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

Bibliographic Data

ID19506441
AuthorsJacqueline Schmidt‐Busby (0000-0002-8090-6050, Counties Manukau Health Middlemore Hospital Auckland New Zealand, corresponding author), Janine Wiles (0000-0001-9538-4630, Faculty of Medical and Health Sciences, School of Population Health University of Auckland Auckland New Zealand), D Exeter (0000-0003-1061-5925, University of Auckland), Timothy Kenealy (0000-0001-6002-4766, Faculty of Medical and Health Sciences, School of Medicine University of Auckland Auckland New Zealand)
Year2019
Volume22
Issue5
Pages1122-1131
Publication date2019-10-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueHealth Expectations (JOURNAL)
Journal identifiersISSN: 1369-6513 • E-ISSN: 1369-7625
PublisherWiley (PUBLISHER • GB)
DOI10.1111/hex.12946
PMID31368649
OpenAlexW2965325047
LanguageEN
Citations received2
References cited27

BACKGROUND: Compared 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). OBJECTIVE: To investigate contextual factors that shape understandings of disease for Pacific peoples with diabetes and ESRD. METHODS: Focussed 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. RESULTS: Participants 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. CONCLUSIONS: Illness 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

Diabetes mellitus · Disease · End stage renal disease · Environmental health · Ethnic group · Pacific islanders · Population · Qualitative research · Samoan · Sociology · Thematic analysis · Diabetes Management and Education · Dialysis and Renal Disease Management · Medicine · Mental Health and Patient Involvement · Psychology · Gerontology

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