Authors: Anderson A, Mills C, Eggleton K.
Reference: New Zealand Medical Journal 10 November 2017, Vol 130 No 1465.
Summarised on: 10 May 2018
This study explored Māori whānau experiences of acute rheumatic fever, including pathways to primary healthcare, and barriers and facilitators for diagnosis of acute rheumatic fever (ARF).
The study employed a Kaupapa Māori Research Method.* Participants included people who self-identified as Māori, had ARF and/or rheumatic heart disease (RHD) and had received ARF/RHD treatment in Northland. Participants also included consenting whānau of people with ARF/RHD. There were 36 participants in the study.
The authors’ identified several barriers and facilitators for a diagnosis of ARF. The biggest barrier is access to primary care.
Access is used to describe both the direct economic cost, such as the cost of the appointment, and indirect costs, such as whānau being able to get time off work. Some whānau reported going straight to the hospital emergency department as it was free. This was believed to be a quicker option, and that they would be referred to the hospital by their GP.
The lack of ability of some GPs to create whanaungatanga (relationships) was a barrier for whānau receiving a diagnosis. Whānau reported feeling judged by GPs due to how they looked, and where they lived.
GPs were also described as being ‘dismissive’ of whānau experiences and questions. Of concern, in some cases whānau felt they had to ‘push’ some GPs to take a throat swab. In contrast to the above negative experiences, one of the key facilitators for a diagnosis was positive relationships between whānau and their GP. In particular, the ability of whānau to trust their GP.
The author’s state that although there are guidelines to ARF, these are not enough to help improve accurate diagnosis.
The authors’ recommend that ‘an effective quality improvement strategy including: audit and feedback, computerised point of care reminders, practice facilitation, educational outreach and processes for patient review and follow-up can overcome health provider barriers. They also suggest investigating the effectiveness off whānau self-swabbing.
Although the above suggestions may help GPs, one of the key findings of this study is the importance of whanaungatanga with whānau for an accurate diagnosis.
The authors argue there is a need for training and evaluation on rapport building and the need for further research in this area.
* ‘Kaupapa Māori research (KMR) has been described as a critical framework that gives meaning to the life of Māori and analyses unequal relations of power that influence Māori wellbeing. It is a methodology that is controlled by Māori to benefit Māori.’