Illness Perceptions and Diabetes Self-Care in Māori and New Zealand Europeans

Abstract

Type-2 diabetes (T2D) is a highly prevalent chronic disease which requires patients to manage their condition by engaging in a range of self-care behaviours. In New Zealand (NZ), Māori are disproportionally affected by T2D, with inequities prevalent in the risk factors for the development of T2D, as well as diabetes-related complications and mortality. Research has shown that illness perceptions, health literacy and patient-practitioner communication relate to glycaemic control (HbA1c) and medication adherence in T2D. Several studies have shown differences in illness perceptions between ethnic groups in NZ, however the perceptions of Māori with T2D had not yet been investigated. This study aimed to investigate differences in illness perceptions, health literacy, patientpractitioner communication and self-care behaviours between Māori and NZ European adults with T2D. A secondary aim was to explore the contribution of illness perceptions to self-care behaviours. A cross-sectional study that was guided by Kaupapa Māori methodology was conducted. 170 participants (85 Māori and 85 NZ European) were recruited from the Auckland Diabetes Centre and completed questionnaires on illness perceptions, health literacy, patientpractitioner communication and self-care behaviours. Participants also completed open-ended questions on self-identity and drawings of their treatment perceptions. Clinical data were collected from participant's medical records. The results indicated that illness perceptions significantly differed between Māori and NZ Europeans with Māori demonstrating higher consequence, concern and illness identity perceptions than NZ Europeans. Māori demonstrated better illness coherence perceptions than NZ Europeans. Causal perceptions also differed; Māori were more likely to attribute T2D to food and drink, whereas NZ Europeans were more likely to attribute T2D to weight. Illness perceptions, particularly in personal and treatment control, predicted glycaemic control and medication adherence in both Māori and NZ Europeans independently. The open-ended questions revealed that Māori saw their identity affected more by diabetes due to stigma than NZ Europeans. The open-ended questions also revealed that whānau/family may play a role in T2D self-management for both Māori and NZ Europeans. Patients' drawings of diabetes treatments provided support to assess illness perceptions in this manner. This was the first study to examine differences in illness perceptions between Māori and NZ European patients with T2D. The results highlight the importance of patients' perceptions, and how they can influence treatment outcomes such as glycaemic control and medication adherence. This research adds to existing literature by demonstrating that Māori see their diabetes as having more symptoms, consequences and higher concern; and have better perceived coherence than NZ Europeans with T2D. These findings highlight the need for NZ health care providers to include culturally relevant and appropriate information in T2D management plans. Future research is needed to investigate interventions that aim to improve T2D self-management by targeting illness perceptions for both Māori and NZ European patients.