Access to medicines and use of medicines by Māori with type 2 diabetes in Tairāwhiti

Type 2 diabetes and its associated co-morbidities have a significant impact on Māori and other indigenous populations. The prevalence of type 2 diabetes in Tairāwhiti was far greater for Māori than non-Māori (11% vs 4%). Māori experience poor diabetes related outcomes: premature mortality, co-morbidities, greater severity of disease and complications, poorer access to health services and diabetes related care and poorer management and treatment of diabetes. This thesis reviews the literature on diabetes amongst Māori and other indigenous peoples; medicines use and access for Māori, other indigenous people and those living in rural areas. The literature review found that, in common with other indigenous peoples, Māori shared a greater prevalence of diabetes, modifiable and non-modifiable risk factors for diabetes, and diabetes-related complications, particularly in the younger population. This thesis includes three inter-related studies to investigate access to medicines and use of medicines by Māori with type 2 diabetes in Tairāwhiti, within a Te ao Māori world view. The first, quantitative, study uses data from pharmacy dispensing computers to explore whether patterns of medicines use match the pattern of need for medicines. This study found that there was inequity and disparity in medicines used in the treatment and management of type 2 diabetes between Māori and non-Māori in Tairāwhiti. The rest of the thesis explores potential reasons for these inequities. The second, qualitative, study explored the lived experience of Māori people with diabetes in Tairāwhiti. People have different health beliefs and attitudes, but this should not be a barrier for them to receive the best care. Communication is a key element at all levels of care. Whānau and health professionals are encouraged to engage in healthy conversations to improve whānau outcomes. The traditional biomedical model of disease and recommended best practice for management of diabetes focuses on self- management, which is not consistent with a te ao Māori view, which is a collective whānau approach. The relationship between whānau and health professionals determines and shapes whānau attitudes and behaviours, and when health professionals connect with whānau in a meaningful way, they enable whānau to make and work towards positive change. The Tairāwhiti context shapes people’s access to medicines in many ways. These are outlined and explored in the third study which looks at how medicines are distributed in the Tairāwhiti region and reports on interviews with people who picked up their medicines from pharmacy depots in the region. This highlights the challenges for those living in remote rural areas of Tairāwhiti to accessing quality medicines and health services. The thesis ends with recommendations, including the need to improve communication and relationships between whānau and health professionals. These are key to improving knowledge and achieving positive outcomes. Health professionals must have an awareness and understanding of different health beliefs and attitudes and the value this brings to their practice. Additional research and action are needed regarding the cost of medicines, accessibility and the quality of medicines in rural areas. Key stakeholders need to work together to improve the management and treatment of diabetes in Tairāwhiti, and focus on whānau outcomes not disease