Nutrition is a determining factor of overall health. Patients can encounter many problems in relation to nutrition and malnutrition, many of which emerge from the cost of living, and how the food system operates. A growing number of people are affected by food insecurity, and it is more likely to affect certain kinds of people, such as Māori and Pacific peoples, and those in lower socioeconomic situations. Issues of food security and loss of food sovereignty compel a Kaupapa Māori investigation of the wider needs of patients living with chronic disease.
The Kaupapa Māori He Pikinga Waiora framework and a mixed method approach was adopted. Focus group interviews were undertaken with 21 Māori patients living with chronic disease between 2021 and 2023. The interviews comprised were a mix of males (n=9) and females (n=12) between the ages of 40 and 83 years. Participants were from diverse backgrounds – both urban and rural, homeowners and renters, retired and working pensioners, and employed workers. Welfare payment was the primary source of income for many.
Patients have their own relationship to food and their own traditions around food because of culture. Consideration should be given to how the topic of Māori kai is approached. Patients felt dietitians did not understand the benefits of Māori kai, such as iron in watercress. While nutrition advice is patient-centred, it is not always whānau and/or household inclusive. Patients appreciate advice that is condition-specific and when practitioners talk through related issues together. Choices around food were constrained by the cost of food.
Experiences of diet and nutrition are related to and shaped by individual, cultural, whānau and societal factors, and dietitians must understand how these impact on nutrition and the everyday management of chronic disease. How food practices operate in the whānau and household contexts are important.