‘Not very responsive for Kaumātua’: A Wānanga-based qualitative study (single-group design) of Māori Kaumātua and Māori health provider experiences of type 2 diabetes care

Abstract

Background Māori experience a disproportionate burden of Type 2 diabetes mellitus (T2DM), with ongoing inequities in access, continuity, and outcomes of care. While culturally responsive approaches are recognised as important, limited qualitative research centers kaumātua (Māori elders aged 50 years and over) voices in evaluating current diabetes care and informing service redesign.

Aim To explore kaumātua and Māori health providers’ perspectives on the cultural responsiveness, strengths, and limitations of current T2DM management in New Zealand, and to examine perceived opportunities for community-embedded and mobile models of care.

Methods A qualitative study informed by Kaupapa Māori principles was conducted using a wānanga-based (collective forum for discussion and knowledge-sharing) approach. Kaumātua living with T2DM were purposively recruited through a Māori community organisation. Collective kōrero (conversation/discussion) were audio-recorded and analysed using reflexive thematic analysis, interpreted through a Kaupapa Māori analytic lens. Reporting followed the Consolidated Criteria for Strengthening Reporting of Health Research Involving Indigenous Peoples (CONSIDER).

Results Seven kaumātua and Māori health providers participated. Current diabetes care was described as fragmented and insufficiently responsive to cultural and contextual needs. Effective care was grounded in whanaungatanga (relationships and connectedness), manaakitanga (care, respect, and dignity), whānau engagement, culturally safe spaces, and accessibility. Structural barriers, including transport challenges, financial pressures, and fragmented information systems, constrained continuity of care. Participants strongly endorsed a mobile, community-embedded diabetes service as a culturally appropriate approach to improving access, continuity, and equity.

Conclusion Kaumātua perspectives highlight the need for relational, culturally grounded, and accessible diabetes care. Mobile, community-embedded models offer a promising pathway to address structural barriers while upholding mana, dignity, and whānau-centred care.