Food Practices and Diabetes Management: The Lived Experience of Tongan People With Type 2 Diabetes Mellitus in New Zealand
Type 2 Diabetes Mellitus (T2DM) is an alarming and growing global epidemic that is particularly prevalent throughout the Pacific region. T2DM disproportionately affects Pacific, Asian and Māori peoples here in Aotearoa New Zealand (NZ) and this prevalence is predicted to increase by 70 to 90 percent within the next 20 years. The focus of this research is T2DM among Pacific peoples, and in particular the Tongan community living in Auckland, NZ. Despite the range of quality standards for diabetes care and various health initiatives in New Zealand, prevalence of T2DM continues to worsen for Pacific peoples. Without the provision of culturally safe and meaningful services for Pacific peoples and their families, this health inequity will worsen with unacceptable impacts on the health and wellbeing of Pacific communities and higher health service costs. This research explored lived experiences of Tongan people with T2DM who are living in Auckland, New Zealand. It aimed to answer the following research questions: i. What is the meaning of being Tongan with T2DM in New Zealand? ii. What are the factors that determine the food practices of Tongan people with T2DM in New Zealand? iii. What can we do to help Tongan people with T2DM better manage their diabetes? iv. What strategies can help improve food practices and diabetes management of Tongan people with T2DM in New Zealand? This research is grounded in talanoa, a Pacific research methodology and method that facilitates participants to tell and share their stories in their own language. This research also draws on Heidegger’s hermeneutic phenomenology to guide data analysis and interpretation. The researcher, a Tongan dietitian who has lived in New Zealand for over 30 years, brings her own pre-understandings and interpretive lens to the thinking and writing. The process of gathering and interpreting lived experiences happens through talanoa and the hermeneutic circle of continuously integrating parts and the whole. It builds upon Tongan values of listening to stories of and seeking to find the meaning through interpretation of those stories. The study participants were recruited through Tongan church leaders and the communities in Auckland. The research was in two phases. Phase 1 was individual talanoa with five Tongans who had T2DM. In phase 2, insights from the interpretation of phase 1 talanoa were presented to three group talanoa with 17 Tongans with T2DM and family members. The purpose of these group talanoa was to work with Tongan people to strategise a way forward, with a focus of ‘what can we do” and/or ‘how can we help make that happen’, to improve the health and wellbeing of Tongans who have T2DM and, in doing so, of the wider Tongan community. This research found that Tongans with T2DM could have had diabetes for many years before they received a diagnosis. That meant that they were not aware of their risk of worsening T2DM and/or diabetes complications. Participants only sought medical help when they experienced some intolerable physical pain. This research also found that Tongans with T2DM recognised the significant impact of Tongan cultural values, family, church and community structures, and roles in diabetes management. For example: who was working, who was buying, who was preparing, what was available, what was being served and at what time, the occasion, who the meals were shared with, and the types and purpose of gifts. Findings also highlighted that diabetes services require a Tongan worldview and a holistic approach that encompass mo’ui lōtolu, wellbeing of sino (body), ‘atamai (mind), and laumālie (spirit/soul) to fulfil fatongia (duty/obligations) tauhi vā (maintain relationships), faka’apa’apa (honours/respect) and serve others. Food practices and diabetes management was never about an individual. It was always about their children, spouse, extended family, friends, church and community in New Zealand, Tonga and overseas. The participants recognised that the loto (heart) is the centre of authority, in deciding what to accept and reject. The heart makes the connection with the mind and the soul/spirit. It requires a Tongan heart (loto’i Tonga), loto lelei (good heart), and willingness to put knowledge into action. They acknowledged the importance of learning and gainng knowledge through talanoa, sharing lived experiences and receiving practical and meaningful information that involves family, church, and community. Food practices that they grew up with in Tonga may no longer be applicable. As Tongans transition into the New Zealand system, food cultural practices need adapting so they are fit for purpose. There are possibilities for modifying practice to enhance the ability of service providers and the Tongan community to get the benefit of talanoa and contextualised services. This study adds knowledge and new understanding to food practices and diabetes management of Tongan with T2DM. The concept of Tongan food basket, Kato Polopola captures the Tongan worldview. This encapsulates talanoa and weaving a holistic approach that is fundamental to mo’ui lōtolu: that is wellbeing within the collective nature of tauhi vā, fulfilling fatongia at all levels, within an individual, famili (family/household), kāinga lotu (church), kāinga (extended family), and kāinga (community) and the diabetes health services. It recognises the central role of the loto (heart), the importance of Tongan cultures and maintaining an authentic relationship (vā). Kato polopola holds all the complex factors together as a whole. It is about no one thing; it is about all the strands woven together held by ‘ofa (love/heart), ‘ilo (knowledge/mind) and lotu (prayers/spirit). Tongan with T2DM need meaningful information and appropriate support to enable commitment for sustainable behavioural changes. This study is the first research that explores lived experiences of Tongan people with T2DM using a combined talanoa and hermeneutic phenomenology approach by a Tongan for, and with Tongan people. This research makes a significant contribution by allowing non-Tongan’s diabetes service providers to develop talanoa-like approach; that is, an unstructured approach that allow opportunities for Tongans with T2DM to share their stories, lived experiences, realities, and gain insight into how Tongans think, interpret their situation and what matters to them in this time and space. Further research is proposed for talanoa participatory action research to work with Tongans who have been diagnosed with T2DM (and their families, church, and community) to plan, act, and reflect on diabetes management strategies, work with health providers in planning, implementing, and evaluating changes to how diabetes care is delivered to Tongan families with T2DM.