A community-based study involving three Pacific church congregations in Auckland has provided a blueprint for introducing a weight management programme to Pacific communities.
The academic-community collaborative research partnership between Pacific church communities in Auckland and the Universities of Auckland, Otago, and Hawaii was funded by a joint partnership between the HRC and the Pacific branch of the Ministry of Health to enhance Pacific research career development and support Pacific-led health research focusing on issues of importance to Pacific people.
Principal investigator Dr Ofa Dewes from the University of Auckland's School of Population Health, says the study built on her earlier research in the Obesity Prevention in Communities (OPIC) study and contribution to the development of the New Zealand Weight Management Guidelines (NZWMG) for children, young people, and adults.
She became increasingly interested in working with Pacific people to identify sustainable solutions and this led to the Diabetes, Obesity and the Church (DOC) study, designed to implement the NZWMG in Pacific church communities.
"We don't need to do anymore research to tell us that we need to lose and manage our weight; we have evidence-based clinical guidelines for weight management. What we need now is research about how to take our knowledge into the community and implement and evaluate it in ways that are culturally centred."
Dr Dewes says a lot of the research with Pacific people had been pan-Pacific but because each Pacific group is unique, she wanted to take an ethnic-specific approach and worked with three different groups.
Her team took the key NZWMG messages around food, activity, and behaviour support, and engaged with the church leaders so they agreed on key objectives, such as increasing the intake of healthy food at church functions and decreasing sugar-sweetened beverages.
Leaders also agreed on the need for increased physical and recreational activity, and decreased sedentary behaviour such as TV watching and playing computer games. The other key aspect was around increasing behaviour change support in the church family.
Dr Dewes says they looked to implement the three key messages of food, activity, and behaviour support in mana-enhancing ways, by empowering the leaders and the church communities to implement them within their church programmes.
Each church decided how they were going to implement the activities in selected programmes, which included an early childhood education centre, Sunday schools, youth groups, leadership groups, elders groups, women’s fellowship, prayer groups, Zumba classes, walking groups, and weekly messages from the pulpit.
"The churches really made this their own. I think that's the key and novel thing about the study, taking the guidelines and facilitating church communities to make them work in their own setting."
Dr Dewes says they saw changes in the types of food and drink served at church, and reported dietary changes.
"As a total Pacific sample there was no statistically significant change observed in those measures, but individual ethnic groups showed some significant changes between baseline and follow-up," she says.
"For example, the Samoan children were eating more vegetable portions by the end of the study, and that was statistically significant. But this is why I think ethnic-specific research needs to be encouraged; we are a diverse population group and our differences need to be understood."
Researchers found a significant change in the amount of time spent walking.
There was no statistically significant change in body mass index (BMI) but Dr Dewes says it shows they have arrested the increase in weight gain and now the focus is on working to reverse it.
"Although there were some changes observed I would want to interpret that with caution. The key message to take from this study is that we have church communities committed to this initiative because of its suitability for all age groups, inclusiveness of the whole family, and heightened awareness about the health issues confronting them. They have taken the Government's solution to addressing the obesity epidemic and applied it in their usual church activities because they want to be part of the solution."
Dr Dewes says other key signs of success included the more than 90 per cent retention rate over 12 months among the 312 participants, and the fact churches have carried on with the programme post-study.
"I still remain in contact with them and they are hoping that I will be able to secure research funds to continue and extend this work to other communities," she says.
"The study was for only 12 months and the obesity epidemic will take longer than this to reverse. We need long-term commitment to studies of this nature. The issues are not going to be resolved overnight and the community want us to continue the relationship, build on our current findings, and take it to the next level."
Dr Dewes believes the things they have developed are transferable to other faith-based organisations or other community groups. For Māori, they could be implemented in the Marae setting.
"Regardless of ethnicity, one of the characteristics of this model was that you engaged with people's culture and whatever appropriate strategies worked for them. I think key to it also was the strength of leadership at all levels – that was pivotal."
Reverend Hola Paea
One of the church leaders involved was the Reverend Hola Paea, Minister of the Tongan Tokaima'ananga Methodist Church in Otara.
They have a congregation of about 200 people at their Sunday services and Rev Paea says they enjoy the sessions they have with Dr Dewes and the research team.
"The encouragement they receive is important in keeping people connected with the programme."
Rev Paea says getting his congregation to eat less fatty meat and more healthy food is a challenge. Previously it was not unusual to see whole animals being prepared and put on the table.
"I said to them to stop cooking that kind of food. Cook something cheaper and save the money to use where it is needed. Save their dollars for their children and their families."
The church also operates an early childhood centre five days a week with 35 children. They serve healthy food with plenty of vegetables and fruit which the children love.
Rev Paea says leadership is important, by encouraging people to do the right thing.
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Dr Ofa Dewes’ study was funded by the HRC in partnership with the Ministry of Health through a 2012 Pacific Health Research Partnership award.