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Enhancing Food Security and Physical Activity for Māori, Pacific and Low-income PeoplesKey components for effectivenessThe following processes have been highlighted as contributing to the success ofinterventions. Involvement of communities and building coalitions from inception;targeting audiences that are already assembled; engaging ‘cultural insider’ investigatorsin leadership roles; mobilising social networks; cultural tailoring of messages andmessengers; and family-based involvement.Potential side-effectsThere are no anticipated side effects of developing culturally-specific interventions.Cost benefit analysisThere are no cost benefit data.Literature scan: National contextA variety of culturally-specific sports and physical activities (eg, kapa haka (Māoriperforming arts, waka ama (outrigger canoes)), kilikiti (Pacific cricket), taiaha (Māoriweaponry) exist. Participation numbers during the previous 12 months for Māori andPacific activities were low. Of the participants who responded the following participationpercentages were found. Kapa haka were 1.1 percent; kilikiti 0.3 percent, and wakaama 0.3 percent compared with activities such as rugby league with 2.1 percent, netball3.7 percent and walking 64 percent. 7A wide variety of interventions have been implemented in New Zealand, which havefocused on improving physical activity and nutrition and/or decreasing obesity. Many ofthese initiatives have been developed in response to the Healthy Eating Healthy Action(HEHA) strategy. In terms of interventions to increase physical activity, a total of14 initiatives were identified in this environmental scan. This list is not exhaustive butrather provides examples of the types of interventions that have been implemented todate. These interventions will be briefly described and where possible, a summary of theevaluation will be provided.Korikori a IwiKorikori a Iwi was a community development action project that used Māori culture as abasis for encouraging good nutrition and regular physical exercise in five Māoricommunities in the Te Taitokerau region (Northland). The broad aim of the project wasto improve health and well-being through health promotion programmes that promotehealthy lifestyles. At a local level the objective was to develop community physicalexercise and nutrition initiatives based on an integrated and holistic kaupapa Māoriframework with Māori in the participating communities. The Whāriki Research Group 19was contracted by the Ministry of Health to undertake formative evaluation during thefirst year (May 2003 to 2004) of the five-site Te Taitokerau Korikori a Iwi projects. Theevaluation highlighted a number of important areas for the development of this project,including: the local and Māori cultural basis of the programme; combining exercise withnutrition validated the Māori holistic perspective; rekindling Māori knowledge andpractices; repackaging of Māori traditional games, activities and weaponry as forms ofexercise, entertainment, learning and coordination skills development; and localknowledge of the community and high levels of innovation in applying Māori frameworksand coordinators. Extending the understanding of healthy lifestyles also had additional173
Enhancing Food Security and Physical Activity for Māori, Pacific and Low-income Peoplesspin-offs to the community in terms of education, whānau/hapū well-being anddevelopment, and longer-term economic development and tourism opportunities. Issuesof sustainability were highlighted, given the short-term funding and time frames, whilsttrying to address long-term issues. It was concluded that building community capacity forthese types of interventions was crucial, and required a mix of effective leadership,advocacy, skills development, and the sharing of knowledge.Ngati Whatua Nga Rima o Kaipara Marae Arataki ProjectThe main aim of the programme was to use a community development approach withina Māori conceptual framework to improve the well-being of Māori in the South Kaipararegion, as outlined in a formative evaluation. 20 The programme staff consisted of aprogramme coordinator and five marae arataki (leaders), who were specially selected bythe marae communities they represent. This was a critical aspect providing credibilityand integrity to the programme and ensuring maximum programme uptake. Participatingmarae were Puatahi, Kakanui, Araparera, Reweti and Haranui, all in South Kaipara.Each of the marae arataki was responsible for developing and implementing aprogramme for their respective marae and whānau communities. The programmes wereintended to support marae and whānau to develop improved and increased awarenessand behaviours around healthy eating and physical activity, to address health and wellbeingissues. Programme activities, events and services were designed in response toinformation gathered from whānau through a needs assessment process. These werepromoted, supported and facilitated by the marae arataki and included modified GreenPrescription, mau rakau (traditional Māori weaponry, te reo, Māori games, walkinggroups, national Push Play events and other traditional activities. A programme logicwas developed as part of the evaluation but no quantitative or cost-effectiveness dataare available.Te Wai o Rona: Diabetes Prevention StrategyTe Wai o Rona was a four-year randomised cluster-controlled trial of intensive lifestylechange with the aim of reducing the incidence of diabetes among Māori. An initial pilotstudy 21 assessed an intensive lifestyle change approach among a Māori community,delivered by a personal trainer (Māori Community Health Worker, MCHW). Theintervention included physical activity and nutrition components. Baseline assessmentsincluded lifestyle questionnaires, anthropometric measurements and blood collection.The pilot study (Vanguard Study) cohort of 160 participants were weighed before andduring MCHW intervention, and compared with 52 participants weighed immediatelybefore intervention and with 1,143 participants from the same geographical area.Results from the Vanguard Study showed the messages, toolkit and delivery approachacceptable to participants. Significant weight loss occurred during the Vanguard Studyamongst all participants. The researchers concluded that community-wide preventionprogrammes are feasible among Māori and are likely to result in significant reductions inthe incidence of diabetes. Unfortunately, physical activity data were not reported.Ngati and HealthyNgati and Healthy 22 is a collaborative community intervention between Ngati PorouHauora and the Edgar National Centre for Diabetes Research, aimed at reducing theincidence of insulin resistance in the short term and type 2 diabetes in the long term.Implementation of the diabetes prevention community intervention began in 2004. Theintervention aims to increase the consumption of fruit and vegetables; increase theconsumption of wholegrain foods; to reduce the consumption of fat, increase exerciselevels; reduce level of smoking; and reduce alcohol intake. In the first two years, the174
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