Title: Application of Community Based Participatory Research to the Creation of a Diabetes Prevention Documentary
with New Zealand Māori
Authors: Farmer, A; Gage, J; Kirk, R. and Edgar, T.
Abstract for APHA Conference: 328687
Abstract Text:
I Want to walk With my Moko is the result of a collaboration between an EMMY award winning
documentary filmmaker and a team of Māori health communication professionals and community
members based in Christchurch, New Zealand. The objective was to utilise a Community Based
Participatory Research (CBPR) approach to create a culturally relevant documentary resource for
Māori at risk for Type 2 diabetes.
Type 2 diabetes is almost three times more common in the indigenous people of New Zealand
(Māori) than non-Māori. Māori are diagnosed younger and are two to three times more likely to
develop complications such as eye disease, kidney failure, strokes and heart disease. Mortality rates
for Māori with type 2 diabetes are seven times higher than for non-Māori. Prevention, detection and
management of diabetes have become a health priority. This is a significant challenge given the low
level of diabetes knowledge and awareness in the Māori community. Further, despite the high rate
of Type 2 diabetes, little is known about their personal understanding or experience of the disease.
Several studies of Māori health identify a need for new health communication approaches to
diabetes prevention in order to reduce the wide gap between Māori and non-Māori disease rates.
There is both an absence of theoretically grounded audio visual materials focusing on Māori health
and a lack of academic studies on diabetes prevention and mediated health communication. This is
particularly true of studies utilising and evaluating documentary narratives.
A CBPR approach to the documentary was appropriate because intervention strategies designed
following its principles will reflect the cultural values and behavioural preferences of the
participating community. A CBPR approach provides a strong model for enacting local action
oriented approaches in the creation of a diabetes documentary that reflects Māori cultural beliefs,
practices, and a narrative tradition.
Documentary video can be an effective health communication tool because it allows for innovative
ways to document and represent people and issues while accommodating power differences
between researchers and the community. It can give voice to participants who are not typically
engaged in research. Utilizing documentary is a way for communities to prioritize their own health
issues and for participants to share their own health narratives.
Working directly with the affected communities can help privilege traditional knowledge. Narrative
is particularly important in indigenous populations where it is customary to receive information by
listening and watching rather than reading. And documentary is well suited for encouraging
behaviour change because it can be employed to demonstrate social modelling or observational
learning as outlined in Social Cognitive Theory.
Target Audience
Māori whānau (families). Key influencers: Mothers. Māori are a collectivist culture as opposed to
individually focused. Whanau (family) is central to Māori culture as well as the Māori understanding
of health.
Supporting Evidence or Research for the Film’s Message
A qualitative research design employing key informant interviews and focus group (Hui) was used to
inform the content of the documentary
Step 1, Partnership building & creation of Community Advisory Board (CAB)
Step 2, Key Informant Interviews with Māori diabetes workers. Local input assured greater social &
cultural relevance for the Hui (focus group) design.
Step 3, CAB members recruited and led Hui and participated in analysis & community feedback. This
enhanced recruitment, ensured research relevance and shaped the creative approach to
documentary.
Step 4, Behavioural theory selected & documentary treatment developed. Community feedback
solicited. Collective efficacy approach assured greater social & cultural relevance of documentary.
Step 5, Film participants’ recruited from the community and filming completed. This engaged
community members in action.
Step 6, Filmmaker presented rough edit for community feedback and made relevant changes. This
ensured relevance and acceptance of documentary.
Step 7, Distribution. Māori health providers and community groups distribute among networks.
Extended Abstract:
The documentary research design was a multi method qualitative approach. Consistent with CBPR
principles it began with partnership development. We identified individuals and Māori health
organizations and providers that were willing to partner in a CBPR approach to developing the digital
media resource. The CAB role was to offer guidance and interpretation at all stages of the research
to ensure cultural relevance was maintained, cultural protocols were observed and analysis of the
research was appropriate. Two information gathering methods were employed.
Key Informant Interviews: We interviewed health workers with direct experience working with
Māori clients at risk for type 2 diabetes. They were asked to share their perspectives about the
Māori cultural understanding of type 2 diabetes including beliefs, risk factors, barriers and
facilitators to physical activity and healthy eating. They were invited to offer their advice and
guidance on how to structure the interview guide for the next stage of research. Advice solicited
from the key informants about what to ask and how to ask it in the focus group was central to
shaping and refining the questions for the next stage of the research
Focus Groups: The goal at this stage of the research was to generate an action-oriented analysis of
the community perspective on type 2 diabetes and engage participants in generating ideas for the
future direction of the documentary resource. Hui explored and extended the themes identified in
the key informant interviews. Beliefs about the causes of type 2 Diabetes, personal susceptibility,
barriers and facilitators to physical activity and healthy eating and recommendations for creating a
culturally appropriate resource were solicited.
Documentary: The first author who is also an experienced documentary maker created a story
treatment that outlined what the resource might look like and what messages the story might
contain. Consistent with the theme that the documentary be whanau (family) focused, the storyline
called for a ‘real’ whanau attempting to make some lifestyle changes to prevent type 2 diabetes. This
treatment was approved by members of the CAB and then presented to a smaller Hui of eight Māori
women for feedback. Māori mothers were consulted as they were identified as the key influencers
regarding family nutrition and exercise. Through word of mouth the CAB and local Māori health
providers identified participants for the documentary. The first author then directed and scripted
the documentary in collaboration with the CAB. After filming and editing was completed Hui were
again held to screen the first edit and further community feedback and input. The completed
documentary, I Want to Walk with My Moko was then promoted and distributed by Māori health
and social service providers.