Meeting the needs of Māori with diabetes:  Evaluation of a nurse-led service.

Abstract

Designated Maori health service providers and specialised Maori nursing roles using "culturally appropriate" practices have been developed in New Zealand to address health disparities between Maori and non-Maori citizens. This study considers the effectiveness, from several perspectives, of a Maori nurse-led diabetes programme offered by Te Hauora O Ngati Rarua. It also identifies salient features of the experience of having diabetes and being on the programme, which consists of the combination of a six week course of group education sessions with one-to-one case management, involving health care, education and support.Programme evaluation was conducted using an embedded case study design. Seven programme participants were followed for 9-12 months, during which time multiple sources of data were accessed, including programme documents, clinical notes, laboratory results and stakeholder interviews. Client outcomes were measured in terms of physiological measures, knowledge acquisition, diabetes management and lifestyle behaviour. Some participants demonstrated improved diabetes management and lifestyle behaviour while actively engaged with the programme, but efforts tended to lapse once support was reduced. This highlighted the importance of optimising the level of long-term self-management support for clients with diabetes. High levels of co-morbidity were common and tended to complicate management. The Transtheoretical Model of Change, Chronic Care Model and Systems Theory shaped the evaluation.The study makes four important contributions to knowledge in this area: 1) it confirms the importance of Maori values and processes in "by Maori for Maori" services as they help to keep clients engaged, 2) it describes how small Maori health providers meet the needs of the local community, and 3) it identifies the value of the Maori Diabetes Nurse Educator (MDNE) role in primary health care.Thus it serves as an affirmation of the importance of the Maori Health Strategy and Maori self-determination in organising and delivering health care for Maori clients. The fourth valuable contribution is the insight gained into the dynamics of Pakeha researchers working in partnership with Maori organisations.

Culturally safe interventions in primary care for the management of chronic diseases of urban Indigenous People: a scoping review

“…The studies and websites reported interventions, for the most part, in the form of programmes (n=8, 1 website), models of care (n=3, 2 websites),27–29 programmes of care (n=5, 1 website),30–34 training for clinicians (n=3)19 35 36 or patients (n=3),36–38 and frameworks guiding the delivery of culturally safe care (n=1, 1 website). They were all implemented in clinical settings to provide culturally safe care for Indigenous populations.…”

First Nation Peoples’ nutrition and exercise group programmes: transforming success through the lifeworld

“…Shared language that aimed to understand “what is valued” required a common dialect, including shared gesture and speech, such as traditional languages, words or phrases. The meaning and use of traditional words or phrases was shared by community members, who also helped others such as researchers to understand the significance to the community (Curtis et al, 2004 ; Janssen & Nelson, 2014 ; Sinclair et al, 2020 ; Tipene-Leach et al, 2013 ; Warbrick et al, 2020 ).…”

“…Drawings, photographs, and metaphors were important to many communities as ways to convey meaning and feelings, as well as to add cultural relationality to a dialogue about a programme (Curtis et al, 2004 ; Janssen & Nelson, 2014 ; Stefanich et al, 2005 ). Throughout the literature pool, meaningful visuals linked traditional ways of sharing knowledge, exemplified by: Shared story telling between staff and participants, involving imagery and analogies to convey information about medical concepts and participants’ experiences.…”

“…Self-awareness and critical reflection extended beyond what was said to include gesture and non-verbal body language (Janssen & Nelson, 2014 ; Jernigan, 2010 ; Prodan-Bhalla et al, 2017 ). Through critical awareness, non-verbal cues may become more recognizable to people from different cultures (discussed in the reference text by Eades ( 2013 )).…”

Reviewing Health Service and Program Evaluations in Indigenous Contexts: A Systematic Review

“…Local Indigenous community ways of knowing and being should be integrated into evaluation logic models, conceptual frameworks, and evaluation designs (Cinelli & Peralta, 2015;Doyle et al, 2016;Freeman, Edwards, et al, 2014;Hayward et al, 2017;Schoen et al, 2010;Sy et al, 2015;Tingey et al, 2015). As part of adhering to local Indigenous protocols, culture, and language, authors also identified the importance of incorporating the local community history and values defined by community members into evaluation work (Brussoni et al, 2012;Gray et al, 1998;Janssen, 2008;Kim & Driver, 2015;Tipene-Leach et al, 2013;Voyle & Simmons, 1999;Ziabakhsh et al, 2016).…”