Diabetes services that work for the community

Diabetes NZ is partnering with health organisations around the country to improve community-based services for those with type 2 diabetes. Newly created roles for hauora kaimahi – diabetes community coordinators – are the key. Meet Kylee Stok, our hauora kaimahi in the Hawke's Bay region.

With a strong background in community healthcare, including as a youth worker, a stop-smoking practitioner, and a health coach, Kylee Stok was the ideal person to fill the new Hawke's Bay role, which was created through a partnership between Diabetes NZ and Health Hawke's Bay.

Kylee Stok

BUILDING THE ROLE FROM THE GROUND UP

Kylee started in her role in November 2021. Since then, she’s been building connections in the community, talking to people living with type 2 diabetes about what does and doesn’t work for them, networking with other healthcare workers, and completing a certificate in diabetes care through Waikato University. Although this course is aimed

mainly at clinical workers, she says she’s gained a good understanding of diabetes from it: ‘It’s been a real eye-opener.’

Kylee has also been setting up the programme she’ll run: Your Life Your Journey.

Around the world, there’s a movement towards group-based diabetes self-management education programmes. Your Life Your Journey was developed by diabetes researchers specifically for people with diabetes in Aotearoa New Zealand.

Kylee says, ‘It’s designed as a six-week programme, delivered one day per week, with each block being two hours long. So small chunks over a six week period. However, we’re going to see what our community needs are and what's going to work best for our clients – our whaiora.

‘So it could be a wānanga-style delivery at a local marae or a local church group. And it may be two full days or broken down over a two-week period.’ The unpredictability of the current Covid pandemic means flexibility of timing is vital. ‘We also want to reduce the barriers for working people, so it may be, for example, evening programmes.’

She says it’s important that, if people have children, they can bring them along. ‘And we need to be mobile as well as accessible.’ That means taking the programme to communities, rather than expecting them to come to it.

WHAT DOES THE PROGRAMME INVOLVE?

Kylee explains, ‘The first Your Life Your Journey session is more of a meet and greet for whaiora. We also encourage their families to come along, or anyone that’s living in the same household, because they may wish to learn how to best support their loved one or even how to change their nutrition together. The programme is something they can do together.’

It’s not just about individuals. ‘We’re equipping people with skills to be a really connected whānau. Also, we need to equip our next generation and the one after that with the tools and skills of knowing how to prevent things that are preventable.’

It’s important that the course is a safe space for talking about diabetes and its effects and complications: ‘We let participants know before we start that sometimes it can be a bit of a reality hit for them. It can be quite confronting because it's, like, “Wow, now I see what's going on here and that's not good.”’

Kylee’s role includes training and supporting 12 facilitators, who take turns as guest presenters on the programme. ‘They range from clinical pharmacists and dieticians to podiatrists and nurse specialists. They will come in and deliver their component, and I also deliver a component in the programme, which is around action planning and goal setting.’

Kylee has to set the tone for everyone, ‘making sure all cultural needs are met such as karakia and waiata’, and being there to keep everything running smoothly.

‘It’s important that whaiora are exposed to clinicians in a comfortable setting, so it's not clinical. It means they’re able to raise questions about what may be the barriers to them going in and engaging with, for example, a podiatrist and knowing that they can have a podiatrist visit funded – things like that.

‘And then, hopefully, out of that six weeks, they’ve formed a bit of a bond and a relationship with each other where they can continue to have a support group or maybe even just find a buddy that they can keep in contact with.’

Kylee’s support continues after the course as well. She’ll see people for one-to-one sessions if they’d like her to, ‘and if they decide to get together for a walking group, I can attend that as well’.

Kylee sees one-to-one or whānau support as a vital part of what she can provide to anyone living with type 2 diabetes, whether they take the programme or not.

She’ll meet people where they feel comfortable, try to understand their needs, and explain what’s available for them and from who. She can help them set goals and create action plans, as well as learn techniques for dealing with the stress and anxiety that diabetes can bring. ‘I like to create that environment for whaiora to have me walk alongside them, rather than leading from the front or pushing from behind.’

She adds, ‘I'm a person that has needed support myself, and it is nice to be able to speak to someone that treats you and sees you as a real person.’

COPING WITH THE TIMES

Rolling out the programme during the pandemic has been challenging. Hurdles have included hesitance from people to attend events, new guidelines around room hire, and even delays to courier services, as Kylee had to source a range of interactive tools for explaining diabetes.

She’s also growing the role just as the health system reforms begin to come into effect, although, so far, because this will happen slowly, it hasn’t impacted on her work.

Kylee says that, in future, ‘I think people in roles like myself will be needed more a lot more. Especially with the crisis of clinical staff we have in our country at the moment. There’s a huge need.

‘I've always believed prevention is bigger than intervention and that prevention starts at grassroots level, which is with our people.’

'Diabetes: Your Life Your Journey’ is a programme created by Capital & Coast DHB, Otago University, and Tū Ora Compass Health. Diabetes NZ is rolling it out across the country under an MOU with Te Whatu Ora – Health NZ Capital, Coast and Hutt Valley.