Whitia Kia Ora: A Culturally Responsive Model of Bicillin L-A® Delivery for People With Rheumatic Fever in the Waikato Region of Aotearoa New Zealand

Abstract

AIM: Acute rheumatic fever (ARF) is an autoimmune response to group A Streptococcus (Strep A) infection that can lead to rheumatic heart disease (RHD). To prevent Strep A infection for people with ARF or RHD, clinical guidelines recommend monthly intramuscular penicillin (Bicillin L-A®) injections for at least 10 years. However, multiple barriers to accessing healthcare affect adherence. This research aimed to improve adherence by developing a Māori and Pacific–centred model of care. METHODS: Qualitative, Kaupapa Māori and Kakala methodology underpinned the research. Data collection from people in the Waikato region with ARF, their whānau and healthcare providers included interviews, wānanga and fono. Data were analysed using a general inductive approach. RESULTS: Forty-seven participants were included: nine people with ARF, 10 whānau, eight health professionals and 21 whānau navigators. Three themes were identified: impacts of a colonial health system on Indigenous whānau; life defined by a disease status; and catalysts of healthcare engagement. A community informed, Whānau Ora model of care was also developed. CONCLUSION: Indigenous methodologies are effective methods to develop community informed, culturally responsive models of care. Although designed for ARF in Waikato, there is potential to adapt this approach for other health conditions and different regions of Aotearoa New Zealand.