Te Kupenga Hauora Māori, The University of Auckland, New Zealand.
South Auckland Clinical Campus, The University of Auckland, New Zealand.
Aust N Z J Public Health. 2019 Jun;43(3):294-299. doi: 10.1111/1753-6405.12890. Epub 2019 Mar 25.
Rheumatic fever (RF) recurrence prevention requires secondary prophylaxis for at least ten years. However, recurrences of rheumatic fever (RRF) persist disproportionately affecting Māori and Pacific youth. Reasons for recurrence rates are not well understood and commonly attributed to patient non-adherence. This research explored Māori and Pacific family experiences of RRF to better understand barriers to accessing secondary prophylaxis to inform health service improvements.
Participants were Māori and Pacific patients who had RRF or unexpected rheumatic heart disease and their family; and health professionals working in RF contexts. Kaupapa Māori, Talanga and Kakala Pacific qualitative methodologies were employed. Data were thematically analysed using a general inductive approach.
Data collection included 38 interviews with patients and families (n=80), six focus group interviews and nine interviews with health providers (n=33) from seven geographic regions. Three key themes were identified where mismatches occurred between services and community needs: 1. Model of delivery; 2. Interpersonal approaches to care; and 3. Adolescent care. Conclusions and Public health implications: Successful RRF prevention requires interventions to address structural causes of inequity, appropriate clinical guidelines and quality health services. Service-delivery models should provide regular prophylaxis in an accessible manner through culturally-safe, community-based, age-appropriate care.
风湿热（RF）复发的预防需要进行至少十年的二级预防。然而，风湿热（RRF）的复发仍然不成比例地影响着毛利人和太平洋岛民的青年。复发率的原因尚不清楚，通常归因于患者不遵医嘱。这项研究探讨了毛利人和太平洋岛民家庭对 RRF 的体验，以更好地了解获得二级预防的障碍，从而为改善卫生服务提供信息。
参与者为 RRF 或意外风湿性心脏病的毛利人和太平洋岛民患者及其家人；以及在 RF 环境中工作的卫生专业人员。采用了毛利人 Kaupapa、塔拉加和卡卡拉太平洋定性方法。使用一般归纳方法对数据进行主题分析。
数据收集包括来自七个地理区域的 38 名患者和家属（n=80）、6 次焦点小组访谈和 9 次与卫生提供者（n=33）的访谈。确定了三个关键主题，即服务和社区需求之间存在不匹配：1. 交付模式；2. 护理中的人际方法；3. 青少年护理。结论和公共卫生意义：成功预防 RRF 需要干预措施来解决不平等的结构性原因、适当的临床指南和高质量的卫生服务。服务提供模式应通过文化安全、以社区为基础、适合年龄的护理，以可及的方式定期提供预防措施。
