Cultural Safety and Equity in Surgical Pathways for New Zealand Māori: An Integrative Literature Review

Abstract

Māori, the Indigenous people of Aotearoa/New Zealand, experience enduring inequities across surgical pathways shaped by historical, social, and political factors. This integrative review examined how Māori cultural safety is embedded in surgical care to identify principles for improving Indigenous health outcomes. Peer-reviewed studies published since 2017 were sourced from three databases and appraised using the Critical Appraisal Skills Program (CASP). Eleven studies met inclusion criteria (New Zealand, n = 6; Australia, n = 5). Two overarching themes, institutional racism and models of care, revealed inequities in prehabilitation, primary care access, and referral processes. While culturally centered models improved experiences, limited uptake restricted impact. Findings emphasize the need for system-level transformation to embed cultural safety and equity across surgical pathways. Six guiding principles include grounding initiatives in Māori worldviews, institutional commitment, barrier reduction, cultural training, whānau engagement, and Indigenous-led hospital design to achieve equitable Māori surgical outcomes.