Perceptions on Healthy Eating Impact the Home Food Environment: A Qualitative Exploration of Perceptions of Indigenous Food Gatekeepers in Urban Fiji.

The home food environment (HFE) can have important direct and indirect impacts on dietary practices. Nutrient transitions in the HFE of Pacific Island countries (PICs) are key contributors of the high rates of adult and childhood overweight and obesity in the region. Pacifica mothers are important sociocultural agents who play critical roles in their HFE through setting eating-appropriateness standards and mitigating the impacts of food availability and accessibility on the HFE. This study used an interpretative phenomenological approach to explore how urban indigenous Fijian mothers perceive healthy eating and how these perceptions impacted the food decisions they made for their families. Mothers in this study held complex, multifaceted perceptions on healthy eating and these perceptions had both positive and negative impacts on the family food choices they made, the strategies they adopted for healthy eating and their perceived motivators for healthy eating. The findings of this study underscore the need for a deeper understanding and analysis of uptake of public health messaging related to healthy and unhealthy eating and the importance of targeted promotion of healthful nutrition in this community. Promoting consumption of traditional and locally grown foods can enhance nutrition and food security and combat nutrition transition in the region.

"I think taking herbal medicine first can help prevent. If it doesn't work, then can take start taking the medication given by the doctors." Patients' perceptions towards hypertension in Fiji.

BACKGROUND: Hypertension remains a public health challenge worldwide however, the prevention, detection, treatment and management of this condition are not highly prioritized. Health knowledge has an important impact on individual's health. The ability to actively participate in screening, diagnosis and management of hypertension are influenced by patient's knowledge of hypertension. To understand why hypertension is so difficult to control, it may be of benefit to gain an understanding of the patient's perspective. Hence, the aim of the study is to explore the perceptions of patients on prevention and diagnosis of hypertension in Fiji. METHODS: The study used a qualitative method approach. The study was conducted at the four purposively selected health centers in the Lautoka/ Yasawa medical subdivision. A purposive sampling was used which included all the patients who attended the SOPD, age more than 18 years and above, diagnosed with hypertension for 6 months or more and attended clinic at one of the 4 selected health centers. Semi-structured open-ended interview guide were used to collect data among patients through in-depth interviews. Thematic analysis was used manually to analyze the data using four steps that is immersion in the data, coding the data, creating categories and identifying themes / subthemes. RESULTS: Twenty-five SOPD patients took part in the in-depth interview and the responses were grouped into two themes. The themes emerged included hypertension knowledge and diagnosis of hypertension in a closed family and self. Subthemes derived from the hypertension knowledge were measures of awareness, hypertension aetiology, risk perception, origin of information and concept of prevention. Sub themes derived from the diagnosis of hypertension in a closed family were perception when first diagnosed, hypertension in relation and hypertension impact. Patients' knowledge on etiologies and risk factors of hypertension were generally poor. Majority of the participants learnt about hypertension in hospitals and few over radios and television. Diagnosis in a closed family triggered worrisome, fear and fright on some patients. CONCLUSION: Majority of the patients have less knowledge about various risk factors of hypertension. Worrisome, fearful, frightful, frustration and sadness were some of the reactions and emotions highlighted by the patients. It is important to design culturally tailored interventions that address the psychological and behavioral needs of the patients. Recommendation to conduct further studies to understand the perception of hypertension among the general public.

Local and Traditional Ecological Knowledge of Fish Poisoning in Fiji.

Fish poisoning (FP) affects human health, trade and livelihood in Fiji, where management has depended mainly on traditional ecological knowledge (TEK). This paper investigated and documented this TEK through a 2-day stakeholder workshop, group consultation, in-depth interviews, field observations, and analyses of survey data from the Ministry of Fisheries, Fiji. Six TEK topics were identified and classified as preventative and treatment options. The preventive approach involves identifying toxic reef fishes, the spawning season of edible seaworms, hotspot areas of toxic fishes, folk tests, and locating and removing toxic organs. For example, 34 reef fish species were identified as toxic. The FP season was associated with the spawning of balolo (edible seaworm) and the warmer months of October to April (cyclone seasons). Two well-known toxic hotspots associated with an abundance of bulewa (soft coral) were identified. Folk tests and locating and removing toxic fish organs are also practised for moray eels and pufferfish. At the same time, various locally available herbal plants are used to treat FP as the second line of defence. The TEK collated in this work can help local authorities better identify the sources of toxicity, and applying TEK preventive measures could stem the tide of fish poisoning in Fiji.

Understanding Sociocultural Influences on Physical Activity in Relation to Overweight and Obesity in a Rural Indigenous Community of Fiji Islands.

INTRODUCTION: Given health disparities and increased rates of obesity and non-communicable diseases seen in Indigenous populations worldwide and the evidence connecting sociocultural knowledge with physical activity, health, and wellbeing, this research was undertaken to understand the social and cultural components contributing to obesity in the Indigenous Fijian rural areas. METHODS: This research is a community-based participatory research (CBPR) project, which engaged community members from a rural iTaukei village in the Fiji Islands. Data collection was carried out through community consultation and semi-structured interviews. The data was analysed using descriptive thematic analysis. RESULTS: Four major themes emerged associated with sociocultural, economic, political, and physical environmental factors. Males emphasised sports and working on farmlands as preferred types of physical activity, while females focused on family activities and daily activities and support for females' separate playgrounds. There was a focus on previous health promotion programs that did not incorporate the cultural values, cultural competence beliefs, and traditional ways of the rural Indigenous Fijian community. CONCLUSION: The healthcare providers and policymakers need to recognise the iTaukei community culture and appreciate traditional methods to promote equitable community participation in decision-making for health promotion. These findings should inform future research and community-based health programs to address the physical activity levels of the rural Indigenous community and may be relevant to other Indigenous peoples.

Cultural values influencing iTaukei women's discussion of family planning in the home.

Pacific Sexual and reproductive health is influenced by cultural taboos and sensitivities. Although Pacific values are integral to family planning, open communication in the home is often difficult in the face of changing socio-cultural norms. This study explores the experiences of iTaukei Pacific women living in Fiji and Aotearoa New Zealand, and their discussion of family planning within the family setting. The study utilises talanoa methodology to understand women's realities and their navigation through shifting sexual and reproductive norms in both countries. The study found that although family may be seen as a place of 'truth' in which appropriate, culturally sensitive family planning communication should be available, this was challenged by cultural taboos or tabu which were persistent in family planning discussions. The study calls for greater reliance on holistic approaches to Pacific family planning perspectives and a greater examination of va or the spaces within which Pacific women's experiences are negotiated and informed.

"Once you get cancer you die. There is no way to get saved from cancer." A qualitative exploration of patients' perceptions towards cancer in Fiji.

BACKGROUND: Understanding patients' perspective to get an insight into cancer, and how best the public health systems can battle with this disease is the way forward in this current world. This study aimed to explore patients' knowledge about common cancers, barriers to assessing cancer information and cancer preventative approaches in Fiji. METHODS: The study used a qualitative method approach that was conducted among patients who attended Special Outpatients (SOPD) at the four selected health centres in Lautoka Subdivision, Fiji from 1st March to 30th April 2021. A semi-structured open-ended questionnaire was used to guide in-depth interviews. These audio recordings were transcribed and analysed using thematic analysis. All interview transcripts were read and similar words and phrases were assigned numbers which were grouped together to identify themes and sub themes. RESULTS: Twenty-eight patients took part in the in-depth interview and the responses were grouped into four themes including; cancer knowledge, diagnosis of cancer in a close friend/family, barriers of communication and optimizing cancer awareness. Patients' awareness about common cancers and cancer risk factors was low. Many barriers for cancer screening were highlighted including stigmatization, fear, worry, death, lack of information, herbal medicine use, lack of resources and delay in diagnosis. Awareness strategies highlighted by participants included community outreach programs, house to house visits, opportunistic screening, engagement of community health care workers and the concept of a cancer hub centre. CONCLUSION: It is evident that there is a range of views from patients towards cancer and it is important to understand these perceptions to better guide public health interventions concerning cancer. This puts more focus on the need to invest more in information, education, and communication material for public campaigns that target a variety of people for a wider reach.

Healthcare workers' perceptions on diabetic foot ulcers (DFU) and foot care in Fiji: a qualitative study.

OBJECTIVES: To explore the perception of healthcare workers (HCWs) on diabetic foot ulcers (DFU) and foot care in Rotuma, Fiji. DESIGN: Using a qualitative study design, two focus group discussions (FGDs) were conducted among HCWs. A semistructured open-ended questionnaire was used to guide the discussion session. Each FGD was audiorecorded and was transcribed. The transcriptions were then manually analysed using thematic analysis. SETTING: Rotuma hospital, Fiji. PARTICIPANTS: HCWs who were working in Rotuma hospital for at least a year and were involved in clinical foot care of type 2 diabetes mellitus patients were included. RESULTS: There were five main themes, namely, depth of knowledge, quality of care in practice, factors of influence on practice, lack of resources and capacity building. Participants had superficial knowledge that showed lack of in-depth scientific knowledge. A lack of staffing in the clinics affected the delivery of service. Additionally, patients defaulting clinics, late presentations with DFU and traditional medicine also affected the quality of healthcare service in clinics. There was also a need for a multidisciplinary team to prevent and manage DFU. HCWs mostly advised on glycaemic control and ignored offering foot care advice in clinics due mainly to the lack of sound knowledge on foot care. There was also a lack of resources, infrastructure, space and professional development opportunities, which negatively impacted how HCWs deliver foot care services to patients. CONCLUSION: HCWs lack significant in-depth knowledge on DFU and foot care. In addition, these are the availability of traditional medicine that delays presentations to hospital, further reducing the quality of services. HCWs need to keep their knowledge and skills updated through regular in-service training on foot care. Resources, infrastructure and supply chains need to be maintained by those in power to ensure HCWs deliver quality foot care services.

Perception of mothers about Acute Respiratory Infections (ARIs) and risk factors affecting children Under 5 Years (U5Ys) in Fiji.

PURPOSE: To explore the perception of mothers about Acute Respiratory Infections (ARIs) and their risk factors affecting children Under 5 Years (U5Ys) in Fiji. DESIGN: This was a qualitative study done in the Integrated Management of Childhood Illness (IMCI) Clinic in Ba Hospital, Fiji. Mothers who had brought in their children with ARIs were selected through a purposive sampling method. A semi-structured open-ended questionnaire was used to guide in-depth interviews. The interviews were transcribed and the thematic analysis was done to look at the themes and sub-themes that emerged. RESULTS: A total of 30 mothers were interviewed. There were five themes that were derived from the interviews including the mothers' perception of ARIs; treatment methods; perceived barriers; services provided by IMCI clinic; and recommendations and suggestions. The mothers were familiar with the causes, risk factors and able to recognize severity of ARIs based on the local context. They mostly relied on traditional and home remedies for ARIs. Most mothers preferred injections for treatment for their child. There were many perceived barriers of ARIs prevention such as traditional norms and poor social support. Most mothers stayed in rural areas which caused poor accessibility to health care services. Few mothers had issues with poor attitude and skills of health care workers. CONCLUSIONS: There are multiple factors that are barriers in reducing the risks of ARIs. There needs to be policies implemented to support the health of children in the communities as well as social support structures. PRACTICE IMPLICATIONS: This study provides a clear picture of the perception of the mothers regarding ARIs in children under five years old. With this information at hand, it is easier to answer the question regarding the perceptions of the mothers of ARIs and the risk factors and design tailored interventions to prevent ARIs among children.

Perception of pregnant women towards early antenatal visit in Fiji: a qualitative study.

BACKGROUND: Antenatal Care (ANC) is an opportunity to provide care to prevent potential maternal and new born mortality and morbidity and reduce new born mortality and morbidity. There has been an increase in the number of women receiving early ANC over the last two decades, however, in many developing regions such as Fiji, women are still delaying initiation of ANC. Therefore, the aim of this study is primarily to explore reasons for delayed initiation of ANC appointments and to explore knowledge and perception of pregnant mothers towards early antenatal appointments in Fiji. METHODS: The study uses a qualitative approach. Data was collected among pregnant women more than 18 years of age after 12 weeks of gestation attending their first ANC clinic at the Ba Mission Hospital (BMH) from February 28 to April 2, 2020. Heterogenous purposeful sampling method was used to select 25 pregnant women for the study. A semi-structured open-ended questionnaire was used for face to face in-depth interviews. Data was analyzed manually using thematic content analysis after verbatim transcription of the interviews. RESULTS: The mean age of the participants was 25.8 ± 5.9 years (age range of 19-40 years). The average gestational age of those making a booking for a consultation was 5.4 ± 1.4 months with a range of 4 to 8 months. The majority of women were multigravida (64%) and multiparous (40%). The main themes that emerged from the study were: i) perception of early ANC booking; ii) perceived barriers of early ANC booking and; iii) enabling factors of early ANC booking. Even though pregnant women have a good knowledge of when to initiate ANC, the practice of early booking was influenced by many other factors. CONCLUSIONS: The results of this study highlight the need to change the current booking system. Efforts are needed to attract the hard-to-reach women through outreach visits and increased communication between health care workers and the community with the use of community resources such as community health workers and traditional birth attendants. The media should be used to create awareness on timing and importance of early ANC visits at a community level.

Traditional knowledge of medicinal plants on Gau Island, Fiji: differences between sixteen villages with unique characteristics of cultural value.

BACKGROUND: Traditional resource management (TRM) systems develop depending on local conditions, such as climate, culture, and environment. Most studies have focused on the TRM system itself, excluding the people who manage the system, and the relationship between the system and the people. The use of resources and people is intimately linked through the practice of TRM systems on Gau Island and this relationship needs to be understood to advance sustainable resource use. METHODS: A survey was conducted on the use of medicinal plants on Gau Island, Fiji. Interviews were conducted from September 2013 to January 2015 with knowledgeable members of each community. The types of plants, prescriptions, and health problems were documented, and social and ecological factors affecting the sustainability of TRM of medicinal plants used in each of the 16 villages were statistically analysed by linear regression analysis. RESULTS: A total of 58 medicinal plants used on a daily basis to treat 27 health problems were identified on Gau. Two medicinal plants, Botebotekoro (Ageratum conyzoides) and Totodro (Centella asiatica), were used in all districts to treat various health problems. There were contrasts between the villages in the medical lore and prescriptions, and villages often used different traditional treatments than others for the same ailment; therefore, the status and knowledge of medicinal plants have developed distinctly in each village. Geographical and social factors have been suggested as possible reasons for the differences in regional resource utilisation among villages. Statistical analysis of the relationship between the state of TRM and social and ecological factors suggest that community solidarity has a positive impact on the sustainable practice of TRM. This study showed that traditional practices simultaneously contribute to the conservation of the natural environment and the binding of communities. CONCLUSIONS: The results highlight the importance of understanding how TRM systems can contribute to the conservation of the natural environment. Cultural activities are essential to raise community solidarity, which has led to the sustainable use of natural resources. This suggests that merely documenting the use of medicinal plants is not enough to ensure that the skills and knowledge are passed down to the next generation.