A latent profile analysis of Pacific health values

Introduction: Pacific health models that centre Pacific values, can serve as a tool to address Pacific disparities in healthcare. In this study, we broadly draw upon the health concepts of these models to determine how Pacific values are translate across Pacific health and wellbeing. Methods: Using data from the New Zealand Attitudes and Values Study, we identified proxy indicators of common Pacific values. With these proxy indicators we developed a LP Latent Profile Analysis A to uncover subgroups of Pacific peoples based on their orientation towards each proxy indicator and their association with psychological distress. Findings: We identified four subgroups of Pacific peoples: (1) 65% of Pacific peoples identified strongly with Pacific values with low associated psychological distress (2) 18% of Pacific peoples identified moderately with Pacific values with medium associated psychological distress (3) 5% of Pacific peoples identified less with Pacific values with low associated psychological distress (4) 12% of Pacific peoples identified ambivalent with Pacific values with high associated psychological distress. Conclusions: These results suggest that Pacific values and the utility of Pacific health models are an appropriate way of framing health and wellbeing for a vast majority of our Pacific population. However, we also need to recognise the incredible diversity among our Pacific community and be understanding and accommodating of the diverse ways that Pacific peoples can express what they consider valuable.

Design and implementation of a Pacific intervention to increase uptake of urate-lowering therapy for gout: a study protocol

Background Gout is a painful chronic disease which disrupts work and family life and can lead to chronic joint damage. Pacific people in Aotearoa/New Zealand experience significant inequities, with over three times the gout prevalence of the non-Pacific non-Māori populations. Pacific people receive less regular urate-lowering drugs to prevent gout flare-ups, and have nine times the hospitalisation from gout compared with non-Pacific non-Māori people. Rates for Indigenous Māori lie between Pacific and non-Pacific non-Māori. A long-established Collective comprising community members from the Pacific People’s Health Advisory Group, clinical staff from the Pacific Practice-Based Research Network, and University of Auckland researchers have identified that improving Pacific urate-lowering therapy use as the research question of prime importance for improved health outcomes of Pacific people in South Auckland. Building on the existing knowledge, this study aims to develop, implement and evaluate a novel innovative intervention to improve the uptake of urate-lowering therapy by Pacific patients with gout. Methods Three-phase mixed methods co-design study using the Fa’afaletui research framework following the STROBE statement. Phase1 is observational times series of prevalence of patients with gout, proportion with urate blood-level monitoring and use of urate-lowering medication over past 5 years. In Phase 2 the Collective will workshop new interventions to address previous uptake barriers, using culturally-appropriate Talanga communications with results synthesised in line with Kakala principles. The designed intervention will be implemented and process and outcome evaluations conducted. Finally, an implementation framework will be produced to facilitate further roll-out. Discussion The study aims to enhance health and reduce inequities for Pacific people, contribute to creation of Pacific health knowledge and translation of research findings into Pacific health gains. Potential longer-term impact is a gout-management pathway for use throughout Aotearoa/New Zealand. Māori have similar issues with high gout prevalence and low urate-lowering therapy use hence the intervention is likely to translate to Māori healthcare. The project will contribute to Pacific research capacity and capability-building as well as general upskilling of community and practice members involved in the co-design processes. Trial registration The Australian New Zealand Clinical Trial Registry is in process, request number 38206, 1-09-2021.

Samoan People’s Knowledge and Understanding of Cardiovascular Disease

<p>This thesis explores Samoan people’s knowledge and understanding of Cardiovascular Disease and its risks; Cardiovascular Risk Assessments; and their reasons for undertaking or not undertaking lifestyle changes, if they are found to be at risk of cardiovascular disease. An interpretive phenomenological design, facilitated by the Talanoa narrative approach, incorporating the ‘Leai se tu fa’amauga’ Pacific framework was employed to conduct this research. Participants were recruited from Primary Health Services in Wellington and Porirua. Sixteen Samoan participants aged 45 to 65, and seven practice nurses were interviewed, supported by a literature review of cardiovascular disease as one of the leading causes of premature deaths and health inequalities in New Zealand, affecting mainly Pacific peoples. Samoan people’s voices utilising fa’a-Samoa worldviews and models of care in particular the NZ health policies to improve health literacy for this population have grounded the research and its findings. My interest in this exploration was a result of my own experience working as a practice nurse in health centres with high numbers of Pacific peoples. I often questioned whether they understood the information they were provided with, when they had their cardiovascular risk assessment. Although cardiovascular risk assessment is one of the government’s primary health targets with an emphasis on increasing the number of assessments for Pacific peoples to improve their health outcomes, Pacific peoples’ health remains poor. A number of health policies and strategies have been in place for almost two decades such as; Making a Pacific Difference and Strategic Initiatives for Pacific Peoples (MoH, 1998), the Pacific Health Disabily Action Plan (MoH, 2002), Improving Quality Care for Pacific Peoples (MoH, 2008c), and Ala Mo’ui: Pathways to Pacific Health and Wellbeing 2010-2014 (Minister of Health & Minister of Pacific Island Affairs, 2010). However there is still little or no progress in Pacific peoples’ health outcomes. The results showed that the lack of health literacy and poor command of the English language limited Samoan people’s knowledge and understanding. A number of additional factors such as demographic characteristics, educational levels, the Samoan worldview and the fa’a-Samoa, patient follow up care, length of appointment times, the ambiguity of information and lack of the continuity of community programmes, all affected the uptake of lifestyle changes. The majority of participants felt there was no true value gained from completing cardiovascular risk assessment. A key question thus raised is, ‘Does completing a cardiovascular risk assessment have any health benefits for Pacific peoples?’ The implications of the key themes that emerged from the data form the basis for recommendations on the role of the practice nurse, current and future health policies as well as future research.</p>

Samoan People’s Knowledge and Understanding of Cardiovascular Disease

<p>This thesis explores Samoan people’s knowledge and understanding of Cardiovascular Disease and its risks; Cardiovascular Risk Assessments; and their reasons for undertaking or not undertaking lifestyle changes, if they are found to be at risk of cardiovascular disease. An interpretive phenomenological design, facilitated by the Talanoa narrative approach, incorporating the ‘Leai se tu fa’amauga’ Pacific framework was employed to conduct this research. Participants were recruited from Primary Health Services in Wellington and Porirua. Sixteen Samoan participants aged 45 to 65, and seven practice nurses were interviewed, supported by a literature review of cardiovascular disease as one of the leading causes of premature deaths and health inequalities in New Zealand, affecting mainly Pacific peoples. Samoan people’s voices utilising fa’a-Samoa worldviews and models of care in particular the NZ health policies to improve health literacy for this population have grounded the research and its findings. My interest in this exploration was a result of my own experience working as a practice nurse in health centres with high numbers of Pacific peoples. I often questioned whether they understood the information they were provided with, when they had their cardiovascular risk assessment. Although cardiovascular risk assessment is one of the government’s primary health targets with an emphasis on increasing the number of assessments for Pacific peoples to improve their health outcomes, Pacific peoples’ health remains poor. A number of health policies and strategies have been in place for almost two decades such as; Making a Pacific Difference and Strategic Initiatives for Pacific Peoples (MoH, 1998), the Pacific Health Disabily Action Plan (MoH, 2002), Improving Quality Care for Pacific Peoples (MoH, 2008c), and Ala Mo’ui: Pathways to Pacific Health and Wellbeing 2010-2014 (Minister of Health & Minister of Pacific Island Affairs, 2010). However there is still little or no progress in Pacific peoples’ health outcomes. The results showed that the lack of health literacy and poor command of the English language limited Samoan people’s knowledge and understanding. A number of additional factors such as demographic characteristics, educational levels, the Samoan worldview and the fa’a-Samoa, patient follow up care, length of appointment times, the ambiguity of information and lack of the continuity of community programmes, all affected the uptake of lifestyle changes. The majority of participants felt there was no true value gained from completing cardiovascular risk assessment. A key question thus raised is, ‘Does completing a cardiovascular risk assessment have any health benefits for Pacific peoples?’ The implications of the key themes that emerged from the data form the basis for recommendations on the role of the practice nurse, current and future health policies as well as future research.</p>

Alea Ke Pau or Negotiated Evaluation: A Vital Concept in Pacific Health Promotion

For Pacific peoples, health promotion, community nursing and community development initiative over many years, has often been conducted within a framework of one-sided decision-making. There is always an imbalance between the power relationships of the community being studied and those of the researchers or health practitioners. As a result, there is lack of understanding on the part of the researchers and the health funding agencies of the need to negotiate processes with members of the community being studied or engaging with. All of this are within an overarching lack of understanding of, and respect for, Pacific cultural values, frameworks and Pacific ways of doing things. This paper seeks to explore an alternative concept whereby these values are acknowledged. This concept is metaphorically called “alea ke pau” (or, negotiated evaluation). This approach is forward-looking and one that respects a ‘bottom-up’ view rather than the traditional ‘top-down’ view of health work and funding agencies. However, using two Pacific research methodologies called Talanga and Kakala, to explore the concept of alea ke pau were held with five men’s focus groups operating within Kava Clubs in Auckland, New Zealand, and five focus groups in Tonga. The results from these discussions are presented demonstrating the development and application of the “alea ke pau” or “negotiated evaluation” approach.

Investigating principles that underlie frameworks for Pacific health research using a co-design approach: learnings from a Tongan community based project

Co-design is a relatively new method employed in public health-based interventions to identify problems, generate and implement solutions through harnessing knowledge and creativity of citizens and staff . Researchers use different co-design steps in the design and implementation of intervention programmes. The co-design approach has been successfully used in redesigning health care services to fit the needs of the consumers and has extended to develop health interventions for communities . In New Zealand, co-design methods have been used to develop health interventions among minority and indigenous groups. Previous research highlighted that co-design fits well when collaborating with these groups as it allows tool redevelopments and re-fining based on the socio-cultural needs of participants. This method captures and understands the needs of the Tongan community, as well as foster expression, reflection, and sharing to inform the development of the intervention. The generation of discussion in co-design aligns with the indigenous knowledge of systems, creation stories and oral stories which provide a culturally empowering way to generate discussion and insights from Tongan communities.

Universal Health Coverage and The Pacific Islands: Challenges Faced and Priority Responses, 2015-2020

Background In 1995, Pacific Health Ministers articulated their vision of a healthy Pacific as ‘a place where children are nurtured in body and mind; environments invite learning and leisure; people work and age with dignity; where ecological balance is a source of pride; and where the ocean is protected.’ Central to this vision is the achievement of universal health coverage (UHC). Method: To shed light on the current UHC-related priorities of Pacific health authorities and promote alignment of domestic and international investments in health sector development, we thematically analyzed the discussion, resolutions, and recommendations from 5-years (2015–2020) of senior-level Pacific health meetings. Results Five main themes emerged, (i) the Healthy Islands vision has (and continues to have) a unifying influence on action for UHC; (ii) adoption of appropriate service delivery models that support integrated primary health care at the community level are needed; (iii) human resources for health are critical if efforts to achieve UHC are to be successful; (iv) access to reliable health information is core to health sector improvement; and (v) while not a panacea for all challenges, digital health offers many opportunities. Small and isolated populations, chronic workforce limitations, weak governance arrangements, aging and inadequate health facilities, and supply chain and logistics difficulties (among other issues) interact to challenge primary health care delivery across the Pacific islands. Conclusion We found evidence that the Healthy Islands vision is a tool that garners support for UHC; however, to realize the vision, a realistic understanding of needed political, human resource, and economic investments is required. The significant disruptive effect of COVID-19 and the uncertainty it brings for implementation of the medium- to long-term health development agenda raises concern that progress may stagnate or retreat.

Covid-19 underscores long held strengths and challenges in Pacific health.

Much has been made of the Pacific Covid-19 response and the manner in which Pacific providers and communities rallied to combat Covid-19, particularly during the second Auckland outbreak. Led by a well-coordinated central team of Pacific experts from across the country, frontline workers, officials, media, communications experts, researchers and community champions across all sectors acted swiftly, demonstrating their versatility and the potential to respond and to protect their people when given the mandate and resources.