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Seeking solutions to health outcome disparities for Māori through educational resources

27 July 2023

Woman stands by etched glass wall
Ms Rebekah Crosswell

Māori are disproportionately affected by type 2 diabetes with significantly poorer outcomes and higher mortality rates. But emerging health academic Rebekah Crosswell (Whakatōhea) is determined to help even the odds for Māori patients with the aid of more culturally relevant educational resources.

The research officer and kaiāwhina with the University of Waikato Medical Research Centre has been awarded a Health Research Council of New Zealand Career Development Grant. The $107,120  grant will fund the research project Matauranga o Mate Huka - Creation of Type 2 Diabetes Resources, with Ms Crosswell as lead investigator.

Type 2 diabetes is described as an ‘emerging pandemic’ with rates on the increase across Aotearoa New Zealand. Māori are disproportionately affected with significantly poorer outcomes and mortality rates that are two to three times higher than that of non-Māori.

Ms Crosswell says that self-management is critical for patients with type 2 diabetes but its effectiveness relies on patients understanding the disease and how to manage it with things like glucose monitoring, medication and lifestyle.

“Educational materials are an incredibly important way of helping patients understand a disease and how to manage it but in Aotearoa, type 2 diabetes resources are often lacking, outdated and/or culturally inappropriate for those who need them most.”

“This grant will fund research into what more effective healthcare education and resources would look like,” said Ms Crosswell.

She adds that at the heart of this project is the need to address long standing inequities around health care and health outcomes for Māori.

Healthcare education incorporates multiple factors including culture, diet, lived experience, mobility, emotional concerns, whānau engagement, finances, medical history and experiences within the healthcare system, as well as health literacy. Ms Crosswell explains:

“Health literacy is one of the biggest barriers in developing effective education tools. It has been identified that many Māori have reduced health literacy. This shows there is greater need for health education that is focused on working with Māori populations.”

“And few local studies have specifically examined type 2 diabetes resources with a Māori focus. I want to use te ao Māori principles and tikanga, including whakawhanaungatanga, tino rangatiratanga, and Te Whare Tapa Wha, to analyse the existing materials and to understand what opportunities exist for improvement.”

Ms Crosswell is planning a multi-phased approach with patient interviews and a collaborative survey with Hauraki Primary Health Organisation with whom the University already has an established research relationship. The research will include Kaumātua, community and cultural leaders during the co-design phase to assure the study is designed by Māori for Māori.

“I want to ensure whānau gain real benefit from this study, that it is conducted in a culturally safe and sensitive way, and that whānau have an active role to play in their ongoing hauora journey.”

The project will commence with an analysis of existing type 2 diabetes resources. With data from the survey and interviews Ms Crosswell will determine new directions for tailoring culturally relevant resources for Māori.

“We know that internationally Indigenous populations have shown success with health education when using visual approaches like pictures and video – and particularly those that reference foods and locations that are familiar to them.”

“This aligns with NZ’s cultural landscape, where Māori populations for generations have been great orators, and pictorial, creative peoples, therefore Māori may benefit from this educational approach.”

Ms Crosswell is being mentored by several University of Waikato researchers across Health and education, and medical specialists affiliated with diabetes research programmes at the University.

She said of Associate Professor of Health Dr Lynne Chepulis and Professor of Population Health, Dr Ross Lawrenson, “I am incredibly grateful for their support and genuine encouragement. It has been pivotal in achieving the grant for this important mahi.”

Ms Crosswell also credits the support of her whānau for her drive to address health disparities, “I was raised in a family where we were taught that it is a privilege to care for others.”

Three other University of Waikato projects have also been awarded HRC funding in this round, each receiving 2023 Health Delivery Research Activation Grants. These grants provide support to establish research evidence needs and opportunities for future health delivery funding.

The impact of health system factors on diabetes management in ethnic minorities (Dr Lynne Chepulis and Dr Mark Rodrigues) and Impacts of losing child disability allowance funding in type one diabetes (Dr Hamish Crocket and Dr Lynne Chepulis) build on the substantial diabetes research happening at the University.

Professor Matthew Parsons will lead Creating and coordinating local informal support, a project looking to mitigate loneliness and build resilience amongst older people/kaumātua.


This research aligns with the following United Nations Sustainable Development Goals:

Good Health and Well-being Reduced Inequalities

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