Cervantée Ek Wild1,2,3, Ngauru T Rawiri1, Esther J Willing4, Paul L Hofman1,5, Yvonne C Anderson1,2,5,6. 1. Liggins Institute, University of Auckland, Auckland, New Zealand. 2. Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. 3. Kōhatu - Centre for Hauora Māori, University of Otago, Dunedin, New Zealand. 4. Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand. 5. Tamariki Pakari Child Health and Wellbeing Trust, New Plymouth, New Zealand. 6. Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand.
Abstract
AIM: It is important that intervention programmes are accessible and acceptable for groups most affected by excess weight. This study aimed to understand the barriers to and facilitators of engagement for Māori in a community-based, assessment-and-intervention healthy lifestyle programme (Whānau Pakari). METHODS: Sixty-four in-depth, home-based interviews were conducted with past service users. Half of these were with families with Māori children and half with non-Māori families. The interviews were thematically analysed with peer debriefing for validity. RESULTS: Māori families experienced barriers due to racism throughout the health system and society, which then affected their ability to engage with the programme. Key barriers included the institutionalised racism evident through substantial structural barriers and socio-economic challenges, the experience of interpersonal racism and its cumulative impact with weight stigma, and internalised racism and beliefs of biological determinism. Responses to these barriers were distrust of health services, followed by renewed engagement or complete disengagement. Participants identified culturally appropriate care as that which was compassionate, respectful, and focused on relationship building. CONCLUSIONS: While Whānau Pakari is considered appropriate due to the approach of the delivery team, this is insufficient to retain some Māori families who face increased socio-economic and structural barriers. Past instances of weight stigma and racism have enduring effects when re-engaging with future health services, and inequities are likely to persist until these issues are addressed within the health system and wider society.
AIM: It is important that intervention programmes are accessible and acceptable for groups most affected by excess weight. This study aimed to understand the barriers to and facilitators of engagement for Māori in a community-based, assessment-and-intervention healthy lifestyle programme (Whānau Pakari). METHODS: Sixty-four in-depth, home-based interviews were conducted with past service users. Half of these were with families with Māori children and half with non-Māori families. The interviews were thematically analysed with peer debriefing for validity. RESULTS: Māori families experienced barriers due to racism throughout the health system and society, which then affected their ability to engage with the programme. Key barriers included the institutionalised racism evident through substantial structural barriers and socio-economic challenges, the experience of interpersonal racism and its cumulative impact with weight stigma, and internalised racism and beliefs of biological determinism. Responses to these barriers were distrust of health services, followed by renewed engagement or complete disengagement. Participants identified culturally appropriate care as that which was compassionate, respectful, and focused on relationship building. CONCLUSIONS: While Whānau Pakari is considered appropriate due to the approach of the delivery team, this is insufficient to retain some Māori families who face increased socio-economic and structural barriers. Past instances of weight stigma and racism have enduring effects when re-engaging with future health services, and inequities are likely to persist until these issues are addressed within the health system and wider society.
Authors: Cervantée E K Wild; Ngauru T Rawiri; Donna M Cormack; Esther J Willing; Paul L Hofman; Yvonne C Anderson Journal: Qual Health Res Date: 2021-03-11
Authors: Cervantée E K Wild; Tami L Cave; Esther J Willing; José G B Derraik; Cameron C Grant; Paul L Hofman; Yvonne C Anderson Journal: BMC Public Health Date: 2021-03-15 Impact factor: 3.295
Authors: Thomas S Hadley; Tami L Cave; José G B Derraik; Paul L Hofman; Yvonne C Anderson Journal: Int J Obes (Lond) Date: 2022-04-29 Impact factor: 5.551