Authentic co-design: an essential prerequisite to health equity in Aotearoa New Zealand.

Current approaches to co-design with Māori and Pacific communities have varying success, highlighting the need for a clear and transparent understanding about the different ways that researchers and communities conceptualise and implement co-design. This study set out to identify key elements of co-designed research and health services important to working with, and achieving equity of health outcomes for, Māori and Pacific communities living in Aotearoa New Zealand. A qualitative evaluation of five research projects, which used co-design with partners from Māori and Pacific communities, involved interviews with researchers and community partners. A Kaupapa Māori framework developed to assess six principles important to Māori co-design was used, and data were coded and thematically analysed. Four additional principles of good co-design and nine lessons for improving the conduct of co-design research were identified. A conceptual model was developed, the Co-design Research Integrity Poutama, which defines increasing levels of co-design exemplified by greater levels of transparency and power-sharing. Authentic co-design of research and health services has a greater likelihood of achieving equitable health outcomes in Māori (the Indigenous People of Aotearoa New Zealand) and in other ethnicities experiencing similar inequities, notably Pacific Peoples, and to those experiencing racial and ethnic inequities worldwide.