Meeting the needs of Aotearoa New Zealand’s older Pacific People is a challenge. A raft of barriers exists that prevents them enjoying equitable health and wellbeing. Disadvantage ranks most prominently.
The price of visiting GPs, or of collecting a prescription, for example, can often dissuade older Pacific people from accessing appropriate healthcare. Additionally, cultural and language barriers also contribute. Many older Pacific people do not feel like they will be cared for in a culturally safe manner.
These factors — and many others — have all “contributed to Pacific peoples having poorer health and greater unmet needs”, explained Ageing Well Principal Investigator Associate Professor El-Shadan (Dan) Tautolo. Pacific people are the only ethnic group in the nation whose mortality rate has stagnated rather than decreased in recent years.
Associate Professor Tautolo, the Director of the Pacific Health Research Centre at Auckland University of Technology, has consistently been interested in addressing the needs of Pacific communities in New Zealand.
In this study, Associate Professor Tautolo and his AUT team of Professor Janis Paterson, Dr Wendy Wrapson, and Professor Stephen Neville, wanted to understand older Pacific peoples’ views on ageing.
What are their needs, what do they consider the barriers and opportunities to accessing healthcare?
And what matters to older Pacific adults when it comes to social participation and healthy ageing?
These questions are particularly apposite because the number of Pacific people over 65 is expected to rise by 70% over the next two decades, according to Statistics New Zealand.
“Our older Pacific adult population is growing faster than our younger population, and they’re living longer lives as well,” says Associate Professor Tautolo. But research on Pacific people has been relatively limited.
The current study sprang out of Associate Professor Tautolo’s directorship of the Pacific Island Families study a pioneering longitudinal study of 1,400 Pacific children born in Auckland in 2000. What the team discovered in the Pacific Island Families study was the importance of culture. A strong cultural identity was good for Pacific peoples’ health. Those who were in sync with their culture had better health outcomes than those who had lost their cultural mooring.
By design, the Pacific grandparents were not simply participants but also “co-researchers”... leading the charge to fix the very health and wellbeing problems they faced.
About the research
Some of the grandparents of the children in the longitudinal study agreed to take part in this new study, eager to also make a “contribution” to their community. Other recruits were found by a major stakeholder of the project, Vaka Tautua, a ‘by Pacific, for Pacific’ social and healthcare services provider.
Three Pacific ethnic groups were involved — Samoan, Tongan and Cook Islands Māori. Admittedly these three groups represent only a few threads in the diverse tapestry of Pacific people. But they do still make up a significant chunk of New Zealand’s Pacific population. Nearly 100 Pacific grandparents volunteered, over a period of more than two years.
By design, the Pacific grandparents were not simply participants but also “co-researchers”, Associate Professor Tautolo says, leading the charge to fix the very health and wellbeing problems they faced. They were involved in every aspect of the project — design, development, and evaluation. Feeling “empowered”, the grandparent-researchers enjoyed the reciprocal nature of the research: participants gained skills; researchers gained knowledge. Participants took ownership to identify and address the biggest challenges they faced; researchers assisted in co-designing potential solutions to these challenges and working with support services.
Genuine engagement was a critical part of the project. Fostering trust and communication amongst the different Pacific communities was not easy, as language barriers and small differences did exist: Pacific groups are not a monolithic group after all.
“Our primary focus was to engage and develop a co-researcher relationship with our Pacific older people, to ensure that our project identified and addressed the issues which were directly relevant for them.”
“Our primary focus”, explains Associate Professor Tautolo, “was to engage and develop a co-researcher relationship with our Pacific older people, to ensure that our project identified and addressed the issues which were directly relevant for them.”
The grandparents’ health priorities were somewhat unexpected. After much discussion, they wanted to focus on two, achievable areas: foot health and digital literacy. Researchers set about supporting the participants to find ways to address these issues.
The team created a “podiatry assessment action plan”, Associate Professor Tautolo notes, which was tailored individually to all the different ethnic groups. “We came up with a foot screening and maintenance programme which was supported by Auckland University of Technology’s Podiatry Department and delivered to the different Pacific ethnic groups within their community settings.” The study found that this focus on foot care “improved mobility, independence and reduced the likelihood of going to hospital.”
Providing the care within the Pacific community proved critical, something the participants advocated for strongly. As Associate Professor Tautolo explains, it “allowed them to be more in control and familiar with the location – and also gave the podiatry staff and students who were part of the initiative, some valuable experience engaging Pacific people within a community setting.” A win-win situation.
High demand for podiatry assessments suggests that folding a podiatry check into outpatient healthcare assessments in ethnic-specific community settings could be an effective way to head off more serious complications, Associate Professor Tautolo argues. Older Pacific people appear at a higher risk of feet and lower limb health issues. So this small change could make a big impact to improving their overall health.
Getting to grips with digital technology was also important to the Pacific grandparents. Associate Professor Tautolo’s team worked with a local public library in South Auckland to design sessions that allowed the participants to get support and guidance to harness the benefits of computers and software. Staying connected and learning how to access creditable information safely were integral to this guidance.
Associate Professor Tautolo’s team co-designed questions and conducted research with Pacific families and their communities in culturally appropriate ways to enhance health outcomes.
All of the grandparent-co-researchers were “very happy with the project” and the way their involvement refined and improved services that existed within the community for older Pacific peoples. Several participants spoke of the “empowerment” and “sense of value” that involvement in the project inspired in them. This was achieved because of the participatory nature of the project and would not have occurred in a “more traditional” research study, Associate Professor Tautolo explains.
The lessons from the study have been spread far and wide, and in unconventional ways. During Fijian language week, the research team released a video, narrated in Fijian with English subtitles, summarising the study findings. Associate Professor Tautolo also addressed over 250 stakeholders at the Pasifika Medical Association Conference in Auckland in 2018, and at the International Association for Gerontology and Geriatrics Asia Oceania meeting in Taiwan in 2019.
The Study’s collaborative nature has important ramifications for future New Zealand research, especially with minority groups. Associate Professor Tautolo’s and their community of participants demonstrate the benefits of collaborative research partnerships, especially among a population that is often isolated and unheard. Associate Professor Tautolo’s team co-designed questions and conducted research with Pacific families and their communities in culturally appropriate ways to enhance health outcomes.
Make no doubt about it: Pacific Island grandparents participated in, and co-led, this study. It was their research, their results. It is no wonder that the outcomes were so positive.
Watch Dr Tautolo’s presentation, “Charting the life course of Pacific families” at He Ora Te Whakapiri symposium in 2018: