A Community Based Participatory Research Approach to Create a Diabetes Prevention Documentary for Māori
Thesis DisciplineHealth Sciences
Degree GrantorUniversity of Canterbury
Degree NameDoctor of Philosophy
Type 2 diabetes is almost three times more prevalent in the indigenous people of New Zealand (Māori) than non-Māori. Despite the high rate of diabetes there is a low level of diabetes knowledge and awareness in the Māori community. Several studies of Māori health identify a need for new health communication approaches to diabetes prevention in order to reduce the gap between Māori and non-Māori disease rates. Several problems can be identified with existing health promotion and education materials about type 2 diabetes for Māori. There is a gap in the literature reporting on what constitutes a culturally appropriate research process for health communication with Māori. A second problem is a difficulty ascertaining how and if health behaviour theory was selected when designing health promotion materials for type 2 diabetes with Māori. There is a need to make explicit the research process and employment of theory in the design of health promotion materials. In addition, little is known about how Māori understand or experience type 2 diabetes, or the social and cultural meaning given to the disease. These are significant gaps because a tenet of effective health communication is the need to engage with and understand how cultural, social, environmental and historical factors influence health behaviours. The research objective was to ascertain how Community Based Participatory Research (CBPR) in combination with indigenous principles and behavioural theory could be employed to create a culturally appropriate resource for Christchurch adult Māori at risk for type 2 diabetes. This study describes the rationale for and process of working in partnership with an indigenous population to develop a health communication resource that reflects Māori beliefs and cultural practices. Principles of CBPR were applied to a qualitative research design employing community engagement and partnership, key informant interviews and hui (focus groups) to inform the messaging of a diabetes prevention documentary. In order to decolonise the research process, Walters et al.’s (2009) “indigenist” research principles were incorporated into the research design and evaluation. The research findings revealed diabetes prevention is a complex and multifaceted problem in the Māori community. There was a clear lack of knowledge and understanding about the causes of type 2 diabetes. At the same time it was common to have witnessed family members die from the disease. This resulted in a strong sense of fatalism and the belief that diabetes is a death sentence. Second, there are multiple barriers for Māori in improving health and preventing the disease. They are economic, social, cultural and institutional. As a result, depression, stress, low self-esteem and low motivation impede health behaviour change. However, the community also identified viable solutions. These included a holistic model of care, collectivist whānau based approaches, and taking small and achievable steps. These findings were then incorporated into the documentary messaging. Community members helped determine the approach to and content of the documentary. Bandura’s social cognitive theory provided a culturally sensitive theoretical basis for behaviour change in the creation of the documentary. A communications focus on whānau (family) was culturally important and positioned as a key reward to implementing health changes. This study concludes that a CBPR approach provides an appropriate model for enacting local action-oriented approaches in the creation of a diabetes prevention documentary that reflects Māori cultural beliefs, practices, and a narrative tradition. This research contributes to the small body of international literature concentrating on the perception and lay understanding of diabetes within indigenous communities and the social and cultural meaning given to the disease. This study supports previous research that has found that CBPR is a strong model for working with indigenous populations when designing and implementing type 2 diabetes health communication materials. The application of CBPR in combination with indigenous principles provides an appropriate framework for non-Māori researchers to support culturally appropriate research that honours indigenous values and protocols.