Pacific and Pasifika Theses
Permanent URI for this collectionhttps://mro.massey.ac.nz/handle/10179/4764
The theses listed in this collection were all completed at Massey University in a range of different departments and institutes. They have been included in this collection if the topic is strongly related to Pasifika/the Pacific.
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Item Māopoopo : a socio-cultural and collective understanding to improve wellbeing amongst Pacific people in Aotearoa/New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Wellington, New Zealand(Massey University, 2021) Tuisano, Hana SalomeThe Aotearoa/New Zealand (NZ) healthcare system, has, like many other colonising ‘Western’ societies, placed a strong emphasis on biomedical models and the physical aspects of ‘disease’. Yet, it is the more encompassing and holistic worldviews of wellbeing that historically and currently resonate most strongly with Indigenous peoples. As a South Pacific country, there are many Pacific peoples who now live in Aotearoa/NZ with multiple generations having migrated from their island homelands over a period of some 80 years. However, there are significant health inequities among Pacific peoples compared with other ethnic groups in Aotearoa that have been ongoing for decades – notably those conditions related to non-communicable disease. This thesis explores the socio-cultural and historical perspectives of Pacific peoples in order to expand understanding about how they view health and wellbeing, an area about which relatively little is known. These understandings have the potential to lead to improved service delivery models and contribute to better health outcomes for Pacific peoples in Aotearoa/NZ. The overall objective of the study is to identify and articulate the values and principles that promote and enable Pacific peoples’ wellbeing and health in Aotearoa/NZ. The aims of the study are to: • draw on Tokelau knowledge of the cultural, historical, and social environment to better understand the influences on Pacific health and wellbeing • examine strategies of health empowerment and wellbeing among Pacific youth, and • examine service delivery models that can lead to improved Pacific health outcomes. The Tokelau worldview of māopoopo was used as an overall principle to inform all phases of this study. Conceptually, māopoopo serves as a cultural connector with people, a motivator of action, and informs principles that guide behaviour in practice. Māopoopo as a practice in action is to restore peace and wholeness and to inform future thinking (lumanaki), which includes an inseparable relationship with te fenua (land) e laga kita ko te fenua (to be determined to look after the land). Māopoopo as a metaphysical state is described in relation to levels of the individual (te tino), the family (Kāiga), the village (te Nuku). Semi-structured interviews and focus groups were carried out with a total of 37 participants including Tokelau elders, Tokelau community leaders, Tokelau adults, Pacific youth, and Pacific health and policy workers between July 2016 and January 2017. The data were analysed using thematic analysis and the emergent themes applied in relation to māopoopo. There were seven key themes identified from this research. The first theme, kāiga (family), was interrelated with the values of loto alofa (kindness), fai kāiga (family orientated), fakaaloalo (respect), loto maualalo (humility), and loto fehoahoani (helping others). The second theme, duty of care (tiute tautua), related to traditional knowledge and the intergenerational transfer of that knowledge, particularly in relation to culture, land, and language. Maintaining family relationships (loto fai kāiga) was the third identified theme and fundamentally underpins and is interrelated with all the first five themes identified. The fourth theme, interconnectedness (fehokotakiga), highlights the breadth of relationships between people and understandings of interdependence as opposed to independence. The fifth theme, spirituality (olaga faka-te-agaga), recognizes the centrality of the church in Pacific communities. Health advocacy was the sixth key theme with the final key theme being the impact of inequities on Pacific wellbeing. This thesis identifies Māopoopo as being an inclusive research approach that can have benefits for Pacific peoples while also having the potential to be developed within health policies to facilitate focus on collective action through effective cross-government and intersectoral approaches. In this way, it could be utilized to ensure effective approaches to collaboration between the health care system and the social, housing, employment, and education sectors. This work highlights the value and utility of applying Pacific understandings of wellbeing to support and empower communities through their active inclusion from the design through to the implementation of services. There is a great need for increased reciprocity in the relationships between government agencies and Pacific communities. There was recognition of the need for the application of cultural practices and concepts into service delivery for Pacific peoples, such as provision of on-site bilingual health workers, and it is therefore imperative that core health delivery services are brought closer into alignment with the realities of Pacific communities, for example, through active engagement with churches. There are significant gaps in health services for Pacific youth. This population group are an energetic group and, most importantly, the fastest growing population in Aotearoa. This current generation plays a significant role in terms of health advocacy, thus, to ensure relevant and effective impact within communities, they must be central players and key informers in the development of any interventions/strategies focussed on Pacific health and wellbeing. Further studies may well be useful to scope or investigate the healthcare services available for Pacific youth. Associated with the position and role of youth within Pacific communities, is the largely untapped potential to utilise the unique skills and knowledge available through intergenerational approaches where the grandparents are the educators in terms of the passing on of cultural knowledge and values. Health services can be made aware of this important pathway by which knowledge is transferred and of the critical role grandchildren could have to change their grandparents’ attitudes towards health.Item Synergising youth empowerment and co-design to transform Pasifika youth into agents of social change : a novel approach to advance healthy lifestyles in Pasifika communities : a thesis presented in partial fulfilment of the requirements of Doctor of Philosophy in Public Health at Massey University, Wellington campus, New Zealand(Massey University, 2020) Prapavessis, DaniCurrent population health statistics demonstrate the need for innovative approaches to improve health outcomes and prevent non-communicable disease (NCD) for Pasifika peoples. This research builds off pilot studies on the effects of youth empowerment programmes to address obesity-related issues amongst Pasifika communities. It developed and tested an original model of co-design embedded within the youth empowerment framework of the Pasifika Prediabetes Youth Empowerment Programme. The programme was co-delivered with two community health service providers (one rural and one urban), employing Community-Based Participatory Research (CBPR) methodology. N=29 youth (aged 15-24 years) participated in eleven educational and capacity-building modules that comprised the empowerment and co-design components during weekly sessions from MayOctober 2018. At the end of the programme, the model of co-design generated two individualised community intervention action plans to reduce prediabetes in their communities. This research employed a qualitative research design with four data collection techniques and thematic analysis to evaluate the effects of the tested programme. It used an original framework of social change to determine the impacts on the youth’s values, knowledge, and behaviours as well as the community organisations, and the socio-cultural norms of each community. It also explicated the contextual considerations of programme uptake in each location. Overall, this research illustrated that co-design is an effective addition to empowerment frameworks. It demonstrated how to operationalise co-design in a community-based setting with youth, and the tested model provided a practical framework to translate empowerment ii outcomes into the community. The programme analyses also led to a more nuanced understanding of social change. This research developed a concept of the process of social change that can be used to inform future programme development and evaluation. This research suggests future translations of the programme to maximise uptake and postulates different community contexts and settings for delivery, beyond Pasifika prediabetes prevention.Item The health seeking behaviours of ageing Niuean women in Central Auckland : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University(Massey University, 2002) Arapai, Doreen MinnieThis qualitative study encompasses several features in its design. It is exploratory, emergent and the realms of discovery and description are informed by Max van Manen's (1990) human science approach. Van Manen's approach has enabled analysis of the data. Human science is comprised of phenomenology, hermeneutics and language and when coupled with the data collection method of focus groups makes for interesting outcomes. Time is needed to develop the narrative texts as phenomenological interpretation is never complete. There will always be levels of understanding waiting to be discovered. As a New Zealand bom Niuean woman, I have provided a preliminary account of the health seeking behaviours of ageing Niuean women (Matua fifine) in Auckland. The context of health seeking behaviour cannot be realized until there is an understanding of the participant's perceptions of health and illness. Understanding peoples perceptions of health and illness may give insights into the reasons for the decisions that the Matua fifine make when choosing to engage or not engage primary and or secondary health services. This also includes traditional medicine and complementary therapies. The assumption is that people make a direct move to seek a healthcare provider when well and unwell. What is not appreciated are the choices that are also available such as self management or a wait and see approach. Equally important is the role of spirituality, which encompasses Christian beliefs and traditional beliefs. Background information of history and the Niuean way of life, sets the context for this study. Consultation within the Niuean community is an ethical consideration that has paved the way for support for this study. This study will enable the voice of the Matua fifine Niue to be heard so that health services will be able to respond to and preserve their dignity and individuality which are foundational for good health and positive ageing.Item Talanoa ile i'a : talking to Pacific Island young people in West Auckland about health : a thesis presented in partial fulfilment of the requirements for the degree of Master of Social Work at Massey University, Albany, New Zealand(Massey University, 2003) Faleolo, Moses Ma'aloThe present study explores the health issues surrounding Pacific Island youth health development. The present study conducted a literature review on youth health issues in New Zealand and found that most are cultural and social related. A second literature review of theoretical dispositions to account for the emergence of youth heath issues found that Pacific Island concepts, medical sociology theory and youth health theory were relevant explanations for the emergence of Pacific Island youth health issues. The present study conducted focus groups with Pacific Island young people about youth health issues to see if the information from the literature review corresponded with the participants’ responses and whether the theoretical explanations were consistent with the participants’ responses. The present study found that a correlation exists between the literature review and the participants’ responses. The present study maintains through the participants’ responses that the key to addressing Pacific Island young people health issues is to involve their families throughout the process of assessment and in the development of response plans. This means the perspectives of those in youth health policy arenas, the perspective of service managers and the perspective of professionals are required to recognise that the perspective of the young person is an essential domain for understanding the cause of and for resolving Pacific Island youth health issues. ‘Talanoa ile I’a’ is the story of Pacific Island young people living in West Auckland. It is based on responses to questions posed to participants of the study in relation to Pacific Island youth health development issues. The present study contends that in order to understand, identify and resolve Pacific Island youth health issues it is important to talk to Pacific Island young people themselves. The present study did not conduct any research with youth policymakers, youth health services or health professionals but preferred to explore youth health with Pacific Island young people themselves. The present study is built on the participants’ responses and provides both warning signs and building blocks for youth health policy, youth healthcare services and youth health professionals. The present study is a Pacific Island approach to Pacific Island youth health issues; it is ‘by Pacific for Pacific’.Item 'Tu ga na inima ka luvu na waqa' : (The bail to get water out of the boat is in the boat yet the boat sinks) : the cultural constructs of health and wellbeing amongst Marama iTaukei in a Fijian village in Lau and in a transnational Fijian community in Whanganui, Aotearoa : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Social Policy at Massey University, Palmerston North, Aotearoa(Massey University, 2015) Meo-Sewabu, Litea DilokiThe study identified that there are a number of criteria that have to be met in order for Marama iTaukei or Indigenous Fijian woman to be perceived as healthy. Findings suggest that current health frameworks need to take into account the determinants of health that are informed by cultural constructs that emerged as key findings in this study including: Dau veiqaravi or being of service, Taucoko ni qaravi itavi or completion and completeness of tasks, Na veiwekani or maintaining harmony in relationships and Kena I rairai outward reflection or physical appearance and Bula vakayalo or Sprituality. Exploring the intricate and delicate weaving of Fijian epistemologies and Western philosophies as illustrated through the Tanoa Health Belief Framework emerging from the findings in this thesis, may ideally be the future to improving health and wellbeing for, Marama iTaukei. The Tanoa Health Belief Framework has been developed to assist health and community workers to assess the determinants of health and wellbeing amongst Fijian women. This was a qualitative study with a total of 23 participants conducted in two geographical locations, one in Fiji and one in Aotearoa. The study was not a comparative study however; the study in Fiji enabled an exploration of how perceptions and experiences of health and wellbeing have evolved as Fijian women have migrated to Aotearoa. Ethnography was used as the overarching methodology as well as the Vanua methodology. Methods used included talanoa, participant observation and photovoice. In terms of methodology, a Tali magimagi Framework pulled together the strands of what constitutes this thesis. This includes the process of ‘cultural discernment’ emerging from the ethics process encountered in this research. The concept of ‘culturally embedded agency’ is also presented in this thesis arguing that there needs to be an agency-oriented approach to women’s agenda. Culturally embedded agency calls for social policy that incorporates full participation of women in society, inclusive of indigeneity goals, cultural wellbeing and fairness. Implications of this study and recommendations are based on ensuring that health and wellbeing is achieved for the Marama iTaukei.Item The South Pacific Islands Resist Diabetes With Intense Training (SPIRIT) Study : investigation of obesity markers and morphological, functional and genetic changes in the skeletal muscle : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Health Sciences, Institute of Food, Nutrition and Human Health, College of Health, Massey University at Wellington, New Zealand(Massey University, 2013) Hayat, IrumThe skeletal muscle (SM), the major tissue for disposal of excess blood glucose, plays a big role in development of insulin resistance leading to type 2 diabetes mellitus (T2DM). Lipid accumulation and decline in mitochondrial activity in SM has been observed in people with T2DM. Several studies have demonstrated that exercise has the ability to increase SM lipid oxidation and mitochondrial activity and hence is effective as a treatment strategy for people with T2DM for improving blood glucose control and insulin sensitivity. The SPIRIT study was the first clinical randomised exercise trial involving a cohort of Polynesian New Zealanders with T2DM. The uniqueness of this study is that it is the first clinical trial in Polynesian population with grade 3 obesity (n=18; BMI 43.8 ± 9.5 kg/m2) and T2DM. The SPIRIT cohort underwent 16 weeks of progressive resistance training (PRT) or aerobic exercise (AER) training. The cohort showed no changes in HbA1c levels after 16 weeks of exercise and hence no improvement in their blood glucose control. This was an unexpected result and led to the following hypothesis which underlines this PhD study – ?In skeletal muscle of SPIRIT cohort, metabolic adaptation to exercise is delayed due to metabolic inflexibility?. To investigate this hypothesis, mitochondrial function and morphology, lipid droplet content and changes in gene expression pre and post exercise intervention were examined in the SM. Since the SPIRIT cohort showed no changes in weight, waist circumference and BMI, examination of the concentration of specific obesity markers pre and post exercise training also occurred. Mitochondrial function was examined pre and post 16 weeks exercise intervention by measuring the SM activity of three key mitochondrial enzymes; citrate synthase (CS) involved in Krebs cycle, beta-hydrxoyacyl-CoA dehydrogenase (BHAD) involved in fat oxidation and cytochrome c oxidase (COX) involved in electron transport chain. The PRT cohort showed statistically significant increases in activity for COX (P=0.005) and CS (P=0.007) with very large effect size (2.3 ± 1.3 and 1.8 ± 1.3 respectively). AER exercise led to significant increases in the activity for all three enzymes COX (P=0.01), CS (P=0.03), BHAD (P=0.03) with moderate effect size for both COX and CS activity but very large effect for BHAD (6.7 ± 1.2). For all three enzymes there were statistically significant differences (P<0.05) between the AER and PRT groups. These results demonstrate increased mitochondrial activity and functioning after 16 weeks of PRT or AER exercise.Item Iron status and factors influencing iron status of Solomon Islands women living in New Zealand : a thesis presented in the partial fulfillment of the requirements for the degree of Masters of Science (Human Nutrition), Massey University, Albany, New Zealand(Massey University, 2012) Kafa, Rosemary I'iluIron deficiency is a global problem among women of reproductive age, particularly in developing countries. A recent survey from the Solomon Islands reported that 44% of women of reproductive aged were anaemic. Currently nothing is known about the iron status of women from the Solomon Islands living in New Zealand (NZ). Aim: This study aims to assess and compare iron status and factors influencing iron status of Solomon Islands with Caucasian women living in and around Auckland, NZ. Methods: This was a cross-sectional study comparing 40 Solomon Islands women with 80 age-matched Caucasian women living in and around Auckland. Serum ferritin (SF), C-reactive protein (CRP) and haemoglobin (Hb) were analyzed. Iron status was defined as: iron replete (SF > 20 µg/L + Hb > 120 g/L), iron deficiency (ID) (SF < 20 µg/L + Hb > 120 g/L) and iron deficiency anaemia (IDA) (SF < 20 µg/L + Hb < 120 g/L). Participants with CRP >10 mg/L were excluded from this study. Dietary assessment was conducted using a computerised iron food frequency questionnaire including questions on dietary habits, purposely to assess foods affecting iron status. In addition, a 24-hour dietary recall was used to assess the average daily nutrient intake of Solomon Islands women. Demographic and body composition data were also collected together with data on other factors affecting iron status such as blood loss and general health history. Results: No significant difference in the prevalence of low iron stores + IDA was found in Solomon Islands and Caucasian women (17 vs. 23%, p=0.478). The frequency of red meat, prepared meat and offal, and all white meat consumption did not differ between the two groups (p=0.187). There was a significant difference in fish/seafood consumption (p=0.001), Solomon Islands women consumed fish/seafood more frequently than Caucasian women. Solomon Islands women also consumed medium-high vitamin C fruits more frequently (p=0.002) and dairy products less frequently (p=0.001) than Caucasian women. No significant difference (p=0.872) was identified in the frequency of intake of beverages containing polyphenol between the two groups. But the analysis of individual beverages showed that Solomon Islands women more frequently consumed black tea compared to Caucasian women, the similar practice was identified from the dietary habit assessment where 40% of Solomon Islands women drank black tea an hour before or after evening meals. Fewer Solomon Islands women consumed multivitamins/minerals than Caucasian women (12.8% vs. 66.7% respectively) and none of the Solomon Islands women reported taking dietary supplements compared to 44% Caucasian women. In regards to menstrual blood loss, although there was no significant difference between the two groups in overall menstrual blood loss units, Caucasian women reported on average 1 day longer menstrual period than Solomon Islands women. A small number of women in each group had previously donated blood, but in every case it had taken place more than 6 months prior to this study. Contraceptive use was significantly lower among Solomon Islands women compared to Caucasian women (p=0.001). Body mass index and waist circumferences were significantly higher (p=0.001 and p=0.001 respectively) in the Solomon Islands women compared to the Caucasian women. Conclusion: The iron status of Solomon Islands and Caucasian women did not differ, but there was variability between groups in the intake of foods and behaviours that are known to influence iron status. This study found both protective and non-protective factors for ID among Solomon Islands women, although the correlation of those factors with iron status were not able to be assessed due to a relatively small sample size and low prevalence of ID/IDA. This study therefore concludes that ID was not a concern for Solomon Islands women living in NZ, and that the prevalence was lower in this group than in women living in the Solomon Islands. This is possibly the result of adapting to different dietary habits and behaviours, increased accessibility to animal sources of iron, and high intakes of vitamin C-rich foods in their host country.
