Pacific families’ experiences of intergenerational diabetes in New Zealand – a qualitative interpretive case study

BACKGROUND: Intergenerational diabetes occurs when multiple members across successive generations in one family develop Type 2 diabetes due to shared genetic and environmental factors. This research describes the experiences, beliefs, challenges, and barriers faced by Pacific families in New Zealand living with intergenerational diabetes. METHODS: A qualitative multiple-case study was conducted with four Pacific families experiencing intergenerational diabetes. Two focus groups were run with three families, and one with the fourth. Data were recorded, transcribed, and analysed for each family case study, then a cross-case analysis was conducted using interpretive descriptive methodology. RESULTS: Nine individuals, aged 20-65 years, representing four families of Tokelauan or Sāmoan heritage, each with three generations affected by diabetes, participated. Three major cross-case themes were identified. These were (a) Diabetes is ubiquitous; (b) The impact of diabetes on families; and (c) Responses to diabetes and its management. These interrelated themes describe factors that may perpetuate or moderate repeating cycles of diabetes across generations. Grandparents were motivated to manage their diabetes and wanted to protect the younger generations. Diabetes legacy stories, misunderstandings about diabetes, and the insidious nature of diabetes were identified as important areas for attention to reduce intergenerational diabetes. CONCLUSIONS: Multiple factors influence intergenerational diabetes. Findings underscore the importance of understanding and working in culturally safe ways with families' diabetes legacy stories, and of addressing misunderstandings about diabetes, particularly in the often invisible, early phases of the disease, to foster early engagement in diabetes care and interrupt the recurring cycle of diabetes.