title: Some characteristics of a serine proteinase isolated from an extreme thermophile for use in kinetically controlled peptide bond synthesis

authors: Peek, Keith

subjects: Proteinases

abstract: The use of proteinases for the synthesis of peptides and esters has been studied for over 50 years and has increased substantially over recent years. In particular, the use of proteinases in anhydrous organic solvents ( < 0.01% water), where they exhibit novel properties, is gaining momentum.¹ However, most of the work on peptide synthesis has been on the use of proteinases in water-miscible solvents. There are a number of advantages in employing water-miscible solvents.² For example, some amino acid derivatives are poorly soluble in nonpolar solvents and limitations due to the diffusion of substrates in biphasic systems or enzymes suspended in hydrophobic solvents are avoided. The main disadvantage of employing water-miscible solvents is that at high concentrations, many enzymes are relatively inactive or denatured due to the stripping of enzyme-bound water.³ The use of proteinases isolated from extreme thermophiles, with their inherent stability to extremes of pH and temperature and to organic solvents, would seem to be one of the obvious ways of solving these problems. In addition, the reactions could be carried out at higher temperatures, which would result in benefits from increased substrate solubilities, accelerated rates of diffusion, and decreased viscosity.

text: Some characteristics of a serine proteinase isolated from an extreme thermophile for use in kinetically controlled peptide bond synthesis The use of proteinases for the synthesis of peptides and esters has been studied for over 50 years and has increased substantially over recent years. In particular, the use of proteinases in anhydrous organic solvents ( < 0.01% water), where they exhibit novel properties, is gaining momentum.¹ However, most of the work on peptide synthesis has been on the use of proteinases in water-miscible solvents. There are a number of advantages in employing water-miscible solvents.² For example, some amino acid derivatives are poorly soluble in nonpolar solvents and limitations due to the diffusion of substrates in biphasic systems or enzymes suspended in hydrophobic solvents are avoided. The main disadvantage of employing water-miscible solvents is that at high concentrations, many enzymes are relatively inactive or denatured due to the stripping of enzyme-bound water.³ The use of proteinases isolated from extreme thermophiles, with their inherent stability to extremes of pH and temperature and to organic solvents, would seem to be one of the obvious ways of solving these problems. In addition, the reactions could be carried out at higher temperatures, which would result in benefits from increased substrate solubilities, accelerated rates of diffusion, and decreased viscosity.

year: 1992

title: Empowering Ni-Vanuatu women: Amplifying Wantok authority and achieving fair market access

authors: Thomas, Andrina Komala Lini

subjects: URBAN WOMEN IN FORMAL AUTHORITY IN VANUATU

abstract: The Republic of Vanuatu (2004) report on Vanuatu’s implementation of the United Nations Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) notes that many urban disenfranchised Ni-Vanuatu women live in poverty and have little access to paid employment. The women who do gain paid employment in formal jobs rarely gain access to positions of authority. The United Nations (UN) offered two strategies to improve the position of Ni-Vanuatu women in Vanuatu. The first is informed by CEDAW in Article Eleven on Employment. The “Equity Desk of the Vanuatu Department of Strategic Management” and the “Vanuatu Department of Women’s Affairs Gender Planner” (The Republic of Vanuatu, 2004, pp. 12-13) have been charged with the responsibility of implementing Article Eleven and developing Equal Employment Opportunities (EEO) programmes for the public sector. This strategy aims to increase women’s access to paid employment in the formal employment sector and encourage women to achieve positions of authority. The second strategy offered by the UN is the establishment of microfinance projects aimed at providing disenfranchised urban women unable to find employment with a means to own and run microfinance businesses to earn a living. Both these strategies have the overarching aim of improving the well-being of Ni-Vanuatu women.

This study has investigated the extent to which access to formal sector jobs and the implementation of microfinance businesses in the informal sector addresses the well-being of Ni-Vanuatu women. These programmes are being implemented within a complex historical, socio-political cultural and economic environment (Van Trease, 1995). This complexity includes the continuance of Wantok systems of governance in the form of matrilineality (predominant in Vanuatu) and patrilineality (adopted from Christian influences in 1800s and colonial legacy in 1906) (Van Trease, 1987; Facey, 1981; Allen, 1981 & Macdonald-Milne & Thomas, 1981). Matrilineal cultural values bequeath patrimony and legacy of lineage and land inheritance from mothers to daughters. Matrilineal women share power with men in community affairs (Maltali, Sandy & Tamashiro, 2009). In patrilineal communities, patrimony and legacy of lineage and land inheritance is passed from fathers to sons (Van Trease, 1987). Patrilineal mothers and daughters have no lineage, land inheritance, or power-sharing rights (Stege, Maetala, Naupa & Simo 2008). Both Wantok systems are based on communal values practised primarily in the rural sector. Urban centres are organised around a modern-cash and market-economy and a governance framework based on the British Westminster model and the French Head of State model (ILO, 2006). This European generated governance system is underpinned by values informed by liberal competitive individualism and an assumed commitment to meritocracy. It is, however, a system of governance steeped in patriarchal nuances as a direct legacy of the colonial regime now adapted and administered by the Vanuatu’s ruling elite, referred as Vanuatu’s urban patriarchy throughout this thesis. 

The theoretical frameworks used in this research draw on both liberal feminist studies and on an adaptation of subaltern scholarship (Thomas & Humphries, 2010 & 2011). The focus is on the legacy of imperialism and colonisation, the politics of power and hegemony, and the expressions of equal rights, emancipation and empowerment as these pertain to the well-being of women in Vanuatu. 

Three sets of qualitative empirical observations were collected: i) a focus group discussion with 20 employer and employee representatives; ii) 36 conversations with women employed in the formal employment sector who held positions of authority within their respective organisations; and iii) 39 conversations with women who owned a microfinance business. My field notes were analysed thematically using a point and counterpoint framework crafted from my interest in the work of Huxley (cf Baker & James, 2000a & 2000b & Dawson, 2009). The point is informed by a liberal feminist lens (Gamble, 1999 & Heywood, 2000). A counterpoint to this liberal feminist interpretation is generated from a post-colonial feminist perspective through an adaptation of subaltern studies (Thomas & Humphries 2010 & 2011; Gamble, 1999 & Spivak, 1988). I draw on my Matrilineal Wantok Feminist Voice (MWFV) to form a standpoint in the discussion and to frame insights drawn from the ideas associated with the solidarity economy (Allard, Davidson & Matthaei, 2009; Harvey, 2006 & Harding, 2004). 
 
Point/counterpoint/standpoint for the research as a whole
Point: Liberal feminist strategies for the emancipation of women (and the intended improvement and well-being of their families associated with this perspective) encourage women to pursue better living standards, achieve empowerment in the home, and seek formal jobs or other market-based income opportunities. If in formal jobs, women are encouraged to seek positions of authority. For these women, the major transition in orientation is the move from Wantok-related patterns of responsibilities and opportunities to those made available in the formal Western-generated economy. These Western ways, with emphasis on individualized opportunity, appear to offer financial gain and familial influences, particularly to women born into patrilineal lineage descent groups. 

Counterpoint: Viewed through the adaptation of subaltern perspectives that I have applied to the liberal feminist remedies for the enhancement of well-being for the women of Vanuatu, it appears that the women of Vanuatu are involved in multiple and simultaneous complex master/slave relationships (Kohn, 2005 & Honderich, 1995). These relationships are exemplified in salaried/professional occupations held by women, between the women and their employers and work-place cultures, between women and rural and urban patriarchal hegemonies, and between women and the cash and market economy. While EEO activities can be seen to make a difference in the lives of some women, taken together, these interventions are reducing the overall well-being for Ni-Vanuatu women more generally. For the Vanwods microfinance women entrepreneurs, master/slave relationships could be discerned between the Vanwods MFI’s social control of the Mamas, the Vanuatu Government’s imposition of high business licence fees to the Mamas, the Mamas and their greater dependence on the cash and market economy, and the Mamas and their relationship with rural and urban patriarchal hegemonies (Thomas & Humphries, 2010 & 2011). These forms of systemic subservience interpreted from the women’s narratives provide a caution against the uncritical adoption of Western liberal feminist ideals (DeVault, 1990). It is matrilineal women; however, who appear to suffer the most from their move into the urban centres as there they must contend with an urban patriarchal hegemony, an impediment which they had not encountered in their former rural communities governed in accordance with matrilineal Wantok values.

Standpoint: The research findings suggest that all women in this study worked long hours, experiencing discrimination and oppression, received low pay, and experienced increased financial obligations as a result of their engagement in formal and informal jobs. As well as being increasingly dependent on inadequate and unsustainable livelihoods in the urban areas, family and Wantok social relations were challenged and diminished as a consequence of their necessary commitment to their jobs and the demands of urban living. Access to traditional forms of authority and sustenance was undermined. 

I conclude that, overall, the implementation of CEDAW-EEO programmes along with the establishment of microfinance projects devised for the emancipation of the disenfranchised women of Vanuatu, while apparently proving beneficial from a liberal feminist interpretation in granting urban women with access to incomes, property and power-sharing, may provide an element of liberation for women of patrilineal descent groups but add new dimensions of patriarchal inhibitors for women of matrilineal descent groups who take up employment under the Westminster rules of governance. The remedies taken as a whole, while promising improved well-being through market-based income generation, remove women from the Wantok kinship social support networks embedded in their indigenous Wantok governance frameworks causing complex problems and hardships for them. Drawing on my Matrilineal Wantok Feminist standpoint position, I suggest that the Solidarity Economy, which combines aspects of market access while still engaging in the traditional systems of social organization, offers an alternative organisational and economic framework for developing and enhancing community well-being in both the rural and urban areas of Vanuatu.

text: Empowering Ni-Vanuatu women: Amplifying Wantok authority and achieving fair market access The Republic of Vanuatu (2004) report on Vanuatu’s implementation of the United Nations Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) notes that many urban disenfranchised Ni-Vanuatu women live in poverty and have little access to paid employment. The women who do gain paid employment in formal jobs rarely gain access to positions of authority. The United Nations (UN) offered two strategies to improve the position of Ni-Vanuatu women in Vanuatu. The first is informed by CEDAW in Article Eleven on Employment. The “Equity Desk of the Vanuatu Department of Strategic Management” and the “Vanuatu Department of Women’s Affairs Gender Planner” (The Republic of Vanuatu, 2004, pp. 12-13) have been charged with the responsibility of implementing Article Eleven and developing Equal Employment Opportunities (EEO) programmes for the public sector. This strategy aims to increase women’s access to paid employment in the formal employment sector and encourage women to achieve positions of authority. The second strategy offered by the UN is the establishment of microfinance projects aimed at providing disenfranchised urban women unable to find employment with a means to own and run microfinance businesses to earn a living. Both these strategies have the overarching aim of improving the well-being of Ni-Vanuatu women.

This study has investigated the extent to which access to formal sector jobs and the implementation of microfinance businesses in the informal sector addresses the well-being of Ni-Vanuatu women. These programmes are being implemented within a complex historical, socio-political cultural and economic environment (Van Trease, 1995). This complexity includes the continuance of Wantok systems of governance in the form of matrilineality (predominant in Vanuatu) and patrilineality (adopted from Christian influences in 1800s and colonial legacy in 1906) (Van Trease, 1987; Facey, 1981; Allen, 1981 & Macdonald-Milne & Thomas, 1981). Matrilineal cultural values bequeath patrimony and legacy of lineage and land inheritance from mothers to daughters. Matrilineal women share power with men in community affairs (Maltali, Sandy & Tamashiro, 2009). In patrilineal communities, patrimony and legacy of lineage and land inheritance is passed from fathers to sons (Van Trease, 1987). Patrilineal mothers and daughters have no lineage, land inheritance, or power-sharing rights (Stege, Maetala, Naupa & Simo 2008). Both Wantok systems are based on communal values practised primarily in the rural sector. Urban centres are organised around a modern-cash and market-economy and a governance framework based on the British Westminster model and the French Head of State model (ILO, 2006). This European generated governance system is underpinned by values informed by liberal competitive individualism and an assumed commitment to meritocracy. It is, however, a system of governance steeped in patriarchal nuances as a direct legacy of the colonial regime now adapted and administered by the Vanuatu’s ruling elite, referred as Vanuatu’s urban patriarchy throughout this thesis. 

The theoretical frameworks used in this research draw on both liberal feminist studies and on an adaptation of subaltern scholarship (Thomas & Humphries, 2010 & 2011). The focus is on the legacy of imperialism and colonisation, the politics of power and hegemony, and the expressions of equal rights, emancipation and empowerment as these pertain to the well-being of women in Vanuatu. 

Three sets of qualitative empirical observations were collected: i) a focus group discussion with 20 employer and employee representatives; ii) 36 conversations with women employed in the formal employment sector who held positions of authority within their respective organisations; and iii) 39 conversations with women who owned a microfinance business. My field notes were analysed thematically using a point and counterpoint framework crafted from my interest in the work of Huxley (cf Baker & James, 2000a & 2000b & Dawson, 2009). The point is informed by a liberal feminist lens (Gamble, 1999 & Heywood, 2000). A counterpoint to this liberal feminist interpretation is generated from a post-colonial feminist perspective through an adaptation of subaltern studies (Thomas & Humphries 2010 & 2011; Gamble, 1999 & Spivak, 1988). I draw on my Matrilineal Wantok Feminist Voice (MWFV) to form a standpoint in the discussion and to frame insights drawn from the ideas associated with the solidarity economy (Allard, Davidson & Matthaei, 2009; Harvey, 2006 & Harding, 2004). 
 
Point/counterpoint/standpoint for the research as a whole
Point: Liberal feminist strategies for the emancipation of women (and the intended improvement and well-being of their families associated with this perspective) encourage women to pursue better living standards, achieve empowerment in the home, and seek formal jobs or other market-based income opportunities. If in formal jobs, women are encouraged to seek positions of authority. For these women, the major transition in orientation is the move from Wantok-related patterns of responsibilities and opportunities to those made available in the formal Western-generated economy. These Western ways, with emphasis on individualized opportunity, appear to offer financial gain and familial influences, particularly to women born into patrilineal lineage descent groups. 

Counterpoint: Viewed through the adaptation of subaltern perspectives that I have applied to the liberal feminist remedies for the enhancement of well-being for the women of Vanuatu, it appears that the women of Vanuatu are involved in multiple and simultaneous complex master/slave relationships (Kohn, 2005 & Honderich, 1995). These relationships are exemplified in salaried/professional occupations held by women, between the women and their employers and work-place cultures, between women and rural and urban patriarchal hegemonies, and between women and the cash and market economy. While EEO activities can be seen to make a difference in the lives of some women, taken together, these interventions are reducing the overall well-being for Ni-Vanuatu women more generally. For the Vanwods microfinance women entrepreneurs, master/slave relationships could be discerned between the Vanwods MFI’s social control of the Mamas, the Vanuatu Government’s imposition of high business licence fees to the Mamas, the Mamas and their greater dependence on the cash and market economy, and the Mamas and their relationship with rural and urban patriarchal hegemonies (Thomas & Humphries, 2010 & 2011). These forms of systemic subservience interpreted from the women’s narratives provide a caution against the uncritical adoption of Western liberal feminist ideals (DeVault, 1990). It is matrilineal women; however, who appear to suffer the most from their move into the urban centres as there they must contend with an urban patriarchal hegemony, an impediment which they had not encountered in their former rural communities governed in accordance with matrilineal Wantok values.

Standpoint: The research findings suggest that all women in this study worked long hours, experiencing discrimination and oppression, received low pay, and experienced increased financial obligations as a result of their engagement in formal and informal jobs. As well as being increasingly dependent on inadequate and unsustainable livelihoods in the urban areas, family and Wantok social relations were challenged and diminished as a consequence of their necessary commitment to their jobs and the demands of urban living. Access to traditional forms of authority and sustenance was undermined. 

I conclude that, overall, the implementation of CEDAW-EEO programmes along with the establishment of microfinance projects devised for the emancipation of the disenfranchised women of Vanuatu, while apparently proving beneficial from a liberal feminist interpretation in granting urban women with access to incomes, property and power-sharing, may provide an element of liberation for women of patrilineal descent groups but add new dimensions of patriarchal inhibitors for women of matrilineal descent groups who take up employment under the Westminster rules of governance. The remedies taken as a whole, while promising improved well-being through market-based income generation, remove women from the Wantok kinship social support networks embedded in their indigenous Wantok governance frameworks causing complex problems and hardships for them. Drawing on my Matrilineal Wantok Feminist standpoint position, I suggest that the Solidarity Economy, which combines aspects of market access while still engaging in the traditional systems of social organization, offers an alternative organisational and economic framework for developing and enhancing community well-being in both the rural and urban areas of Vanuatu.

year: 2013

title: Effective implementation science processes for Māori and Indigenous health interventions

authors: Harding, Truely Janine

subjects: Implementation science

abstract: Background
This thesis considers the implications implementation science has for Indigenous communities, specifically in reducing health inequities for the Māori community of New Zealand. Implementation science has been discussed among many Western health interventions and this thesis adds to that body of literature while highlighting the impact implementation has for Indigenous communities. 
Implementation science is a growing body of literature that can identify the most effective processes for health organisations and governments to best engage with Indigenous communities facing health inequities. An important aspect of that is ensuring the Indigenous voices and perspectives are represented just as much as the academics and scholars in those fields. The purpose of this thesis is to highlight the facilitators and barriers of implementing health interventions with Māori communities in Aotearoa New Zealand. This thesis aims to contribute to the conversation about reducing health inequities Māori communities’ face in New Zealand by enhancing implementation effectiveness. Therefore, it is an effort to illuminate the importance of the inclusion of community voice and perspectives when implementing health interventions with Indigenous communities. The thesis is with publications and includes four distinct studies.
Methodology & Methods
The key methodologies used in this study were Kaupapa Māori methodology and the He Pikinga Waiora (HPW) Implementation framework. Kaupapa Māori has been used as both a form of resistance and a methodological strategy, where research is created, developed, and carried within a Māori worldview with the aim to have positive outcomes that are beneficial for Māori. The HPW framework provided a holistic approach to guide this research through its key elements of: culture-centered approach, community engagement, systems thinking, and integrated knowledge translation. It is a forward-thinking approach as it is flexible in its design, which allows the framework to be tailored to a variety of implementation situations. The framework is centred in Kaupapa Māori methodology. Each principle of Kaupapa Māori and each element of HPW provide a holistic approach to implementation science.
Given this thesis includes four publications, a range of methods were employed for data collection. The first study was a systematic review of studies that was completed using preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. This involved a stringent search strategy and inclusion criteria where studies included went through data extraction and methodological appraisal followed by an analysis through a qualitative synthesis of findings. Studies two and three employed semi-structured interviews that were analysed through thematic analysis. Study two included 19 participants who were either health professionals or researchers, and study three included 17 participants who were health professionals. The fourth study included an online cross-sectional survey of 200 health professionals and used statistical modelling to identify factors important for implementation effectiveness.
Results 
The first study included a systematic literature review to examine the implementation of a non-communicable disease health intervention for Indigenous communities using HPW as an evaluation tool. Twenty-one studies were included. Two thirds of these studies demonstrated high levels of community engagement and community voice/ agency, while 40% had individual-level outcomes with some systems thinking, and 33% included individual-level outcomes and limited systems thinking. Finally, almost 40% of studies included high levels of end-user engagement reflective of integrated knowledge translation, but nearly half had limited end-user engagement with the remaining neither high or low. This study found that the HPW Implementation Framework is a comprehensive model for understanding implementation effectiveness in Indigenous communities and highlighted the high levels of community engagement and community voice. It also brings to light that the long-term sustainability and translation of evidence to practice may be inhibited because of lower levels of systems thinking and integrated knowledge translation. 
The second study researched the perceptions health professionals have on co-designing health-promotion interventions with Indigenous communities in New Zealand. Co-designing health-promotion interventions with Indigenous communities presents many benefits and challenges. This study identified that the facilitators for co-designing health-promotion interventions with Māori communities were collaboration and community voice. Furthermore, the two key barriers identified were mismanaged expectations between the researcher and community and the research constraints placed by funding agencies. The findings support the development of more effective co-design health-promotion interventions within Māori communities which may address health inequities. 
The third study endeavoured to identify the facilitators and barriers in disseminating and adopting a health intervention developed by a community-academic partnership. This study explored general perceptions of the implementation process and also included a case study of an innovative intervention. The facilitators included community engagement, programme structure, programme adaptability and creators’ experience. The barriers consisted of funding access, funding constraints and organisational constraints. This study also highlights the importance of community engagement and adaptability suggesting a need for translation as well as diffusion. Additionally, this study identified nuanced aspects of funding and resources for organisations that constrain organisations in employing health interventions designed by others.
The final study identified factors that New Zealand health professionals rate as important for implementation effectiveness for health interventions with Māori communities. This study provided a unique perspective of health professionals on implementation effectiveness when working with Māori/Indigenous communities. Paired sample t-tests revealed four levels of importance for implementation effectiveness with organisational teamwork and community autonomy as most important. Only 24% of participants had prior experience with a previous health intervention with Māori communities. The two key overall factors that were associated with participants’ rating of implementation effectiveness in these previous interventions were process and community. This study identified the key areas of implementation effectiveness as community engagement and participatory process. Furthermore, the final study contributes to the body of literature that challenges traditional top-down approaches of implementation.
Conclusion
This research aimed to identify the facilitators and barriers to disseminating and implementing health interventions with Māori communities in New Zealand. A synthesis of the four studies provided four key themes for this thesis. This thesis reinforces the position that Indigenous and Māori implementation science should be focused on the process and community engagement. In doing so, community engagement ensures a cultural-centred approach that prioritises Indigenous knowledge and autonomy in the process of implementation. Furthermore, the barriers identified in this thesis recognise the challenges that remain in limited funding for translating research into implementation practice and managing expectations amongst the implementation team. This thesis has implications for New Zealand district health boards and health organisations who are wanting to increase the effectiveness of the health interventions they are implementing with Māori communities, particularly when trying to address health inequities. Overall, this study is an attempt to bridge the gap between translating research and the processes of putting it into practice.

text: Effective implementation science processes for Māori and Indigenous health interventions Background
This thesis considers the implications implementation science has for Indigenous communities, specifically in reducing health inequities for the Māori community of New Zealand. Implementation science has been discussed among many Western health interventions and this thesis adds to that body of literature while highlighting the impact implementation has for Indigenous communities. 
Implementation science is a growing body of literature that can identify the most effective processes for health organisations and governments to best engage with Indigenous communities facing health inequities. An important aspect of that is ensuring the Indigenous voices and perspectives are represented just as much as the academics and scholars in those fields. The purpose of this thesis is to highlight the facilitators and barriers of implementing health interventions with Māori communities in Aotearoa New Zealand. This thesis aims to contribute to the conversation about reducing health inequities Māori communities’ face in New Zealand by enhancing implementation effectiveness. Therefore, it is an effort to illuminate the importance of the inclusion of community voice and perspectives when implementing health interventions with Indigenous communities. The thesis is with publications and includes four distinct studies.
Methodology & Methods
The key methodologies used in this study were Kaupapa Māori methodology and the He Pikinga Waiora (HPW) Implementation framework. Kaupapa Māori has been used as both a form of resistance and a methodological strategy, where research is created, developed, and carried within a Māori worldview with the aim to have positive outcomes that are beneficial for Māori. The HPW framework provided a holistic approach to guide this research through its key elements of: culture-centered approach, community engagement, systems thinking, and integrated knowledge translation. It is a forward-thinking approach as it is flexible in its design, which allows the framework to be tailored to a variety of implementation situations. The framework is centred in Kaupapa Māori methodology. Each principle of Kaupapa Māori and each element of HPW provide a holistic approach to implementation science.
Given this thesis includes four publications, a range of methods were employed for data collection. The first study was a systematic review of studies that was completed using preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. This involved a stringent search strategy and inclusion criteria where studies included went through data extraction and methodological appraisal followed by an analysis through a qualitative synthesis of findings. Studies two and three employed semi-structured interviews that were analysed through thematic analysis. Study two included 19 participants who were either health professionals or researchers, and study three included 17 participants who were health professionals. The fourth study included an online cross-sectional survey of 200 health professionals and used statistical modelling to identify factors important for implementation effectiveness.
Results 
The first study included a systematic literature review to examine the implementation of a non-communicable disease health intervention for Indigenous communities using HPW as an evaluation tool. Twenty-one studies were included. Two thirds of these studies demonstrated high levels of community engagement and community voice/ agency, while 40% had individual-level outcomes with some systems thinking, and 33% included individual-level outcomes and limited systems thinking. Finally, almost 40% of studies included high levels of end-user engagement reflective of integrated knowledge translation, but nearly half had limited end-user engagement with the remaining neither high or low. This study found that the HPW Implementation Framework is a comprehensive model for understanding implementation effectiveness in Indigenous communities and highlighted the high levels of community engagement and community voice. It also brings to light that the long-term sustainability and translation of evidence to practice may be inhibited because of lower levels of systems thinking and integrated knowledge translation. 
The second study researched the perceptions health professionals have on co-designing health-promotion interventions with Indigenous communities in New Zealand. Co-designing health-promotion interventions with Indigenous communities presents many benefits and challenges. This study identified that the facilitators for co-designing health-promotion interventions with Māori communities were collaboration and community voice. Furthermore, the two key barriers identified were mismanaged expectations between the researcher and community and the research constraints placed by funding agencies. The findings support the development of more effective co-design health-promotion interventions within Māori communities which may address health inequities. 
The third study endeavoured to identify the facilitators and barriers in disseminating and adopting a health intervention developed by a community-academic partnership. This study explored general perceptions of the implementation process and also included a case study of an innovative intervention. The facilitators included community engagement, programme structure, programme adaptability and creators’ experience. The barriers consisted of funding access, funding constraints and organisational constraints. This study also highlights the importance of community engagement and adaptability suggesting a need for translation as well as diffusion. Additionally, this study identified nuanced aspects of funding and resources for organisations that constrain organisations in employing health interventions designed by others.
The final study identified factors that New Zealand health professionals rate as important for implementation effectiveness for health interventions with Māori communities. This study provided a unique perspective of health professionals on implementation effectiveness when working with Māori/Indigenous communities. Paired sample t-tests revealed four levels of importance for implementation effectiveness with organisational teamwork and community autonomy as most important. Only 24% of participants had prior experience with a previous health intervention with Māori communities. The two key overall factors that were associated with participants’ rating of implementation effectiveness in these previous interventions were process and community. This study identified the key areas of implementation effectiveness as community engagement and participatory process. Furthermore, the final study contributes to the body of literature that challenges traditional top-down approaches of implementation.
Conclusion
This research aimed to identify the facilitators and barriers to disseminating and implementing health interventions with Māori communities in New Zealand. A synthesis of the four studies provided four key themes for this thesis. This thesis reinforces the position that Indigenous and Māori implementation science should be focused on the process and community engagement. In doing so, community engagement ensures a cultural-centred approach that prioritises Indigenous knowledge and autonomy in the process of implementation. Furthermore, the barriers identified in this thesis recognise the challenges that remain in limited funding for translating research into implementation practice and managing expectations amongst the implementation team. This thesis has implications for New Zealand district health boards and health organisations who are wanting to increase the effectiveness of the health interventions they are implementing with Māori communities, particularly when trying to address health inequities. Overall, this study is an attempt to bridge the gap between translating research and the processes of putting it into practice.

year: 2021