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.

Premarital relationships and condom use among young people in Suva, Fiji.

Background Young people in Fiji experience high rates of sexually transmissible infections and early pregnancy. Despite being identified as a key priority group in national strategies, little is known about use of condoms among young people in premarital relationships. This study aimed to enhance understandings of premarital sex and condom use practices among young people in Fiji. METHODS: Focus group discussions with 33 young women and men aged 18-29 years and 17 interviews with young women aged 18-26 years in an urban setting in Fiji were conducted. Inductive thematic analysis examined condom use practices. RESULTS: Participants described a range of contextual influences inhibiting or enabling condom use. Factors inhibiting condom use included sociocultural expectations regarding premarital abstinence; young people's engagement in hidden sexual relationships; limited intergenerational dialogue about sexual health issues; judgmental attitude of staff at condom access points; male dominance of condom use preferences; and belief condoms disrupt intimacy, reduce sexual pleasure and infer a lack of trust. Factors that enhanced condom use included accessing condoms through discreet methods; adult beliefs that supported safe sex practices; and refusing to have sex without a condom. CONCLUSION: Findings broaden understandings of young people's condom use practices in Suva, Fiji. The findings illustrate the need for culturally appropriate youth-centred sexual and reproductive health (SRH) programs and services. Specific strategies that might enhance young people's condom use include community- and youth-led responses; peer condom distribution; provision of condom dispensers in community settings; scaling up of youth-friendly SRH services; and the delivery of comprehensive sexuality and relationships education.

The Everyday Politics of Risk: Managing Diabetes in Fiji.

In this article, I investigate how diabetes-related risks are experienced and managed in Fiji. Neoliberal discourses implore patients to be risk-averse and blame poorer Indigenous (iTaukei) people with diabetes for "irresponsible" treatment choices and medication "noncompliance." Drawing on ethnographic fieldwork conducted during 2015-16, I suggest lower-income iTaukei people with diabetes face multiple layers of risk in everyday life beyond biomedical definitions, including spiritual threats; cultural politics; and limited healthcare access. People with diabetes pragmatically weigh up these risks when choosing whether to seek treatment, be it biomedical, faith-based, pharmaceutical, or herbal remedies. Better understanding how patients experience and manage risk will improve diabetes care.

Young women's perceptions and experiences of sexual risk in Suva, Fiji.

This paper explores young iTaukei (Indigenous Fijian) women's perceptions and experiences of sexual risk. It draws on qualitative data collected in Suva, Fiji in 2011 and 2012. Participants included iTaukei female university students aged 18-29 years. We describe nine forms of sexual risk identified by young iTaukei women, and group these risks into three clusters - social risks, physical risks and intimate relational risks. We discuss how young women prioritise these risks differently depending on context, location and relationship. Findings point to a critical mismatch between current public health risk priorities and those risks identified as most important in the lives of young iTaukei women. Findings have important implications for strengthening sexual and reproductive health policy and practice in Fiji.

Chronic Kidney Disease in New Zealand Maori and Pacific People.

Chronic kidney disease (CKD) disproportionately affects Maori (the indigenous people of New Zealand [NZ]) as well as Pacific people, particularly from Samoa, Tonga, and Fiji. As New Zealand is home to the largest population of Pacific people, New Zealand and the Pacific Islands fulfil the definition of a CKD 'hotspot'. Although diabetic nephropathy is the major cause of CKD, with disproportionately higher rates in NZ Maori and Pacific people, there is increasing evidence that there is a familial predisposition to CKD that is not due to diabetes. Further studies are required to understand the reasons for this pre-disposition.

A Qualitative Exploration of Fijian Perceptions of Diabetes: Identifying Opportunities for Prevention and Management.

Rates of diabetes are high in many communities of Pacific Island peoples, including people from Fiji. This qualitative study explores knowledge and attitudes towards diabetes among i-Taukei Fijians to facilitate the cultural tailoring of diabetes prevention and management programs for this community. Fijians aged 26 to 71 years (n = 15), residing in Australia, participated in semi-structured interviews; 53% (n = 8) were male. Interviews were audio-recorded, transcribed verbatim, then thematically analyzed. Diabetes is recognized as an important and increasing health problem requiring action in the i-Taukei Fijian community. Widespread support for culturally appropriate lifestyle interventions utilizing existing societal structures, like family networks and church groups, was apparent. These structures were also seen as a crucial motivator for health action. Intervention content suggestions included diabetes risk awareness and education, as well as skills development to improve lifestyle behaviors. Leveraging existing social structures and both faith and family experiences of diabetes within the Fijian community may help convert increased awareness and understanding into lifestyle change. Ongoing in-community support to prevent and manage diabetes was also regarded as important. We recommend building upon experience from prior community-based interventions in other high-risk populations, alongside our findings, to assist in developing tailored diabetes programs for Fijians.

Weighing outcome vs. intent across societies: How cultural models of mind shape moral reasoning.

Mental state reasoning has been theorized as a core feature of how we navigate our social worlds, and as especially vital to moral reasoning. Judgments of moral wrong-doing and punish-worthiness often hinge upon evaluations of the perpetrator's mental states. In two studies, we examine how differences in cultural conceptions about how one should think about others' minds influence the relative importance of intent vs. outcome in moral judgments. We recruit participation from three societies, differing in emphasis on mental state reasoning: Indigenous iTaukei Fijians from Yasawa Island (Yasawans) who normatively avoid mental state inference in favor of focus on relationships and consequences of actions; Indo-Fijians who normatively emphasize relationships but do not avoid mental state inference; and North Americans who emphasize individual autonomy and interpreting others' behaviors as the direct result of mental states. In study 1, Yasawan participants placed more emphasis on outcome than Indo-Fijians or North Americans by judging accidents more harshly than failed attempts. Study 2 tested whether underlying differences in the salience of mental states drives study 1 effects by inducing Yasawan and North American participants to think about thoughts vs. actions before making moral judgments. When induced to think about thoughts, Yasawan participants shifted to judge failed attempts more harshly than accidents. Results suggest that culturally-transmitted concepts about how to interpret the social world shape patterns of moral judgments, possibly via mental state inference.

Similarities and Differences in Maternal Responsiveness in Three Societies: Evidence From Fiji, Kenya, and the United States.

The first relationship between an infant and her caregiver, typically the mother, lays the foundation for cognitive, social, and emotional development. Maternal responsiveness and affect mirroring have been studied extensively in Western societies yet very few studies have systematically examined these caregiving features in non-Western settings. Sixty-six mother-infant dyads (7 months, SD = 3.1) were observed in a small-scale, rural island society in Fiji, a village in Kenya, and an urban center in the United States. Mothers responded similarly to infant bids overall, but differences were found across societies in the ways mothers selectively respond to affective displays. This has implications for understanding early emotion socialization as well as understanding variation in infant social ecologies across the globe.

Obstetric and psychosocial risk factors for Australian-born and non-Australian born women and associated pregnancy and birth outcomes: a population based cohort study.

BACKGROUND: One in four Australians is born overseas and 47% are either born overseas or have a parent who was. Obstetric and psychosocial risk factors for these women may differ. METHOD: Data from one Sydney hospital (2012-2013) of all births recorded in the ObstetriX database were analysed (n = 3,092). Demographics, obstetric and psychosocial risk profile, obstetric interventions and complications and selected maternal and neonatal outcomes were examined for women born in Australia and overseas. RESULTS: Women born in Australia were younger, more likely to be primiparous (28.6 v 27.5%), be obese (32.0% v 21.4%), smoke (19.7 % v 3.0%), have an epidural (26.2% v 20.2%) and were less likely to have gestational diabetes mellitus (GDM) (6.8% v 13.7% when compared to non-Australian born women. The highest rates of GDM, Gestational Hypertension (GH) and maternal anaemia were seen in women born in China, the Philippines and Pakistan respectively. Differences were also seen in psychosocial screening between Australian and non-Australian women with Australian-born women more likely to smoke and report a mental health disorder. There was an association between having an Edinburgh Postnatal Depression Scale (EPDS) ≥ 13 and other psychosocial issues, such as thoughts of self-harm, domestic violence, childhood abuse etc. These women were also less likely to breastfeed. Women with an EPDS ≥ 13 at booking compared to women with EPDS ≤12 had a higher chance of being diagnosed with GDM (AOR 1.85 95% CI 1.14-3.0). CONCLUSIONS: There are significant differences in obstetric and psychosocial risk profiles and maternal and neonatal outcomes between Australian-born and non-Australian born women. In particular there appears to be an association between an EPDS of ≥13 and developing GDM, which warrants further investigation.

Globalization and eating disorder risk: peer influence, perceived social norms, and adolescent disordered eating in Fiji.

OBJECTIVE: The increasing global health burden imposed by eating disorders warrants close examination of social exposures associated with globalization that potentially elevate risk during the critical developmental period of adolescence in low- and middle-income countries (LMICs). The study aim was to investigate the association of peer influence and perceived social norms with adolescent eating pathology in Fiji, a LMIC undergoing rapid social change. METHOD: We measured peer influence on eating concerns (with the Inventory of Peer Influence on Eating Concerns; IPIEC), perceived peer norms associated with disordered eating and body concerns, perceived community cultural norms, and individual cultural orientations in a representative sample of school-going ethnic Fijian adolescent girls (n = 523). We then developed a multivariable linear regression model to examine their relation to eating pathology (measured by the Eating Disorder Examination-Questionnaire; EDE-Q). RESULTS: We found independent and statistically significant associations between both IPIEC scores and our proxy for perceived social norms specific to disordered eating (both p < .001) and EDE-Q global scores in a fully adjusted linear regression model. DISCUSSION: Study findings support the possibility that peer influence as well as perceived social norms relevant to disordered eating may elevate risk for disordered eating in Fiji, during the critical developmental period of adolescence. Replication and extension of these research findings in other populations undergoing rapid social transition--and where globalization is also influencing local social norms--may enrich etiologic models and inform strategies to mitigate risk.

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.

Country of birth and hospital treatment for psychosis in New South Wales.

BACKGROUND: Migration has been found to be a risk factor for schizophrenia in several high-income countries. AIM: To examine whether overseas migrants to New South Wales (NSW) have higher rates of admission to psychiatric hospitals for psychotic disorders, including schizophrenia and mania, compared to people born in Australia. METHODS: The country of birth of people admitted to public mental health units for the treatment of psychotic illness and for non-psychotic disorders between 2001 and 2010 was compared to the country of birth for the NSW population in the 2006 census. Meta-analysis was used to estimate the odds of being admitted for any psychotic disorder, for a schizophrenia-related psychosis and for mania compared to non-psychotic disorder, for those born in Australia, New Zealand and for nine global regions. RESULTS: Those born in Oceania (including Melanesia, Fiji, Samoa, Tonga and other Polynesian islands, but excluding Hawaii and New Zealand) had the highest odds of admission for the treatment of psychosis compared to a non-psychotic disorder and had the highest odds of being admitted with a diagnosis of schizophrenia or mania. CONCLUSIONS: In the years 2001-2010, those born in Oceania were at an increased risk of admission to NSW psychiatric hospitals for the treatment of psychotic illness.

Export quality: representing Fijian bodies and the economy of war.

Fijian bodies have become a valuable commodity in the economy of war. Remittances from workers overseas are Fiji's largest income ­ exceeding that of tourism and sugar export. This essay examines historical and contemporary representations of the black male body that perpetuate the exploitation of Fijians by inscribing the Fijian male body as warrior, criminal and protector. Taking a multidisciplinary approach informed by sociology, cultural theory, Pacific studies, visual culture, feminist and post-colonial theory, my practice is the vehicle through which I address issues of neocolonial commodification of Fijian bodies. Through an analysis of my own staged photographs and vernacular images taken by Fijians working for private security military companies and British and US armies, I hope to challenge audiences to consider their own perceptions of Fijian agency and subjectivity. By theorising the politicisation of the black body and interrogating colonial representations of blackness, I argue that we can begin to create links between the historical and contemporary exploitation of Fijians and that at the essence of both is an underlying racial hierarchy and economic requirement for cheap and, arguably, expendable labour.

Psychological impact and the burden of caregiving for persons with spinal cord injury (SCI) living in the community in Fiji.

UNLABELLED: STUDYDESIGN: This study was designed as a cross-sectional one. A set of structured questionnaires was administered. OBJECTIVES: The purpose of the study was to explore the psychological response of the caregivers of people with spinal cord injury (SCI) and to assess the burden of caregiving for SCI persons living in the community in Fiji. SETTING: Fiji, South Pacific. METHODS: A total of 30 primary caregivers of persons with SCI. The Index of Psychological Well-Being (IPWB) was used to assess the psychological impact of care giving, and Caregiver Burden Inventory (CBI) was used to evaluate the burden associated with caregiving for persons with SCI. Barthel Index (BI) scale was used to measure the functional abilities of the care recipients. RESULTS: The majority of the participants (n=20) were women, who had an ethnic Fijian background (n=18) and were married (n=18), and were spouses (n=13). Mean BI of the persons with SCI was 7.1 (s.d.=5.23) on a 0-20 scale, with 90% (n=27) suffering from moderate-to-very severe disability (BI<15). The mean duration of caregiving was 6.1 years (s.d.=4.23). On average, the caregivers provided 6.1 h (s.d.=2.19) of caregiving per day. The experiences of caregiving adversely affected the caregiver psychological well-being. Participants demonstrated high levels of time-dependent and development burden. Caregiving was significantly related to the number of hours spent providing care (r (s)=0.35, P<0.05), and the older caregiver age (r (s)=0.46, P<0.01). CONCLUSION: Being a primary caregiver of a SCI person contributes to caregiver burden and psychological distress. The findings indicate that the contributions of these people should be recognized and interventions should be tailored not only toward the needs of the care recipients but also to the needs of the caregivers.

Targeting cyclone relief within the village: kinship, sharing, and capture.

This article investigates the targeting of cyclone relief within villages in Fiji. It focuses on how relief allocation is linked with informal risk sharing and elite capture, both of which are directly related to kinship. The results are as follows. First, food aid is initially targeted toward kin groups according to their aggregate shocks and then shared among group members. Right after the cyclone, when aid is scarce, households with damage to their housing and with greater crop damage are allocated less aid within the group. Instead, they receive greater net private transfers in other forms, especially in labor sharing. Consistent patterns are found in village, cropping, and housing rehabilitations. Second, there is no elite capture of food aid in the kin group, and instead, traditional kin leaders share food with others; however, non-kin-based community leaders capture aid when it is allocated across kin groups. Third, distinct from food aid demanded by all, tarpaulins demanded by victims only strongly target individual housing damage at the village level­not the kin group­independent of social status. As with food aid, victims with greater crop damage are given a lower priority. Implications for relief policies are discussed.

South Asian immigrant women's experiences of being respected within cancer treatment settings.

The purpose of this focused ethnographic inquiry was to examine South Asian immigrant women's experiences and perceptions of respect within health professional-client relationships in the context of a Canadian outpatient treatment clinic. Characteristics of respect described by 11 women interviewed were the meaning of respect, health professional's way of being, their way of attending to the person, and their way of talking. Language, cultural values and beliefs, along with underlying societal, individual and institutional factors that coexist with health professionals' ability to create respect were some of the dimensions that influenced how immigrant women experienced respect. Health professionals' capacity to acknowledge South Asian immigrant women as individuals helped to formulate/construct respect for their individual identities. The need to be respected for 'my social identity' as an immigrant woman with cancer was woven throughout women's stories, illustrated by their personal experiences and perspectives.

Development of a measure of "acculturation" for ethnic Fijians: methodologic and conceptual considerations for application to eating disorders research.

Acculturation has been examined as a risk factor for eating disorders, but interpretation of findings has been limited by inconsistent operationalization of this construct across studies. The study aim was to develop and evaluate a population-specific measure of acculturation for ethnic Fijian adolescent schoolgirls, to use in future analyses related to eating disorders. Our findings suggest that acculturation is a multidimensional construct characterized by distinct, though related, dimensions of orientation to ethnic Fijian and/or western/global culture with respect to a range of behaviors and attitudes. In contrast to theoretical models positing uni-dimensional, orthogonal, or oblique relations between cultural identities in individuals undergoing acculturation, our study findings support a heterogeneous pattern among correlations of dimensions across contrasting cultural identities. We suggest multidimensional measures of acculturation are optimal--and socio-demographic proxies inadequate--for characterization of this complex process for health research.

Youth health-risk behavior assessment in Fiji: the reliability of Global School-based Student Health Survey content adapted for ethnic Fijian girls.

OBJECTIVE: The Global School-based Student Health Survey (GSHS) is an assessment for adolescent health-risk behaviors and exposures, supported by the World Health Organization. Although already widely implemented - and intended for youth assessment across diverse ethnic and national contexts - no reliability data have yet been reported for GSHS-based assessment in any ethnicity or country-specific population. This study reports test-retest reliability for GSHS content adapted for a female adolescent ethnic Fijian study sample in Fiji. DESIGN: We adapted and translated GSHS content to assess health-risk behaviors as part of a larger study investigating the impact of social transition on ethnic Fijian secondary schoolgirls in Fiji. In order to evaluate the performance of this measure for our ethnic Fijian study sample (n=523), we examined its test-retest reliability with kappa coefficients, % agreement, and prevalence estimates in a sub-sample (n=81). Reliability among strata defined by topic, age, and language was also examined. RESULTS: Average agreement between test and retest was 77%, and average Cohen's kappa was 0.47. Mean kappas for questions from core modules about alcohol use, tobacco use, and sexual behavior were substantial, and higher than those for modules relating to other risk behaviors. CONCLUSIONS: Although test-retest reliability of responses within this country-specific version of GSHS content was substantial in several topical domains for this ethnic Fijian sample, only fair reliability for the module assessing dietary behaviors and other individual items suggests that population-specific psychometric evaluation is essential to interpreting language and country-specific GSHS data.