## 3 Discussion  
This is the first study to explore Maori beliefs about antibiotics and their use for cold or flu symptoms. We adopted a qualitative research approach to allow exploration of the experiences and perceptions of Maori in-depth. We identified systemic, social and individual factors that influenced antibiotic use for Maori. Personal beliefs were influenced by the wider health systems and infrastructures within NZ, which also impacted on the social issues that people experienced. Most participants appeared to have low expectations for antibiotic treatment for cold and flu symptoms; many expressed that they did not want to have unnecessary antibiotics or reported experiencing adverse effects with previous treatment. From the themes identified from this study, there are several key factors that could potentially be modifiable or targeted in an intervention to improve antibiotic use. First, knowledge relating to infections (viral or bacterial) and their management (symptomatic care or antibiotics) appeared to be lacking in this participant group. Participants described seeking information or clarification from other sources immediately after their GP consultation, using Google or whanau, which reflects a clear need for better, more accessible information in this population. As provision of information in way that is tailored to an individual's health literacy level reflects the response of the health service or provider, and not simply the knowledge or capacity of the person seeking care, these findings suggest that health professionals need to develop and implement more effective resources for Maori who present with infections that may or may not require antibiotics (8, 10). Participants described a hierarchy during the consultation with the doctor, where the doctor's advice was seen as an important 'direction' even if they did not understand the information about antibiotics. People felt that it was not safe to ask questions or question treatment decisions. Unfortunately for Maori in NZ, there is both under-prescribing of necessary treatments and over-prescribing of inappropriate medications [21], creating and sustaining health inequities [4; 5]. There is potential for 'good prescribing' when patients and their prescribers discuss the reasons for the medicine, including risks and benefits [1; 17; 18]. Our findings suggest a need to address the relationship between health providers and Maori '10,21]. We identified issues of access and poverty that play a big factor in healthcare. Any relationship between the participants and their doctors has potential to be hindered by access and poverty issues. Participants described a cycle of Maori being unable to access care due to poverty and lack of transport, health professionals not seeing or understanding these issues and behaving in ways that caused misinformation or mistrust--for example, communicating information in a way that participants felt like they had not been listened to, and people's beliefs about antibiotics being further undermined. This cycle needs to be broken. Any campaigns focusing on the education in Maori communities need to be done in a culturally safe way [22]. Programs that educate health professionals about appropriate antibiotic use have been shown to be effective in reducing unnecessary prescribing of antibiotics [23]; attention to developing similar programs for prescribers working with Maori communities may be useful. Participants highlighted a key point about their preference not to take antibiotics or at least for health providers to consider incorporating traditional medicine or alternative Maori traditional remedies as part of their treatment plan. This was reinforced by participants' negative experiences and past adverse effects with antibiotics, which impacted their preference to seek alternative remedies (rongoa). Ancestral knowledge was lost because of colonisation with unequal treatment of Maori within societal institutions displacing many cultural traditions such as tohunga [24].