Whitireia Institute, DX Box: SX33459, Porirua, Wellington, New Zealand.
Department of General Practice and Primary Care, Faculty of Medical and Health Sciences, University of Auckland Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand.
BMC Health Serv Res. 2022 May 19;22(1):672. doi: 10.1186/s12913-022-08057-4.
Prevalence of Type 2 diabetes mellitus (T2DM) is high among Māori and other Pacific Island peoples in New Zealand. Current health services to address T2DM largely take place in primary healthcare settings and have, overall, failed to address the significant health inequities among Māori and Pacific people with T2DM. Culturally comprehensive T2DM management programmes, aimed at addressing inequities in Māori or Pacific diabetes management and workforce development, are not extensively available in New Zealand. Deliberate strategies to improve cultural safety, such as educating health professionals and fostering culturally safe practices must be priority when funding health services that deliver T2DM prevention programmes. There is a significant workforce of community-based, non-clinical workers in South Auckland delivering diabetes self-management education to Māori and Pacific peoples. There is little information on the perspectives, challenges, effectiveness, and success of dietitians, community health workers and kai manaaki (KM) in delivering these services. This study aimed to understand perspectives and characteristics of KM and other community-based, non-clinical health workers, with a focus on how they supported Māori and Pacific Peoples living with T2DM to achieve better outcomes.
This qualitative study undertaken was underpinned by the Tangata Hourua research framework. Focus groups with dietitians, community health workers (CHWs) and KM took place in South Auckland, New Zealand. Thematic analysis of the transcripts was used to identify important key themes.
Analysis of focus group meetings identified three main themes common across the groups: whakawhanaungatanga (actively building relationships), cultural safety (mana enhancing) and cultural alignment to role, with a further two themes identified only by the KM and CHWs, who both strongly associated a multidisciplinary approach to experiences of feeling un/valued in their roles, when compared with dietitians. Generally, all three groups agreed that their roles required good relationships with the people they were working with and an understanding of the contexts in which Māori and Pacific Peoples with T2DM lived.
Supporting community based, non-clinical workers to build meaningful and culturally safe relationships with Māori and Pacific people has potential to improve diabetes outcomes.
新西兰的毛利人和其他太平洋岛民中，2 型糖尿病（T2DM）的患病率很高。目前，主要在初级保健环境中开展针对 T2DM 的卫生服务，但总体上未能解决毛利人和太平洋岛民中 T2DM 患者的显著健康不平等问题。旨在解决毛利人或太平洋岛民糖尿病管理和劳动力发展方面不平等问题的综合文化 T2DM 管理方案在新西兰并未广泛提供。在为提供 T2DM 预防方案的卫生服务提供资金时，必须优先考虑改善文化安全的策略，例如教育卫生专业人员并培养文化安全实践。在南奥克兰，有大量社区为基础的非临床工作者向毛利人和太平洋岛民提供糖尿病自我管理教育。关于营养师、社区卫生工作者和 kai manaaki（KM）在提供这些服务方面的观点、挑战、效果和成功的信息很少。本研究旨在了解 KM 和其他社区为基础的非临床卫生工作者的观点和特点，重点是他们如何支持患有 T2DM 的毛利人和太平洋岛民实现更好的结果。
本定性研究的基础是 Tangata Hourua 研究框架。在新西兰南奥克兰，与营养师、社区卫生工作者（CHWs）和 KM 举行了焦点小组会议。使用主题分析对转录本进行分析，以确定重要的关键主题。
焦点小组会议的分析确定了三个共同主题：whakawhanaungatanga（积极建立关系）、文化安全（增强能力）和角色的文化一致性，另外两个主题仅由 KM 和 CHWs 确定，他们都强烈认为多学科方法对他们在工作中感到被忽视或不受重视的经历有影响，与营养师相比。一般来说，所有三个组都同意，他们的角色需要与他们合作的人建立良好的关系，并了解毛利人和太平洋岛民 T2DM 患者的生活背景。
支持社区为基础的非临床工作者与毛利人和太平洋岛民建立有意义和文化安全的关系，有可能改善糖尿病的结果。
