Co-designing a community-based intervention for prediabetes among Tongan youths in New Zealand : a thesis presented in partial fulfilment of the requirements of Doctor of Philosophy in Public Health at Massey University, Wellington Campus, New Zealand

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Massey University
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The Tongan population is the second largest Pacific ethnic group in New Zealand, and they have a high rate of prediabetes, characterised by high obesity, hypertension, sedentary behaviours, and unhealthy diets. Addressing this condition through a Tongan community centred based programme, the progression of type 2 diabetes and future health complications can be prevented. Aim: The overall objective of this study was to investigate the Tongan youths and adults’ understanding of prediabetes by mobilising them into collective actions to lead healthier lives. Methods: There were three phases of this study. Phase one explored the perception and understanding of prediabetes and its impact on health and well-being among 8 youth and 11 adults. Phase two applied the Bratteteig co-design methodology to co-develop and implement a community-based intervention called Polokalama mo’ui lelei to address the main characteristics of prediabetes (diet, physical activity, weight management and enhanced knowledge about prediabetes). Phase three involved two online focus groups (youth group=4, adult group = 3) to evaluate the effectiveness of the Polokalama mo’ui lelei. Findings: Phase one findings highlighted that the Tongan youth and adults have limited knowledge of prediabetes which was attributed to the lack of understanding and access to health promotion services. This was compounded by generational health information that had been conceptualized within families, further enhancing their limited understanding. Phase two of the co-designed program showed improvements in weight management measurements; however, the number of participants was too small (n=10) to infer meaningful findings. Phase three findings highlighted key barriers for accessing the program, such as household income, education and motivation factors, and socio-cultural and economic factors. Conclusion: Education and knowledge about prediabetes was viewed as a major issue for the Tongan community members when they had learnt about it. The co-design approach in phase two was demonstrably a socially relevant approach to undertake with the Tongan community, but the method used was not a culturally relevant approach. As a result, a major development from this study was the establishment of the Fengaueaki Fakataha model, a new Tongan model of health. This model provides Tongan cultural insights and protocols which help explain the findings, and it could be used as a guide for conducting future research when working with Tongan communities.

Prediabetic state, New Zealand, Tongans, Health and hygiene, Services for, Social life and customs