Clark Mau Te Rangimarie, Manuel Jenni, Lacey Cameron, Pitama Suzanne, Cunningham Ruth, Jordan Jennifer
Department of Māori Indigenous Health Innovation, University of Otago, PO Box 4345, Christchurch, New Zealand.
Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
J Eat Disord. 2023 Feb 15;11(1):22. doi: 10.1186/s40337-023-00748-5.
Health, illness, and the body are conceptualized within the cultural context of a society. The values and belief systems of a society, including media portrayals, shape how health and illness present. Traditionally, Western portrayals of eating disorders have been prioritized over and above Indigenous realities. This paper explores the lived experiences of Māori with eating disorders and their whānau (family/support system) to identify the enablers and barriers to accessing specialist services for eating disorders in New Zealand.
Kaupapa Māori research methodology was used to ensure the research supported Māori health advancement. Fifteen semi-structured interviews were completed with Māori participants including; those with an eating disorder diagnosis (anorexia nervosa, bulimia nervosa, and binge eating disorder), and/or their whānau. Structural, descriptive, and pattern coding was undertaken within the thematic analysis. Low's spatializing culture framework was used to interpret the findings.
Two overarching themes identified systemic and social barriers to accessing treatment for Māori with eating disorders. The first theme, was space, that described the material culture within eating disorder settings. This theme critiqued eating disorder services, including idiosyncratic use of assessment methods, inaccessible service locations, and the limited number of beds available in specialist mental health services. The second theme, place, referred to the meaning given to social interactions created within space. Participants critiqued the privileging of non-Māori experiences, and how this makes a place and space of exclusion for Māori and their whānau in eating disorder services in New Zealand. Other barriers included shame and stigma, while enablers included family support and self-advocacy.
More education is needed for those working in the space of primary health settings about the diversity of those with eating disorders to enable them to look beyond the stereotype of what an eating disorder looks like, and to take seriously the concerns of whaiora and whānau who present with disordered eating concerns. There is also a need for thorough assessment and early referral for eating disorder treatment to ensure the benefits of early intervention are enabled for Māori. Attention given to these findings will ensure a place for Māori in specialist eating disorder services in New Zealand.
健康、疾病和身体是在社会文化背景中被概念化的。一个社会的价值观和信仰体系，包括媒体呈现，塑造了健康和疾病的呈现方式。传统上，西方对饮食失调的描述优先于本土现实。本文探讨了患有饮食失调症的毛利人及其whānau（家庭/支持系统）的生活经历，以确定新西兰获得饮食失调专科服务的促进因素和障碍。
采用毛利人 kaupapa 研究方法，以确保研究支持毛利人的健康进步。对毛利参与者进行了 15 次半结构化访谈，包括：患有饮食失调症诊断（神经性厌食症、神经性贪食症和暴饮暴食症）的人，和/或他们的 whānau。在主题分析中进行了结构、描述和模式编码。使用洛的空间化文化框架来解释研究结果。
两个总体主题确定了毛利人获得饮食失调治疗的系统性和社会障碍。第一个主题是空间，它描述了饮食失调环境中的物质文化。这个主题批评了饮食失调服务，包括评估方法的特殊使用、难以到达的服务地点以及专科心理健康服务中可用床位数量有限。第二个主题是场所，指的是在空间内创造的社会互动所赋予的意义。参与者批评了非毛利人经历的特权化，以及这如何在新西兰的饮食失调服务中为毛利人及其 whānau 创造一个排斥的场所和空间。其他障碍包括羞耻和污名，而促进因素包括家庭支持和自我倡导。
在初级卫生保健领域工作的人员需要更多关于饮食失调患者多样性的教育，以使他们能够超越饮食失调的刻板印象，并认真对待有饮食失调问题的 whaiora 和 whānau 的担忧。还需要对饮食失调治疗进行全面评估和早期转诊，以确保毛利人能够受益于早期干预。关注这些研究结果将确保毛利人在新西兰专科饮食失调服务中有一席之地。
