Abstract
Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain significant health issues for Māori and Pacific communities in Aotearoa New Zealand (NZ). Subcutaneous injection of penicillin (SCIP) enables injections to be given 10-weekly as an alternative to the standard four-weekly intramuscular (IM) injections. As part of a clinical trial involving participants with ARF who have been on SCIP for at least one year, we aim to explore treatment adherence, pain management, and quality of life for Māori and Pacific participants and their families (whānau). A community centred approach aligned with Kaupapa Māori, and Pacific-centred research values was used. Semi-structured interviews were conducted with 10 families, including nine participants on SCIP. Data collection occurred between March and August 2024. Thematic analysis was used to identify key themes from participants' experiences. Six themes emerged: Reduced burden of treatment; emotional impact from reduced injection frequency; family-centered care by healthcare providers; relationship building (whakawhanaungatanga); health literacy; and pain management. Participants valued SCIP's 10-week dosing interval, which contributed to improvements in quality of life. The extended dosing interval also alleviated emotional barriers, including the stress associated with more frequent injections. Participants valued that nurses offered them the choice of which location to receive their injections, at home, in a clinic, at work, or at school. Strong relationships with healthcare providers, especially research nurses, were essential for adherence. This study highlights that the extended dosing interval provided by SCIP reduced the physical and emotional burdens participants experienced with their monthly IM BPG injections, thereby enhancing quality of life. The findings emphasise the importance of culturally responsive, family-centered models of care. SCIP offers an opportunity to improve adherence to secondary prophylaxis and if implemented as a standard treatment option, improve health outcomes both in NZ and internationally.