Counties Manukau Health, Middlemore Hospital, Auckland, New Zealand.
Faculty of Medical and Health Sciences, School of Population Health, University of Auckland, Auckland, New Zealand.
Health Expect. 2019 Oct;22(5):1122-1131. doi: 10.1111/hex.12946. Epub 2019 Aug 1.
Compared with New Zealand Europeans, Pacific peoples in New Zealand develop type 2 diabetes at a higher rate and a younger age, and have 3.8 times higher incidence of end-stage renal disease (ESRD).
To investigate contextual factors that shape understandings of disease for Pacific peoples with diabetes and ESRD.
Focussed ethnography. In-depth interviews were conducted with 16 Pacific people on haemodialysis for diabetic ESRD, in Auckland, New Zealand. Study participants aged between 30 and 69 years old were of Samoan, Cook Islander, Tongan, Niuean or Tokelauan ethnicity. Thematic analysis was used to code and identify themes.
Participants were embedded in a multigenerational legacy of diabetes. The limited diabetes-related education of earlier generations influenced how future generations behaved and understood diabetes. Perceptions were compounded by additional factors including the invisibility of early-stage diabetes; misunderstandings of health risks during communication with health providers; and misunderstandings of multiple conditions' symptoms and management. Participants had limited engagement with health services until their diagnosis of ESRD acted as a trigger to change this behaviour. However, this trigger was not effective in itself-rather, it was in combination with relevant education delivered in a way that made sense to participants, given their current understandings.
Illness representations drive choices and behaviours with respect to self-management of diabetes and engagement with health services. Diabetes is often present in multiple generations of Pacific people; therefore, illness representations are developed and shared within a family. Changing illness representations requires engagement with the individual within a family context.
与新西兰欧洲人相比，新西兰的太平洋岛民患 2 型糖尿病的比率更高、发病年龄更小，且终末期肾病（ESRD）发病率高出 3.8 倍。
探讨影响糖尿病和 ESRD 太平洋岛民疾病认知的背景因素。
聚焦民族志。在新西兰奥克兰，对 16 名接受血液透析治疗的糖尿病 ESRD 太平洋岛民进行了深入访谈。研究参与者年龄在 30 至 69 岁之间，分别来自萨摩亚、库克群岛、汤加、纽埃或托克劳。采用主题分析法对访谈内容进行编码和主题识别。
参与者深受糖尿病多代遗传史的影响。早期几代人有限的糖尿病相关教育影响了后代的行为和对糖尿病的理解。其他因素进一步加剧了这种认知，包括早期糖尿病的隐匿性；与医疗服务提供者沟通时对健康风险的误解；以及对多种疾病症状和管理的误解。参与者在确诊 ESRD 之前与卫生服务机构的接触有限，直到确诊后才改变这种行为。然而，这种触发因素本身并不能产生效果，而是与以参与者当前理解为基础、以他们能接受的方式提供的相关教育相结合，才能产生效果。
疾病认知会影响糖尿病自我管理和卫生服务机构参与的决策和行为。糖尿病在太平洋岛民的多代人中都存在；因此，疾病认知是在家庭中形成和共享的。改变疾病认知需要在家庭环境中与个体进行接触。
