Tale of two churches: differential impact of a church-based diabetes control programme among Pacific Islands people in New Zealand.

AIMS: To compare the impact on weight and exercise of a 2-year church-based diabetes risk reduction programme in four churches in South Auckland, New Zealand. METHODS: A prospective non-randomized controlled study of a modular lifestyle and diabetes awareness intervention programme applying community development principles. The study involved four complete church congregations, two Samoan and two Tongan, with 516 participants at commencement. Risk of Type 2 diabetes is high among both ethnic groups. RESULTS: Overall, 285 subjects were available for their second assessment. In one intervention church, weight gain was controlled (vs. control 0 +/- 4.8 vs. +3.1 +/- 9.8 kg, respectively; P=0.05), diabetes knowledge (+46 +/- 26% vs. +4 +/- 17%; P<0.001) and regular exercise (at least 3 days per week: +22% vs. -8%; P=0.032) increased and readiness to change weight (P=0.007) shifted towards maintenance (e.g. maintenance +41% vs. +8%, respectively). The other intervention church increased diabetes knowledge (+19 +/- 24 vs. +8 +/- 25; P<0.024), but no other significant personal changes occurred. Attendance and perceived utility of the programme were greater in the first intervention church. CONCLUSIONS: A moderate intensity, community-based, structured diabetes awareness and lifestyle programme can reduce diabetes risk, but increasing diabetes knowledge alone is not necessarily associated with healthier lifestyle choices. Continuous and detailed monitoring of penetration of interventions may be essential to help guide the timing of interventions and identify the need for additional strategies to increase participation and motivation.

Community development through partnership: promoting health in an urban indigenous community in New Zealand.

Indigenous people who have been dispossessed of their lands and resources bear a disproportionate burden of health problems. Programmes aimed at improving their health status must operate within the context of colonisation history and the contemporary cultural renaissance whereby indigenous populations are asserting their rights to self-determination. Community development strategies incorporating empowerment as both means and end are consistent with the aspirations of the renaissance and reflect the principles of the Ottawa Charter for Health Promotion. This paper describes a formative and process evaluation of a community development partnership for health promotion between a health group and an urban Maori community in New Zealand. Key issues encountered related to trust, prioritisation of health, and appropriate research paradigms. Most significant among these was trust, or more specifically, distrust among Maori engendered by historical and contemporaneous experiences of contact with Europeans. Ultimately, the partnership achieved what it set out to do when the Maori partners took over the running of their own health groups and health programme. Building upon a detailed literature review and data from the evaluation, the paper offers a list of recommended procedures for the development of partnerships, applicable to health and other domains. Recommendations encompass preparatory steps, the formation of a partnership committee, programme planning and development, and the appointment of a community-based liaison worker. A conclusion of the research and premise underpinning the recommendations is that devolution of power is a key aspect of organisational process underlying successful partnerships involving professional groups and indigenous people.