Diabetes in New Zealand: Lifestyle and Prevalence
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This study aims to investigate the underlying link between lifestyle and prevalence of diabetes in relation to the outcome variables of physical activity status and dietary intake in the concerned population of diabetic individuals belonging to the age group of 35-60 years and residing in New Zealand.
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Name of the University:
‘Diabetes’-Silent disorder that
causes health damage
Name of the University:
‘Diabetes’-Silent disorder that
causes health damage
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Abstract
Background: Consistent with the global health burden, diabetes continues to be a major health challenge
in New Zealand as well. Healthcare infrastructure is undergoing rapid and drastic changes to cope up with
this menace. People belonging to diverse race and ethnicity in the New Zealand context, and of varied age
group are likely to be at risk of harboring this disease thereby necessitating adoption of suitable
interventions for mitigating the condition.
Aim: The prospective study will strive to find out the underlying link between lifestyle and prevalence of
diabetes in relation to the outcome variables of physical activity status and dietary intake in the concerned
population of diabetic individuals belonging to the age group of 35-60 years and residing in New Zealand.
Method: A quantitative and exploratory research design will be employed in course of the study to obtain
relevant information related to the topic of investigation in the concerned population. The primary
outcome variables of the study will be the assessment of the physical activity level and dietary intake of
the individuals. Global Physical Activity Questionnaire and Eating Habits Questionnaire will be chosen
for assessing the physical activity and nutritional consumption of the respondents through survey. A
sample size of 100 Kiwi respondents who fit into the predefined criteria will be recruited in the study. The
diabetic patients will be screened through proper pathological examinations to be included in the study.
Statistical analyses through correlation will be computed for understanding the association among the
outcome variables with the prevalence of diabetes. Understanding about the association will help to
recommend strategies for ameliorating the diabetes condition in the relevant population.
Ethics: The study will conform to all accepted protocols as well as established ethical and legal guidelines
so that the interests of the participants are safeguarded thereby increasing the credibility and acceptance of
research done.
Background: Consistent with the global health burden, diabetes continues to be a major health challenge
in New Zealand as well. Healthcare infrastructure is undergoing rapid and drastic changes to cope up with
this menace. People belonging to diverse race and ethnicity in the New Zealand context, and of varied age
group are likely to be at risk of harboring this disease thereby necessitating adoption of suitable
interventions for mitigating the condition.
Aim: The prospective study will strive to find out the underlying link between lifestyle and prevalence of
diabetes in relation to the outcome variables of physical activity status and dietary intake in the concerned
population of diabetic individuals belonging to the age group of 35-60 years and residing in New Zealand.
Method: A quantitative and exploratory research design will be employed in course of the study to obtain
relevant information related to the topic of investigation in the concerned population. The primary
outcome variables of the study will be the assessment of the physical activity level and dietary intake of
the individuals. Global Physical Activity Questionnaire and Eating Habits Questionnaire will be chosen
for assessing the physical activity and nutritional consumption of the respondents through survey. A
sample size of 100 Kiwi respondents who fit into the predefined criteria will be recruited in the study. The
diabetic patients will be screened through proper pathological examinations to be included in the study.
Statistical analyses through correlation will be computed for understanding the association among the
outcome variables with the prevalence of diabetes. Understanding about the association will help to
recommend strategies for ameliorating the diabetes condition in the relevant population.
Ethics: The study will conform to all accepted protocols as well as established ethical and legal guidelines
so that the interests of the participants are safeguarded thereby increasing the credibility and acceptance of
research done.
Introduction to Topic
Diabetes is a metabolic syndrome occurring due to insufficiency
or defect of insulin production from the pancreas and
characterized by high levels of glucose in the circulating blood.
Types of Diabetes include:
Type 1 diabetes in which pancreas produces little or no insulin
Type 2 diabetes in which defective insulin receptors lead to
insufficient production of insulin (Drummond, 2015)
Global burden of diabetes is a major health concern to
the scientific and healthcare community.
Diabetes is a metabolic syndrome occurring due to insufficiency
or defect of insulin production from the pancreas and
characterized by high levels of glucose in the circulating blood.
Types of Diabetes include:
Type 1 diabetes in which pancreas produces little or no insulin
Type 2 diabetes in which defective insulin receptors lead to
insufficient production of insulin (Drummond, 2015)
Global burden of diabetes is a major health concern to
the scientific and healthcare community.
Introduction to Topic
Diabetes increases the risk for other co-morbidities such as
cardiovascular as well other metabolic disorders like obesity.
Prevalence of type2 diabetes is greater in comparison to type1
diabetes accounting for 90-95% of the total diagnosis of
diabetes.
Overall 1 out of 3 individuals are fund to be pre-diabetic in
which the blood level of glucose is high but not sufficient to be
diagnosed as diabetic.
Incidence and prevalence are found to vary depending on the
racial and ethnic diversity (Eldredge, 2016).
Diabetes increases the risk for other co-morbidities such as
cardiovascular as well other metabolic disorders like obesity.
Prevalence of type2 diabetes is greater in comparison to type1
diabetes accounting for 90-95% of the total diagnosis of
diabetes.
Overall 1 out of 3 individuals are fund to be pre-diabetic in
which the blood level of glucose is high but not sufficient to be
diagnosed as diabetic.
Incidence and prevalence are found to vary depending on the
racial and ethnic diversity (Eldredge, 2016).
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Introduction to Topic
Strategies to combat diabetes include:
Engagement to daily physical activity
Adoption of a healthy diet plan
Management of body weight
Compliance to medicinal therapy (García-Moreno, 2013; Shi
& Hu, 2014)
Strategies to combat diabetes include:
Engagement to daily physical activity
Adoption of a healthy diet plan
Management of body weight
Compliance to medicinal therapy (García-Moreno, 2013; Shi
& Hu, 2014)
Diabetes in New Zealand
Diabetes in New Zealand is a vital health disorder
240,000 are detected to be suffering from diabetes (type2
diabetes mainly)
100,000 remains undiagnosed with diabetes despite being
afflicted by the condition
In addition to obesity rates of diabetes are on the rise
Type2 diabetes is the most prominent of the identified
disorders (Health.govt.nz, 2017).
Diabetes in New Zealand is a vital health disorder
240,000 are detected to be suffering from diabetes (type2
diabetes mainly)
100,000 remains undiagnosed with diabetes despite being
afflicted by the condition
In addition to obesity rates of diabetes are on the rise
Type2 diabetes is the most prominent of the identified
disorders (Health.govt.nz, 2017).
Diabetes in New Zealand
Populations under threat encompass:
Māori and Pacific Islanders
South Asian population
7% of the population affected by diabetes
1 out of 5 Kiwis are at risk of harboring diabetes
(Maoridiabetes.co.nz, 2017).
Populations under threat encompass:
Māori and Pacific Islanders
South Asian population
7% of the population affected by diabetes
1 out of 5 Kiwis are at risk of harboring diabetes
(Maoridiabetes.co.nz, 2017).
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Diabetes in New Zealand
Figure 1: Frequency of diabetes by age
groups in 2007 and 2014
Figure 1: Frequency of diabetes by age
groups in 2007 and 2014
Professional Practice Area
Healthcare industry operates adopting a multidisciplinary
approach where every member play significant roles.
Physician, nurse and allied healthcare workers form the
backbone of the system
Healthcare workers work in conformity with established
guidelines to ensure health and wellbeing of the diseased
population (Grol et al., 2013)
Healthcare industry operates adopting a multidisciplinary
approach where every member play significant roles.
Physician, nurse and allied healthcare workers form the
backbone of the system
Healthcare workers work in conformity with established
guidelines to ensure health and wellbeing of the diseased
population (Grol et al., 2013)
Professional Practice Area
Community Healthcare Workers (CHW)
Provide basic healthcare and medical service to the
community
Renders prevention, promotion ad rehabilitation of
care
Members of the same community in which they work
Supported by health system
Receive shorter duration of training than professional
workers
(Who.int, 2017)
Community Healthcare Workers (CHW)
Provide basic healthcare and medical service to the
community
Renders prevention, promotion ad rehabilitation of
care
Members of the same community in which they work
Supported by health system
Receive shorter duration of training than professional
workers
(Who.int, 2017)
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Professional Practice Area
Essential roles played by CHW include:
Giving advice to other healthcare professionals
regarding linguistic issues and the need for abiding by
cultural sensitivity
Serve as mediator between community and health
professionals
Intimately associated with services relevant to Public
Health
(Health.govt.nz, 2017).
Essential roles played by CHW include:
Giving advice to other healthcare professionals
regarding linguistic issues and the need for abiding by
cultural sensitivity
Serve as mediator between community and health
professionals
Intimately associated with services relevant to Public
Health
(Health.govt.nz, 2017).
Professional Practice Area
CHWs are suggested to be undertake community based
participatory research (CBPR) to harbor optimal
outcomes in keeping with the distinct cultural beliefs and
practices of the indigenous communities like that of the
Māori population
Community based interventions may be improvised and
implemented by CHWs to streamline practices that are
capable of mitigating health conditions like that of
diabetes (Stats.govt.nz, 2017)
CHWs are suggested to be undertake community based
participatory research (CBPR) to harbor optimal
outcomes in keeping with the distinct cultural beliefs and
practices of the indigenous communities like that of the
Māori population
Community based interventions may be improvised and
implemented by CHWs to streamline practices that are
capable of mitigating health conditions like that of
diabetes (Stats.govt.nz, 2017)
Literature Review
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Key Practice Issues
Prevention and treatment of diabetes may be achieved
through consideration of key practice issues in the
relevant professional practice area that include:
Health inequalities or Ethnic disparities
Unwillingness for visiting healthcare services due to
cost
Lack of awareness
Lack of trained healthcare professionals
Prevention and treatment of diabetes may be achieved
through consideration of key practice issues in the
relevant professional practice area that include:
Health inequalities or Ethnic disparities
Unwillingness for visiting healthcare services due to
cost
Lack of awareness
Lack of trained healthcare professionals
Key Practice Issues
Ethnic disparities or health inequalities
Māori people represents systematic inconsistencies in
health outcomes, determinants of wellbeing, health
framework responsiveness, and representation in the
healthcare sector division workforce (Hawley &
McGarvey, 2015)
Poor access to primary healthcare services
Tukuitonga, 2013)
Ethnic disparities or health inequalities
Māori people represents systematic inconsistencies in
health outcomes, determinants of wellbeing, health
framework responsiveness, and representation in the
healthcare sector division workforce (Hawley &
McGarvey, 2015)
Poor access to primary healthcare services
Tukuitonga, 2013)
Key Practice Issues
Figure 2: The percentage of adults consuming minimum two
servings of fruits sustained to decline across every ethnic group
(Ministry of Health NZ, 2017)
Figure 2: The percentage of adults consuming minimum two
servings of fruits sustained to decline across every ethnic group
(Ministry of Health NZ, 2017)
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Key Practice Issues
Unwillingness for visiting healthcare services due to
cost
Access to primary heath service is impeded by cost
factor (Wilkinson et al., 2014)
Pacific and Maori community members do not visit
physician because of cost issue (King et al., 2009).
Unwillingness for visiting healthcare services due to
cost
Access to primary heath service is impeded by cost
factor (Wilkinson et al., 2014)
Pacific and Maori community members do not visit
physician because of cost issue (King et al., 2009).
Key Practice Issues
Figure 3: Rate of obesity increased with socioeconomic deprivation (Ministry of
Health NZ, 2017)
Figure 3: Rate of obesity increased with socioeconomic deprivation (Ministry of
Health NZ, 2017)
Key Practice Issues
Figure 4: Cost can be an obstacle for gaining access to primary health care
(Ministry of Health NZ, 2017)
Figure 4: Cost can be an obstacle for gaining access to primary health care
(Ministry of Health NZ, 2017)
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Key Practice Issues
Lack of awareness
Poor prognosis of diabetes retinopathy risk factors
(Papali'i-Curtin, & Dalziel, 2013 )
Unhealthy consumption of food and beverages that
are calorigenic in nature (Metcalf et al., 2014).
Lack of reluctance to utilize medication as treatment
modality by healthcare professionals (Krebs et al.,
2016).
Lack of awareness
Poor prognosis of diabetes retinopathy risk factors
(Papali'i-Curtin, & Dalziel, 2013 )
Unhealthy consumption of food and beverages that
are calorigenic in nature (Metcalf et al., 2014).
Lack of reluctance to utilize medication as treatment
modality by healthcare professionals (Krebs et al.,
2016).
Key Practice Issues
Lack of skilled manpower who are capable of adopting
appropriate strategies to remedy the issue of diabetes in
the concerned population Chang et al., 2017)
Lack of skilled manpower who are capable of adopting
appropriate strategies to remedy the issue of diabetes in
the concerned population Chang et al., 2017)
Existing Gaps in Knowledge and Area of further
Investigation
Evidences support that there is dearth of information related to
Knowledge, practice, and outlook are inter-connected which on
effective learning, updated information, customs and tradition
(Serrano-Gil, & Jacob, 2010).
Intolerance and non-compliant behaviours of healthcare
professionals (Mortell et al., 2012).
Scope of investigations include:
Training and education imparted to the healthcare professionals
to combat the community based disorder
Narrowing of the healthcare discrepancies to establish equality
Investigation
Evidences support that there is dearth of information related to
Knowledge, practice, and outlook are inter-connected which on
effective learning, updated information, customs and tradition
(Serrano-Gil, & Jacob, 2010).
Intolerance and non-compliant behaviours of healthcare
professionals (Mortell et al., 2012).
Scope of investigations include:
Training and education imparted to the healthcare professionals
to combat the community based disorder
Narrowing of the healthcare discrepancies to establish equality
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Research Proposal
Research Question
The basic research questions of the prospective study
may be stated as:
How far individuals belonging to 35-60 years,
diagnosed as diabetic and residing in New Zealand are
predisposed to be affected by diabetes due to dietary
intake and physical activity level?
Is there any association between lifestyle of an
individual and onset of diabetes?
The basic research questions of the prospective study
may be stated as:
How far individuals belonging to 35-60 years,
diagnosed as diabetic and residing in New Zealand are
predisposed to be affected by diabetes due to dietary
intake and physical activity level?
Is there any association between lifestyle of an
individual and onset of diabetes?
Study Aims
The prospected study aims to
investigate on the nutritional and physical activity
level of the individual who has been suffering and
diagnosed with diabetes condition in which the blood
glucose level is higher than normal to be labeled as
diabetic
Lifestyle of the vulnerable population of 35-60 years
will be put under scanner to closely understand the
association of lifestyle with the onset of diabetes.
The prospected study aims to
investigate on the nutritional and physical activity
level of the individual who has been suffering and
diagnosed with diabetes condition in which the blood
glucose level is higher than normal to be labeled as
diabetic
Lifestyle of the vulnerable population of 35-60 years
will be put under scanner to closely understand the
association of lifestyle with the onset of diabetes.
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Research Design
Quantitative Research
Exploratory in nature
Supported by rigorous statistical
computations
Derivation of meaningful information from
the retrieved data
Quantitative Research
Exploratory in nature
Supported by rigorous statistical
computations
Derivation of meaningful information from
the retrieved data
Methodology
Survey method to procure information from the
respondents
Sample size comprising of 100 Kiwi subjects
recruited for the study
Inclusion criteria for participants
Belong to the age group of 35-60 years
Biochemical estimation confirms the presence
of diabetes
Survey method to procure information from the
respondents
Sample size comprising of 100 Kiwi subjects
recruited for the study
Inclusion criteria for participants
Belong to the age group of 35-60 years
Biochemical estimation confirms the presence
of diabetes
Methodology
Primary outcome variables that will be measured
Physical activity status on a daily basis
Daily nutritional consumption
Questionnaires to be used to measure the variables
include:
Global Physical Activity Questionnaire for daily
physical activity status (Kyu et al., 2016)
Eating habits questionnaire for daily dietary
intake (England et al., 2015)
Primary outcome variables that will be measured
Physical activity status on a daily basis
Daily nutritional consumption
Questionnaires to be used to measure the variables
include:
Global Physical Activity Questionnaire for daily
physical activity status (Kyu et al., 2016)
Eating habits questionnaire for daily dietary
intake (England et al., 2015)
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Significance of the Study
Trends in lifestyle of the inhabitants of New
Zealand
Association between lifestyle and prevalence of
diabetes in the chosen population
Insight on the level of daily physical activity and
nutritional intake status of the concerned
individuals
Trends in lifestyle of the inhabitants of New
Zealand
Association between lifestyle and prevalence of
diabetes in the chosen population
Insight on the level of daily physical activity and
nutritional intake status of the concerned
individuals
Ethical Considerations
Informed consent from the
respondents for participation in the
study
Study approved by the
Institutional Review Board
Informed consent from the
respondents for participation in the
study
Study approved by the
Institutional Review Board
Ethical Considerations
Data maintained in safe custody of the principal
investigator with secured password in laptop
Confidentiality and privacy of data retrieved
from participants maintained in conformity with
Data Protection Act (Streiner, 2015)
Data maintained in safe custody of the principal
investigator with secured password in laptop
Confidentiality and privacy of data retrieved
from participants maintained in conformity with
Data Protection Act (Streiner, 2015)
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Timeframe of Study
Month Activity
May Initiation of work on research
proposal and pilot study
June Submission of research proposal
July Obtaining approvals from ethical
team
August Questionnaire designing and
Medical Tests
September Data Analysis
October Writing data Analysis, Final
conclusion and Recommendation
November Submitting draft of dissertation
Month Activity
May Initiation of work on research
proposal and pilot study
June Submission of research proposal
July Obtaining approvals from ethical
team
August Questionnaire designing and
Medical Tests
September Data Analysis
October Writing data Analysis, Final
conclusion and Recommendation
November Submitting draft of dissertation
Costing
Funding for the project will be sought from the
Ministry of Health, New Zealand to cater to
every aspect of the study.
Funding for the project will be sought from the
Ministry of Health, New Zealand to cater to
every aspect of the study.
Costing
Particulars Amount
Meeting with patients $ 1,200
Travel cost $ 1,500
Advertisement for study $ 800
Medical personnel salary $ 7,100
Ethical measures $ 500
Equipment $ 1,600
Stationary $ 600
Total Expenditure $ 13,300
Particulars Amount
Meeting with patients $ 1,200
Travel cost $ 1,500
Advertisement for study $ 800
Medical personnel salary $ 7,100
Ethical measures $ 500
Equipment $ 1,600
Stationary $ 600
Total Expenditure $ 13,300
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References
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Chang, L. L., Lee, A. C., & Sue, W. (2017). Prevalence of diabetic retinopathy at first presentation to the retinal screening service in the
greater Wellington region of New Zealand 2006–2015, and implications for models of retinal screening. NZ Med J, 130(1450), 78-
88.
Clifford, A., McCalman, J., Bainbridge, R., & Tsey, K. (2015). Interventions to improve cultural competency in health care for
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Health Care, 27(2), 89-98.
Coppell, K. J., Mann, J. I., Williams, S. M., Jo, E., Drury, P. L., Miller, J. C., & Parnell, W. R. (2013). Prevalence of diagnosed and
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Creswell, J. W. (2013). Research design: Qualitative, quantitative, and mixed methods approaches. Sage publications.
Daly, B., Arroll, B., Sheridan, N., Kenealy, T., & Scragg, R. (2014). Diabetes knowledge of nurses providing community care for
diabetes patients in Auckland, New Zealand. Primary care diabetes, 8(3), 215-223.
A, B. (2014). Research methods in health: investigating health and health services. . McGraw-Hill Education (UK).
American Diabetes Association. (2014). Standards of medical care in diabetes—2014. Diabetes care, 37(Supplement 1), S14-S80.
Atlantis, E., Joshy, G., Williams, M., & Simmons, D. (2017). Diabetes among Māori and Other Ethnic Groups in New Zealand.
In Diabetes Mellitus in Developing Countries and Underserved Communities (pp. 165-190). Springer International Publishing.
Blackwell, D. L. (2014). Summary health statistics for US adults: national health interview survey, 2012. Vital and health statistics.
Series 10. Data from the National Health Survey,.
Boulware, L. E. (2016). Race and trust in the health care system. Public Health Reports.
Chan, WC. (2015). Linking Ministry of Health and Test Safe data to support population health improvement. Presentation to Ministry of
Health, Counties Manukau District Health Board.
Chang, L. L., Lee, A. C., & Sue, W. (2017). Prevalence of diabetic retinopathy at first presentation to the retinal screening service in the
greater Wellington region of New Zealand 2006–2015, and implications for models of retinal screening. NZ Med J, 130(1450), 78-
88.
Clifford, A., McCalman, J., Bainbridge, R., & Tsey, K. (2015). Interventions to improve cultural competency in health care for
Indigenous peoples of Australia, New Zealand, Canada and the USA: a systematic review. International Journal for Quality in
Health Care, 27(2), 89-98.
Coppell, K. J., Mann, J. I., Williams, S. M., Jo, E., Drury, P. L., Miller, J. C., & Parnell, W. R. (2013). Prevalence of diagnosed and
undiagnosed diabetes and prediabetes in New Zealand: findings from the 2008/09 Adult Nutrition Survey. The New Zealand
Medical Journal (Online), 126(1370).
Creswell, J. W. (2013). Research design: Qualitative, quantitative, and mixed methods approaches. Sage publications.
Daly, B., Arroll, B., Sheridan, N., Kenealy, T., & Scragg, R. (2014). Diabetes knowledge of nurses providing community care for
diabetes patients in Auckland, New Zealand. Primary care diabetes, 8(3), 215-223.
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clinical use in the prevention and management of obesity, cardiovascular disease and type 2 diabetes. European journal of clinical
nutrition, 69(9), 977.
Farmer, A., Gage, J., Kirk, R., & Edgar, T. (2016). Applying Community-Based Participatory Research to Create a Diabetes Prevention
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John Wiley & Sons.
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Drummond, M. F. (2015). Methods for the economic evaluation of health care programmes. . Oxford university press.
Eldredge, L. K. (2016). Planning health promotion programs: an intervention mapping approach. . John Wiley & Sons.
England, C. Y., Andrews, R. C., Jago, R., & Thompson, J. L. (2015). A systematic review of brief dietary questionnaires suitable for
clinical use in the prevention and management of obesity, cardiovascular disease and type 2 diabetes. European journal of clinical
nutrition, 69(9), 977.
Farmer, A., Gage, J., Kirk, R., & Edgar, T. (2016). Applying Community-Based Participatory Research to Create a Diabetes Prevention
Documentary with New Zealand Māori. Progress in Community Health Partnerships: Research, Education, and Action, 10(3), 383-
390.
Furrow, B. R. (2013). Health Law: Materials and Problems.
García-Moreno, C. P. (2013). Global and regional estimates of violence against women: prevalence and health effects of intimate partner
violence and non-partner sexual violence. . World Health Organisation.
Grol, R., Wensing, M., Eccles, M., & Davis, D. (Eds.). (2013). Improving patient care: the implementation of change in health care.
John Wiley & Sons.
Gu, Y., Warren, J., Kennelly, J., Walker, N., & Harwood, M. (2015, August). Incidence Rate of Prediabetes: An Analysis of New Zealand
Primary Care Data. In Driving Reform: Digital Health is Everyone’s Business: Selected Papers from the 23rd Australian National
Health Informatics Conference (HIC 2015) (Vol. 214, p. 81). IOS Press.
Hawley, N. L., & McGarvey, S. T. (2015). Obesity and diabetes in Pacific Islanders: the current burden and the need for urgent
action. Current diabetes reports, 15(5), 1-10.
Health.govt.nz. (2017). Diabetes. Ministry of Health NZ. Retrieved 14 August 2017, from
http://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/diabetes
Health.govt.nz. (2017). Working for a better future Careers in Public Health. Health.govt.nz. Retrieved 14 August 2017, from
https://www.health.govt.nz/system/files/documents/publications/working-better-future-careers-public-health.pdf
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Kyu, H. H., Bachman, V. F., Alexander, L. T., Mumford, J. E., Afshin, A., Estep, K., ... & Cercy, K. (2016). Physical activity
and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and
dose-response meta-analysis for the Global Burden of Disease Study 2013. bmj, 354, i3857.
Larson, L. K. (2015). Employee Health--AIDS Discrimination (Vol. 10). Larson on Employment Discrimination.
Maoridiabetes.co.nz. (2017). Diabetes rates rising - one in five Kiwis at risk » Maoridiabetes. Maoridiabetes.co.nz. Retrieved
14 August 2017, from http://www.maoridiabetes.co.nz/about-diabetes/what-is-diabetes-prediabetes-video/diabetes-rates-rising/
Metcalf, P., Scragg, R. K. R., Sundborn, G., & Jackson, R. (2014). Dietary intakes of Pacific ethnic groups and Europeans living
in Auckland: the Diabetes, Heart and Health Study.
Ministry of Health NZ. (2017). Ministry of Health NZ.
Mortell, M. (2009). A resuscitation “dilemma” theory–practice–ethics. Is there a theory–practice–ethics gap? Journal of the
Saudi Heart Association, 21(3), 149-152.
Mortell, M., Gallagher, R., Sunley, K., Tanner, J., Timms, A., Pugh, H., & McCallum, L. (2012). Hand hygiene compliance: is
there a theory-practice-ethics gap? Health Technology Assessment, 15, 30.
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New Zealand: 2011-2012. The New Zealand Medical Journal (Online), 126(1383).
Serrano-Gil, M., & Jacob, S. (2010). Engaging and empowering patients to manage their type 2 diabetes, Part I: a
knowledge, attitude, and practice gap? Advances in therapy, 27(6), 321-333.
Shi, Y., & Hu, F. B. (2014). The global implications of diabetes and cancer. The lancet, 383(9933), 1947.
Statistics, N. C. (n.d.). Health, United States, 2015: with special feature on racial and ethnic health disparities. 2016.
Stats.govt.nz. (2017). Health and Pacific Peoples in New Zealand. Stats.govt.nz. Retrieved 14 August 2017, from
http://www.stats.govt.nz/browse_for_stats/people_and_communities/pacific_peoples/pacific-progress-health/
improving-health-pacific-peoples.aspx
Streiner, D. L. (2015). Health measurement scales: a practical guide to their development and use. . Oxford
University Press, USA.
Sushames, A., Uffelen, J. G., & Gebel, K. (2016). Do physical activity interventions in Indigenous people in
Australia and New Zealand improve activity levels and health outcomes? A systematic review. International
Journal of Behavioral Nutrition and Physical Activity, 13(1), 129.
Tukuitonga, C. (2013). Pacific people in New Zealand. Published by the Medical Council of New Zealand, 65.
WHO Western Pacific Region. (2017). WHO Western Pacific Region.
Who.int. (2017). Community health workers: What do we know about them? The state of the evidence on
programmes, activities, costs and impact on health outcomes of using community health workers. Who.int.
Retrieved 14 August 2017, from http://www.who.int/hrh/documents/community_health_workers.pdf
Wilkinson, A., Whitehead, L., & Ritchie, L. (2014). Factors influencing the ability to self-manage diabetes for
adults living with type 1 or 2 diabetes. International journal of nursing studies, 51(1), 111-122.
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