Fefine Tonga moe ifi tapaka: A qualitative study to explore Tongan female tobacco smoking & cessation in the Auckland region.

ABSTRACT Introduction Tongan female smokers’ smoking experiences have manifested within a realm of socioeconomic and cultural conditions in New Zealand with cessation service engagement relatively low. Due to the projected tobacco burden attributed to Pacific women, pertinent research proves vital to bettering understandings of smoking and cessation within this group. This study explored the knowledge and experiences of smoking and smoking cessation services among Tongan women aged 16 years and over, living in the Auckland region. Methods This qualitative research design utilised the Kakala model to ensure processes were culturally appropriate and meaningful. Data was collected through eight face-to-face semi-structured interviews transcribed by the researcher and employed the toli, teu and luva process from the Kakala model to form relevant themes. Findings The findings suggest smoking among Tongan females is a social vector that marks independence and maintains friendships, despite known adverse health effects and stigma. It is characterised as stress relief that has habituated into day-to-day routine for most. Their aspirations to live longer for their family is a strong motivator but quitting remains difficult and should be done autonomously by the individual. Tongan female smokers stated smoking cessation services as ineffective and need to be adapted and consulted by and within the community. Stop smoking services should encourage autonomy among Tonga women in order to improve utilisation and engagement. Service delivery for Tongan female smokers needs to be on-going and long-term support reoriented within the community for more Tongan women to become completely smokefree. Conclusions Tongan female smoking in New Zealand is comprised of experiences surrounding friendships, family and culture. This study concludes that although smoking harms are widely known, cessation service delivery can be transformed by utilizing existing Tongan cultural roles such as that of the mehikitanga (paternal aunt) to encourage non-smoking among extended female generations.

What is the experience of registered nurses in assessing people with severe mental illness for metabolic syndrome?

Introduction: Metabolic Syndrome is a prevalent condition in New Zealand and worldwide, affecting adult populations, especially those who are in long-term antipsychotic medications for severe mental illness. Registered nurses play a crucial role in improving the health of this population. Methods: Five registered nurses with at least two years of working experience in the mental health settings participated in this qualitative, exploratory study, underpinned by the Kakala Research Framework. Semi-structured face-to-face interviews with the participants were undertaken to gather research data and thematic analysis was used to find common themes. Findings: Registered nurses in mental health services are experiencing clinical and professional enablers as well as professional, organisational and systematic barriers in assessing people with severe mental illness for metabolic syndrome. Conclusion: Skilled registered nurses in mental health services are required to take the responsibility for providing a “one-stop-shop” for people with metabolic syndrome.

Covid-19 outbreak reflects inequities in health and socioeconomic disadvantage in Aotearoa/New Zealand and the Pacific Islands

The Covid-19 outbreak in Aotearoa/New Zealand is a timely reminder of the chronic inequities in health and the importance of socioeconomic factors in the origins of the disease. The pandemic has affected mainly indigenous Maori and Pacific people. There were 5,371 confirmed and probable cases of Covid-19 as at 13 November 2021, of which 2,104 (39%) were in Maori and 1,646 (31%) were in Pacific people. Furthermore, 228 (70%) of all hospital admissions were Maori and Pacific people

Are ‘Behaviour Change’ Approaches to Obesity and Health Effective? A case Study from Samoa

‘Behaviour Change’ approaches in public health strategies have been used in Pacific Island countries to address the problem of dietary and lifestyle changes that are believed to be the cause of rising rates of obesity and associated NCDS. We consider the limitations of this approach in the context of Samoa’s socioeconomic situation and public health policy and propose that an ‘obesogenic’ environment and structural factors are causational and require policy measures that go beyond the scope of responsibilities of the Samoa Ministry of Health

Timings of Permanent Tooth Emergence in Children of Rural Vanuatu, Melanesia

Introduction Global patterning and timing of permanent tooth emergence is influenced by ethnicity, with no known timings reported for ethnic Melanesian children living in the tropical archipelago of Vanuatu. Aim To determine timings of permanent tooth emergence and sequencing for children who reside in rural Vanuatu. Methods Children aged 4-17 years (n=1026), part of a larger oral health cross-sectional study, were examined recording all permanent teeth present, across four spatially separated islands. Binary logistic modelling established children’s median age of emergence of each permanent tooth for each study area. Results The median emergence of first permanent molars for girls is 4.9-years and 5.3 -years for boys. In all locations, children had all permanent teeth emerge by age 11 years (excluding 3rd molars). Clinically important differences exist for permanent tooth emergence by study area. Discussion Permanent teeth emerge earlier for Ni-Vanuatu children compared to both Melanesian children of Papua New Guinea as well as other ethnicities across Oceanic countries. These results can be used as a set standard for Vanuatu. Early tooth emergence suggests oral health education programmes should target pregnant women with clinical preventive strategies commencing for their children before 5-years of age.

Alcohol Advertising in Pacific Islands Countries and Territories: A Scoping Review

Introduction: Alcohol has become embedded into the cultural, economic, and social fabric of Pacific Island Countries and Territories (PICT); however, it continues to be a neglected health issue for many PICT. This scoping literature review explores current alcohol advertising policies in each PICT. Methods: This review utilises the 'Preferred Reporting Items for Systematic Review and Meta-Analyses for Scoping reviews' to identify literature on alcohol advertising policies. Twenty-five sources, ranging from 1963 to 2020, form the final data synthesis. Findings: The results of this review reveal that not all PICT have alcohol advertising restrictions in place. Health warning labels as a means of deterring alcohol use are also inconsistent across PICT but aid in consumer decisions. A notable concern in alcohol advertising is the use of culture as a marketing ploy. Conclusion: This review provides essential information on alcohol advertising in PICT. Nine PICT enforce some form of alcohol advertising prohibition, and ten do not. In countries with alcohol advertising, drinking behaviours vary, demonstrating a need for further research on the implementation efforts of current policies. In countries with no alcohol advertising, alcohol use is normalised and portrayed as unproblematic. The use of health warning labels is also not consistent amongst PICT. The use of culture as a marketing ploy is unacceptable as it belittles culture and is disrespectful to leaders. Understanding the alcohol advertising restrictions that work in each PICT can help decrease alcohol consumption and the harms associated with its misuse across all PICT. Keywords: Alcohol, Advertising, Pacific.

Moving with the times: evolution of Buttabean Motivation – a community-based, Pacific-centred approach to health

Buttabean Motivation (BBM) is a grassroot initiative aiming to improve Pasifika and M?ori health through free community bootcamps offering exercise, motivation and nutritional advices, and with online programmes of workouts and meal plans. It is a dynamic organisation, responding to community needs, providing practical solutions to issues such as food insecurity and influenza vaccination while maintaining its core focus of reducing obesity among Pasifika and M?ori through nutrition and physical activity.. BBM forms active and changing relationships with numerous organisations that offer support. They would like to work with the government and the district health boards, but the structure and changing nature of their organisation does not fit traditional funding models. To show that BBM is effective for Pacific people beyond anecdotal evidence, BBM has partnered with University of Auckland researchers. The research team are using a kaupapa M?ori and co-design approach to explore how BBM might benefit the community and reduce health inequities, especially whether BBM’s model of social collectivism enables sustainable weight loss for Pasifika and M?ori in the current obesogenic environment. Weight reduction programmes typically find that after initial success, participants have reverted to pre-programme weight by five years. BBM’s “whole of life change” approach may lead to sustained weight loss not demonstrated by other programmes. Using co-design, a BBM/University of Auckland partnership is evaluating the effectiveness of the BBM programme for sustained health and wellbeing. BBM is grounded in the Pacific/indigenous health frameworks fonofale, te whare tapa wh? and fa’afaletui addressing physical, mental, spiritual, family and social health in the context of people’s lives. The research will use a longitudinal cohort approach study design, using metrics and outcomes of relevance to its participants and the programme. A systems analysis will facilitate understanding of the strengths and challenges to delivering a holistic and sustained service for the community. BBM provides much promise in reducing health inequities for Pasifika and M?ori, however the model creates challenges for ongoing funding, business structure and evaluation. The goal is to find ways that both the programme and social institutions, including funders and evaluators, can adapt to meet these real-world challenges.

Engagement with Diabetes Retinal Screening: An analysis of secondary data from the Pacific Eye Institute in Suva

Objectives: Diabetic retinopathy (DR) is one of the primary causes of preventable vision loss and blindness. Diabetic retinopathy screening (DRS) is essential to detect microvascular damage to the retina; it can be performed in primary care or specialist eye health clinics. The system of referral, screening, and treatment relies on an organized primary care referral pathway, accessible services, and at least a basic level of health literacy among those living with or under threat of developing Diabetes Mellitus (DM). Methods: Routinely collected patient data from the Pacific Eye Institute (PEI) in Fiji was analyzed to describe a) clinical and demographic DR patient characteristics and b) characteristics of patients demonstrating higher clinic engagement (using multiple logistic regression). Results: Of 9287 patients who first attended the PEI for DRS between 2012 and 2017, 22% presented with sight-threatening diabetic retinopathy (STDR) in at least one eye. The average duration of DM was 3 years; self-reported glycaemic control was poor. Indo-Fijian or other ethnicity (both vs iTaukei, OR=2.30, 95%CI 1.96-2.70 and OR=2.18, 95% CI 1.63-2.92, respectively; p<0.001), high blood sugar (OR 1.39, 95%CI 1.10-1.75, p=0.006), longer duration of disease (OR=1.21, 95%CI 1.02-1.43, p=0.027), peripheral neuropathy (OR=1.43, 95%CI 1.24-1.65, p<0.001) and STDR (OR=3.30, 95%CI 2.78-3.92, p<0.001) were associated with greater odds of higher clinic engagement. Male gender (Odds Ratio (OR)=0.83, 95% Confidence Interval (CI) 0.72-0.95, p=0.006), younger or older age (both vs 40-70 years; <40 years, OR=0.48, 95%CI 0.37-0.63, ?70 years OR=0.61, 95%CI 0.48-0.76, p<0.001), year of first clinic visit (2013 vs 2012 OR=0.58, 95%CI 0.50-0.69, p<0.001; 2014 vs 2012 OR=0.36, 95%CI 0.30-0.43, p<0.001) and moderate visual impairment (OR=0.67 95%CI 0.56-0.80, p<0.001) were associated with lower odds of high clinic engagement. Conclusion: Our results identify patient groups that may be more vulnerable to lower engagement with eye health services. Increasing engagement may help reduce delays in screening and treatment. Given the projected continued rise in DM in the Pacific region, investing in robust electronic data systems that collect and connect public health and clinical data is imperative. Health literacy is important for the prevention of DM, timely DM diagnosis, and screening for complications such as DR.

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.

Exploring Key Components of Successful Distance Learning Programs: A Case Study in Palau

Introduction: The Pacific faces multiple healthcare crises, including high rates of noncommunicable diseases, infectious disease outbreaks, and susceptibility to natural disasters. These issues are expected to worsen in the coming decades, increasing the burden on an already understaffed healthcare system. Improvements in technology and accessibility have increased telehealth’s utility and have already proven to reduce costs and increase access to care in remote areas. Telehealth includes distance learning; a form of education that can help alleviate many healthcare issues by providing education to healthcare professionals and upskilling staff, which can promote workforce retention and decrease patient mortality. Distance learning programs at the Ministry of Health in the Pacific nation of Palau were examined and key elements to their success were identified. Methods: Thirty-four people, mostly health professionals at the Belau National Hospital in Palau were interviewed. Standardized questions and surveys were conducted in person throughout the month of July 2019. Findings: Two examples of successful distance learning programs were identified. Consulting with staff and analyzing each program, four factors for a successful distance learning program were identified: having a cohort, having a facilitator, dedicated study time off from work, and motivation. Conclusions: In countries as geographically isolated as the Pacific, with poor access to specialists and resources, telehealth has the potential to radically change how healthcare is delivered. Palau shares similar resources and issues as other countries in the Pacific and the lessons learned from their successful programs can be adapted to help other Pacific nations develop their own distance learning programs.