Love Shouldn't Hurt - E le Saua le Alofa: Co-designing a theory of change for preventing violence against women in Samoa.

Despite the widespread adoption of Theories of Change (ToC) for programme evaluation, the process of collaboratively developing these theories is rarely outlined or critical analysed, limiting broader methodological discussions on co-production. We developed a ToC as part of E le Saua le Alofa ('Love Shouldn't Hurt') - a participatory peer-research study to prevent violence against women (VAW) in Samoa. The ToC was developed in four phases: (1) semi-structured interviews with village representatives (n = 20); (2) peer-led semi-structured interviews with community members (n = 60), (3) community conversations with 10 villages (n = 217) to discuss causal mechanisms for preventing VAW, and (4) finalising the ToC pathways. Several challenges were identified, including conflicting understandings of VAW as a problem; the linearity of the ToC framework in contrast to intersecting realities of people's lived experiences; the importance of emotional engagements, and theory development as a contradictory and incomplete process. The process also raised opportunities including a deeper exploration of local meaning-making, iterative engagement with local mechanisms of violence prevention, and clear evidence of ownership by communities in developing a uniquely Samoan intervention to prevent VAW. This study highlights a clear need for ToCs to be complemented by indigenous frameworks and methodologies in post-colonial settings such as Samoa.

Prevalence of Chlamydia trachomatis infection in Samoan women aged 18 to 29 and assessment of possible risk factors: a community-based study.

BACKGROUND: Knowledge about genital Chlamydia trachomatis (CT) infections in the Pacific is limited. In this study we investigated CT infection in Samoan women. METHODS: We recruited women having unprotected sex aged 18 to 29 years from 41 Samoan villages. They completed a questionnaire and provided a urine sample for CT testing by PCR. Associations between CT infection and possible risk factors were explored using logistic regression. RESULTS: Altogether, 239 women were recruited; 86 (36.0%; weighted estimate of prevalence: 41.9%; 95% CI: 33.4-50.5%) were positive for CT infection. A higher proportion of women aged 18 to 24 were positive (54/145; 37.2%) than those aged 25 to 29 (32/94; 34.0%; p=0.20). Being single (OR 1.92; 95% CI: 1.02-3.63) and having two or more lifetime sexual partners (OR 3.02; 95% CI: 1.19-7.67) were associated with CT infection; 27.6% of those with one lifetime partner were positive. Participants who had a previous pregnancy were less likely to be positive (OR 0.49; 95% CI: 0.27-0.87). Primiparous and multiparous women were less likely to be positive than nulliparous women (OR 0.54; 95% CI: 0.30-0.99 and OR 0.46; 95% CI: 0.24-0.89, respectively). CONCLUSIONS: The prevalence of CT infection in these Samoan women is very high. Further studies, including investigating the prevalence of CT infection in men, and strategies for sustainable control are needed.

Care for the seafarers: a review of mental health in Austronesia.

INTRODUCTION: Continent-based regional reviews of mental health may not fully describe the status of ethnocultural groups that are widely dispersed across multiple continents or traditional world regions. Our aim was to describe the Austronesians, an ethno-linguistic group living primarily in islands and coastal areas in the Pacific and Indian Oceans and Southeast Asia. METHODS: Consulting lay databases, we created matrices to describe the demographic, political, and socioeconomic profiles of nations with majority and minority indigenous Austronesian language-speaking populations. We then accessed the scientific literature to describe examples of mental health disparities and/or challenges in mental health care delivery. RESULTS: Many Austronesian-speaking people have experienced recent or current foreign occupation, lack of recognized sovereignty, poverty and low socioeconomic status, and low availability of psychiatric resources and providers. An analysis of the biological, psychological/psychocultural, and social and environmental impacts (risk or protective) on either the prevalence/presentation of mental illness, help-seeking behavior or access to mental health care, or management of mental illness suggested that there may be relatively unique stressors (e.g. loss of homeland from either global warming or nuclear contamination) affecting people in this region and certain biological profiles (e.g. susceptibility to obesity and metabolic syndrome) that may impact psychiatric treatment. DISCUSSION: Solutions to mental health challenges in this world region may include culturally relevant and integrative mental healthcare delivery models; resource preserving, prevention-focused universal mental healthcare; and technology to improve connectivity and increase access to either direct services or workforce-building education and training.

A qualitative investigation into key cultural factors that support abstinence or responsible drinking amongst some Pacific youth living in New Zealand.

BACKGROUND: Abstinence and responsible drinking are not typically associated with youth drinking culture. Amongst Pacific youth in New Zealand there are high numbers, compared to the general New Zealand population, who choose not to consume alcohol. The Pacific youth population is made up of several ethnic groups; their ethno-cultural values are largely Polynesian and heavily influenced by the socio-economic realities of living in New Zealand. This paper explores factors that support abstinence or responsible drinking amongst Pacific youth living in Auckland. METHODS: A qualitative study comprised of a series of ethnically-, age-, and gender-matched semi-structured focus group discussions with 69 Pacific youth, aged 15-25 years from a university and selected high-schools. Participants were purposively sampled. RESULTS: Key cultural factors that contributed to whether Pacific youth participants were abstinent or responsible drinkers were: significant experiences within Pacific family environments (e.g. young person directly links their decision about alcohol consumption to a positive or negative role model); awareness of the belief that their actions as children of Pacific parents affects the reputation and standing of their Pacific family and community (e.g. church); awareness of traditional Pacific values of respect, reciprocity and cultural taboos (e.g. male-female socialising); commitment to no-alcohol teachings of church or religious faith; having peer support and experiences that force them to consider negative effects of excessive alcohol consumption; and personal awareness that being part of an (excessive) drinking culture may seriously affect health or impede career aspirations. CONCLUSIONS: The narratives offered by Pacific young people highlighted three key communities of influence: family (immediate and extended, but especially siblings), peers and church. Young people negotiated through these communities of influence their decisions whether to drink alcohol, drink excessively or not at all. For each young person the way in which those three communities came together to support their decisions depended on the specificities of their lived contexts. Pacific young people live lives that share some things in common with other New Zealand youth and others which are more specific to a Pacific ethnic group, especially in relation to the traditional beliefs of their Pacific parents and community. In the development of alcohol harm reduction strategies seeking active Pacific young person and family compliance, it is these "other ethnic things" that requires careful and more qualitative consideration.

Strengthening health research capacity from within Samoa.

This article reflects on the challenges of strengthening health research capacity from within Samoa. It examines the status of health research and related curricula in Samoa and discusses the outcomes of a new postgraduate applied social and health research methods course taught in Samoa for the first time from 5 January to 12 February 2010 by the Department of Preventive and Social Medicine, University of Otago in collaboration with the Centre for Samoan Studies, National University of Samoa. The article argues that collaborative health research courses such as this methods paper can fill a curriculum gap in New Zealand and Samoa and contribute directly toward strengthening Samoa health research capacity in ways that benefit both Samoa and New Zealand. This initiative can be a flagship for strategies operating from within Samoa that can build real win-win type partnerships. These can be ably led by Samoans for the ultimate development of an affordable and sustainable quality health and education infrastructure for Samoa.

Towards quality Pacific services: the development of a service self-evaluation tool for Pacific addiction services in New Zealand.

OBJECTIVES: To describe the development and use of a quality improvement service self-evaluation tool within Pacific addiction services in New Zealand. METHODS: The study involved two phases: (i) a development phase; and (ii) a testing phase. In Phase I, a preliminary tool was developed and piloted with two Pacific addiction drugs services. It was modified to reduce the number of statements, aligning the statements with the National Sector Standards and incorporating Pacific concepts, themes and motifs that underlie the practices of Pacific providers. In Phase II the resulting tool, named Potalanoa, was then tested in four Pacific addiction treatment services. All services provided feedback on the user acceptability and feasibility of the tool, usefulness and adaptability of the tool to specific service settings. RESULTS: The participating services generally found the evaluation tool to be understandable, acceptable and useful. Each service provider demonstrated varied use or implementation strategies for Potalanoa with a general consensus that incorporating the evaluation process within existing team meetings would be ideal. The involvement of all staff within a group setting was also found to be an essential part of the process and a trained facilitator helped with the flow of discussion. CONCLUSIONS: The study found that there is a need for an evaluation tool for the provision of quality services. For Pacific services it was important that the tool recognize and capture the Pacific approaches utilized in their service delivery. Overall the tool was found to be acceptable and feasible to use, assisted services to identify areas of achievement and to prioritize areas requiring improvement and was adaptable to 'real world' Pacific addiction treatment settings in New Zealand.

Exploration of Pacific perspectives of Pacific models of mental health service delivery in New Zealand.

There is increasing concern about the inequalities, overall health outcomes, and mental health of Pacific peoples residing in New Zealand. The New Zealand Mental Health Survey (Te Rau Hinengaro), conducted in 2003/2004, identfied Pacific peoples as having a higher 12-month prevalence of mental disorders than the general population. The burden of mental health amongst Paqfic peoples was identified as high and associated with other socioeconomic correlates. Pacflcpeoples were also more likely not to access professional mental health assistance. The aim of this study was to provide indepth qualitative data that explored Pacflc perceptions and experience of the theory practice, and utilisation of Pacific mental health services in New Zealand This paper documents: (i) the different models of care practiced in the Pacific mental health sector and (ii) the specific components that: (a) make these models uniquely Pacific, and (b) that consumers and families identWed as integral to the recovery process. Pacific peoples 'views of mental health from the following three perspectives were studied: (i) the service provider (ii) the mental health consumer and (iii) the family member, using focus group interviews in Auckland, Hamilton, Wellington, and Christchurch. The results report the different perceptions of the Pacific focus group and interview participants. Our findings indicate that firstly, having appropriate family and community support networks (psycho-social and community), appropriate living environments and meaningful workfor consumers, and secondly, access to culturally competent mental health staff contributes towards consumer recovery and assisting families. In conclusion, Pacific models of care (service delivery) were found to be informed by Pacific models of health belief and existed in implicit rather than explicit forms. To develop clearer or specific articulations of Pacific models of service delivery, the first step for services is to develop written expositions (a theory) of how these models might be framed taking into equal account cultural, clinical, and service management issues.

Exploring the 'cultural' in cultural competencies in Pacific mental health.

Cultural competency is about the ability of individuals and systems to respond respectfully and effectively to the cultural needs of peoples of all cultures. Its general attributes include knowledge, attitudes, skills and professional judgment. In Pacific mental health, 'the cultural' is generally understood to be ethnic culture. Accordingly, Pacific cultural competencies assume ethnic specific markers. In mental health Pacific cultural competencies has seen a blending of cultural and clinical beliefs and practices. This paper provides an overview of five key theme areas arising from Auckland-based ethnic-specific Pacific workshop data: language, family, tapu relationships, skills and organisation policy. Workshop participants comprised of Pacific mental health providers, Pacific consumers, family members of Pacific consumers and members of the Pacific community members. This paper purports that identifying the perceptions of different Pacific groups on ethnic-specific elements of cultural competencies are necessary to build and strengthen the capacity and capability of mental health services to provide culturally relevant services.

The substances and choices scale (SACS)--the development and testing of a new alcohol and other drug screening and outcome measurement instrument for young people.

AIMS: To describe the development and evaluation of the Substances and Choices Scale (SACS), an adolescent alcohol and other drug (AOD) self-report instrument designed in a similar format to the Strengths and Difficulties Questionnaire (SDQ). DESIGN: A literature review, extensive consultation and discriminant analysis on a pilot sample (n = 61) of adolescents informed the development of the SACS. The psychometric properties of the SACS were then tested in a larger community and clinical sample. SETTING: Three youth out-patient AOD treatment services and three secondary schools in Auckland, New Zealand. PARTICIPANTS: 13-18-year-old males and females attending the services (n = 120) or schools (n = 531). MEASUREMENTS: The SACS was administered with the CRAFFT, the Problem Oriented Screening Instrument for Teenagers (POSIT) and the Strengths and Difficulties Questionnaire (SDQ). FINDINGS: Reliability of the SACS was sound, with coefficient alpha 0.91 and 3-week test-retest correlation 0.88. Congruent validity coefficients of the SACS versus the CRAFFT and the POSIT were 0.79 and 0.91, respectively. A ROC curve demonstrated the SACS as having a predictive value of 92%. Repeat SACS scores in a treatment sample indicated that the SACS had utility in measuring change. Feedback from participants indicated that the SACS was highly acceptable. CONCLUSIONS: The SACS is a simple AOD instrument that is reliable, valid and acceptable to young people. It has utility in screening and measuring outcome and should enhance the identification and treatment of AOD difficulties in adolescents across a range of health settings.

New Zealand Pacific peoples' drinking style: too much or nothing at all?

AIMS: To describe the alcohol consumption patterns and related harms of some Pacific peoples (Samoan, Cook Islands Maori, Tongan, Niuean, Fijian, and Tokelauan) living in Aotearoa (New Zealand), and to draw comparisons with measures from the general New Zealand population. METHODS: The Pacific Drugs and Alcohol Consumption Survey (PDACS) was carried out with 1103 randomly selected Pacific peoples aged between 13 and 65 years old who were resident in households throughout New Zealand. The survey used computer-assisted telephone interviewing (CATI) and computer assisted cell-phone interviewing (CACI). The interviews were carried out in 2002/03. We descriptively compare findings from the PDACS with those from the 2000 National Alcohol Survey (NAS). RESULTS: Fifty-seven percent of Pacific peoples were drinkers (males 61%, females 51%), compared with 85% of the general New Zealand population (males 88%, females 83%). The average annual consumption of absolute alcohol was 21 litres for Pacific drinkers (males 28 litres, females 14 litres) compared with 11 litres for general New Zealand population drinkers (males 16 litres, females 7 litres). The typical occasional quantity consumed by Pacific drinkers was eight drinks (males: nine drinks, females: five drinks) compared with four drinks for drinkers in the general New Zealand population (males: five drinks, females: around four drinks). Thirty-three percent of Pacific drinkers consumed enough to feel drunk at least weekly (males 41%, females 25%) compared with 9% of drinker in the general New Zealand population (males 13%, females 6%). Eighteen percent of Pacific males and 10% of Pacific females reported being physically assaulted by someone who had been drinking compared with 8% and 5% of national males and females respectively. Twenty-three percent of Pacific males and 16% of Pacific females got drunk when there was an important reason to stay sober, compared with 8% and 5% of general New Zealand males and females respectively. Nineteen percent of Pacific males and 21% of Pacific females reported being involved in a serious argument after they had been drinking compared with 12% and 8% of general New Zealand males and females respectively. CONCLUSIONS: The proportion of Pacific drinkers is less than the proportion of drinkers in the general New Zealand population. However, Pacific drinkers consume larger annual volumes and typical occasion amounts of absolute alcohol than drinkers in the general New Zealand population. Pacific peoples drinking patterns appear to be more harmful with greater proportions of Pacific peoples reporting violence and injury from other peoples' drinking, and greater proportions of Pacific drinkers reporting problems from violence and serious arguments as a result of their own drinking compared with the general New Zealand population and general New Zealand population drinkers.