Abstract:
This thesis explores Samoan people’s knowledge and understanding of Cardiovascular Disease and its risks; Cardiovascular Risk Assessments; and their reasons for undertaking or not undertaking lifestyle changes, if they are found to be at risk of cardiovascular disease. An interpretive phenomenological design, facilitated by the Talanoa narrative approach, incorporating the ‘Leai se tu fa’amauga’ Pacific framework was employed to conduct this research. Participants were recruited from Primary Health Services in Wellington and Porirua. Sixteen Samoan participants aged 45 to 65, and seven practice nurses were interviewed, supported by a literature review of cardiovascular disease as one of the leading causes of premature deaths and health inequalities in New Zealand, affecting mainly Pacific peoples. Samoan people’s voices utilising fa’a-Samoa worldviews and models of care in particular the NZ health policies to improve health literacy for this population have grounded the research and its findings.
My interest in this exploration was a result of my own experience working as a practice nurse in health centres with high numbers of Pacific peoples. I often questioned whether they understood the information they were provided with, when they had their cardiovascular risk assessment.
Although cardiovascular risk assessment is one of the government’s primary health targets with an emphasis on increasing the number of assessments for Pacific peoples to improve their health outcomes, Pacific peoples’ health remains poor. A number of health policies and strategies have been in place for almost two decades such as; Making a Pacific Difference and Strategic Initiatives for Pacific Peoples (MoH, 1998), the Pacific Health Disabily Action Plan (MoH, 2002), Improving Quality Care for Pacific Peoples (MoH, 2008c), and Ala Mo’ui: Pathways to Pacific Health and Wellbeing 2010-2014 (Minister of Health & Minister of Pacific Island Affairs, 2010). However there is still little or no progress in Pacific peoples’ health outcomes.
The results showed that the lack of health literacy and poor command of the English language limited Samoan people’s knowledge and understanding. A number of additional factors such as demographic characteristics, educational levels, the Samoan worldview and the fa’a-Samoa, patient follow up care, length of appointment times, the ambiguity of information and lack of the continuity of community programmes, all affected the uptake of lifestyle changes. The majority of participants felt there was no true value gained from completing cardiovascular risk assessment. A key question thus raised is, ‘Does completing a cardiovascular risk assessment have any health benefits for Pacific peoples?’ The implications of the key themes that emerged from the data form the basis for recommendations on the role of the practice nurse, current and future health policies as well as future research.
