AbstractsMedical & Health Science

Te Rongoā Kākāriki: Kanohi-ki-te-kanohi, e pai ana?

by Margaret H. Williams

Institution: AUT University
Year: 0
Keywords: Lifestyle intervention, the Green Prescripton; Type 2 diabetes mellitus; Kaupapa Maori research; Mixed methods randomised trial
Record ID: 1304157
Full text PDF: http://hdl.handle.net/10292/8648


In Aotearoa New Zealand the prevalence of Type 2 diabetes mellitus (T2DM) is three times higher for Māori than New Zealand European and is increasing. Participation of Māori newly diagnosed with T2DM with the Te Rongoā Kākāriki (Green Prescription, GRx) health service is lower than for New Zealand European. This thesis has four linked aims: i) to examine differences in the engagement and active participation (adherence) (Chapter 4), ii) to compare changes in physical and metabolic measures (Chapter 5) using a kanohi-ki-te-kanohi (face-to-face) mode of delivery or waea (telephone) for Māori and New Zealand European, iii) to better understand the perceptions, knowledge and activities of the participants that enabled them to participate (Chapter 6) and iv) to understand better how participants make and maintain lifestyle changes through the GRx health service. This GRx research study was a randomised trial (ACTRN012605000622606) using a kaupapa Māori framework and research principles, with a mixed methods approach, in which Māori and New Zealand European women and men newly diagnosed with T2DM were randomised to either kanohi-ki-te-kanohi (face-to-face) mode of delivery or waea (telephone) for six months. Physical and metabolic measurements were made, questionnaires completed and interviews undertaken at baseline, six and 12 months. After 12 months medical records were accessed for glycated haemoglobin (HbA1c) and lipid measures associated with metabolic risk. Analysis of variance (ANOVA) was used to examine for differences among the categorical variables of ethnicity, mode of delivery and gender. A total of 152 (96 women, 56 men) participants aged 30-86 years consented to participate and completed baseline measurements. Recruitment was less than the target (240), but equal numbers of Māori and New Zealand European were recruited, from GRx referrals that were predominantly non-Māori. The participants included 68 Māori, 70 New Zealand European and 14 ‘Other’ (neither Māori nor New Zealand European). The main findings excluded the ‘Other’ group. More New Zealand European than Māori remained in the randomised trial at six (74% vs. 51%) and 12-months (56% vs. 30%), respectively. There was a trend for more participants to remain in the kanohi-ki-te-kanohi (face-to-face) (68%) compared with the waea (telephone) (58%) mode of delivery at six months. The physical and metabolic data revealed that at the end of the 6-month GRx intervention, for 88 participants, body weight was reduced by 1.6 kg (95% CI, 0.3 to 2.8) and waist circumference by 3.6 cm (95% CI, 2.4 to 4.9). At six months, of the 63 who had HbA1c measured there was a reduction of 1.3% (95% CI, 0.3 to 2.4). No differences by GRx mode of delivery, ethnicity or gender were observed in these analyses. At the 12-month follow-up, for the 59 participants measured (20 Māori and 39 New Zealand European), the body weight and waist circumference measures were reduced from baseline by 2.3 kg (95% CI, 0.5 to 4.0) and 5.5 cm (95% CI, 3.4 to 7.6), respectively. In 36…