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ABSTRACT
AIM: To co-design and implement a whānau-centred, community-based lifestyle programme (Kimi Ora) intended to ensure no worsening of HbA1c and to improve wellbeing for Māori whānau and communities with diabetes or pre-diabetes.
METHODS: Māori healthcare providers, community members, research advisors and wider stakeholders used a co-design process underpinned by He Pikinga Waiora to collaboratively develop and implement Kimi Ora Control group comparisons and participants were recruited from Te Kohao Health. Multi-method monitoring and collection captured individual, whānau and community data.
RESULTS: Kimi Ora was run in two communities in Aotearoa New Zealand. In total, there were 35 participants who took part in an eight-week programme offered five times alongside a comparison group comprising 21 participants. Kimi Ora resulted in significant improvements on all biomedical measures compared to baseline, and participants had gains relative to the comparison group for variables including weight, BMI, blood pressure and waist measurement. Of particular note was the 100% retention rate and sustained community support for Kimi Ora.
CONCLUSIONS: Outcomes from Kimi Ora demonstrate this programme, which was actively tailored for and worked with Māori communities in a responsive and flexible manner, resulted in successful biomedical outcomes, high engagement and high retention.
Diabetes is being experienced at epidemic rates and is disproportionately affecting Indigenous peoples.1 In Aotearoa New Zealand, diabetes age-standardised prevalence is 1.6-2.4-times higher for Maori compared to those of European ethnicity.2'3 This is associated with significant complications from the burden of diabetes, with increased rates of cardiac complications, renal failure and amputation3 and, most importantly, avoidable mortality for Māori.4 Overall, Māori have a 1.8-times greater health burden than non-Māori and a nine-year lower average life expectancy.3 Research into the different rates point towards obligations under Te Tiriti o Waitangi as a fundamental driver of the unequal distribution of the determinants of health and inaction in the face of need.5'6
Treatment of type 2 diabetes mellitus (T2D) seeks to reduce blood glucose levels through diet, exercise, lifestyle changes and, where necessary, the use of medication. In New Zealand's current primary care environment, treatment is heavily focused on medicine. Diet, exercise and lifestyle prescriptions in primary care achieve mixed results, suggesting there may be an "unknown" factor. Although it is well established that glycaemic control is closely linked to...