Whānau Ora approach supporting diabetes self-management

A Whānau Ora approach to encourage people with diabetes to take control of their own health is having success in the King Country.

Health and social services provider Taumarunui Community Kokiri Trust (TCKT) delivers wraparound services underpinned by kaupapa Māori values.

It is committed to a Whānau Ora approach, putting whānau at the core of decision-making, supported by an integrated model of care to support whānau to become self-managing.

Storyboard summarising the project's aims, approach and outcomes

TCKT operates three GP clinics, and delivers numerous other services, including early childhood education, mental health and addiction, Whare Ora (healthy homes) and kaumātua services throughout the Taumarunui and Te Kuiti area.

Its disease state management (DSM) service supports whānau to self-manage medical conditions through health promotion, health and disability service coordination, Māori housing repairs and maintenance, and Pou Hākinakina (healthy lifestyle) programmes.

Across the three GP clinics, more than 500 clients aged 45 or over have type 2 diabetes, 50 percent of whom are Māori.

The service’s DSM nurse, Aroha Te Tai-Demspey, says because of TCKT’s extensive networks, they identified many of the community’s whānau who weren’t engaged with any health services would also have type 2 diabetes.

TCKT’s project to develop an integrated diabetes pathway through community engagement was one of nine projects from primary care provider teams from around the country selected for the Health Quality & Safety Commission’s 2019 Whakakotahi quality improvement programme.

Primary care teams were supported by the Commission to implement quality improvement projects in an area of patient care they wanted to improve that was important to their patients and community, and to them as providers.

All the projects supported the Commission’s three primary care strategic priority areas of equity, integration and consumer engagement. Equity was given greater importance in the Whakakotahi 2019 selection criteria.

A member of each project team was also offered a position on the primary care quality improvement facilitator course delivered by Ko Awatea and the Commission's primary care and leadership and capability building programmes.

The project’s main activity was a weekly education and support clinic in a community setting, open to anyone, whether they were a TCKT client or not.

‘This approach is especially important for whānau, because going to a GP clinic is a barrier for a variety of reasons,’ says Ms Te Tai-Dempsey. ‘Trying to change a mindset in a clinical environment is difficult.

‘We explain type 2 diabetes can be reversed and they don’t have to be dependent on their diagnosis. They learn they can make changes to their lifestyle to improve their diabetes and we’re there to support them. Our Whānau Ora navigators are also there to guide them to access health and other services.

‘We really listen to our whānau so they are comfortable in telling us their stories. It gives them confidence in themselves so they can take control of their own health and talk to their GPs about what they want for themselves.’

She says explaining the importance of regular blood sugar level checks to keep their diabetes under control was key at the beginning of the project.

‘Many didn’t understand the need for it and some weren’t having their levels checked at all. Once they made that connection through education, they began to take control and ask for the laboratory form to check their HbA1c levels.’

Ms Te Tai-Dempsey says undertaking the project showed the importance of nutritious food for whānau to manage their diabetes and the weekly session now has a ‘food as medicine’ focus.

‘Discussing the nutritional value of food and alternative food choices is much more meaningful to our whānau than talking about the pathophysiology of diabetes.’

Attendees are a wide variety of ages from 30s to 80s and have either type 1 or type 2 diabetes. Some bring their partners along too.

‘One woman became so enthusiastic she became a diabetes advocate.’

Word has spread and clinicians from TCTK’s three medical centres are beginning to refer patients to the education sessions.

Ms Te Tai-Dempsey is grateful for the opportunity to do the quality improvement course and the advice and leadership from the Commission’s quality improvement team. TCTK is now looking at how the tools gained can be applied in other projects to improve the health of whānau.

‘Some of our whānau are used to being told what to do and take their medication because their doctor said so. Many don’t feel they have the right to even have a discussion about the decisions made by GPs because “they’re the doctor and I’m just the patient”. I teach those who come to see me to believe in themselves, and change is happening. Standing in your own mana is powerful.’