Quality Standards for Diabetes Care Toolkit

Implementation advice

Māori and Pacific peoples

‘The degree of comfort individuals feel with seeking health services impacts on their use of services and in turn health outcomes … The delivery of care in a culturally appropriate manner is an important element in determining both the willingness of people to access services and the success of any treatment or care then delivered’ (Durie 2001 in Mauri Ora Associates 2008, p 12).
Health care professionals must consider their own attitude, awareness, knowledge, and skills before any health care interactions with individuals, family/whānau.
Developing the Māori workforce across the spectrum of service providers and disciplines is essential in order for services to provide appropriate care to Māori individuals, their whānau and all New Zealanders (Ministry of Health 2013). In 2012, there were 77,929 Māori students studying in tertiary institutions in New Zealand. Of these 12,116 (15.5%) students were enrolled in health related subjects with 2285 (18.9%) students completing their health-related qualification in that year. Durie (2003) supports increasing the indigenous workforce and discusses pertinent points when looking at workforce issues for Māori. For example, if the doctor and patient are from different cultural backgrounds there is a greater likelihood of non-compliance and misdiagnosis. Furthermore Durie (2003) recommends giving priority to developing an indigenous health workforce that has both professional and cultural competence including adopting indigenous health perspectives such as spirituality into conventional health services. Emphasis should also be given to self-determination and autonomy.
Additionally, consideration must be given to the Māori worldview, cosmology and tikanga; concepts of whānau, tapu, and noa; and holistic views of health (Mauri Ora Associates 2008). Some helpful recommendations for treating Māori with diabetes can be found in the booklet prepared for the Medical Council of New Zealand by Mauri Ora Associates Best health outcomes for Māori: Practice implications. It can be accessed at: https://www.mcnz.org.nz/assets/News-and-Publications/Statements/Best-health-outcomes-for-Maori.pdf.
An article describing Māori models of health to promote the health of Māori can be accessed here: www.hauora.co.nz/resources/Hauora%20KeepinguptoDate3-09.pdf.
Consideration must be given to the worldview of Pacific peoples, and the specific cultural preferences of the individual and family/whānau. Important aspects are relationships, family, community and environment; holistic health and spirituality; contribution and responsibility; correctness and respect; faith, integrity and dignity (Mauri Ora Associates 2010). Some helpful recommendations for working with Pacific peoples with diabetes can be found in the booklet prepared for the Medical Council of New Zealand by Mauri Ora Associates Best health outcomes for Pacific peoples: Practice implications. It can be accessed at: www.mcnz.org.nz/assets/News-and-Publications/Statements/Best-health-outcomes-for-Pacific-Peoples.pdf.
Examples of government strategies that are trying to address health inequalities are the implementation of the He Korowai Oranga: Māori Health Strategy (Ministry of Health 2014); the Māori health provider development scheme, Māori hauora/health scholarships; promotion of Māori health models; DHB Māori Health Plans; Whānau Ora programmes and funding rongoā Māori in some areas.
The report Primary Care for Pacific People: A Pacific and health systems approach (Southwick et al 2012) presents evidence to support improvements in primary care delivery to Pacific peoples. The full document is available here: www.pacificperspectives.co.nz/primary-health-research.html or here: www.health.govt.nz/publication/primary-care-pacific-people-pacific-and-health-systems-approach. Below is a summary of recommendations from pages 14–18:

1. Require public funded primary care organisations to provide appropriately anonymous data for quality improvement, accountability and achievement of Better Sooner More Convenient Care (BSMC) health services for Pacific people.

2. Improve consistency in the application of capitation funding at primary health organisation (PHO) and practice level so as to achieve a population health approach which includes targeting enrolled patients with high health needs and service delivery models based on a primary care team approach. Many practices are still operating a fee-for-service regime internally.

3. Improve the use of ethnicity data. Despite near universal collection of data, there is very little analysis or use of this information to improve quality of health services and to determine who is not accessing services. Mandatory reporting of service provision and outcomes by ethnicity would be one mechanism to address health equity.

4. In locating primary care provision, the availability of public and/or private transport is a key factor affecting Pacific peoples’ access to primary care.

5. Require improved appointment system approaches in order to deliver Better Sooner More Convenient Care to Pacific peoples. This will generally mean practices actively managing a balance between consultations with and without pre-arranged appointments, and flexible length of consultation and appointment times.

6. Implement strategies that derive advantage from the clustering of Pacific peoples by area of residence and by practices they choose to attend. This clustering can facilitate delivery of local solutions within these clusters to target high needs groups requiring chronic care management.

7. Support cultural competence across the health services workforce and training for health professionals in family/whānau based approaches to health and wellbeing.

8. Pacific health workers make a significant contribution to Pacific health improvement, in frontline roles offering language and cultural skills and at every level of the health system providing insights into the realities of the health system and of Pacific world views. Pacific Health and Disability Workforce Development Plan has been a key resource for supporting Pacific workforce participation at all levels of the health system. This support should be continued.

9. Development of policy for translation services and approaches to support effective communication between Pacific peoples and health care providers is required to address this complex topic.

10. Further investment in the development of ethnic-specific research methodologies to promote intercultural understanding and enhance the richness and knowledge of diverse populations within the New Zealand context.