by an ethnic concordant facilitator and observed by a researcher. Focus groups were two hours in length, and discussed the strengths, challenges and opportunities for the Vision 20:20 initiative. Participant information sheets were distributed prior to each focus group and informed, written consent was obtained. Discussions were recorded with a digital voice recorder and transcribed verbatim.

2.3.2 Workshops

Workshops involved a relatively large number of attending students and whānau (up to 80 people). The workshops were one hour long and held in two large rooms within a hall of residence. Each workshop was led by a Māori facilitator and observed by a non-Māori research assistant to take observational notes. Participant information sheets were distributed prior to the workshop and informed, written consent was obtained to audio record and transcribe the discussions. Workshops included karakia, whakawhanaungatanga, kai and koha ($50 vouchers) were provided. Participants were allocated into small groups of up to 10 people. Data collection included information recorded on flip charts, audio recordings and observational notes.

2.4 Data analysis

A general inductive thematic analysis was undertaken to analyse text data (transcripts, flipcharts and observational notes) from focus groups and workshops. Data was independently coded by six researchers (four Māori, one Pacific and one non-Māori-non-Pacific). Researchers independently read through text in alignment with the research objectives. Individual codes were re-assessed collectively through group discussions reviewing consistencies and differences in coding to create a coding framework. Most coding was consistent between researchers, deviations were resolved via the Indigenous ‘give way’ rule which acknowledges that all researchers contribute to analysis but when there are inconsistencies or conflicts with cultural analysis, Indigenous researchers have the final decision [22]. The codes and associated data were entered into NVivo version 12 Analysis Software (QSR International Pty LTD, 2018) by one (non-Maori-non-Pacific researcher) and consistently checks were done by two Maori researchers.

Thematic analysis followed a similar process to the coding. The research team and advisors individually repeatedly read through coded NVivo data to identify patterns and commonalities that aligned with the project’s objectives: successes, challenges, and opportunities. Researchers then collectively refined these patterns as key themes through multiple group discussions with six researchers (four Māori, one Pacific, one non-Māori-non-Pacific) based on consensus decisions and the give way rule to determine the final themes. Identification of themes was highly consistent across researchers. Themes were presented to the Project Advisory Group for feedback to inform culturally appropriate outcomes [23].

3 Results 

Two workshops (25 participants) and seven student focus groups (42 participants) were held with 67 students and whānau (Table 1). One workshop was held with whānau of Whakapiki Ake students and one was held with Whakapiki Ake secondary school students. Two focus groups were undertaken with students in Hikitia te Ora, five with students enrolled in other bachelor degrees: Medicine (MBChB) and Health Sciences (BHSc), and one with students enrolled in postgraduate health programmes (PG).

Table 1 Participants description by degree programme, gender, ancestry and age
Full size table

The findings are presented in relation to the three overarching research objectives: 1- successes of Hikitia te Ora; 2- challenges in Hikitia te Ora; 3-opportunities for development of Hikitia te Ora.

3.1 Successes of Hikitia te Ora

The four most commonly identified elements of success in Hikitia te Ora were: (1) whanaungatanga; (2) academic and pastoral support; (3) structure and design of the programme; (4) teaching content delivered in Hikitia te Ora.

3.1.1 Whanaungatanga

Students highlighted the importance of creating enduring friendships and being part of social cohorts in Hikitia te Ora. They reported these were often based on their shared cohort experiences. The relationships provided students with social and academic support during and beyond their studies:

Having done Cert [Hikitia te Ora] and everything it was such a good choice for me… the number one best thing I got out of Cert probably isn’t even the academic side, it’s literally all the friendships I made. Those friendships I made were the people I stuck with for the rest of my years, and I’m still with. And you go through things together, you bounce off each other. When someone falls you pick them up, so that’s the best thing that’s helped me being successful, is the people that I’ve studied with. (Medical student, non-clinical, Māori).

3.1.2 Academic and pastoral support

Students spoke positively of the support provided through Hikitia te Ora. They described how the multi-pronged approach including MAPAS advisors, teaching staff, and individualised processes such as one-to-one academic advisory sessions, helped to keep their focus on studying to become better learners:

For me it was the tutors and the lecturers. They were really approachable and they really made it clear that they were there to help us, and they didn’t mind us asking them for help, like extra sessions and stuff… like our relationship with the tutors and the lecturers helped us to be better learners and engage more with our learning. (CertHSc student, Pacific).

Support from other students in Hikitia te Ora was also important for participants. Students felt that being part of a close, non-competitive cohort promoted learning as this student stated; ‘It’s not discouraging, like you’re encouraged when you see other people trying to encourage you as well.’ (CertHSc student, Pacific).

3.1.3 Support with transition to tertiary study

A common narrative conveyed by participants focused on Hikitia te Ora as a bridging pathway of learning, helping them to prepare for first year courses as it ‘is what helps you be successful’ (CertHSc student, Māori). Students valued the flexibility of the programme in providing a foundational platform for both their learning and ‘learning to cope’ with often quite challenging pastoral contexts:

So many of us in the cohort, we have not been prepared for first year [study] but we wouldn’t have been prepared for all the things that come with it, and you still have to deal with first year. Coz so many of our cohort had things happening on the side, you know, everyone always has stuff going on in their lives. And so last year was kind of like everyone was slowly able to at least learn how to better be able to handle that and still be in that study space, still learning, still being around your peers and all that, and still trying to succeed while dealing with those things. So I think Cert was a really, really good year for that, for like helping people to be able to cope. Coz I know a lot of us, if we got into first year directly last year we probably would’ve crashed and burned, I know I would have. (CertHSc student, Māori).

Other structural elements of Hikitia te Ora that participants found useful for their learning included learning tools such as student’s personalised study plans, and formal programme events with students’ whānau. Every student in Hikitia te Ora creates a personalised study plan that is assessed and used as a learning reflection resource. Students appreciated this resource as a management tool as it ‘taught me how to study, how to do things, and in itself, like every single week’ (CertHSc student, Māori).

3.1.4 Valuing whānau involvement

The positive influence of inclusion  of students’ whānau in the programme in events such as the powhiri (welcome ceremony),  whānau handover evening, and and the whānau information evening held in the first semester were highlighted by participants. Whānau valued being ‘involved in their [children’s] academic journey, like having this opportunity [Whakapiki Ake whānau evening] to get to know what they’re in for or what we’re in for.’ (Whakapiki Ake whānau, Māori) Whānau appreciated getting to know the teaching staff, having a space to ask questions, and to learn about the programme. For students, these interactions brought their whānau closer to them on their academic journeys and facilitated their ability to manage family expectations and understanding of the workload and study required at a tertiary level:

At the beginning, like when I first started uni[versity] it was my family. I think because they didn’t understand the amount of work we get, and how we have to study all the time and stuff. And so they couldn’t understand that some of the commitments we have, we have to put it aside and not attend like church. Like for me, I had to stop going to some of the youth stuff because I had to study, and so at first my parents didn’t understand it. But I think they came to like the Cert thing for the parents, and then they sort of got it, but yeah.’ (CertHSc student, Pacific).

3.1.5 Programme content

Taught content in Hikitia te Ora was noted as a key facilitator of learning by many participants. Taught content allowed for the transitioning of disciplinary knowledge, attaining core academic competencies and promoted self-confidence of students. The narrative below described how science content aided a student to successfully navigate from secondary to tertiary study:

With bio[logy] and chemistry, the labs were really good practice for this year [Year 1], because in high school I feel like they didn’t really teach us how to do many methods and stuff. But using the lab equipment, yeah, and just the content itself… like kind of learning the skeleton last year to prepare us for this year so we’re only really learning details. So we know a basic overview of things, and then we just have to go in and name specific things. (CertHSc student, Pacific).

In addition to disciplinary-specific knowledge such as skeletal anatomy, content taught in Hikitia te Ora facilitated the development of core academic learning competencies such as time management, preparing for an exam, and writing essays:

…so like APD [Academic Professional Development], the first semester we learnt how to do a uni[versity] essay. Compared to high school essays they’re just different. Like high school essays are so, you know, you stick to a structure, like three body paragraphs, intro[duction], conclusion and they’re really opinion based. Like you’re talking about how you feel about something. But uni[versity] essays, you have to learn how to reference and it’s all evidence based and stuff. (CertHSc student, Pacific).

Whānau valued the focus of Hikitia te Ora in allowing students the space and encouragement to acknowledge their cultural identity:

One thing I found with our daughter was, coz we haven’t really raised them in the Māori way, she went to the Coach [Whakapiki Ake and Hikitia te Ora event], and she came back… and she said I know my pepeha [ancestral lineage], I know where I’m from, I know the reason for it, I really felt like I belonged … And that was a massive success. (CertHSc whānau, Māori)

A few student participants also noted how the decolonising Indigenous curriculum of Hikitia te Ora promoted their self-esteem to ‘be confident in who we are’ (CertHSc student, Māori). However, students also described the difficulty they experienced in transitioning from Indigenous to non-Indigenous academic programmes and how to negate their understandings of equity and identify as Indigenous students within these spaces:

Cert was so aggressive with [promoting] Māori and Pacific [ethnic identity], which is good coz it kind of like sets us up to be confident in who we are, I kind of am having a lot of trouble approaching first years that are non-MAPAS. Coz I don’t want to offend them, I don’t want them to think I’m stealing their spot in med[icine]. (CertHSc student, Māori).

Hikitia te Ora endeavours to prepare students for the experiences of racism commonly experienced by Māori or Pacific students in health professional education programmes. Although stigma is still encountered, as evidenced by the quote above about fears of being perceived as ‘stealing their spot’ in medicine.

3.2 Challenges

Participants identified social and programme specific challenges within Hikitia te Ora. Four themes associated with these challenges included (1) divisive social groupings; (2) ethnic-focused content; (3) timetabling and workload; (4) support.

3.2.1 Divisive social grouping

Some participants found the social formation of Hikitia te Ora to be divisive and challenging for social inclusion. Divisions tended to be based on ethnic identity and extended to social interactions external to the programme such as recreation interests:

Within Māori and Pacific Islanders[sic] you clique yourself. You don’t want to get lost, so you just go into that group… Coz we get a lot of people who are of the same, coz my friends don’t have to go out or anything. We all don’t go out and we all just study, and we only see each other when we study, and other than that we’re at our homes. So that’s why we’re together, coz if we have another friend who likes parties and drinks, they wouldn’t understand…Like it’s hard to relate to them. (CertHSc student, Pacific)

Despite some students feeling there were social divisions in Hikitia te Ora due to ‘cliques’, others found the close bonds students developed created social challenges in first year programmes between Hikitia Te Ora graduates and non-Hikitia te Ora first year students. Hikitia te Ora graduates felt they were stigmatised as they were perceived to be more academically equipped and ‘comfortable’ in these programmes than non-Hikitia te Ora first year students which created a perceived ‘separation’:

…looking at your success, for me you’re wanting to help everyone. It feels really bad coming from Cert, you know everyone, and you know that you can help each other, but you see the first years [non-Hikitia students] that, you know, they get intimidated by the fact that for these first couple of weeks we’re doing okay because we’ve learnt a lot of the stuff in Cert…I get the sense that because of that all the first years who weren’t part of Cert feel like they can’t come up and ask us for help, or can’t come up and say can we study together? They feel like they can’t, and then when you see them struggling but they’re not feeling like they can ask you for that help because of the kind of stigma around all the Certy kids [former Hikitia te Ora students], it’s kind of gutting. I don’t think it’s bad intentioned, it’s just because we know each other and they’re not something that’s safe, like you don’t know them, so you feel like you’re more comfortable with Certies. (CertHSc student, Māori)

3.2.2 Ethnic-focused content

Another challenge identified was the need for Hikitia te Ora to engage better with students of ethnicities beyond Māori, Samoan and Tongan. Some students felt that certain content marginalised their specific Pacific identity (e.g. Cook Island), contributed towards social cliques, and limited their ability to be culturally responsive health professionals to diverse communities: They felt that teaching content predominantly focused on Māori, Tongan and Samoan contexts, and ‘there was a very Māori point of view and spin on things’ (MBChB student, Non-clinical, Pacific).

With those lectures, when I was with a Pacific Islander[sic], I’d be like is it the same in your culture? Just to have them acknowledge that there are different cultures in here besides, like it was always, if we were talking about Pacific it’s either we were talking about Samoan or Tongan. There was nothing, like we didn’t do Cook Island. I felt like if we’re supposed to be all round health professional for both Māori and Pacific, I’m not just going to meet somebody that’s Māori, Samoan, Tongan. There’s going to be other cultures. (CertHSc student, Māori)

3.2.3 Timetabling and workload

Timetabling of Hikitia te Ora courses was reported as a barrier to studying for students and cited as a key reason for non-engagement and non-attendance in the programme. Timetabling concerns related to the times and lengths of lectures as well as back-to-back teaching schedules. Teaching sessions scheduled for early morning starts (9am), and late evening finishes (6 pm), were considered unappealing to students where ‘no one wanted to commit to that’ (CertHSc student, Māori). Likewise, three hour lectures were considered ‘a definite big no go’ (CertHSc student, Māori), students felt these lengthy sessions were not conducive to their leaning, recommending they ‘could probably skip an hour’ (CertHSc student, Māori). Students also found the amount of assessment in the programme hindered their learning by reducing time they had free to study content; ‘like every single week… we had so many assignments they changed the structure because of it’ (CertHSc student, Māori).

3.2.4 Support

Participants reported variable experiences of academic and pastoral support in Hikitia te Ora, these often related to rapport they formed with their advisors. Students found that one-to-one sessions with academic advisors could create discomfort, particularly when asked about their peers’ behaviour; ‘I found it a bit, not rude, but kind of like out of there to have your lecturer ask you ‘why aren’t your peers coming to my class’’ (CertHSc student, Māori). Some students also found that the sessions with their advisors were too infrequent to provide meaningful support:

The way that my KT [academic advisor] sessions went when I’d talk to other Certies [Hikitia Te Ora students] about the way that theirs went they were so different and so contrasted. I know that obviously they’ve got to divide us up between the lecturers and every lecturer is different, but I felt like the advisor that I was with, yeah, it was a check in for your academics and seeing what you’re doing well and what you’re not doing. But it felt like you couldn’t really, I felt like because those sessions a) happened so few and far between, and b) like I had a[n] advisor who I didn’t feel like I really clicked with. (CertHSc student, Māori)

Participants highlighted a lack of programme responsiveness to issues that arose within Hikitia te Ora, including clique separation. Participants felt that teaching staff were sometimes slow to react to issues even when made aware of them by students:

The lecturers knew about it… They would have seen it too, it was obvious. But I feel like they learnt about it too late to do anything about it. Like towards the end of Sem[ester] 2, but it was happening throughout the whole of the year. When we talked to them about it they were like ‘oh yeah, I see that’…. I think they knew pretty early but they acted on it too late. (CertHSc student, Pacific).

3.3 Opportunities for development

Three key recommendations arose from discussions with participants: (1) further develop the Pacific curriculum; (2) increase the number of students in the programme; (3) provide a programme specific study space.

3.3.1 Developing Pacific curriculum

The three key suggestions proposed by participants for developing Pacific curriculum included increasing taught Pacific content, increasing opportunities for cultural sharing between Māori and Pacific, and explicitly acknowledging Pacific diversity where ‘Pacific are not just Pacific, it’s individual cultures within Pacific’ (CertHSc student, Pacific):

I wanted to learn more about the Pacific Islands, I think it was how it was presented. We had like a basic knowledge of Māoridom [through a] lecture, it was kind of cool, I learned some stuff there about it and it was great. But it would’ve been nice if they’d done a lecture for the Pacific Islands like that. (CertHSc student, Māori)

3.3.2 Increasing student numbers

Participants acknowledged the benefits of Hikitia te Ora as a foundational bridging programme for health sciences and felt that increasing the number of students entering the programme would benefit student success into health programmes:

I feel like the quota [restriction] of only 75 [students accepted into the programme] is a bit short, especially since within the first two or three weeks the number didn’t even, like they said only 75 people could get chosen out of over 100 that applied, maybe 100s. And a lot of people missed out and they were really sad…but then there are those that only applied to Cert, and really wanted to do it and then didn’t get chosen… And they felt really sad they lost that opportunity. (CertHSc student, Pacific)

3.3.3 Hikitia te Ora study space

Another common recommendation provided by participants was to create a Hikitia te Ora-specific study space. Participants felt that a dedicated, programme specific study space would not only support student learning but also create greater social cohesion in the programme to reduce social cliques:

You know what would be really nice, like thinking about it now, if they had the space, but to have like a Cert [Hikitia te Ora] room for just Certies [students of Hikitia te Ora]. (CertHSc student, Māori)

4 Discussion

Key strengths of Hikitia te Ora identified in this study were embedding whakawhanaungatanga into the programme, provision of academic and pastoral support, Indigenous and foundational-focused course content, and the flexible, comprehensive structure of the programme. These are consistent with the growing body of literature on developing successful tertiary pathways into health professions for Māori and Pacific students [24].

The importance of facilitating a smooth transition to tertiary study for underrepresented learners is clear in the literature [25], and bridging programmes have been found to play a key role in this pathway [26, 27]. Whanaungatanga has been previously identified as a critical feature of creating and maintaining social connections between students, academic staff, whānau and communities [2, 11, 24]. Likewise, inclusion of academic and pastoral support and has been endorsed as a ‘best’ practice approach to Indigenous tertiary health programmes as a successful equity resource [28]. These elements of Hikitia te Ora, along with the diverse course content have been described by Curtis [16] as a ‘Learning Community’ approach to teaching including ‘multi-faceted, inclusive, culturally responsive and engaging teaching and learning’. Given these findings, the Learning Community approach should be considered as cornerstone element for education programmes that include Māori, Pacific and potentially other Indigenous student groups.

Social and programme specific contexts were identified as two areas of Hikitia te Ora where participants experienced challenges. While practical elements of the programme such as timetabling and workload can be addressed through restructuring and resourcing, social challenges around social cliques and divisive groupings within the cohort are more complex. Formation of social cliques are a common phenomenon in educational settings [29,30,31,32], although to date there is scant research undertaken with Indigenous students. Ethnic concordance [29, 31], social capital [29, 32], pedagogy, and the structure of teaching environments [30] are all attributed as influential to the formation and maintenance of social cliques. Recommendations to address social cliques tend to target teaching pedagogy, such as privileging inclusive values and peer learning. The structure of taught environments can also promote cohesion by avoiding small, segregated teaching areas. Random or teacher-allocation of students into learning and assessment groups was also a recommendation to avoid formation of social cliques through student directed allocation [29, 30]. However, all these recommendations stemmed from studies with Western and migrant students. To ensure robust, culturally responsive interventions for Māori and Pacific groups more research needs to be undertaken utilising Indigenous positioning and frameworks such as Kaupapa Māori research.

The study generated clear recommendations to improve Hikitia te Ora, these were to further develop the Pacific curriculum, increase the number of students in the programme, and to provide a programme-specific study space. The inclusion of more Pacific educators, explicit integration of Pacific pedagogies and strong emphasis on reciprocal relationships between diverse Pacific communities and non- Pacific stakeholders have been promoted to improve Pacific education in national educational research guidelines [33]. Implementing these elements in the programme, while still acknowledging the status of Māori as tangata whenua (Indigenous people as reaffirmed under Te Tiriti o Waitangi, the founding Treaty document of Aotearoa), could improve learning outcomes and experiences of Pacific students in Hikitia te Ora.

Recognition of the limited number of student admissions into Hikitia te Ora and the limited designated study space reflect the host institution’s prioritisation of resourcing. Resource distribution within educational settings commonly favours privileged student cohorts, and in turn, creates inequitable outcomes in student achievement [34]. In Aotearoa, educational settings are founded on colonial legacies of British settlers. The system therefore inherently privileges students who align with values of this colonial structure. Mayeda et al. [35], argue that this systemic, institutionalised privilege and its inverse-institutionalised racism, create and maintain educational inequities for Māori. The University of Auckland recently devised a strategic plan—Taumata Teitei 2030 [36], which states that improved access, recruitment, retention and progression for Māori and Pacific students are an educational priority. This shift in policy may signal a recognition of the importance of equitable educational resourcing, and, with ongoing advocacy from Vision 20:20, and broader community and tertiary stakeholders, may contribute to improved outcomes for Hikita te Ora. By implementing the recommendations in this research, the authors are hopeful that a future where 10 percent of the workforce in Aotearoa is comprised of Māori and Pacific people transforms an Indigenous aspiration into a lived reality.

5 Strengths

A strength of this research was the application of an Indigenous research paradigm to an area traditionally dominated by Western methodologies. Kaupapa Māori positioning, and alignment with Pacific Talanoa principles, enabled the researchers to draw on cultural understandings of learning, include whānau and students as participants through well established relationships, and undertake a critical analysis of power dynamics influencing educational inequities.

Having both student and whānau voices in this research helped identify a number of unintended consequences of teaching interventions, including the perceived lack of focus on non-Tongan, non-Samoan Pacific identities, and the discomfort students felt when being asked about why their peers were not attending class. This highlights the importance of using high-quality research to inform evidence-based equity interventions.

6 Limitations

As with many research contexts, participants in this study were self-selecting and their experiences may not align with those who did not participate. Voices of Pacific whānau were not included in this research, further work to explore their perspectives is recommended. This research only evaluated 1 year of Hikitia te Ora students, and some findings may be cohort-specific, although the inclusion of past students in the focus groups helps mitigate this issue.

7 Conclusion

This qualitative study, utilising an Indigenous research positioning, provides important insights into the strengths, challenges, and opportunities of a tertiary bridging programme for university health professional programmes. Factors that strongly influence student success include whanaungatanga, academic and pastoral support, programme structure and the teaching content. Challenges include social cliques and divisive social groupings, timetabling of courses and high workloads. Implementing the findings from this study offer potential to improve educational outcomes for Māori and Pacific students, and may have the potential to benefit other bridging foundation courses aiming to promote health workforce development for Indigenous and other under-represented learners.