Rahiri Jamie-Lee, Tuhoe Jason, Gillon Ashlea, MacCormick Andrew D, Hill Andrew, Harwood Matire
South Auckland Clinical Campus, The University of Auckland, Middlemore Hospital, Auckland, New Zealand.
Tokoroa Family Health, Tokoroa Hospital, Tokoroa, New Zealand.
ANZ J Surg. 2020 Apr;90(4):508-513. doi: 10.1111/ans.15610. Epub 2019 Dec 16.
Health equity is a fundamental right afforded to all regardless of ethnicity. However, in New Zealand (NZ), health inequities are most compelling for Indigenous Māori who experience inadequate access to services, poorer quality of care and poor health outcomes as a result. Bariatric surgery is the most effective intervention for weight loss and remission of obesity-related disease where all other interventions have been exhausted. This Kaupapa Māori qualitative study presents Māori perspectives of bariatric surgery from the largest public bariatric centre in NZ and offers solutions for enhancing bariatric service responsiveness to Māori.
This qualitative study was informed by Kaupapa Māori methodology and involved a general inductive thematic analysis of 31 semi-structured interviews with Māori patients who had bariatric surgery at Counties Manukau Health in South Auckland, NZ.
Four key themes were identified following analysis: (i) Kaupapa Māori standards of health; (ii) bariatric mentors; (iii) bariatric psychologists; and (iv) community-integrated support. These themes offer four tangible solutions for optimizing bariatric pathways for Māori from the perspectives of Māori bariatric patients.
Kaupapa Māori, community-centred and greater non-surgeon aspects of bariatric supportive mechanisms comprise key areas of opportunity for public bariatric pathways in NZ. Surgical leadership is required to advance health equity and service responsiveness to Māori.
健康公平是所有人都享有的一项基本权利，不论种族如何。然而，在新西兰（NZ），健康不平等现象对原住民毛利人来说最为突出，他们难以获得充分的服务，医疗质量较差，健康结果不佳。在所有其他减肥干预措施都已用尽的情况下，减肥手术是治疗肥胖症及相关疾病最有效的干预手段。这项以毛利人 kaupapa 为导向的定性研究呈现了新西兰最大的公共减肥中心的毛利人对减肥手术的看法，并为提高减肥服务对毛利人的响应能力提供了解决方案。
这项定性研究采用了毛利人 kaupapa 方法，对在新西兰南奥克兰的 Counties Manukau Health 接受减肥手术的 31 名毛利患者进行了半结构化访谈，并进行了一般归纳主题分析。
分析后确定了四个关键主题：（i）毛利人健康标准；（ii）减肥手术指导者；（iii）减肥手术心理专家；（iv）社区综合支持。这些主题从毛利减肥患者的角度为优化毛利人的减肥途径提供了四个切实可行的解决方案。
以毛利人 kaupapa 为导向、以社区为中心以及减肥支持机制中更多非手术方面，是新西兰公共减肥途径的关键机会领域。需要手术领域的领导来促进健康公平以及提高对毛利人的服务响应能力。
