Pacific peoples have poorer health status across a wide variety of measures compared to the total New Zealand population. They also appear to have the least advantage from changes to the delivery in primary care. This report presents evidence to support improvements in primary care delivery to Pacific peoples.
Purpose
This report presents evidence to support improvements in primary care delivery to Pacific peoples. It arises from a 2010 Request for Proposal (RFP), Improving Pacific Health Outcomes: Research on the delivery of primary care to Pacific Peoples in New Zealand, which was jointly funded by the Ministry of Health (MoH) and the Health Research Council of New Zealand (HRC).
The joint initiative sought to improve knowledge about the most effective ways to improve both Pacific peoples’ access to and use of primary care and, ultimately, Pacific health outcomes.
Methodology
The research team developed cultural methodologies and frameworks appropriate for diverse Pacific communities to involve, engage and capture the views of Pacific peoples. A Pacific Expert Advisory Group (PEAG) oversaw development of the narrative methodology and data collection fono, and considered results against ethnic-specific cultural frameworks to ensure cultural integrity was maintained.
PEAG members recruited research assistants and focus group participants from their ethnic communities around the country. Eighteen research assistants recognised for their roles as effective community networkers were engaged to recruit participants and facilitate meetings in Pacific ethnic languages. There were 36 focus groups in total, held in Auckland, Hamilton, Wellington and Christchurch between 30 September and 10 October 2011. Eight groups were held in English; the remaining 28 were held in Samoan, Tongan, Cook Islands Māori, Niuean, Tuvaluan, Kiribati or Tokelauan.
The research project was guided by the Talatalaga a Aiga methodology and talanoa, which underpinned information gathering. Both methodologies are embedded in on-going relationships or va (sacred space) between communities, families and individuals. The invitation to talanoa and acceptance by participants was part of on-going reciprocal interactions between senior members of the Pacific health sector and communities. As part of this on-going reciprocity, researchers provided food and a small financial contribution to show appreciation, and promised to return and share their research results.
Key Results
The Pacific population is experiencing unmet health needs and variations in the qualtiy of health care. The three major barriers for Pacific are cost, transport and language. Other barriers include family commitments, difficulty in meeting appointment times, difficulty in understanding the nature and necessity of an appointment, lack of access to after hour services, communication barriers, inflexible employment, and feeling cultural discomfort when discussing health issues with non-Pacific practioners. Additionally, structural problems include long waiting times, lack of discussion time with doctor, crowded clinics, and the bringing and minding of children. Providers' concerns are centred on practical issues of appointment systems, contacting people and payments. Some providers have put in place strategies to balance the needs of appointment and walk in patients; multiple contacting methods such as reminder phone calls and text messages; and setting up automatic payements or accepting non-payments or writing off bills.
Improving Pacific engagement in primary care is reliant on both primary care to create an environment and deliver services that is culturally safe and employs strategies that increase Pacific access to and utilisation of primary health care, while at the same time Pacific people taking control of their health and doing the best they can under varying circumstances.