How can the use of urate-lowering therapy for gout by Pacific people in New Zealand be improved? A co-design project

Problem

Compared to the rest of New Zealand, South Auckland has a large Pacific population living in high socioeconomic deprivation and with poor health outcomes. Inequalities result from poor access to services and/or inappropriate service delivery. The current health system does not meet Pacific peoples’ health needs.

Approach

Using a co-design approach, a Collective consisting of the Pacific People’s Health Advisory Group (a Pacific community group), a Pacific practice-based research network, and university researchers have partnered to ask and answer questions of importance and relevance to Pacific health. Once the research question is refined, funding is sought and Pacific students and postdocs join the team, helping build research capacity. The first project addresses gout. Pacific people in New Zealand have a three-fold prevalence of, and nine-fold hospitalisation from gout compared with non-Pacific people, yet use less regular urate-lowering drugs to prevent gout flare-ups. Building on existing knowledge, we aim to develop, implement and evaluate a novel, innovative and culturally appropriate intervention improving Pacific urate-lowering therapy use. Pacific cultural values include the importance of family, collectivism, spirituality, reciprocity and respect. The research uses the fonofale (meeting-house) holistic model incorporating physical, mental, spiritual, family and cultural socio-demographic determinants of health.

Findings

proportion with urate blood-level monitoring, and use of urate-lowering medication over past five years nationally and regionally, is underway. An international systematic review and national stocktake of existing gout interventions has been conducted to inform intervention development. The first brainstorming workshop (via zoom due to COVID-19) has generated many ideas with data entered into NVivo and thematic analysis conducted using a general inductive approach. Using these findings an intervention will be further refined in subsequent workshops. The designed intervention will be implemented and process and outcome evaluations conducted, with an implementation framework produced to facilitate further roll-out.

Consequences

A second research question addressing rhematic fever prevention, another high prevalent disorder in Pasifika, using a similar study design, is also underway. These studies aim to enhance health and reduce inequities for Pacific people and contribute to creation of Pacific health knowledge with translation of research findings into Pacific health gains. These are community-initiated questions with the developed interventions created and owned by the intended beneficiaries, which should maximise their use and modification to suit different contexts. On a more general level, the innovative approach we are using in these projects can help inform how the local community and university-based researchers can work collectively and co-design needs-based programmes and interventions to improve health outcomes in vulnerable populations.