Understandings of disease among Pacific peoples with diabetes and end‐stage renal disease in New Zealand

Abstract

BackgroundCompared with New Zealand Europeans, Pacific peoples in New Zealand develop type 2 diabetes at a higher rate and a younger age, and have 3.8 times higher incidence of end‐stage renal disease (ESRD).ObjectiveTo investigate contextual factors that shape understandings of disease for Pacific peoples with diabetes and ESRD.MethodsFocussed ethnography. In‐depth interviews were conducted with 16 Pacific people on haemodialysis for diabetic ESRD, in Auckland, New Zealand. Study participants aged between 30 and 69 years old were of Samoan, Cook Islander, Tongan, Niuean or Tokelauan ethnicity. Thematic analysis was used to code and identify themes.ResultsParticipants were embedded in a multigenerational legacy of diabetes. The limited diabetes‐related education of earlier generations influenced how future generations behaved and understood diabetes. Perceptions were compounded by additional factors including the invisibility of early‐stage diabetes; misunderstandings of health risks during communication with health providers; and misunderstandings of multiple conditions’ symptoms and management. Participants had limited engagement with health services until their diagnosis of ESRD acted as a trigger to change this behaviour. However, this trigger was not effective in itself—rather, it was in combination with relevant education delivered in a way that made sense to participants, given their current understandings.ConclusionsIllness representations drive choices and behaviours with respect to self‐management of diabetes and engagement with health services. Diabetes is often present in multiple generations of Pacific people; therefore, illness representations are developed and shared within a family. Changing illness representations requires engagement with the individual within a family context.

Socio-Economic Inequity: Diabetes in New Zealand

“…As primary healthcare is expected to see the largest rises in out-of-pocket health expenditure in GP appointments and prescription co-payments ( 1 ), access to preventative healthcare becomes less equitable, impeding early intervention and compounding inequity of outcomes for healthcare. This inequity is compounded by the positive feedback loop of poor health literacy ( 22 , 23 ), which furthers distrust in the profession as a whole.…”

Self-management action and motivation of Pacific adults in New Zealand with end-stage renal disease

“…[14, 15] In a recent study, we found (mis)understandings of disease risk and consequences reinforced the low engagement in diabetes self-management, including attending DSME programmes. [16] We also concluded that health messages delivered by health providers required relevancy to the patients context within which the information is obtained, understood and acted upon. In New Zealand, drug treatments to prevent developing ESRD follows international guidelines[17] to address blood pressure, proteinuria, smoking, and glomulated lipids except that glucose lowering medications for New Zealand patients are limited to metformin, acarbose, sulphonylurea, and insulin.…”

The Significance of Exposure to Pregestational Type 2 Diabetes in Utero on Fetal Renal Size and Subcutaneous Fat Thickness

“…e time between diagnosis of T2D and renal failure is tightly correlated. However, with an earlier age of diagnosis, the age of those requiring dialysis is also decreasing [15][16][17].…”