Barriers to Type 2 Diabetes Management for Indigenous Peoples in New Zealand: A Synthesis of Clinician Perspectives

Context: Type 2 diabetes (T2D) affects more than 270,000 New Zealander’s including a disproportionate number of Indigenous Maori. T2D is predominantly treated in primary care, however, T2D care for Maori is often sub-optimal because of reduced access to care, decreased prescribing, a Westernised model of care and clinical inertia / workload issues.

Objective: To explore clinician perspectives of barriers to effective management of Māori with T2D in their practice.

Study Design and Analysis: Qualitative research design using semi-structured interviews with participants. Analysis was guided by Braun and Clarke (2006) thematic analysis by four researchers and finalised among a wider multi-disciplinary team.

Setting or Dataset: Primary care settings in Auckland/ Waikato region of New Zealand

Population Studied: 27 general practice healthcare professionals, including ten general practitioners, eleven general practice nurses and six prescribing pharmacists.

Intervention/Instrument: Qualitative research

Outcome Measures: Thematic analysis

Results: Three over-arching themes were identified and were similar for all practitioners: health system limitations, complexities of diabetes management, and the need for a multi-disciplinary approach. Clinicians expressed many difficulties, including restricted consultation times, cost of services, inaccessible opening hours, healthcare not operating from an Indigenous worldview, patient psychosocial distress, a lack of cultural education alongside a historical dis-trust of Western medicine by many Māori clients. A need for strong therapeutic relationships was noted, as well as a primary care workforce that could need patient needs.

Conclusions: Clinicians stressed the need for more a collaborative and culturally-relevant team approach for T2D management in primary care, with clinical and non-clinical roles highlighted as beneficial to improving healthcare delivery and patient health outcomes. Given the current strained healthcare climate in NZ, further investigation into the feasibility of redistributing some clinician responsibilities to appropriate administrative or specialist experts is warranted. Future policy and healthcare initiatives could look to develop best practice with the input of wider multi-disciplinary teams as well as patient voices to ensure empowerment and agency of patient health management.