Worldviews of hearing health for Pacific peoples in Aotearoa New Zealand: a mixed methods study.

Introduction Pacific peoples experience inequity in accessing hearing health care and are disproportionately exposed to the underlying determinants impacting ear and hearing health in Aotearoa New Zealand. Understanding community members' worldviews, including perspectives, beliefs and values, is essential in developing appropriate and responsive hearing healthcare services to meet the needs of Pacific peoples. Aim The purpose of this paper is to understand the worldviews, knowledge and beliefs held by Pacific peoples regarding hearing health in Aotearoa New Zealand. Methods A mixed-methods approach was used. Twelve semi-structured face-to-face interviews were conducted with Pacific community members. Twenty-five participants completed an online questionnaire. A simultaneous, integrated mixed-methods approach was used to analyse the qualitative and quantitative data. Results Five main themes were established, which were: The Meaning of Hearing; Causes of hearing loss; Consequences of hearing loss and Disability; and Improving health care for ear disease and hearing loss. Discussion Pacific peoples value hearing health to communicate and connect with their families and communities. Participants highlighted the importance of hearing health across the life course. Although the study findings revealed there is potentially less stigma and shame around hearing loss in New Zealand, denial and fatalistic attitudes towards hearing loss may delay some people from seeking healthcare services. Participants expressed key ways in which the health system can be more responsive to the hearing health needs of Pacific peoples in Aotearoa New Zealand.

Ethnic-specific characteristics associated with longitudinal response patterns from prebirth to 12 years: evidence from Growing Up in New Zealand.

BACKGROUND: Longitudinal studies can generate valuable scientific knowledge, but can be compromised by systematic attrition. Previous research shows that sociodemographic characteristics (eg, ethnicity, age, educational level, socioeconomic circumstances) are associated with attrition rates. However, little is known about whether these characteristics differ by ethnicity, and how this impacts cohort retention strategies. METHODS: Using antenatal to 12-year data from the Growing Up in New Zealand birth cohort study (N=6743), we examined transversal response rates by ethnicity (Maori, Pacific, Asian, European), used sequence analysis and cluster analysis to identify unique longitudinal response patterns, and binary logistic regression to examine ethnic-specific sociodemographic characteristics associated with these response patterns. RESULTS: The overall response rate at 12 years was 71.0%, with ethnic differences in response rates widening over the six data collection waves. Three longitudinal response patterns were identified: frequent responders (65.2%), intermittent non-responders (29.6%) and frequent non-responders (5.2%). Sociodemographic characteristics such as younger maternal age and lower maternal education were associated with a higher likelihood of membership in the non-response clusters across all ethnic groups. However, there were also important nuances by ethnicity. Individual level factors (eg, household material deprivation and maternal general health) tended to be associated with non-response for Europeans, whereas structural level factors (eg, area-level deprivation and racial discrimination) tended to be associated with non-response for Maori, Pacific and Asian peoples. CONCLUSION: Ethnic differences in longitudinal response patterns are due to multiple factors of disadvantage, and therefore require targeted retention strategies. Stratifying analyses by ethnicity is important for revealing nuanced insights.

Investigating the relationship between prenatal alcohol exposure and children's behavioural and emotional development: analysis of the Growing Up in New Zealand study.

AIMS: To examine the relationship between prenatal alcohol exposure (PAE) and children's behavioural and emotional development in a large generalizable sample of women and their children in Aotearoa New Zealand. METHODS: Using data from the Growing Up in New Zealand longitudinal cohort, we investigated the relationship between maternal PAE and behavioural and emotional development in 8-year-old children. We explored secondary outcomes including measures of language, executive function, academic achievement, and adaptive behaviour. RESULTS: We found no significant differences in the measures of behavioural and emotional development in children 8 years old based on alcohol consumption. No significant differences in behavioural and emotional development were found based on amount of PAE and when PAE occurred, despite controlling for a range of potential confounding factors, such as neighbourhood deprivation and maternal health measures. PAE was associated with significantly higher scores for parent-rated oral language indicating better oral language. In Maori mothers, PAE was significantly associated with an increased risk of higher scores on two of the Strengths and Difficulties Questionnaire subscales. CONCLUSIONS: We did not find an association between PAE and behavioural and emotional development in children aged 8 years. PAE and behavioural and emotional development are difficult to measure accurately, and the moderating variables between them are complex. Future analyses will require larger cohorts of mothers and their children using precise measures of PAE and outcomes to enable more precise estimates of association.

A study of Samoan, Tongan, Cook Island Maori, and Niuean infant care practices in the Growing Up in New Zealand study.

BACKGROUND: Despite a low rate of infant mortality, Aotearoa New Zealand has a high rate of Sudden Unexpected Death in Infants (SUDI), with disproportionate impact for Pacific infants. This study explored the infant care practices, factors and relationships associated with increased risk of SUDI amongst Tongan, Samoan, Cook Islands Maori, and Niuean mothers in New Zealand, to inform evidence-based interventions for reducing the incidence of SUDI for Pacific families and their children. METHODS: Analysis comprised of data collected in 2009-2010 from 1089 Samoan, Tongan, Cook Islands Maori and Niuean mothers enrolled in the Growing Up in New Zealand longitudinal cohort study. The sleeping environment (bed-sharing and sleep position) of the infants was assessed at 6 weeks. Multivariable logistic regression analysis were conducted, controlling for sociodemographic factors to explore the association between selected maternal and pregnancy support and environment factors and the sleeping environment for infants. RESULTS: Mothers who converse in languages other than English at home, and mothers who consulted alternative practitioners were less likely to follow guidelines for infant sleeping position. Similarly language, smoking, alcohol, household dwelling, crowding and access to a family doctor or GP were associated with mothers following guidelines for bed-sharing. CONCLUSION: The impact of SUDI on Pacific infants may be lessened or prevented if communication about risk factors is more inclusive of diverse ethnic, cultural worldviews, and languages. Societal structural issues such as access to affordable housing is also important. This research suggests a need for more targeted or tailored interventions which promote safe sleeping and reduce rates of SUDI in a culturally respectful and meaningful way for Pasifika communities in Aotearoa, New Zealand.

Is the Concept of Solastalgia Meaningful to Pacific Communities Experiencing Mental Health Distress Due to Climate Change? An Initial Exploration.

The critical inquiry is how Pacific communities themselves characterize mental distress as a result of climate change. If not solastalgia, what more suitable terms might they use? This viewpoint article aims to initiate a discourse using solastalgia as the focus for the Pacific by 1. providing a definition of solastalgia; 2. examining its application in Pacific research; 3. presenting limitations of solastalgia; and 4. assessing its appropriateness for Pacific communities. There is a dearth of research using solastalgia, particularly within Pacific communities. The Pacific region's diverse contexts may already possess terms that effectively convey place-based distress that solastalgia attempts to describe. However, the authors found that solastalgia holds limited utility in the Pacific region, primarily based on a review of the literature, which involved keyword searches in Google Scholar such as solastalgia, mental health, mental distress, wellbeing, climate change, environmental distress, displacement, and Indigenous and Pacific peoples. More importantly, the concept is limited in capturing Pacific experiences of land loss due to climate change events, particularly, as the Pacific imbues land with profound significance, intertwined with culture, identity, and wellbeing. Land loss equates to a loss of culture, identity, wellbeing, and kinship in most Pacific contexts. It is apparent that broader and more holistic approaches are required.

Investigating the health status of primary school children in Tonga: Lessons learnt and reflections on field work in the Pacific Islands.

Globally, the child health focus has been on reducing under-5-year mortality, with large populations in low-resource regions prioritised. Children in older age groups, particularly in less populated regions such as the Pacific, have received limited attention. Child health research in the Pacific region has been lacking, and research approaches for the region have historically been from Western biomedical paradigms. We completed the study of primary school children's health over a period of 5 years. Firstly, we conducted a literature review, then we completed an audit of hospital admissions of primary school children, then we completed a two-round Delphi process and finally, we piloted the survey in three primary schools. Our results found there were high levels of oral health problems, ear health, obesity and exposure to violence and poverty impacting on the quality of health of primary school-age children. Identifying these indicators was made possible by the partnerships and trust established by the study team and provides specific and measurable targets for future work to improve the quality of child health outcomes. This paper describes key field work lessons learnt for research in the Pacific region. It must: (i) be on the platform of relationship, cultural safety and local ownership; (ii) include consideration of holistic Pacific paradigms of health; (iii) be adaptive to the context and environment; and (iv) be committed to long-term partnership and work.

Strategies and tools to aid the transition between paediatric and adult health services for young adults with neurodevelopmental disorders: a scoping review protocol.

INTRODUCTION: The transition from paediatric to adult healthcare comes with risk and vulnerability for young adults with neurodevelopmental disorders and their carers. Deficits in health, social and disability systems and the fragmentation of services exacerbate problems during the transition period, leaving young people and their carers feeling disconnected with existing services. With advances in healthcare, the number of young adults with neurodevelopmental disorders requiring transition services is increasing. This scoping review aims to summarise the strategies and tools that help ease the transition to adult services for young adults with neurodevelopmental disorders. METHODS AND ANALYSIS: Systematic searches of MEDLINE, EMBASE and PsychInfo on the OVID platform were performed on 28/05/2022. Studies that describe tools or strategies designed to ease the transition from child-centred to adult-orientated healthcare for young adults with neurodevelopmental disorders will be included. Two authors will independently review titles, abstracts and full-text articles against the inclusion criteria to determine eligibility. Data will be extracted and synthesised using descriptive stats and thematic analysis. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines will be followed. CONCLUSION: This scoping review will synthesise the published literature describing strategies and tools to improve the transition of young adults with neurodevelopmental disorders to adult services. The findings of the review may inform areas of future research to improve care for all involved in the transition process. ETHICS AND DISSEMINATION: This review will include published data; as such, ethics approval is not required. We will publish our findings in an open-access, peer-reviewed journal and summarise the results for dissemination to the wider community of clinicians, allied healthcare professionals, teaching professionals, policymakers, non-governmental organisations, impacted youth and parents.

Pakeha/Palangi positionality: disentangling power and paralysis.

Significant health inequities in Aotearoa present compelling evidence that responsibilities under Te Tiriti o Waitangi have not been upheld. The aim of this paper is to present our experiences as Pakeha/Palangi working in Maori and Pasifika health in Aotearoa. We are interested in what prevents the upholding of responsibilities by tangata Tiriti and in how, as tangata Tiriti, we can do better. In this paper we explore responsibilities of tangata Tiriti by describing the context and evaluating power, paralysis, and positionality. "Power" is identified as a key factor continuing to perpetuate colonisation and systemic racism. "Paralysis" occurs due to individual racism, apathy, guilt and/or a fear of doing wrong. "Positionality" is an internal and external process that involves consciousness of biases, perspectives, values, privileges, beliefs, superiority and identities. Finally, we point to tools of engagement with the aim of serving and creating space for self-determination for Maori and Pasifika peoples.

Surviving versus thriving: The wellbeing of primary school aged children in Tonga.

AIM: To enable improvements in global child health, the focus must move beyond child survival to child wellbeing. In the Pacific Islands, the wellbeing of children has received little attention. This study aimed to investigate the wellbeing of children from three primary schools in Tonga. METHODS: A cross-sectional survey was completed in three primary schools in Nuku'alofa with children aged 5-15 years. The study participants (256 children, 143 caregivers) completed the Child Health and Illness Profile - Child Edition, CHIP-CE (Version 1.0). RESULTS: On average, >70% of children and caregivers described home and school environments as positive. From the children's reports, boys had significantly lower scores for risk avoidance than girls (3.40 vs. 3.73, P < 0.001). Children aged 5-7 versus 8-15 years had significantly lower scores for satisfaction (3.63 vs. 3.92, P = 0.002), resilience (3.34 vs. 3.56, P = 0.016) and achievement (3.25 vs. 3.62, P = 0.002). From the caregivers' report, girls had significantly lower scores for academic performance than boys (3.60 vs. 3.81, P = 0.04). Boys had significantly lower scores for individual risk association compared to girls (3.93 vs. 4.29, P = 0.01). Overall CHIP-CE scores were lower than those of comparable populations in the West, while at the same time protective factors were documented. CONCLUSIONS: Understanding child wellbeing in the Pacific is critical for strengthening protective factors known to mitigate poor child health outcomes. Continuing to base global child health success on child survival alone misses opportunities for improving the wellbeing of nations.

Evaluation of vision screening of 5-15-year-old children in three Tongan schools: comparison of The Auckland Optotypes and Lea symbols.

BACKGROUND: Comprehensive vision screening programmes for children are an important part of public health strategy, but do not exist in many countries, including Tonga. This project set out to assess: (1) the functional vision of children attending primary schools in Tonga and (2) how a new recognition acuity test (The Auckland Optotypes displayed on a tablet computer) compares to use of a standardised eye chart in this setting. METHODS: Children from three Tongan primary schools were invited to participate. Acuity testing was conducted using a standardised recognition acuity chart (Lea symbols) and the tablet test displaying two formats of The Auckland Optotypes. Measures of ocular alignment, stereo acuity and non-cycloplegic photorefraction were also taken. RESULTS: Parents of 249 children consented to participate. One child was untestable. Only 2.8 per cent of testable children achieved visual acuity worse than 0.3 logMAR in the weaker eye. Results from the Spot Photoscreener suggested that no children had myopia or hyperopia, but that some children had astigmatism. The tablet test was practical in a community setting, and showed ±0.2 logMAR limits of agreement with the Lea symbols chart. CONCLUSION: The sample of children in Tongan primary schools had good functional vision. A modified version of the tablet acuity test is a promising option for vision screening in this context.

Child morbidity as described by hospital admissions for primary school aged children in Tonga 2009-2013.

AIMS: To describe inpatient utilisation patterns for primary school aged children in Tonga. METHODS: We described admissions for children aged 5-11 years to the main hospital in Tonga from January 2009 to December 2013. Rates with 95% confidence intervals (CI) were compared using rate ratios (RR). RESULTS: There were 1,816 admissions. The average annual admission rate was 20.2/1,000 (95% CI 19.3-21.1). Hospital admission rates were higher in younger than older children (5-7 versus 8-11 years, RR=1.28, 95% CI 1.18-1.41) and in boys than girls (RR=1.52, 95% CI 1.38-1.68). Injury and poisoning (28%), non-respiratory infectious diseases (19%), respiratory conditions (16%), abdominal/surgical conditions (13%) and dental (9%) were the most frequent admission reasons. A larger proportion of younger versus older children were hospitalised for dental (16% vs 1%, P<0.001) or respiratory conditions (18% vs 14%, P=0.02). A larger proportion of older children were hospitalised for abdominal/surgical conditions (15% vs 11%, P=0.008), other infectious diseases (21% vs 17%, P=0.04), other conditions (10% vs 6%, P<0.001) and cardiac conditions (2% vs 1%, P<0.001). CONCLUSIONS: In children 5-11 years in Tonga, 85% of admissions were for five groups of conditions. These data inform priority areas for healthcare spending and enable comparisons over time and between different Pacific countries.