Using arts-based approach to gain in-depth understanding of the lived experiences of chronic pain with Māori

To observe how Māori with chronic non-cancer pain and whānau represent, symbolize and embody chronic pain.

We adopted a qualitative mixed-methods approach developed in two phases. Phase I focused on establishing relationships between the main researcher (LGF) and the participants, which consisted of comprehensive, in-depth, semi-structured interviews about their chronic pain journey. In Phase II, arts-based approach comprised the selection of memorabilia (objects/things) or taonga (treasured social or cultural item) representing their chronic pain and talking about it using principles of photovoice in a second interview. Interviews were transcribed using Otter.ai and coded using NVivo, followed by a reflexive thematic analysis. Engagement with critical theory and the Two-Eyed Seeing (TES) favored Indigenous perspectives through a Western framework. Regular self-reflection on LGF’s positionality was key for study methodology and conduct.

Five participants were included, all older than 30 years old and reporting a pain duration of at least four years. All self-identified as Māori, and two also self-identified as New Zealand European. Discovering Māori ancestry and developing a Māori identity was a recent process for two participants. First level interpretation based on an iterative process of data familiarization and engagement with the theoretical framework by LGF pointed to the layered aspect of living with chronic pain for Māori whānau. The selection of taonga (e.g., a pounamu - greenstone), altogether with their stories, in the arts-based approach highlighted the centrality of community support networks and connection with land and indigeneity for making sense of chronic pain. Engaging with the TES epistemology led to strong collaboration with participants through feedback and interpretation confirmation, in addition to the researcher accompanying participants in daily activities (e.g., walks). In both study phases, experiences related to Māori healing and knowledge (rōngoa and mātauranga Māori) were unpacked after explicit prompting by the researcher based on the participant’s chosen items.

An arts-based approach made evident the socio-historical aspects of Aotearoa influencing their pain experience, including but not limited to colonisation and cultural erasure, in which people may need permission and reassurance of being in a safe space to talk about cultural-specific topics.

Talking about chronic pain through arts-based methods elicited stories, memories, habits, references and experiences related to chronic pain that would have been left unspoken or untouched otherwise. Integrating arts-based approaches into chronic pain assessment, management strategies and clinical routines may contribute to unearthing important insights to pain meaning-making for Māori.