Navigating the space between co‐design and mahitahi: Building bridges between knowledge systems on behalf of communities

**Background:** The health system in Aotearoa/New Zealand does not provide culturally responsive services, programmes, or approaches. Indigenous, remote, and vulnerable populations who have been exposed to inequitable processes resulting in social, economic, political, and health disparities are not well served by the current system. Co-design is a Western methodology that provides a platform for community voices to be heard in health system design, but it lacks the cultural context required to ensure equitable approaches for Māori and other Indigenous populations. The authors propose mahitahi as a culturally responsive co-design approach that builds knowledge from within the Māori worldview. The concept of an 'interface space' between Western and mātauranga Māori knowledge systems, introduced by Durie, is described as a 'third space' where innovative solutions drawing on the strengths of both worldviews can be created.

**Methods:** This is a narrative review and opinion piece drawing on the authors' own research experience and published literature. The authors describe the phases of co-design as outlined by the Auckland Co-design Lab: Phase 1 – Frame & Engage (clarifying intent and who needs to be involved); Phase 2 – Explore & Connect (developing insights with whānau and stakeholders); Phase 3 – Imagine & Create (exploring possible responses); and Phase 4 – Make & Test (testing new ideas and prototypes). Mahitahi is described as a kaupapa Māori design methodology underpinned by specific mindsets: Mahitahi (collaboration and collective responsibility), Mahi Toi (creative exploration), and Mahia te mahi (action-based doing and testing). Wānanga (traditional cultural knowledge forums) are identified as preferred spaces for mahitahi work because they involve practices such as whakawhanaungatanga (relationship building) and manaakitanga (reciprocity and compassion). Three case examples from the authors' work are provided: (1) a mahitahi wānanga using pūrākau (traditional storytelling) to design solutions for healthy nutrition among Māori; (2) Whakapiki Wairua, a mindfulness project with 22 young Māori using action-based participatory methods including Hohou te Rongo (meditations), Whakapakari Tinana (physical and mental resilience activities), and Mahi Toi (creative visual arts); and (3) a study on Māori flourishing where mahi toi was used to translate qualitative findings into Māori tohu (symbols) through collaboration with a tā-moko practitioner.

**Key Results:** The authors identify several challenges with co-design: it is often co-opted and used to describe what is actually consultation, where researchers have predefined ideas and consult only on specific components rather than involving communities from inception. This can reinforce colonial mindsets and create ineffective services. Authentic co-design is time-consuming, logistically complex, and constrained by funding and conflicting philosophical approaches. Critical reflection and consistent interaction with the community, as well as strong pre-existing relationships, help navigate these challenges. The authors note that co-design and mahitahi can seem unstructured because processes evolve organically rather than being fully described before work begins. A key limitation identified is the small pool of published literature about mahitahi, as Western academic publication standards do not align with kaupapa Māori spaces where success is measured by community-focused dissemination strategies.

**Clinical Implications:** The authors provide specific recommendations: (1) Co-design principles need to be culturally grounded so that the final approach has impact for those who need it most; (2) Indigenous knowledge systems are likely to have innate co-design principles that may not be written about in Western literature; (3) Mahitahi should be the preferred methodology when co-creation is needed for solutions to support Māori health and wellbeing; (4) For other Indigenous and vulnerable communities, co-design should be based on the knowledge systems of those communities; (5) Consultation and engagement are essential but co-design is not simply consultation—communities should be involved in the entire research process from setting priorities to dissemination; (6) All co-design and mahitahi processes should nurture knowledge transfer to increase capacity and capability with each project. The paper concludes that building capacity within co-design and mahitahi research spaces is critical, especially given current health system reforms in Aotearoa requiring more culturally responsive and equitable approaches.