I Want to Walk with my Moko: Preventing Type 2 Diabetes

I Want to Walk With my Mokois 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.

Step 8: Process evaluation. Ongoing.