This thesis sought to explore the experiences of: 1) Māori and Pacific people living with type 2 diabetes (T2D), and their whanau; and 2) the kai manaaki (KM), community health workers (CHWs) and dieticians who provide care to Māori and Pacific people living with T2D in the community.

The burden of T2D is greatest for Māori, the Indigenous peoples of Aotearoa New Zealand, and for Pacific peoples, who both have higher rates and worse outcomes compared with non-Māori and non-Pacific people. Significantly, for Māori and Pacific people with T2D, the disparity in outcomes (including dependence and quality of life) compared with New Zealand Europeans increases significantly at all touch points including pre-diabetes, diagnosis, assessment, and treatment. The reasons for this are complex, and in some part can be related to gaps in suitable health provision and workforce to appropriately meet the needs of Māori and Pacific peoples.

This PhD thesis project comes under the umbrella of a larger body of research. The National Health Coalition successfully gained Health Research Council (HRC) funding for a research project to test a new initiative, Mana Tū, which is an exploration framework for culturally responsive approaches and strategies implemented by the KM who work alongside Māori and Pacific in their community.

The study’s aim was twofold. The first aim was to gain a better understanding of the roles of three types of health workers who work with Māori and Pacific people in the community as to their views on the deliberate strategies they were employing to support better health outcomes. The second aim was to provide a deeper understanding of Māori and Pacific people with T2D, and their whanau, and their experiences of a preventative diabetes programme offered through Mana Tū by a workforce that was trained to work with Māori and Pacific people with T2D in primary care settings.

A qualitative approach to the research was undertaken in order to gain an understanding of these two groups’ experiences, attitudes and beliefs. As this project involved Māori and Pacific as researchers and researched and sought to make a positive difference for Māori with T2D and their whanau, it was identified there were limited frameworks that support robust research methodologies with both Māori and Pacific peoples. Subsequently, the Tangata Hourua research framework, drawing from Kaupapa Māori (Māori principles) and Pacific methodologies was developed in response to this gap. The Tangata Hourua research framework was used to guide various studies in this research project.

The first study identified five themes from health care workers working with Māori and Pacific with T2D in the community from data collected from three focus groups. Three main themes were identified across the three focus groups: whanaungatanga (actively building relationships), cultural safety (mana enhancing) and cultural alignment. Another two themes were identified only by the KM and CHWs, who both strongly associated a multidisciplinary approach with experiences of feeling valued in their roles, which was different from the dietitians. A focus on supporting community-based, non-clinical workers in building meaningful and culturally safe relationships with Māori and Pacific people has the potential to improve diabetes outcomes and is urgently required.

The second study’s findings were from a component of the Mana Tū research programme looking at the experiences of 1) people living with T2D and their whānau, and 2) KM, CHWs and dieticians who provide care to Māori and Pacific people living with T2D in the community. From this study, seven themes emerged which included the finding that clients and whānau appreciated and better engaged with health care workers who: could culturally meet their needs; spoke their language or spoke in non-clinical terms that could be understood; understood who they were and the communities they came from; provided services that were adaptable and non-clinical in their approach, such as where they were delivered; and provided a multidisciplinary approach. These findings drive a strong call for a diabetes prevention strategy that achieves the aspirations of Māori and Pacific people to take charge.