5.0 The 'ideal' service
5.1 What would the ‘ideal’ service or programme consist of?
Summary
Māori and Pasifika parents both identified similar aspects that they believed were key to the ‘ideal’ service or programme. These aspects related to who the service provider should be, who would be able to access the service, and what specific services would be provided in order to successfully address obesity.
The ideal service provider would be someone with ties to the local community and be of the same ethnicity as the participants
Respondents felt the ideal service would be run by (past or present) members of their local community; someone who understands the community and the people who live there. For Māori, the service would ideally be supported or promoted by their local iwi, and for Pasifika through their churches.
It was also important that the service be run (or at least fronted) by people of the same ethnic background as the participants. That is, someone friendly and open, who understands their cultural needs and makes them feel comfortable and at ease.
If the service is fronted by someone who is not obviously Māori or Pasifika, they must be friendly, able to relate well with participants and ideally have some sign of a Māori or Pasifika connection (i.e. through their clothing or greenstone/bone jewellery for example).
The people running the programme/providing the services need to be enthusiastic and motivated if they are to keep their clients on track. It is also important that the people running the service are themselves not overweight.
Respondents felt it was also important the programme be developed by people with relevant professional knowledge and experience. Once the final programme has been developed and tested, it could then be adopted by other communities. Rather than have many different providers working in isolation to create their own obesity programmes, a collaborative, unified approach would result in a more efficient use of resources and expertise.
The service would be available to everyone in the community, not just Māori, Pasifika or low income people
The service would ideally be free and available to not only Māori or Pasifika but to people of all ethnicities and income brackets. Although note, that if the service were available to other ethnicities it would need to have staff members of each of those ethnicities.
One group of respondents also suggested that in order to improve the service’s access to the wider community, some type of mobile unit could be used to visit homes or areas of the community that otherwise may not be able to visit one particular site or would feel uncomfortable doing so.
The service needs to involve the whole family, not just the children
To achieve the cultural and behavioural change required to effectively address the issue of child obesity, respondents felt it was important to get the whole family involved, not just the children, but the household decision-makers.
Respondents also felt it was the parent’s responsibility to lead by example, not only in relation to food, but by participating in physical activity.
You can’t tell the kids to go outside and play so you can sit on the couch and watch a movie.
They also felt that providing a service that focused on families with children who were already overweight was one that was not going to be effective. Educating parents and getting them to change their behaviour and encourage their children to do the same would be the ideal way to prevent the issue from occurring – rather than trying to fix it after it had already happened.
The service would provide information, advice and physical activity
The ideal service or programme would provide a range of activities to address the issue of obesity. However, the key feature would be one that focused on educating parents. Educating them about health and nutrition, about the consequences of being overweight, and how they might access or provide healthy food options for their families.
As well as being education-based, the service would also need to involve physical activities and goals for the whole family. It was also suggested that budgeting services be provided.
The duration of the ideal service was also discussed. Based on their own experience, the ideal service would involve at least two sessions per week, over the course of 5-6 months. However, in order to achieve long term behavioural changes, respondents felt on-going support would be required to keep people on track and motivated to continue their efforts in the years to come, so they in turn could pass the knowledge and positive behaviours gained on to the next generation.
Past programmes were introduced for 3 months or 6 months and then pulled. When this happens the gains are quickly lost and everyone slips back to where they were.
5.2 What are the barriers to access and how might they be overcome?
The main barriers identified by Māori and Pasifika respondents were very similar:
| Barriers | Possible solutions |
|---|---|
| Cost | Cost is a significant barrier for Māori and Pasifika families. To enable access, any service or programme developed would have to be free of charge, or have a very minimal fee involved. Cost also prohibits many Māori and Pasifika families from being able to afford healthy food options. Budgeting advice and/or tips on how to cost effectively provide nutritious meals could help to address this. |
| Awareness (of services and programmes already available) | Word of mouth is always going to be the primary source of information sharing amongst Māori and Pasifika, particularly in terms of creating awareness of available services and programmes. However, other channels were also suggested, such as promoting services through churches or local Iwi groups, advertising on television or radio, or using social media (i.e. Facebook). |
| Not being able to connect/relate to the people providing the service | For Māori and Pasifika people in particular, being able to connect or feel comfortable with a service provider is very important. If they feel uncomfortable or judged they are unlikely to engage or participate in the programme or service at all. Not only does the service provider need to be friendly and welcoming, they would also ideally be of the same ethnicity or at least be from the local area. |
| Apathy/lack of motivation | On-going support and encouragement is needed to maintain interest in any sort of programme or service, particularly one that involves physical participation. Incentivising goals would also help encourage uptake and on-going participation. |
5.3 Other suggestions as to how to address the issue of child obesity
Respondents also raised a number of suggested ways in which they felt the Government could help address New Zealand’s child obesity issue. These suggestions are listed below:
- Remove the GST from fruit and vegetables.
There’s always going to be a cost and if that means taking off that GST, then so be it. I know that if GST went off Mr Asian-man’s fruit shop, I’d be there in an instant.Make the healthy foods cheaper. I remember going to Pak ‘n’ Save and a bag of tomatoes was $8! I was like ‘wow!’ … especially when hearing that it’s ‘New Zealand grown’.All the food that they promote us to eat. Make it cheaper! The fruit, the vegetables, lean meat, seafood. All the food that is recommended by the Ministry of Health!
- Reducing the cost of public facilities such as swimming pools, costs involved in sports administration, swimming lessons, etc. One respondent said they registered a softball team and it cost $5,000.
For the sports, like swimming, give subsidies, more subsidies. Make it cheaper to play sports so children can be more active.We did our baseball this year, and just for one team, under 8’s, it was $5,000 and we’ve got two of those. And then swimming is like $250 a term for one kid. It’s not cheap.
- Develop communications campaigns similar to those used to change New Zealanders’ attitudes towards smoking. Use shock tactics to show the consequences of obesity.
With Island people, education is one thing but I think that when it comes to health issues, we need to scare them! Don’t just educate them, scare them.
There are real life stories … if a kid comes in with a bag full of medicine (all sorts of medicines), and you have to try to live through that for the rest of your life, trust me … you will never ever want to go down that path. The message has to go to the people for them to see that this is proof! Look at the reality of this, this is the damage!
I think until someone dies of that [obesity-related illness], will they get it.
- Increase tax on unhealthy foods (i.e. takeaways) or limit the number of takeaway outlets in each community.