The prevalence of chronic kidney disease in Samoans living in Auckland, New Zealand.

AIMS: Pacific peoples have higher rates of chronic kidney disease (CKD) and are five times more likely to commence kidney replacement therapy compared with New Zealand (NZ) Europeans. As the majority live Auckland, this study looked at the prevalence of CKD in two Auckland Pacific Island health providers caring for a large proportion of Pacific peoples, of which almost 50% are Samoan, as well as NZ Europeans. METHODS: De-identified information was requested on individuals who had two or more CKD tests (serum creatinine and urinary albumin creatinine ratios) more than 3 months apart. CKD prevalence across different demographic groups was determined. Logistic regression was used to look at associations of known risk factors and CKD. RESULTS: Data from 25 127 patients was evaluated. Of the total sample, 7451 individuals identified as Samoans. The prevalence of CKD amongst all Samoans in this sample was 17.8% increasing to 36.3% in those Samoans that had been tested for CKD. The prevalence of CKD in this total sample was 13% increasing to 27.5% considering only those who had CKD testing. The odds of Samoans having CKD (adjOR: 1.9 [95%CI 1.7, 2.2]), all other Pacific Island ethnicities identified and NZ Maori (adjOR:1.5 [95%CI 1.3, 1.8]), were increased compared with non-Maori-non-Pacific (likelihood p value <.001). CONCLUSION: We report the high prevalence of CKD (15.9%-33.4%) in Samoans living in New Zealand. This reveals an urgent need for further studies to develop strategies to prevent or reduce the development of kidney failure and premature death.

Global health classroom: mixed methods evaluation of an interinstitutional model for reciprocal global health learning among Samoan and New Zealand medical students.

BACKGROUND: Global health education partnerships should be collaborative and reciprocal to ensure mutual benefit. Utilisation of digital technologies can overcome geographic boundaries and facilitate collaborative global health learning. Global Health Classroom (GHCR) is a collaborative global health learning model involving medical students from different countries learning about each other's health systems, cultures, and determinants of health via videoconference. Principles of reciprocity and interinstitutional partnership informed the development of the GHCR. This study explores learning outcomes and experiences in the GHCR between students from New Zealand and Samoa. METHODS: This study used a mixed methods approach employing post-GHCR questionnaires and semi-structured face-to-face interviews to explore self-reported learning and experiences among medical students in the GHCR. The GHCR collaboration studied was between the medical schools at the University of Otago, New Zealand and the National University of Samoa, Samoa. RESULTS: Questionnaire response rate was 85% (74/87). Nineteen interviews were conducted among New Zealand and Samoan students. Students reported acquiring the intended learning outcomes relating to patient care, health systems, culture, and determinants of health with regards to their partner country. Interview data was indicative of attitudinal changes in relation to cultural humility and curiosity. Some reported a vision for progress regarding their own health system. Students in the GHCR reported that learning with their international peers in the virtual classroom made learning about global health more real and tangible. The benefits to students from both countries indicated reciprocity. CONCLUSIONS: This study demonstrates GHCR to be a promising model for collaborative and reciprocal global health learning using a student-led format and employing digital technology to create a virtual classroom. The self-reported learning outcomes align favourably with those recommended in the literature. In view of our positive findings, we present GHCR as an adaptable model for equitable, collaborative global health learning between students in internationally partnered institutions.

Kidney failure in Samoa.

BACKGROUND: There is limited literature on kidney disease in the Pacific Region, despite it being recognised as a leading cause of death in some Pacific Island nations. Kidney replacement therapy is only available in a handful of Pacific Islands. This paper reports the epidemiology of haemodialysis patients in Samoa. METHODS: Registry data from the National Kidney Foundation of Samoa was analysed to estimate the incidence and prevalence rates of kidney failure from the rates of haemodialysis in Samoa and to explore some of the demographic features related to kidney failure in Samoa. FINDINGS: In total, 393 patients have received long-term haemodialysis in the National Kidney Foundation of Samoa since its inception in 2005 until August 2019. 43% of the haemodialysis population were women and the mean age of people dialysed was 54.9 years. The crude mean incidence rate of kidney failure in Samoa, based on treated kidney failure cases, is 224 patients per million population with a crude prevalence of 629 patients per million population. Diabetic nephropathy (69.4%) was the leading cause of kidney failure. INTERPRETATION: This is the first paper to report the epidemiology of haemodialysis patients in Samoa and reveals an urgent need for further studies on the extent of chronic kidney disease, and kidney failure, in Samoa to develop country specific prevention strategies to mitigate this growing burden and optimise care for kidney failure patients in Samoa. FUNDING: : No funding was received for this study.

The perspectives of Samoan patients and health professionals about access to renal services in New Zealand.

AIM: Information about Pacific patients' access to renal services is limited. This research aims to describe Samoan patients' access to nephrology services in New Zealand. METHODS: Interviews were conducted with six health professionals and four Samoan patients about access to renal services in 2016. Participants were recruited using the snowball method. Interviews were audio-recorded and transcribed. Field notes were also taken. Data were analysed and coded to identify emerging key themes about how Samoan patients access renal services in New Zealand. RESULTS: Health professionals and Samoan patients' perspectives on pathways for accessing renal services in New Zealand were similar. However, there were differences between perspectives and access. Samoan patients' actual pathways or access to services were often complex involving acute presentations to hospital. Patients moving between New Zealand and Samoa also contributed to these complexities. Miscommunications between patients and health professionals, patients' lack of understanding about chronic kidney diseases, their beliefs and use of traditional medicine also impacted on their pathways to services. CONCLUSION: This study identified factors that affected Samoan patients' access to renal services in New Zealand. Raising awareness of chronic kidney diseases and addressing barriers to accessing services is likely to enable timely interventions and improved outcomes.

Evaluating the effectiveness of a programme for improving the participation and academic success of an underrepresented minority group in New Zealand.

Pacific peoples are a minority under-represented ethnic group in higher education in New Zealand. This article explores the effectiveness of a specific programme, which sought to improve outcomes of Pacific students in the tertiary environment. The aim of the evaluation was to determine the effectiveness of an intervention programme (2013-2015) to increase the participation and academic success of Pacific students in the first year in Health Sciences. The study found the academic results of Pacific students who participated in the intervention programme were significantly better compared to those who did not. The findings inform future research, suggesting that, when assessing the effectiveness of a programme, it is useful to explore the performance of the whole cohort separately to those who declared intention or interest to attend the programme. Strategies to support participation of each of these groups are likely to be different. Having a standardised approach when comparing groups will adjust for any confounding factors or prior differences. This will allow a more accurate assessment of the effectiveness of the programme being evaluated. This paper presents the importance of a robust approach to the delivery and evaluation of intervention programmes for improving outcomes for underrepresented students in the tertiary environment.

Proposed new industry code on unhealthy food marketing to children and young people: will it make a difference?

Reducing the exposure of children and young people to the marketing of unhealthy foods is a core strategy for reducing the high overweight and obesity prevalence in this population. The Advertising Standards Authority (ASA) has recently reviewed its self-regulatory codes and proposed a revised single code on advertising to children. This article evaluates the proposed code against eight criteria for an effective code, which were included in a submission to the ASA review process from over 70 New Zealand health professors. The evaluation found that the proposed code largely represents no change or uncertain change from the existing codes, and cannot be expected to provide substantial protection for children and young people from the marketing of unhealthy foods. Government regulations will be needed to achieve this important outcome.

Training a medical workforce to meet the needs of diverse minority communities.

BACKGROUND: The growing demand for a competent health workforce to meet the needs of increasingly diverse societies has been widely acknowledged. One medical school in New Zealand explored the integration of the commonly used patient-centred model approach, with an intersectional framework in the development of a cultural competency training programme. In the Pacific Immersion Programme, medical students in their fourth year of training are given the opportunity to learn about different factors that influence the health and health care of a minority community through immersion in that community. The programme objectives include enabling students to learn through experience living within the local community context, and supporting them to re-evaluate their own personal beliefs, assumptions and/or prior prejudices. This study evaluates the usefulness of this programme in the training of medical students to work in diverse communities. METHODS: Two analytical approaches were used for evaluation. Deductive and inductive analyses were conducted on 235 reflective essays completed by three cohorts of students from 2011 to 2013 to ascertain the value of the programme for student learning. In addition, one cohort was invited to complete a pre and post-programme questionnaire. RESULTS: Overall, the students found the programme to be a valued learning environment. They found living within a Pacific family environment to be an eye opening experience. It increased students comfort level in cross cultural engagement and emphasised the importance of patient's perspectives in health care provision. Students' self-reported knowledge about Pacific cultural values, protocols, traditional beliefs and the main health challenges increased significantly after the programme. They appreciated learning directly from community members, and through observations about how culture, beliefs and the socio-economic environment influence peoples' health and wellbeing. CONCLUSIONS: Medical schools are required to train a competent health workforce to meet the needs of diverse communities. The Pacific Immersion Programme provides a unique learning environment which can improve the training of doctors to work in diverse communities. The key to its success is enabling students to be engaged learners from "the inside" rather than an "outsider looking in". The Programme enables experiential learning in a sensitive and meaningful way and can be useful for training in other institutions.

An assessment of an outcome of injury questionnaire using a Pacific model of health and wellbeing.

AIM: To use a Pacific model of health to describe relationships between questions within a structured questionnaire developed for a prospective study of injured New Zealand residents' outcomes and important elements of Pacific people's health; and identify health issues of particular importance for Pacific peoples that future studies may consider including. METHOD: The Fonofale model of Pacific health identifies culture, family, physical, spiritual, and 'other' elements (e.g. socioeconomic status and service use) as important. In consultation with Pacific researchers, each question from a Prospective Outcomes of Injury Study (POIS) questionnaire was assessed. Relationship between the type and number of POIS questions were considered in relation to each of the Fonofale elements. RESULTS: Two-thirds of the POIS questions were able to be placed within a single element of the Fonofale model; remaining questions were placed into multiple elements. The POIS questionnaire strongly addressed the physical, mental and 'other' Fonofale elements. Culture, spirituality and family elements were not strongly addressed. CONCLUSIONS: The Fonofale model identified areas of strength in the POIS questionnaire, and areas of limitation. Researchers undertaking population studies or surveys could consider using a Pacific model to help inform structured questionnaire development.

Pacific students undertaking the first year of health sciences at the University of Otago, and factors associated with academic performance.

AIM: To describe Pacific students in the first year of health sciences at tertiary level, their academic performance, and factors associated with academic outcomes. METHOD: Routinely collected data for students who enrolled in the Health Sciences First Year (HSFY) programme at the University of Otago between 2007 and 2011, including their school National Certificate in Educational Achievement (NCEA) results were obtained in anonymous form. Descriptive statistics were calculated and regression analyses were undertaken using SAS v9.2 software. RESULTS: A small but increasing number of Pacific students are enrolling in health sciences at tertiary level. Pacific students had poorer performance compared to non-Pacific students in both NCEA and the HSFY programme. Factors associated with academic performance were gender, NCEA results, school decile, accommodation type, ethnicity, international status and disability. CONCLUSION: Pacific students are under-represented in health sciences and would benefit from better preparation from school. Pacific solutions are required to improve academic outcomes over and above mainstream policy solutions. Tertiary institutions need to engage prospective students earlier to ensure they are well informed of requirements, and are appropriately prepared for study at the tertiary level.

Pacific peoples three months after injury: a comparison of outcomes between Pacific and non-Pacific participants in a NZ cohort study.

OBJECTIVES: To: describe pre-injury characteristics of Pacific (n=239) and non-Pacific (n=2,611) participants and compare their outcomes three months after injury. METHODS: Participants were New Zealand residents aged 18-64 years referred to the Accident Compensation Corporation's injury entitlement claims register. Univariate and multivariable analyses compared pre-injury and injury-related characteristics of Pacific and non-Pacific people and assessed the unadjusted and adjusted relative risks for selected outcomes. RESULTS: Of the 2,856 participants, 239 identified at least one Pacific ethnicity. Adjusted relative risks (aRR; 95% confidence intervals) for Pacific peoples, with the non-Pacific group as the reference, indicate Pacific peoples were: less likely to have no/lesser problems with disability (aRR=0.82; 0.70,0.95); less likely to have no problems with EQ-5D self-care (aRR=0.88; 0.80,0.98); less likely not to report EQ-5D anxiety/depression (aRR=0.84; 0.76,0.93); and less satisfied with social relationships three months after injury (aRR=0.89; 0.83,0.95). CONCLUSIONS: Evidence does not suggest Pacific peoples' likelihood of paid employment differs from non-Pacific people three months after injury. However, Pacific peoples appear to have an increased likelihood of problems with disability, self-care, anxiety/depression and social relationships. IMPLICATIONS: This study provides information about a range of previously unknown outcomes following injury for Pacific peoples in New Zealand, and suggests areas of possible focus for health and rehabilitation service providers and policy-makers interested in improving outcomes for injured Pacific peoples.

Community experience of a Pacific Immersion Programme for medical students in New Zealand.

AIM: To obtain the views of the Pacific community about their involvement in a Pacific Immersion Programme, to determine the programme's viability as a resource for medical education. METHOD: The Pacific Immersion Programme run by the Dunedin School of Medicine had four attachments (March, April, June and September) with local Pacific communities in 2011. Community focus groups were held the week immediately after each attachment. There were two focus group sessions for each attachment, one obtained the views of adults and the other of young people. Focus groups consisted of eight participants recruited through community coordinators and were facilitated by trained research assistants. Sessions were audio recorded and analysed using a thematic framework. RESULTS: Sixty-four members of the community participated in the focus groups. Eight themes emerged from the discussions. The community agreed the Pacific Immersion Programme strengthened community cohesion through efforts to engage the students. There was shared learning and created opportunities for engagement between medical students and the community's younger generation. The Pacific families shared with the students about their health and context through storytelling, dancing and singing and cultural ceremonies. Participants hoped students achieved what they wanted from the programme and the experience was useful for their work in the future. CONCLUSION: Community based medical education is a unique and useful approach for teaching medical students about the health of a minority community. The purpose of the paper is to highlight the impacts on participating communities. Nurturing established relationships and providing mutual benefits for both partners will ensure this opportunity will be available as a learning resource for future medical students.

Pacific Island publications in the reproductive health literature 2000-2011: with New Zealand as a reference.

BACKGROUND: There is a keen interest to develop research systems and increase research output in the 14 Pacific Island Forum Countries (PIFC) to support development of policies and practice based on locally relevant research evidence. AIMS: To assess the quantity and characteristics of reproductive health research output by each country (14 PIFC) from 2000 to 2011 using New Zealand's reproductive research outputs as the reference. METHODS: A systematic search of the literature using a broad definition of reproductive health. RESULTS: There were 174 papers published in the PIFC from 2000 to 2011 compared with 628 papers published in New Zealand (NZ). Most (57%) of the PIFC papers were from Papua New Guinea (PNG), although Samoa had the most papers by population (10/100,000). Five of the countries did not have a single publication. The majority of papers from both the PIFC and NZ were observational studies (72 vs 36%). Authors from Australia were responsible for 34% of PIFC publications followed by 25% from PNG. Sixty-three per cent of papers by PIFC sole and first authors were published in local journals, whereas 86% of non-PIFC authors published in international journals. CONCLUSION: There is a need for reproductive research in PIFC. PNG had the most publications on the back of a well-funded dedicated research institute and a significant collaboration with Australian researchers. The large number of papers in PIFC countries without PIFC authors raises the question about the need to require non-PIFC researchers to enter into genuine research partnerships in order to build research capacity in the PIFC.

A Pacific population's access to and use of health services in Dunedin.

BACKGROUND: Pacific peoples in New Zealand (mostly of Samoan, Tongan, or Cook Islands origin) have poor health compared to the total New Zealand population. Understanding their access to and use of health services is important in resolving this. METHOD: A survey of Pacific peoples in Dunedin obtained information about their access to and use of health services. RESULTS: 372 questionnaires were analysed. Approximately one-quarter did not have a regular doctor or health service. At least 50% used hospital emergency services for non-urgent illnesses. Nearly two-thirds used a "walk-in" primary care service. DISCUSSION: A significant proportion of Pacific peoples did not have a regular GP or health service in Dunedin. It was surprising students were more likely to be in this category because student health services should be more affordable. A "walk-in" primary care facility has a role in the delivery of primary care services. Pacific organisations can assist primary care providers to encourage access to and the appropriate use of health services.

Access to general practice for Pacific peoples: a place for cultural competency.

INTRODUCTION: Access to primary health care services has been identified as a problem for Pacific peoples. Although cost is the most frequently cited barrier to Pacific service utilisation, some research has indicated that access may also be influenced by features of mainstream primary care services. This study aimed to identify features of mainstream general practice services that act as barriers to accessing these services for Pacific peoples in order to explore strategies that providers could adopt to enable their practices to be more welcoming, accessible and appropriate for Pacific peoples. METHODS: Pacific participants were recruited through Pacific networks known to Pegasus Health and via 'snowball' sampling. In total, 20 participants participated in one of three focus groups. A semi-structured interview explored the participants' views and experiences of mainstream general practice care. Thematic analysis was utilised to interpret the data. FINDINGS: The analysis revealed five themes highlighting non-financial features of mainstream general practice services that may influence the availability and acceptability of these services to Pacific peoples: language and communication; rushed consultations; appointment availability; reception; and Pacific presence. CONCLUSION: The findings indicate that all personnel within the primary care setting have the ability to directly engage in the improvement of the health status of Pacific peoples in New Zealand by developing cultural competency and incorporating flexibility and diversity into the care and service they provide.

Investigating factors that influence success of Pacific students in first-year health sciences at university in New Zealand.

AIMS: Pacific peoples in New Zealand are a migrant population and suffer disproportionately from poor education outcomes compared to the total population. The purpose of this study was to understand factors that influence academic achievement of Pacific students studying health sciences at the University of Otago. METHODS: Pacific students enrolled in health sciences first year (HSFY) in 2010 were invited to complete a questionnaire on their experiences and adjustment to university. It sought information on university preparedness and "engagement factors". Academic results were obtained. RESULTS: 90% of eligible Pacific students completed the questionnaire. Most students scored their experiences at university highly. Following first semester exams, 60% passed all papers and 40% failed one or more papers. Of those who failed a paper, 50% felt they had developed good study skills. One-third would memorise facts without fully understanding them. Fourteen (23%) HSFY students were successful in getting into a health professional course after end-of-year exams. CONCLUSIONS: Factors influencing academic outcomes of Pacific students at first year of study at University are complex. Further research focussing on effective roles universities can play in the provision of support, and the influence of preparedness prior to entering university is required.

Training medical students in Pacific health through an immersion programme in New Zealand.

AIMS: Medical schools are required to adequately prepare students to work in increasingly diverse and multi-ethnic societies. Students need to be able to integrate clinical knowledge with an understanding of the society they live in. Pacific peoples are a disadvantaged migrant minority ethnic group in New Zealand. This paper discusses the development of, and lessons learnt from a Pacific Immersion Programme for medical students at the University of Otago, New Zealand. METHODS: A cultural programme was developed where fourth-year medical students spent a week-end with a local Pacific family in Dunedin. Students were invited as part of the programme evaluation to provide feedback on their experiences and lessons learnt. Student evaluations were analysed and are reported here in summary form. RESULTS: Medical students were able to learn from observations, participation in activities and stories shared by families about issues that influenced the health of the community. This provided insight about factors that are important to consider, when working with Pacific peoples in New Zealand. The programme also provided positive benefits for the local community. CONCLUSIONS: This cultural immersion programme provided important learning opportunities for medical students. It is important to value and empower communities when developing cultural teaching programmes. The incorporation of the programme as part of the curriculum, and its implications for overall assessment and performance of students, makes it a valued part of learning.

A Pacific immersion programme--is it useful in teaching Pacific health to future doctors in New Zealand?

BACKGROUND AND CONTEXT: Pacific peoples make up approximately 7% of the total population in New Zealand, and are over-represented in poor health statistics. There are very few Pacific peoples in the health workforce. Most Pacific patients will be seen by a non-Pacific health professional when seeking medical care. It is important for all health education institutions, therefore, to include Pacific health as part of their curricula. ASSESSMENT OF PROBLEM: This article outlines the development and evaluation of a Pacific immersion programme to teach medical students about Pacific health. The programme was developed with the assistance of local Pacific community leaders. Learning objectives for students, protocols and processes were developed. These learning objectives and feedback from medical students, staff and host families, formed the basis for evaluating the programme. RESULTS: Students found the programme to be very useful. Host families were satisfied with the experience. Staff support ensured the programme became a required part of learning at the Dunedin School of Medicine. STRATEGIES FOR IMPROVEMENT: The pilot programme was initially offered as an optional choice for students. In the future, all students at the Dunedin School of Medicine will be expected to undertake the programme. A research project looking at changes in knowledge, skills and attitudes of students after the programme will be of value. LESSONS: The programme provided a useful way for teaching Pacific health to undergraduate medical students. Other institutions could consider this method for teaching Pacific health in their curricula.