Should I Stay or Should I Go Now? Systemic mapping of barriers to generate solutions for equitable access to gambling harm services

Gambling harm is increasingly recognised as a significant public health concern in Aotearoa New Zealand, with Māori, Pacific, Asian communities, and youth disproportionately affected. While these groups experience higher levels of harm, they are less likely to engage with formal help services, pointing to deeper structural and cultural issues. Traditional interventions focused on individual responsibility have limited effectiveness.

This research explores these issues, recognising that access to care is shaped by a combination of institutional, social, and cultural forces.

Using Q-methodology, the study investigates the subjective viewpoints of priority groups and gambling service providers on the barriers and enablers to help-seeking. This approach highlights common themes that extend beyond individual experiences. Four distinct factors emerged from the analysis:

• Factor 1, Stigma-Related Avoidance, captures how shame, fear of exposure, and concerns about confidentiality discourage disclosure and delay engagement. Participants described internalised blame and deep discomfort with the idea of being labelled.
• Factor 2, Socially and Culturally Trapped, reveals how language barriers, relational disruptions, and cultural incongruities between clients and services perpetuate feelings of alienation. A perceived lack of cultural safety and understanding was frequently cited as a reason for withdrawal.
• Factor 3, Ambivalence About Change, reflects a tension between recognising harm and maintaining a sense of control. Some participants believed gambling was manageable or driven by skill and were uncertain about whether formal help was necessary.
• Factor 4, Service Failure to Understand Lived Context, points to systemic shortcomings including inflexible service structures, lack of family-oriented models, and cultural dissonance between mainstream practices and lived realities.

The study shows that these factors intersect in ways that compound disengagement and sustain inequities. However, the study also illuminated opportunities for transformation. Participants identified culturally grounded, whānau-centred, and mana-enhancing approaches as powerful enablers of change.

The study concludes by advocating for a reimagined approach to gambling harm – one that centres relationality, equity, and cultural integrity in the pursuit of responsive and effective support systems.