This work aimed to determine the effectiveness of Māori diabetes podiatry services in reducing lower limb amputation in Aotearoa by Māori for Māori. The first objective of this study was to evaluate the current evidence regarding the effectiveness of diabetes podiatry services in Aotearoa. The second objective was to explore the views and perceptions through a Māori lens of (i) Māori podiatrists with an Annual Practicing Certificate in Aotearoa who provide diabetes podiatry services (ii) Māori stakeholders who provide services utilising te ao Māori concepts; and (ii) Māori with diabetic foot problems relating to the effectives of podiatric services in Aotearoa. The third objective was to ensure the research benefits Māori and aligns with tikanga values.

In reviewing the literature, we considered effectiveness to include reduced length of hospital stay; reduced hospital admission; return to primary care; improved patient self-management; reduction in ulceration/re-ulceration; reduction in amputation; and limb salvage. Only international studies met these criteria. The three studies (Craig et al., 2013; Perrin et al., 2012a; Searle, 2008) clearly demonstrated triaging people based on their foot risk category either in the community or secondary setting is an appropriate way of determining acute from chronic foot pathology. However, there was no clear consensus on how to effectively manage moderate-to-high foot risk categories. A limitation of the literature review was the lack of evidence for diabetes podiatry services in Aotearoa.

A kaupapa Māori evaluation approach was used to identify the effectiveness of diabetes podiatry services by Māori for Māori. This approach ensured the process of, and results from the work aligned with tikanga Māori. A collaborative approach between the researcher, the National Hauora Coalition, and a research whānau determined the evaluation processes. A mixed methods approach using semi-structured interviews, electronic surveys and quantitative service data was collected to inform this work. Key themes from the evaluation concluded that current diabetes podiatry services are effective when Māori feel engaged with the practitioner and Māori podiatrists embed mātauranga and tikanga in their approach to Māori with diabetes. The participants in this study suggested mutual learning within culturally safe environments. Furthermore, culturally responsive learning opportunities need to be embedded in undergraduate studies and continuing professional development for registered podiatrists and those wishing to practice in Aotearoa. Finally, funding bodies need to invest in Māori development and capability if they are truly committed to the Pae Ora (Healthy Futures) Bill (2022). It is essential that provisions for the inclusion of non-clinical measures of wellbeing are incorporated into diabetes podiatry practice and reporting. These are necessary to ensure these services are meeting the aspirations of Māori. In conclusion, there is a significant opportunity to embed effective Māori-driven diabetes podiatry service to reduce lower limb amputation among Māori in Aotearoa through authentic and collaborative approaches.